One Doctor Is Speaking Out In Favor of Birth Plans—Here’s Why

An OB-GYN office discouraged their patients from creating birth plans. Here’s why one doctor says that’s poor patient care.

By Beth Ann Mayer

There’s a cliché that you can’t plan labor and delivery. Things happen, even if you’ve had a healthy pregnancy.

That’s true. Fetal heart rates can drop, babies can get stuck, or the birthing person’s blood pressure can spike. Despite running every day of my pregnancy with my first, his heart rate dropped after nearly 60 hours of labor. So I had a C-section.

But just because you can’t plan labor and delivery doesn’t mean you can’t have a birth plan.

One New York City-based OB-GYN office recently sent out a letter asking patients not to develop birth plans, and Instagram isn’t thrilled about it.

The letter, which comes from Weill Cornell Medicine OB/GYN Faculty Practice, reads in part:

“We warmly welcome discussions regarding labor and delivery…however, as your physicians, we feel that birth plans can be a detriment to our relationship…We feel that the use of birth plans too frequently sets up unrealistic expectations and conditions for potential conflict. We are your caregivers and would like to use our knowledge and experience to act in the best interest of you and your baby.”

Heather Irobunda, M.D., FACOG, got ahold of the letter, and it set off alarm bells. She took to Instagram to explain why.

“I went through OB/GYN training—we were taught that birth plans were things that just added annoyance to your day,” Dr. Irobunda wrote. “We weren’t taught to take them seriously.”

Dr. Irobunda admits she once took that approach to birth plans. But her perspective on them has changed.

“I understand the utility in them,” she continued. “I also know that it’s an organized way for my patients, especially my patients that feel they don’t have a voice in this system, to find their voice…I use it as a guide and also to frame conversations.”

Dr. Irobunda fears this OB-GYN practice’s approach cuts off discussions before a patient can have them, and that’s problematic in a country with a poor maternal mortality rate.

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“People feel powerless in medical spaces, especially in obstetric spaces—ESPECIALLY IF THEY ARE PEOPLE FROM MARGINALIZED COMMUNITIES,” Dr. Irobunda says.

Dr. Irobunda called for doctors to honor patients’ desires and the “way they choose to assert their desires.”

“I have so much more to say on this but would like to hear your thoughts on this,” she concluded.

And give their thoughts they did. The post racked up more than 300 comments in three hours and most applauded Dr. Irobunda, including some doctors.

“Amen to all of this, Heather….I thought the same in residency, and now I realize I was carrying forth the same biases that are in this letter. Communication is key, and a birth plan is one tool. Don’t shut down the convos before they start,” replied Jennifer Lincoln, M.D., IBCLC.

“Thank you, Heather, for never shying away from the hard convos,” commented Pooja Lakshmin, M.D.

Others appreciated having an ally in the system.

“Thank you for your advocacy, Dr. Irobunda. My sister died as a newborn because of doctors who refused to have open communication and made fatal errors. The world needs you, and I am so appreciative of what you do for families like mine,” shared another user, who posts as @lauralikespictures.

“Thank you for speaking up, despite the risk! People deserve providers like you,” wrote Instagrammer @salamanderpal.

It’s true that the U.S. has a higher maternal mortality rate. The U.S. was recently given the distinction as the most dangerous developed country to give birth in. Black birthing people are three times more likely to die from a pregnancy-related issue than their white counterparts, according to CDC data.

People shouldn’t be dying of childbirth and pregnancy-related complications at the rate they are in 2022. Yes, the desired result is a healthy and happy birthing person and baby. But, quite frankly, that’s the bare minimum. In fact, saying, “all that matters is a happy healthy mom and baby” when someone brings up their birth plan is as dismissive as saying “fed is best” and handing over formula when someone who wants to breastfeed/chestfeed is struggling on day one instead of getting a competent lactation consultant to help. It’s the easy way out—for the person saying it.

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By the way, no one wants to survive birth and have a healthy baby more than the person giving birth.

I say this because I’ve experienced it. Don’t get me wrong, my first son is happy and healthy. I would also be lying if I said I wasn’t disappointed with how things played out. On the day he was born, I was the last person in the room to see him—it took a half-hour for me even to catch a glimpse of his face. The medical students in the operating room saw him before I did. I didn’t get to hold him for two hours. For more than a year after his birth, my heart broke when I looked at the timestamp of the photos on my iPhone. I felt detached, like a surgical patient, not a mother.

The thing is, my son was happy and healthy after birth, and so was I. I would have liked to have held him sooner, an option I learned after the fact was available to me but not offered.

So, when I got pregnant for a second time, I learned I was not eligible for a VBAC because of birth spacing. I researched gentle C-sections and asked for a clear drape and skin-to-skin in the operating room, as long as everyone was healthy. I hired a doula who gave me tips for advocating for myself. In short, I had a birth plan.

My doctor told me the drape was fine, but skin-to-skin might not be—an anesthesiologist would have the final say. I kept bringing it up until one day, unsatisfied by the response I was getting, I got real. I told him that the anesthesiologist would head off to another patient and not remember my name or my child’s face by lunch, but I would forever remember our birth story. I wanted my baby on my bare chest if everyone was happy and healthy. Skin-to-skin contact aids in the facilitation of breastfeeding and thermal regulation. I wanted that for my baby.

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To his credit, my doctor got the names of everyone who would be on staff during my C-section, cleared my plan with them, and called me a couple of days later to tell me we were good to go.

In a plot twist, my water broke two days early, and I wound up with another doctor. My husband and I had to advocate all over again. At one point, the doctor performing the C-section asked, “Why do you care so much?”

Care so much about holding the child I carried for nine months? Is that a rhetorical question?

I got skin-to-skin in the OR thanks to a nurse who didn’t need to ask why I cared so much—she knew. It was a beautiful, healing experience that I will never forget.

Patients deserved to be heard. If everyone is happy and healthy, they deserve to write the birth story they envisioned as long as it’s safe. Kudos to providers like Dr. Irobunda, my usual OB-GYN, and the nurse at my C-section for understanding.



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