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My OB-GYN Made Me Sign Away My Birth Plan

Photograph by Twenty20

No candles for me.

While scrolling my Instagram feed, I came across a post by a beautiful mom-to-be with a mega following. She described her birth plan in the caption: dim lights, no yelling, candles, delayed cord cutting. The list went on.

A few weeks later, I was sitting at my new OB-GYN's office, staring at a document that said she did not accept birth plans and instead performed only standard-of-care practices. If I wanted to see her, I had to sign. When I put on my lawyer's hat, I understand the need for such an agreement. Birth plans themselves are not contracts. They represent what we would like under ideal circumstances.

But expectant moms have the right to feel strongly about our hopes for how the delivery will go. After all, it's a process that involves our bodies and our babies. How could it not be personal? Of course, the issue becomes more complicated when you figure that a doctor's recommendations might be at odds with our plans. Especially under unforeseen circumstances.

I have to admit I felt a little disappointed thinking that I was nowhere near getting dim lights and candles at my birth. As I considered how my experience would go, it looked more like the kind of scene that's supposed to get us all to rethink the American model of obstetrics. I've watched “The Business of Being Born”. I too have imagined myself having an unmedicated birth in some idyllic setting, attended by wizened, old midwives.

It's easy to say, “Well, if that's what you want, just get another doctor!”

But when an OB-GYN is otherwise ideal in terms of location and insurance coverage, it makes the decision a little harder. Despite paying good money for our family’s insurance, it doesn’t cover the local midwife practice (which I’m sure is candle-friendly).

So how important are birth plans? Online, I found a number of women who said they encountered resistance from doctors and nurses when it came to their birth plans. I’ve also read a number of accounts where birth plans end up going out the window.

As a pregnant woman, it can feel like you're caught up in one big system. We all are.

But even if birth plans are just a set of goals, it seems reasonable to have that kind of discussion with your doctor. After all, what might be another work day for my OB-GYN is an experience I will remember forever.

At my next appointment, I brought up the birth plan ban with the doctor.

“Well, some people want to give birth in a forest,” she said.

“Uh-huh ...” (Gotta admit, I can see the appeal.)

“It means we can't accommodate special requests, like birthing tubs,” she explained.

I said that I was mostly concerned with interventions. For instance, if I went to labor naturally, would there be reason to enhance labor with drugs? She said that if everything was progressing normally, she agreed there was no need for drugs, but that some women do go into labor naturally and end up needing help, in which case an intervention might be a good option. I left the conversation feeling less worried about the whole thing.

I know that more personalized health care exists out there, but it seems you only get it if you pay for it or if you happen to live in a place where the medical field in general has adopted certain values into its standard of care.

In the United States, giving birth with midwives and doulas is niche. The issue goes deeper than birthing tubs. We're a litigious society and I have no doubt doctors organize their practice with liability concerns in mind. Yet, it seems the attitudes and approaches by individual OB-GYNs end up shaping what obstetrics look like in our country. That means it's implicated in our higher rates for C-sections, complications and maternal mortality.

As a pregnant woman, it can feel like you're caught up in one big system. We all are.

At the end of the day, I'm approaching the prospect of giving birth with the best hopes for a healthy mom and baby. It's the ultimate birth plan and one no one can argue with.

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