Certified nurse midwife Dr. Stephanie Mitchell shares tools from her step-by-step guide to building a birth plan, and discusses why getting your plan together—and onboarding everyone on your birth team—can help ensure you are respected and heard during your birth experience.
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Related Birthful episodes:
- How to Have a Great Hospital Birth
- Know Your Options for Where to Give Birth
- Know What You’re Up Against When Giving Birth at a Hospital
- Showing Up at Your Birth, with Shalome Stone
- The First-Time Parent’s Childbirth Handbook: A Step-By-Step Guide for Building Your Birth Plan, Dr. Stephanie’s book
- Download our birth preferences worksheet
- The Birth Sanctuary Gainesville, Dr. Stephanie’s freestanding birth center
One thing you can do for you is to write your birth plan! Identifying your birth preferences is a critical step in having a birth experience that feels right for your needs. After listening to this episode, there is no doubt that you understand the importance of having a birth plan, but if you need additional framework, do not hesitate to pick up a copy of Dr. Stephanie’s comprehensive guide, The First-Time Parent’s Childbirth Handbook: A Step-By-Step Guide for Building Your Birth Plan.
The one thing you can do for the rest of us is help build the strong foundation of the Birth Sanctuary Gainesville, the only freestanding birth center in the state of Alabama, by contributing to their GoFundMe campaign, as well as ensuring you follow @the.birth.sanctuary on Instagram, where Dr. Stephanie organizes and disburses scholarships for BIPOC aspiring midwives.These efforts are vital for improving outcomes for racialized birthing parents with the research-backed benefits of the midwifery model of care, both in Alabama with its high rate of perinatal mortality and morbidity, as well as nationwide in the U.S. where Black birthing parents in particular die during pregnancy, labor, and postpartum at significantly higher rates than their non-Black peers.
How Your Birth Plan Impacts Your Birth Experience
Most satisfactory birth experiences are not ones in which you get what you get. It is that you are listened to. It is that you are provided an opportunity, yes, to be heard, and just to have been respected, and you can do a lot of work in making that happen for yourself.
That’s Certified Nurse Midwife and author of The First-Time Parent’s Childbirth Handbook: A Step-by-Step Guide for Building Your Birth Plan, Dr. Stephanie Mitchell, talking about the key elements for having a satisfying birth experience, which starts with figuring out what’s important to you and communicating it with your birth team. Today, we’ll be talking about why your birth plan is an amazing tool to help you in this process, how it will serve you both during pregnancy and birth, and why you should really think twice about anyone who dismisses your birth plan, because if they don’t support your birth plan, then whose plan are you gonna get? I’m Adriana Lozada and you’re listening to Birthful, here to inform your intuition.
Welcome, Stephanie. I am so happy and honored to have you here on the show. Before we get started, why don’t you tell people a little bit about yourself and how you identify?
Mitchell: Thank you so much for having me here. I’m so excited to talk to you today. My name is Stephanie Mitchell. People call me Stephanie. People call me mom. People call me Dr. Mitchell. I’m a midwife, and a mother, and a wife, and so however I meet people along their journey, we learn to name each other however we fit into each other’s circle and world view. So, thanks for that. That’s so great. She and her are my pronouns and that’s awesome. Thank you.
Lozada: Yeah. And thank you. So, birth plans. Why even write a birth plan in the first place?
Mitchell: Well, for the majority of people, which is 98% of American birthers who are going to have a baby, have a tendency to be cared for in an industrial type setting. And a lot of people may not feel like that. They’re like, “Oh, wait, but I go to my local clinic, and I love my midwives and doctors. What do you mean, industrial? What do you mean? What are you talking about?” I mean that the way that healthcare is set up for folks who are pregnant, and the industry of obstetrics has really changed a lot in the last certainly quarter of a century, but more so than that it’s really over the last century we’ve seen some dynamic changes in how care is delivered.
And so, industrial, when I say that in that sense, I mean high volume, fast paced. And to accomplish these things, you have to be pretty industrialized about it. You have to have a certain regimen and regime and in order to keep things running at a smooth kind of pace. And so, when you have a birth plan, it says to folks, “Wait a second. I understand this is industry. I get this is industry. But there are some things that I may want or that are important to me that are outside of what type of care you are provided.”
Lozada: Well, and I so agree. I think it was Rockstar Magazine, Shalome Stone, that once told me… She was like, “Winging it is not a birth plan.” There was a quote in your book that really unpacked that in a way that just resonated so much with me, and the quote was, “Those who do not express any preference will get the standard hospital or birth center experience based on the experience, comfort, and preferences of the provider or birth space and not on points important to the individual.” Which is what you’re saying, but I think we’ve gotta stress that, that if you don’t present your choices, then you’re just gonna get the default.
Mitchell: I was just about to say no plan is our plan, but it’s influenced by our experiences as labor and delivery nurses, as technicians in the hospital, as obstetricians, as midwives. It is a job. It is root and routine and that’s what it is. And you’ve come into this as an individual. This may be your first time going through this, but this is what we do every day. It becomes very much routine. And so, when you come here into these spaces and you don’t have a plan, that’s cool. That’s fine. We got you covered. We do this every day. You’re getting the standard operating procedure. And there’s not anything inherently wrong, per se, but it’s just the standard and you’ve gotta know what the standard is so that when you don’t want what the standard is, you can be like, “Oh, no. Oh, no, no, no, no. I don’t want that. I’ve done my due diligence. Here’s my birth plan and this is kind of what it is.”
Lozada: Well, and the other thing to understand is there are different interests in play and if you don’t come advocating for your own interests and your own choices and you’re gonna get the routine one, it might not be putting your interests in the forefront. So, what we’re seeing is if you just default to whatever the standard plan, you might really suffer.
Mitchell: It’s actually a flawed system on so many levels, but what we’re seeing these days is something that the United States would like to refer to as a maternal mortality crisis, and what the crisis actually is is that there’s a huge disparity in the outcomes for women who are Black and having birth and their outcomes and women who are counterparts or not Black or African American identifying. There’s a huge disparity.
So, that goes to show us, like at baseline, wait a second, at baseline perhaps what we’re just offering you might not quite be good enough. And so, there’s certainly some aspects to start taking a closer look at, and I think birth plan is just the easy way to say, “Hold on a second, now. Wait a minute. I done seen your standard operating procedure and I don’t want it because the outcomes are not conducive to me wanting something of that nature.”
Lozada: So then, okay, you’re convinced that you need to write a birth plan. Where do you start?
Mitchell: You could start anywhere along the timeline of being pregnant or even beforehand. I advise people to jump around. Look at a birth plan. See what’s on it. What does that even consist of? What are the subtopics? What am I even gonna be deciding about? Some folks, right off the bat they’re like, “Oh yes, I know I want this. This is absolutely critical. And other things maybe are not so important. And then some areas I have no idea about,” so that kind of tells you how much time you need to be devoting towards learning about some of your other options, so that’s just in terms of the physical nature of the birth plan. That’s where you start.
Lozada: Why don’t you tell us what are some of the sections or parts that a birth plan includes?
Mitchell: The majority of it is going to be about when you’re in that actual birth space. So, we devote a lot of time talking about the environment of the birth space. Who you want to be there? What do you want to feel like? What things make you feel safe or that you want? The other pieces have to do with like the actual labor course, meaning you want or are not opposed to having IVs, or rather you would rather be maintaining your hydration status orally. Other pieces of the birth plan have to do with your preferences for pain management strategies, things that you’d like to try or not try. Would you like to be offered medication? Would you like to be offered the ability to get up and move around or get into the water?
These are the things that are the critical pieces of it or components of it. It’s a piece of paper, really. I mean, when we get down to it, it’s just a piece of paper, but it’s so dynamic because when we think about birth in general, there’s so many facets that come into play that there’s no way we could possibly organize or predict all of the pieces that will come into play.
Lozada: At the end, what you want is something that is almost like a resume, like very short, to the point, but there’s all this distilling of information that I find goes through in the path towards getting to that final document. Would you agree with that?
Mitchell: It’s absolutely kind of what I spoke to in the book in terms of the discussion plan versus the actual birth plan. Because really, that is what it’s about. At the end of it, you have a single piece of paper, but you cannot allow this piece of paper to just be kind of cast aside, or not listened to, but the amount of work and time that you have put into developing the choices on this piece of paper should not be a willy nilly thing. It should never be tossed aside. It is critical. It is like, “I’ve taken the time to go through all of these things. I’ve unearthed the plans that are gonna be important for me, for my labor course, for my newborn.” It distills through all of the work that you’ve done through the course of this pregnancy so that you can have a satisfactory birth experience.
Lozada: What if people are finding their birth plan is being dismissed or somebody’s rolling their eyes? Like, what can they do at that moment?
Mitchell: One of the most critical things that needs to really occur for the process of labor and birth to occur in its most unencumbered state is for someone to be in a place of physical and mental safety. You want to be safe presenting as you are. It is not a moment to have to worry about whether people are thinking about you, or whether people support you, or all of these things. I would just question how I would feel about going to a provider when I start to ask these questions about a birth plan and I am feeling dismissed, ignored, but you have to wonder what that means for you when you are in probably one of the most vulnerable physical states of your life and you know that what you want is going to be laughed at, dismissed, and ignored. That’s not the time. You need to be going into your birth and you need to be knowing who’s on your team, who are your people.
So, I question. You bring up a birth plan and you get that type of response, that does not bode well for you being in a space of physical mental safety at the time where you need it most. So, those are the questions that I encourage people. Start asking these questions and if folks get uncomfortable, you need to decide on what the reason is that they’re getting uncomfortable that you’ve decided to do your due diligence about what you’d like for your labor and your birth. And a birth plan has nothing to do with making medical decisions, because you’re not a doctor. You’re just a human being. You’re not a… This isn’t your thing. You know?
But the body is your thing, and the labor is your thing, and so you actually do get a huge, huge chunk of say so and autonomy to this entire process. This should be brought up early, early on. You want a provider that’s gonna be on the same page that you are.
Lozada: And I really appreciate in that aspect that in the book you mention a birth plan as this living document, where you have two phases to it. You’ve got your discussion plan, and your birth plan is the final document, but this discussion plan involves actually discussing it with your care provider, with your partner, with anybody who’s gonna be part of your birth team knowing that say you won’t know who the nurse is, but everybody else should be on your side already and knowledgeable of what’s in this birth plan. So, what could that discussion look like throughout your pregnancy with your care provider?
Mitchell: I think a lot of times when people think about labor and birth, there’s obviously the component of pain, or being uncomfortable, or that type of thing. And there are various methods and modalities to be able to manage that, so I think a large portion of people’s birth plan is like how they are planning to get through that process, be it through an environment that is comfortable to them or be that by modalities of medication or other methods of either meditation, or IV pain medicine, or hydrotherapy, or all of the other methods of pain control. A lot of times if you are unprepared in the how you plan to manage the discomfort and frankly pain of labor and childbirth, then you get into a situation where the default is what you get, which is what I would venture to say 90% of people choose, which is epidural anesthesia. Which is a fine choice for pain control, but how have you chosen this as your method of pain control, but you haven’t done any due diligence prior to that so that when you arrive at the hospital, they’re like, “Wait a minute. I didn’t know I have to be here by myself in this room. Wait a minute, I didn’t know that I have to have an IV in order to have this. Hold on, I didn’t know that I need a catheter.”
But if you haven’t cracked the discussion about it, then you haven’t provided yourself enough opportunity to receive information to make choices that are going to be good choices for you. And the most satisfactory birth experiences are not ones in which you get what you get. It’s where you’ve had autonomy and you are part of the decision-making team. And it doesn’t mean that everything works out how you envisioned it working out. That’s not what a satisfactory birth experience consists of necessarily. It is that you are listened to. It is that you are provided an opportunity, yes, to be heard, and to be a member of the team, or not be railroaded into making decisions. It’s to have been offered consent. It is to have been respected. It is to have been provided additional resources and support. It is to be cared for in the best possible way in the postpartum period.
These are things that make the birth experience satisfactory, and you can do a lot of work in making that happen for yourself if you are prepared.
Lozada: One of the things I really appreciated in the book was that you had questions. Questions to ask the place of birth, questions to ask of your provider, but also questions to ask of your partner. Why is that important?
Mitchell: So important. Oh, my goodness, the most important thing. I’m gonna tell you why, because we have ideas or how we envision other people, and so we may have preconceived notions about how we envision our partner in that birth space, and we might envision them as being very hands on, and really into the process, and maybe up until catching the baby, or you may envision something like that, which is a reasonable, valid option for a lot of folks. But you don’t have this discussion with your partner, okay? And they don’t want nothing to do with that piece of it and they’d rather be a more passive bystander. And that is also a very valid way to enter into the birth space.
The mis-congruence that we have here is that when folks end up in the birth space and they’ve never kind of had this discussion about their level of comfort, the things that are important to them, then we end up with a real problem. And I mean this on several fronts. One, on a physical level, like I said before, your body functions at its peak capability when it is safe. Maslow’s hierarchy of needs. We must have our physical safety and it moves onto psychological safety and all of these things on board for our bodies to function at peak capacity. I’ve had folks who’ve clearly never had a conversation to their provider or to their partner about how they felt to be physically exposed. I have had folks who physically resisted their body because they were so uncomfortable with being exposed.
And so, if you don’t have these conversations with your partner beforehand, and not just like on the physical aspect of your levels of vulnerability, but like how do they feel to see you cry? How would they feel if you do something out of line, like that you don’t normally do, like curse, or sitting on the toilet and having bowel movements? Is that what you do in regular life? If that’s the way y’all relationship rolls, that’s fine. That’s fine. But there is some very vulnerable activities that occur during labor and birth and if you haven’t talked about this, you may find yourself, both of y’all, in a very uncomfortable situation. And I hate it for y’all. Ask the questions. And that’s of your provider, and that’s of your doula, and that’s of your partner, because you’re gonna learn something.
Lozada: What is the benefit of having your care provider sign off on your birth plan?
Mitchell: A birth plan is not a contract. It is not a medical negotiation. Things change in labor. It is dynamic. A signature of your provider means that we’ve gone over each of these things and I as your provider, who have taken care of you during the entire course of your pregnancy and not just meeting you today, agree that what you have planned for your birth are a reasonable option for you as a first time, second time, or whatever, normal, healthy, individual. I’ve read it. I’ve read it. We’ve talked about it. And that’s why I signed it. There’s no reason a provider should not sign off on someone’s birth plan. It doesn’t mean you like it, or you love it, because we are autonomous individuals. It means we have talked about everything on there and that is what it is.
So, find me a provider who don’t want to sign off on your provider and you found me a provider who don’t give a shit about what you want for your individual options, and that’s all I have to say about that. I’m fired up.
Lozada: I like it. So, no, and I really appreciate it because as you have these provider groups that are numerous, you’ve got 10, 12, 15 individuals, you don’t know who’s gonna be there for your day of birth, and so having that signature on the bottom that says so and so looked at this and we have discussed it, and they said, “Okay, this is something we can do for you,” then it arms you with a little bit of power, a little bit of like… Not that I’m gonna guarantee that this needs to happen, but I’ve had the discussion, and somebody told me I could have this, so why are you telling me now that I can’t?
Mitchell: Honestly, you get to decide, and that’s what it is at the end of the day, and there’s not a single provider on earth that will say anything caveat to that. At the end of the day, you get to decide.
Lozada: When you get to the hospital or the birth center, is there… When is the best time to give your birth plan to the care provider?
Mitchell: Immediately. Immediately. As a matter of fact, there’s not a single place that really wants you to just show up unannounced, whether it’s a birth center or whether it’s a hospital. They’re usually expecting you. There’s somebody that’s in labor, they’re expecting you. So, even if you feel like you have something that’s on your birth plan, particularly if it’s outside of the standard, like if you’re gonna be doing something that is outside of the standard and you’re on your way in, you’re like, “Yeah, this is me. We’re the folks you heard about. We’re headed in.” No, you don’t have to be… As soon as you get to your birthplace, you can hand it over to whoever is going to be the first person who’s providing care to you.
I just want to say also is if you hand over that birth plan, let me just say this real quick, because this is gonna happen, so I just need y’all to be prepared. If you hand over that birth plan and they take it and they put it aside, or they take it and they don’t stop immediately and look at it, I might have someone remind the individual that that’s your birth plan and they’re going to need a nurse who has read through it. They’re gonna need a nurse who has read through it. You better show this some respect. Put some respect on that birth plan, all right? Because it will happen. And you don’t, as the birth individual, you don’t need to be the one that has to say that, but maybe you should designate an individual to be making sure that they’ve actually just gave two cents about figuring out who you were. If they show any inclination of them not wanting to care about that, I would be… but I’m a different person, but I’d be requesting a new nurse. I’m sorry. I’d be requesting a new provider. I don’t know what’s… but that’s that.
Lozada: Well, and I think it’s… No, you’re making a great point, because you’ve put so much work into this birth plan, I think people should be… We’ve been led to believe to do otherwise, but I think people should be really proud of their birth plan, and as such, wave it loud and proud, and have copies, because if so and so misplaced your birth plan or they can’t find it after you already gave it to say the nurse in triage, then here’s another one. Here’s a birth plan for you, and here’s a birth plan, like-
Mitchell: Absolutely. Absolutely. You’re not gonna be annoying. You’re not gonna be… This is important. This is a moment that just… It can pass you by, you can miss it, you can be like, “Oh, I kind of wanted that.” You know? What? You can be prepared. You need to have your champions behind you who are willing to be like, “Oh, wait. Wait. Wait a second. They said they wanted this.” You know.
Lozada: Yeah. There’s no do-overs in birth. Not in the one… Unless you have another kid, yeah. The other thing that can be difficult with birth plans is when labor with its own set of circumstances takes a path that is not matching what you had on your birth plan, and you feel that that birth plan is getting derailed or “going out the window.” How can the birthing person regain that power over their birth, that sort of that feeling of the investment they had on these choices that are now not possible? How can they navigate that?
Mitchell: So, it’s tough, because there’s not a lot of things in labor and birth that are like you don’t have an option and choices over. So, we just have to start with that. So, when we say derailing, that shouldn’t be taken as a sign of that, of disrespect, or disregarding. That’s different. A derailment is like you may… I’m thinking of more like you had a plan for a vaginal birth, but it appears that you’re gonna be having a surgical birth. That is something that’s a different situation.
The majority of time, there should not be any other derailments because the majority of things will not be an emergency and you should have time to talk about these things and decide if there is an immediate risk to you, an immediate risk to your baby. What are the alternatives? What are the consequences? Barring very, very few circumstances. Very, very, very few circumstances which are truly emergency. And I just want to say as a side note for folks who deliver in a hospital that most of the time, their births, even though it seems like an emergent situation, it’s not an emergent situation. When you have time to ask questions, you have time to be able to receive a full consent, and a consent is not just about signing a paper. It’s about that you have got an opportunity to ask questions about why somebody would like to make a decision. I can’t overemphasize that enough because it just doesn’t happen.
So, in terms of a birth plan, it really should not be about a derailment, that you’re being ignored, or not provided an opportunity to hit any of those options on your birth plan.
Lozada: Yeah, and so it’s more of a readjustment and knowing that listen, you might not have things go exactly you want, but then you have the opportunity is what I’m hearing, you have the opportunity and time for a discussion to find an alternative that is right for you and then aligns with your choices.
Mitchell: That’s exactly right.
Lozada: Stephanie, should people that are not planning to have a surgical birth still go over the process of figuring out what their choices would be if they would need a surgical birth?
Mitchell: No plan’s our plan. No plan is our plan. And as it stands in this country with our 32% C-section rate, generally speaking you have a one-in-three chance of walking into a hospital and having a surgical birth. That’s just what it is. So, if you’ve planned to ignore that piece of it in hopes that you aren’t of the one in three, then I hate that for you. I hate that you haven’t planned and due diligence in the exact same way as these unexpected outcomes occur. But also, as I mention in the book, as well, because I would be remiss not to mention that there are overwhelming reasons why people end up having surgical birth, and if that is of utmost importance to you, then you’ve gotta do the work that it takes to divest from what the standard is. Remember, I said the standard is one in three. What can you do to change those outcomes for you? There’s a lot of things.
Preparation is one, but planning to not have a plan is a terrible idea, because you’re just gonna get what we want.
Lozada: Thank you so much for coming and sharing all your knowledge with us. It’s been a pleasure.
Mitchell: Likewise. Yes.
Lozada: That was Dr. Stephanie Mitchell, a Certified Nurse Midwife in Alabama who is in the development and planning process for the Birth Sanctuary Gainesville. Follow her on Instagram @doctor_midwife, and don’t miss her weekly Sunday Cervix Instagram live events.
I hope that your main takeaway from our conversation is that unless you want the industrialized cookie-cutter birth plan offered by your hospital, you need to determine and communicate your personal wishes. So, the one thing you can do for you is to write your birth plan. Schedule some time on your calendar right away to get it started and for more guidance, pick up a copy of Dr. Stephanie’s comprehensive guide, The First-Time Parent’s Childbirth Handbook: A Step-by-Step Guide for Building Your Birth Plan, or go to Birthful.com/BirthPlan, all one word, to download our birth preferences worksheet.
The one thing you can do for the rest of us is help expand birthing options that support autonomous birth plans and provide better outcomes for low-risk birthers, especially those who unjustly experience racism in their healthcare. A great way to do this is by supporting Dr. Stephanie’s efforts to build the Birth Sanctuary Gainesville, which will be the only free-standing birth center in the state of Alabama. To learn more, follow @the.birth.sanctuary on Instagram, where Dr. Stephanie organizes and gives scholarships for aspiring midwives, and consider contributing to their GoFundMe campaign.
You can connect with Birthful on Instagram @BirthfulPodcast and to learn more about Birthful and my birth and postpartum preparation classes, go to Birthful.com
Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro is our associate sound designer and mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.
Lozada, Adriana, host. “How Your Birth Plan Impacts Your Birth Experience.” Birthful, Lantigua Williams & Co., June 23, 2021. Birthful.com.
About Dr. Stephanie Mitchell, DNP, CNM
Stephanie Mitchell is a doctoral prepared certified nurse midwife, author, blogger, wife, and mother of four. Her comprehensive background in adolescent, and full-scope women’s health are the focus of her practice. Her doctoral research and capstone, addressed low-intervention labor and birth in the hospital setting. She is credited with the development of the innovative ‘Intermittent Auscultation Checklist’ which assists labor and delivery providers in identification of appropriate candidates for low intervention labor and birth as the standard of care. She is also credited for the development and institution of a birth preferences tool as a method of patient engagement in which physiologic preferences are brought back into labor and birth spaces which have slowly medicalized over the last 50 years, bringing along with it, abysmal outcomes.
After relocating from Boston, Massachusetts to Gainesville, Alabama in 2020, she is in the development and planning process for Birth Sanctuary Gainesville, a free-standing birth center serving the rural birthing community of West Alabama. In her leisure time you can find Dr. Mitchell using her social media platform moniker, Doctor Midwife, to educate, humor and enlighten her audience about the experiences of existing in a Medical Industrial Complex.
Stephanie spends her free and available time attempting to keep her home clean, her children fed, while remaining full of hope that they have some semblance of hygiene as they grow to be happy, well-adjusted, childhood-trauma-free adults, who can pay their own bills.
Follow her on Instagram @doctor_midwife (don’t miss her Sunday Cervix!) and get prepared for your birth with her new book, The First-Time Parent’s Childbirth Handbook: A Step-By-Step Guide for Building Your Birth Plan.
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