If you bring up your birth story among a group of moms, it’s amazing how quickly everyone around you will reciprocate.
Two weeks ago I went to play mahjong with a local parents group. Three of the four women at my table had children under age two, and we got to talking about our births. Their stories all had one thing in common: they deviated from the birth plan.
Every birth. Including mine — twice.
So if birth plans don’t survive contact with reality, why make one? That’s what this post is about. Because you *should* still make one – and reading this may change how you approach yours.
Birth planning is one of those areas where the mental load gets quietly handed from the expert to the amateur. Your doctor — who has delivered hundreds of babies — tells you to “go make a birth plan.” And now you, who have delivered zero babies, are supposed to figure out what belongs in one. It’s the same pattern that plays out across parenthood: every family solving the same problems alone, from scratch, when tools and systems already exist.
That’s exactly what happened to me. When I found out I was pregnant, I wanted to talk about labor during my first medical visit. (I knew the options for getting the baby out of me and they all seemed…bad.)
I was disappointed when my doctor told me to go home, make a birth plan, and we’d discuss it in a few months. But I trusted the process.
So I went home– and immediately realized I had no idea how to make one. The whole reason I had questions was that I had never given birth before. How was I supposed to plan for something I’d never experienced?
I Googled it. What I found was not helpful. Blogs where people mentioned the music in their birth plan (What does music have to do with giving birth?). Posts about how many people you want in the room (Am I even going to be aware of who’s in the room?). Nothing that gave me a framework — just other people’s random preferences, which raised more questions than they answered.
And even if I could identify a few obvious preferences — like hoping to avoid a C-section — I had no idea what else belonged in a birth plan.
This is the real problem with birth plans. You’re being asked to make informed decisions about something utterly outside your experience. It’s like asking someone who has never been on a plane to create a guide to navigating airport security.
I am really good at internet research. So I went digging for a birth plan checklist — not a blog post, not someone’s personal narrative, but a systematic tool.
I found one and it changed everything.
The best way I can explain why: a checklist is like being handed a restaurant menu instead of being asked “what do you want to eat?” It gives you the universe of possibilities so you can form opinions, rather than staring at a blank page trying to invent categories you don’t know exist.
The checklist is organized into categories, headers, and options — pain relief, delivery positions, who’s in the room, what happens immediately after delivery. Instead of doing extensive research and trying to synthesize it all into something coherent, the checklist does the mental lift for you. You go through and check off what applies.
Is it the most direct and explicit thing to hand a nurse? Probably not. But that’s not the point. The point is that when you sit down to think about pain relief, you have a genuinely extensive list of options in front of you. When you talk to your doctor, you can have a precise conversation instead of groping around for information in real time.
The checklist turned me from a passive recipient of medical care into an informed participant in my own delivery. (I found a second exceptionally useful menu too — Penny Simkin’s Pain Medication Preference Scale – I linked both at the bottom.)
Here’s the thing: the ladies at mahjong weren’t anomalies. I don’t know a single person whose labor and delivery followed their birth plan. The baby takes over.
The real point of a birth plan is the making of it. It’s a process for getting aligned — with yourself, with your partner, with your provider, and with whoever ends up in the room when you deliver (which may not be the provider you planned with). You’re getting clear on what you want in an ideal situation. And then the baby does what the baby does.
I think of it like rehearsing for improv. You don’t rehearse to memorize lines. You rehearse so everyone understands the characters, the themes, and the boundaries — so that when the performance goes off script (and it will), everyone can improvise from a shared understanding of what matters.
That’s what the birth plan does. It’s not a prescription. It’s preparation for the improvisation.
I didn’t want to be induced. But my water broke and labor didn’t start, and my doctors advised Pitocin because too much time had passed. What we all want is a healthy baby and a safe delivery, so when you get medical advice like that, you typically follow it.
(For anyone worried about missing out on a natural labor experience by having an induction: I was induced with my first and went into labor spontaneously with my second. To me, it felt pretty much exactly the same.)
When people imagine their birth going off-script, they usually think about medical surprises — the baby is breech, labor stalls, an emergency C-section. But there’s another category of variable that can change your plan, and it has nothing to do with biology or medicine: the external environment in which your birth is happening.
You could get stuck in traffic and end up delivering in your car (yes, this really does happen sometimes - it’s not just a TV plot point!). You could arrive at the hospital to discover that a resource you were counting on isn’t available because of who’s on shift that night. The world doesn’t pause because you’re in labor — and your birth plan checklist won’t have a section for any of it.
Here’s how it played out for me. I had planned to use a bathtub as a form of pain relief — not a water birth, just the counter-pressure of being in warm water to manage pain. My hospital had one available to women who requested it, so I requested it.
The doctor said no — through a nurse, not to my face — because my labor wasn’t far enough along. I pushed back. This was always part of my plan. Eventually the doctor agreed, but it was stressful getting her to say yes – and the whole time, it was all via messages from the nurse. I never even got to make the ask directly to the doctor myself.
The bathtub was heavy and could only be moved by specific staff with the right authorization. They had to find those people. But it was a Friday night. Four hours later — four hours of me at the threshold of what I could bear — there was still no bathtub.
I had a pain escalation plan — a sequence of interventions from least to most medical, with my preferred order mapped out in advance. The next step after bathtub was supposed to be nitrous oxide gas. But that also had to be brought to my room by hospital staff. And the hospital had just demonstrated that it couldn’t deliver resources in a reasonable timeframe. So I made a strategic decision: I wasn’t going to gamble another four hours on the gas never arriving, only to discover I’d waited too long for an epidural. You have to be able to hold still for that, and as the pain increased, I was running out of runway. I skipped it and went straight to the epidural.
Zero regrets. This was the right choice for me: once I was not in torturous pain, I could actually enjoy the experience.
The lesson: the bathtub wasn’t unavailable because it was broken or reserved. It was unavailable because it was a Friday night and the people authorized to move it weren’t around. That’s a staffing problem, not a medical one — and it’s the kind of external variable that no amount of medical preparation can account for.
This is why preparation matters: when you know your priorities and the universe of options that exist, you can adapt in the moment, even when the environment (or the baby, or the medical reality) doesn’t cooperate.
The only people I know who have successfully had an unmedicated birth either were doulas or had doulas. If that’s a high priority for you, a doula is worth serious consideration.
Even if your partner is committed, labor is relentless — after hours of providing counter-pressure, even the most devoted support person wears down. The birthing parent has no choice but to keep going; the supporting partner can falter. A doula is a professional who has accompanied many births, who can pace herself, and who can help you stick to what you said you wanted.
They can’t make decisions for you. But they’re a voice in the room whose only interest is your birth plan and your safety. They’re not influenced by billing, shift changes, or institutional dynamics. When my doctor denied the bathtub request through a nurse intermediary, a doula might have advocated differently than I could from a hospital bed mid-contraction.
1. Use a checklist, not a blank page. A birth plan checklist gives you categories and options so you’re not guessing at what to ask about. Pair it with Penny Simkin’s pain medication preference scale to get clear on your priorities. The point isn’t the document — it’s the education.
2. The plan won’t match reality. That’s a-ok. Making it means you show up informed. When you deviate, you’ll know what you’re changing and why — instead of having things happen to you.
3. You can’t control the environment, but you can ask about it ahead of time. There’s a difference between “we have a birthing tub” and “a birthing tub will be available to you at 2 AM on a Saturday.”
4. If unmedicated birth is your goal, having a professional advocate dramatically increases your odds. A doula is the only person in the room whose sole job is helping you stick to your plan.
5. Expect at least one thing to go off script — and you’ll have a better experience. At the end of the day, what matters is a healthy baby and a healthy parent.
You won’t follow your birth plan. But you’ll be a better improviser for having made one.
Resources:
- Bebo Mia Birth Plan Checklist
- Penny Simkin’s Pain Medication Preference Scale
The birth plan is one kind of preparation. But there’s a bigger preparation gap that almost nobody addresses: what happens to your life after the baby arrives. Most people prepare for one day of labor and not for the 18 years that come after. I cover that in The You Plan.
This post is from the subsection Preparing for Parenthood by The Third Shift.
The Third Shift begins the moment you’re pregnant. Suddenly, you’re juggling thousands of decisions about topics you know nothing about—baby gear, nursing logistics, postpartum mental load, partner delegation—without any framework for evaluating them. This section applies the same operational thinking we use for household management to the specific overwhelm of preparing for a baby.
If you’re expecting, start here. If not, you can easily opt out of the “Preparing for Parenthood” posts — or stick around and share your wisdom in the comments!
Thanks for reading!
Jennifer
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