Reply turned post, on birth plans

At Your Cervix has a post up on birth plans from the nurse's point of view:

I have noticed that the longer the birth plan, the greater attempt at control, the more likely that the woman will not get the birth she desires. The increased chance of pitocin, epidural and eventual c-section.

Keep it short and sweet. Many things can be excluded from your birth plan/list. ...

Don't go into great detail about freedom of movement in labor, lights down low, no students, plans to breastfeed, no supplements, etc, etc, etc. Many of those things you can control in labor. Get up and move in labor. Turn the lights down. Use the tub/shower.

I encourage you to go over there and read the whole thing, as well as the comments - all pretty interesting.

My reply, which got kind of overlong and so is getting its own revised and expanded post:

Interesting comments!

My (evolving) philosophy on birth plans is that they should be about what you can control, not what you can't. It's not a movie script.

Some birth plans will say "I want to be allowed to push in a variety of positions, and to squat for delivery." Well, you can't control whether you will deliver squatting. Maybe when it comes times to give birth, you're going to be too tired or baby only tolerates you being on your side or you're more comfortable on your hands and knees.

You also can't control whether you'll be "allowed" to push in different positions - or rather, the only way you can control that is by 1) choosing a provider who is open to that and/or 2) actually GETTING in different positions to push, whether or not your provider likes it. Putting on your birth plan doesn't make it so.

And, like you said, there are some things that are under your control without needing to specify them - you can turn the lights low and fill up the bath on your own. If you're concerned that you'll be too intensely in labor to think of things independently, then make sure your support people are ready to be proactive! And if you're not sure if they will be, hire a doula! ;-)

In the end, I think the best way to use a birth plan is for things you know people are fine with you doing, but that are not totally routine so that they might need a reminder. In your sample birth plan you talked about intermittent auscultation, no IV, no separation, no offering pain meds. In advance, you made sure that everyone was on board, and this was just a reminder that these were your preferences.

I will say, I think for some people, it doesn't hurt to put "no students" on there too if that's very important to them. I know as a nurse you might feel confident about recognizing and turning away students, but not all patients do. I talked to a mom recently who had people flood the room for her first birth as baby was about to crown and she was frightened. She thought something was wrong with the baby. When she asked the nurse later, the nurse said it was a group of students. This mom was surprised to hear that she could have declined to have students in the room. I think based on her previous experience, she might be more emphatic about that this time around - if so it would probably help to state it up front.