1. (Polly) Perez, Paulina G. BSN, RN, FACCE, LCCE, CD

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Why do the two words "birth plan" strike terror in the hearts of many perinatal nurses? Could it be because birth plans challenge us to look at our control issues and ask ourselves about our role in the birth process and how much flexibility we can offer? Perhaps one of the most important things about birth plans is how they force us to open a dialogue with the family, looking at ourselves and our practices through their eyes (Baird, 2000.) When women have birth plans, we have to consider if we empower women during the birth process and if we believe in normal birth, or just the risks of birth.


A good birth plan functions as a nonconfrontational way for a pregnant woman to make her birth preferences clear. If used properly, birth plans can begin communication between care-givers and birthing families about mutual expectations, responsibilities, and goals. They are part of the family-centered approach to healthcare built on concepts of respect, strength, choice, information, support, flexibility, and empowerment (Institute for Family-Centered Care, 2005). The most effective birth plans combine the mother's needs with the experience of the care providers within the framework of practice standards. A plan becomes a foundation on which to resolve differences between the pregnant woman's expectations and the hospital or caregiver's usual practice.


As a childbirth educator and perinatal nurse, I have used birth plans as tools to improve communication and foster respect, because they identify preferences in a nonbinding contract and help women have responsibility for their own birth experience. The use of birth plans can decrease conflicts, reducing "the likelihood of litigation and improv[ing] the quality of medical care" (LSU Law Center, 2005). During labor many women feel vulnerable and have difficulty making decisions. A well-thought-out birth plan may give the woman and her family a sense of control, minimize vulnerability, and eliminate the need to make decisions under pressure. Women with birth plans are not questioning providers' experience and expertise, but rather are asking us to view birth through their eyes (Gerteis, Edgeman-Levitan, Daley, & Delbanco, 2002).


Birth plans help a woman clarify her thoughts, wants, and needs about birth. They also provide a framework for resolving inconsistencies between the patient's expectations and the hospital or caregiver's procedures. A pregnant woman should carefully consider and prioritize her preferences, while learning the birthing practices in her chosen institution. A plan asks questions on a variety of topics: diet, spiritual/religious aspects of birth, medication, medical procedures, maternal positions, second stage, cesearean birth, the newborn, and postpartum. Using this type of birth plan helps the birthing woman identify priorities and enhances dialogue (Perez, 2002).


Birth plans work best when they build on a trusting relationship with care providers in the woman's chosen site of birth. They help pregnant women to "bond" with us as caregivers and the site of the birth (American Hospital Association &Institute for Family-Centered Care, 2005).


In my opinion, the question is not should birth plans be used, but how can they be used most effectively? Caregivers should consider several important issues:


* What are the individual needs of both the pregnant woman and her partner?


* What can we do to establish a more cooperative and empathic mindset in which to consider the patient's needs as well as our own?


* How can we use the birth plan as a vehicle to empower the birthing woman?


* What can we do to make our units more "mother-friendly" regarding birth plans?


* What can we do to make the couple feel safe in our care?



Birth plans capitalize on the strengths of the laboring woman, her family, and caregivers, benefiting all. In my opinion, birth plans should be an essential part of planning for childbirth and can assist in creating joyous beginnings.




American Hospital Association & Institute for Family-Centered Care. (2005). Strategies for leadership: Patient and family-centered care. Chicago: American Hospital Association.


Baird, K. (2000). Customer service in health care: A grassroots approach to creating a culture of service excellence. San Francisco: Jossey-Bass. [Context Link]


Gerteis, M., Edgeman-Levitan, S., Daley, J., & Delbanco, T. (2002). Through patients' eyes: Understanding and promoting patient-centered care. San Francisco: Jossey-Bass. [Context Link]


Institute for Family-Centered Care (2005). Family-centered care. Retrived May 7, 2005, from[Context Link]


LSU Law Center. (2005). Medical and public health law. Retrived May 6, 2005, from[Context Link]


Perez, P. (2002). Your birth plan and your birth. Johnson, VT: Cutting Edge Press. [Context Link]