How to Approach The "Birth Plan" as an Evidence-based Patient Advocate in the Hospital Setting

Even with my midwifery collaborative care model as my Labor and Delivery foundation, when I first got off orientation I dreaded hearing, "Here's my birth plan." The connotation of that sentence immediately put me on edge as though I was going to have to spend the next 12 hours justifying every single recommendation, plan, medical intervention, and safety protocol my facility had put in place in an attempt to "keep the patients safe." I, like most people, likely said something snarky or rolled my eyes as I took your birth plan and made a copy for your chart to be passed on to whoever else were to take care of you.

And then Covid happened. Very quickly I was forced out of my comfort zone. It didn't matter anymore about what preconceived notions I had; no unconscious bias. I was tasked with not only keeping people alive, but guiding them through an unknown epidemic, alone.

In December 2019 I started travelling "locally." My first hospital was a small, brand-new extension of a much larger hospital system. Most of my patients were Hispanic and only spoke Spanish. I wasn't a stranger to using a medical translator, but I found that it was incredibly impersonal. How was I supposed to feel good about helping my patients and those entrusted in my care, if in their most vulnerable moments, I had to use body language to communicate.

Tone is lost with a translator. Empathy is lost with a translator. I elicited help from the 1/10 patients that were bilingual speaking both English and Spanish. I started with short introductory sentences and then moved onto critical triage questions: "Is your baby moving normally? Do you have any vaginal bleeding? Are you having any contractions? Where is your pain? Do you have any medical conditions or is there any complications in the pregnancy?"

Fast forward to March 2020. Hospitals are locked down. No one in or out without medical screening for COVID. Single family households with multigenerational families and people taking whatever jobs they could find to make ends meet to feed their families.

Desires or preferences didn't matter. There were no birth plans. And in this moment, I realized just how important those pieces of paper were. They weren't just a random list of wishes. Birth plans were lists of choices people had thought about and chosen, CHOICE. CHOOSEN. Do you know what I realized I wasn't? A choice. Myself, all of the other nurses and staff, (possibly with the exception of the doctor or midwife,) the bed, the water temperature, the policies, the monitoring, the communication, all of it was not chosen by the patient. We selected it for you, out of "safety." It didn't take long for me to wish a patient would walk in the hospital with a piece of paper titled "Birth Plan."

I think it's time we start thinking about birth plans differently. Let's meet in the middle with birth preferences. It says, "This is what I want in an ideal world," but leaves room to pivot and make informed decisions. It allows for consent. It takes the responsibility of consent and informed care and places it appropriately on the healthcare team. It allows for open ended communication and keeps the patient the center of care. It changes how care is received because now, the patient is the Team Leader. We all have the same goal: The safety of you and your baby. We just need to change the way we communicate that.

Click below for me free Birthing Preference Sheet as a guide for creating your Birth Story!

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