Learning Objectives
By the end of this section, you will be able to:
- Explain the purpose of a birth plan
- Identify the content of a birth plan
Birth plans can be empowering because they give a sense of control to the birthing person. Birth plans can also cause deep distress, depending on how the birthing person experiences their birth and the level of support they receive for their preferences. Nurses are crucial in helping to identify the desires of their patients and in supporting those goals as well as possible. If plans need to change, nurses can discuss the medical reasons for the change and help ensure that a different part of the plan will be utilized.
Purpose of a Birth Plan
A birth plan is meant to be a form of communication between a birthing person, their support people, and the care team they have chosen for their birth. ACOG (2022) notes that a birth plan is “a written outline of what you would like to happen during labor and delivery” (p. 1). ACOG (2022) also provides a template for a sample birth plan. While some birth plans include requests that seem routine, others include specific or unusual requests. Some birth plans are specific to the childbirth education and preparation the birthing person is using. Many childbirth education programs will provide information on birth plans; other programs might assist the patient in creating a birth plan based on the philosophies of the childbirth method. One of the greatest benefits of writing a birth plan is the knowledge that comes from the research and preparation needed to formulate the plan itself. When done well, a birth plan is simply a list of preferences a birthing person has for their birth. The person understands that this is a plan, but that alternatives may be necessary if unforeseen changes occur.
Legal and Ethical Issues
Patients Who Decline Interventions in Pregnancy
When pregnant patients refuse interventions or treatment that can cause negative consequences to the patient or the fetus, nurses and health-care providers are faced with an ethical dilemma. According to the American College of Obstetricians and Gynecologists (2019), pregnancy does not negate a patient’s right to refuse treatment. ACOG also states that coercion is unethical and recommends asking why the patient is refusing. Understanding the reason for refusing allows nurses and health-care providers to reach a decision based on the patient’s values and the evidence of best practice. Ultimately, the nurse must respect the patient’s autonomy.
Content of a Birth Plan
Birth plans are as individual as a resume, but like a resume, they have typical core components. In general, the plan will include (ACOG, 2022):
- desires for pain management and how the patient plans to request these
- wishes for positioning in labor
- environmental comforts or requests like dim lighting, multiple pillows, a birthing ball
- IV access (planned or as needed)
- desires for fetal and contraction monitoring
- whether antibiotics will be accepted or declined in labor
- how the person wants to manage the pushing phase, such as not pushing in lithotomy position or having warm compresses for the perineum
- wishes for episiotomy or request to avoid unless an emergency arises
- skin-to-skin contact after birth
- feeding preferences
- newborn procedures and their timing
- plans for the placenta
- secondary plans for change in birth mode to cesarean, such as having a support person present, photos/videos, skin-to-skin and breast-feeding in the operating room, and clear drape to view the birth
For a model birth plan, see Figure 14.8.
When the nurse admits the laboring person, the nurse should ask if they have a birth plan and review it with the patient or support person. This is a time for the patient to see that the nurse is aware of their desires. It puts the patient at ease and shows that the nurse is willing to work with them to provide the type of birth they have planned. This is also a time for the nurse to explain anything that cannot be done in that setting and to help the patient design an alternative plan as needed. Nurses play a large part in ensuring the patient’s wishes are followed. If an unforeseen event occurs and a deviation from the plan must be made, the nurse can share the patient’s wishes with the health-care provider and discuss options to attempt to respect those wishes as much as possible.