My mother had a "birth plan." Three days before she was due, she packed a suitcase and wrote up a list of people to call once the baby arrived. She then reminded my father to water the plants, pick up the dry cleaning, and draw the living-room curtains each day so the afternoon sun wouldn't fade the couch.
Today, a birth plan means something very different. It's an actual document that outlines your ideal delivery for your doctor. Particulars once left to the hospital staff—from medical procedures to ambient details like lighting and music—are now painstakingly stipulated by the mother-to-be. "I'd like to wear contact lenses," states one birth plan posted online. "I'd like to wait until the umbilical cord has stopped pulsating before it's clamped and shut," says another, along with, "I'd like to avoid an enema or extensive shaving of pubic hair."
Online templates at Childbirth.org, Birthplan.com, and BabyCenter give women a chance to build-a-birth by ticking a series of boxes on everything from epidurals to videography. Do you want to avoid pain medication? Check. Are you in favor of episiotomies? Nope. Would you like the lights dimmed during prelabor, then dialed up for transition? Click. Do you mind if the staff of residents witness your stitching-up, or are you more of a "closed set" type, preferring just your doula and The Best of Enya?
"Birth plans are a rather new phenomenon," says Marsden Wagner, coauthor of Creating Your Birth Plan and former director of women's and children's health at the World Health Organization. "This is the only country in the world that has highly trained specialists trying to manage all normal births." As a result, he says, scheduled inductions, C-sections, and pain medications have become systematic. Birth planners, he says, are "taking back control of the management of their births."
A woman's rights are obviously important, and what could possibly be wrong with stating your wishes before giving birth? There is a legitimate concern of gratuitous intervention, and the thought of being poked, cut into, or drugged against our will is enough to awaken the Karen Silkwood in any of us. But is that really all birth plans are? Civil-rights tools, much like living wills?
"Birth plans are manifestos about the kind of parents we think we're going to be, or about our philosophy of life," says Sheila Heen, 39, a mother of three in Carlisle, Massachusetts. "They remind me of that old saying: 'I was a great parent before I had kids.' Before I was a parent, I was sure my kids would have impeccable manners, the cutest outfits, and entirely nutritious meals. Now I'm happy if they wear something and don't throw food."
You know that other saying, about the best-laid plans. "My plan went out the window when my babies were in distress after long labors," says Marika Bremson, 36, in Seattle, of both her deliveries (one ended in a vacuum extraction, the other in a C-section). Becky Houlding, 36, in Brooklyn, had a birth plan for her first child that also proved unhelpful after she tried to push out a 10-pound baby for three hours without an epidural. "I'd asked that Bob Marley be played while I was in labor," she says. "I guess I also should have asked that the CD be turned off after it had played through four times. All I could think was, Every little thing is not gonna be all right!"
"Birth plans are essentially mocked," reports a former ob-gyn resident at a New York City–area hospital. "The big joke is that women who come in with a birth plan or a pregnancy ball have set such high expectations that they're almost destined for the OR." Of course, there are also doctor-friendly birth plans. "Mine had three points," says Jen Sacon, 39, a mother of three in Pittsfield, Massachusetts. "1. Don't let me die. 2. Don't let my baby die. 3. Give me drugs."
Still, whether a woman's approach to pregnancy is to post the sonogram to her blog or to get a leg wax as contractions hit, she's the one who has to give birth. If you've seen March of the Penguins, you know we're not the only species to treat gestation with a little pomp and circumstance. It's just whatever gets you through the day.
