The birth plan might be a dream, but it’s still mine
"Someone's sitting in the shade today because someone planted a tree a long time ago." - Warren Buffett
What’s the point of my birth plan (preferences), if no one is going to adhere or support?
Every pregnant person is different and will prepare differently for birth. Whatever the path taken, I cannot emphasize enough the importance of sharing birth preferences with providers for the sake of your own empowerment and autonomy, and understanding when they cannot live up to those preferences that those reasons are explained so thoroughly the birthing person completely understands their options and the various scenarios they might encounter.
I created my first birth preference using a template I found online but for my second birth I found ease and functionality in the ones built via Motherboard, all thanks to my birth doula’s recommendation. This application was simple and gave me multiple options and the ability to build both a home birth, birthing center plan, and hospital birth plan.
I want to focus on my first birth plan, however, as this was the only time that I did not feel my preferences were entirely supported by medical staff. When I created it I was very much “I will do it myself” not fully understanding what each preference would mean for my personal experience when the big day arrived. For me, my Word Document-built birth plan provided me a sense of security, confidence, and reduced my overall anxiety.
When a birth plan is built the expectation is that the OB, midwives, nurses, and doula will follow through and only need to adjust regarding a person’s health status or the baby’s. Changes are communicated in a respectful and informative manner, not a threatening one, condescending, or demeaning approach.
A birth plan? Sure, if it makes you feel better.
The birth plan was first introduced in the US in 1980 as a means of providing expectant mothers (this now encompasses all birthing people) and their partners with options for their birthing experiences. While there are variants in overall look and feel, availability, and resources to create one, the birth preference typically contains guidance to medical staff. You don’t need to be fancy, you can write it out on a piece of loose leaf paper.
For my first birth preference I included no medication or IV during labor, intermittent monitoring, free movement, food and drink access, the lights in the room remain dim and a natural water rupture. For delivery I asked for a water birth,and requested a gentle cesarean if one was urgently necessary. For my delivery I selected immediate skin-to-skin, my husband to cut the cord, delayed cord clamping, delayed exams for bonding, and breastfeeding as soon as possible to optimize the golden hour.
All of my obstetricians were highly recommended by other mothers in my city. Their practice was known for being generally supportive of natural birthing approaches. That was most comforting to me at the time, the OB’s were all Black women specifically West Indian, like me. I met with each of them before my induction and labor and felt comfortable with the care they provided me prenatally, for the most part. It was not until around my expected due date (EDD) that things started to feel clinical and business-like.
Around my 40 week visit I asked my nurse “Should I make a birth plan?” Her response was “Sure, if it makes you feel better.” I expected a response more akin to “That’s a great idea! Do you need a template?” or “This is how we can support your plan.” “In the event of an emergency, these are the reasons we would not adhere to your plan.” And so on. This resource serves as a piece of two-way communication between patient and provider, establishing clear directions regarding my personal priorities and values as a human being and expectant mother. But my head nurse did not seem interested in helping me develop it or adhere to it when the time came.
Well, if you care, here’s my plan.
A supportive hospital or birthing staff (more people are having babies in birthing centers and home) should display active listening, flexibility and adaptability, and provide evidence-based information to help you make informed decisions. A birth doula can help you choose this team as well as play an integral role supporting the team. Research consistently shows that birthing people have improved birth experiences when they receive strong social support with shorter labors, better pain management, and less need for medical intervention. Who would not want this for a birthing person?
No plan survives first contact. It is ok to change one’s mind as pain management techniques are not working and medical complications can arise. I encourage many birthing people to accept this, however birthing teams must be prepared to communicate with families if changes need to be met to ensure the health and wellbeing of the birthing parent and baby. So if you’re not feeling two way communication, pipe up! Or if you're blessed to have a doula or your mom is in the room with you - they can be your advocate.
From the moment my husband and I arrived at our labor room, my birth preferences were already disregarded.
If you recall the basic elements of my birth plan, I wanted to try for a water birth, at least a water labor. But the staff refused to fill up the bathtub and informed me that they had to monitor me for a few hours before I could get in. I agreed, not knowing at the time that it was within my rights to decline, and was immediately hooked up to the monitor. After a while the contractions started increasing in intensity and occurrence. I was tripling - a dysfunctional uterine contraction pattern that becomes concerning despite reassuring fetal heart rate patterns. When I asked what was meant by tripling I was informed “It’s just not a good sign, baby’s heart rate has to be monitored closely. Don’t go anywhere.” Where was I going? I asked if the baby was doing well and medical professionals responded with “we’ll keep you on the monitor, you should rest.” I didn’t find comfort in this statement nor could I relax enough to make labor progress.
The water labor never happened and the nurses neglected to bring it up again despite my contractions normalizing and my strong desire and request for water labor. never brought it up again, despite my contractions normalizing and me feeling up to the task.
If you do not take this Pitocin, you will end up getting a c-section.
How did my contractions normalize? I had been taking Primrose oil the weeks prior, as well as experiencing my first-ever acupuncture session, ate dates, walked and exercised, but there were still a few natural remedies I was not savvy on. While my labor was progressing slowly over the last week of my pregnancy, it just was not fast enough for my doctors the date of my scheduled induction.
First, the doctors attempted mechanical dilation with a balloon catheter. After twelve hours of on and off contractions, things steadied out but I had not dilated at all,stuck at the beginning, 1 centimeter.
I asked that labor not be sped up via other medical means but was informed that I would get a c-section if I did not accept the Pitocin. There are significant risks to speeding up labor when there is no medical reason to do so, such as placental abruption, need for an epidural, and increased risk of c-section. But for me I felt the c-section was the ultimate sacrifice of that autonomy I deserved. I understand that in times of medical necessity and emergency, the cesarean is the safest approach to save birthing parent and child, or either. It does not make someone any less a mother (birthing parent) but I was genuinely frightened of it beyond measure. I immediately said to the doctor, “No! Give me Pitocin. I do not want a c-section.”
The nurses could not inject the Pitocin into my IV bag any faster. No one explained to me what a Pitocin induced labor would look like, the intensity, the pain that would follow, it hit me like a truck. I started to yell during the pain, unsure what to do when a nurse asked me why I was yelling and that I needed to tone it down so that my pain was not that serious. To this day, I remember blacking out from the intensity and pain of the contractions that followed. As long as I live I will never forget how that nurse treated me. It could have been an opportunity to coach me through some pain management techniques, but instead she dismissed my pain and scoffed at my novice attempt of dealing with the pain without medical intervention (epidural). I felt embarrassed and ultimately asked for the epidural.
During my last cervical check the doctor informed me that I was 9cm dilated and almost there. As soon as she walked out the room I knew it was time to push. My husband rushed back out to grab the nurse and doctors who just left. My second doctor who was on shift that night said “I just checked her there is no way…” She examined me again and said “oh nevermind, it’s time!” It may have been my first baby, but the body knows exactly what to do when the conditions are right. Instinct kicks in and wins the day. I gave birth to a beautiful almost nine pound baby girl after fifteen minutes of pushing.
I admit, I struggled to bond with the baby right away. I was in complete shock and the stitches made the healing process relentless. I could not stop thinking about how I was treated in the hospital, about how it made me feel, incompetent and not strong enough to bring a child into the world without making vocal noises.
Your preferences matter.
Even six years later I find myself questioning whether I asked enough questions or not. Did I choose the right birth team? Why hadn’t I hired a doula? I felt like I remained pretty flexible for all that was thrown my way, but it would have been great to have someone else versed in the goings on of the hospital to be my advocate.
In light of disparities in health care, particularly pre and post natal care in the U.S. everyone stands the potential to experience challenges during birth. We know the factors that emphasize them. I believe an often overlooked opportunity rests in building out a birth preference. If anything, it is an opportunity to understand the options that are available to a birthing person, empowering them to envision the birth they want and asking questions when they’re not being delivered.
My continued advice would be to maintain proactive communication with your providers, birth team, and partner - as it pertains to your birth plan and develop plan B and C in the event alternative scenarios arise. Do not be afraid to share your voice or come across as being labeled difficult. A birth doula can really help you draft a comprehensive birth plan, along with your partner. We only have so many birthing opportunities in our lifetime.
I made sure to complete my hospital survey in the hopes that the birthing people after me have a better experience. I never felt comfortable or like anyone was trying to help me during my labor. If we all continue to share the good, bad, and not so pretty with hospital staff, birth centers, birth teams, and other birth workers, that feedback will only continue to improve the system. Working with all these people ahead of time to develop a birth plan can play dividends. Everyone who can be present for your birth will have a sense of buy-in, and together we can truly see the empowerment and care that we are owed and deserve.
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Jannelle Allong-Diakabana is a former Army Officer, accomplished leader, and innovator in strategic communications and public relations. Currently, Jannelle is a senior manager of executive communications at BMC Software. She also founded Flower n' Fox Doula LLC in early 2024 after spending the last five years supporting family and close friends during the postpartum period, which she found incredibly rewarding. Her first postpartum experience inspired her, and she believes everyone deserves a doula, especially during the fourth trimester. Jannelle is a dedicated advocate for pregnant and birthing people, actively supporting birthing people in her local area. Jannelle holds a Master's in Strategic Public Relations from George Washington University and a Bachelor's from the United States Military Academy. She is currently a member of DONA International, the National Black Doula Association, and the Southern Colorado Doula Collective. She also finds time to teach swimming to babies and adults with British Swim School.
