The perfect birth plan can change. And it often does.

When a patient arrives on labor and delivery clutching her birth plan, I’ll admit, I want to escape immediately to a remote, uninhabited island with no modern form of communication. I’d crate the carrier pigeons too, just to be safe.

Many of us who deliver babies have an unshakable belief that women with birth plans unlock Pandora’s nether regions, releasing a huge flock of horrifying Kraken. The Kraken take perverse glee in ensuring that nothing will go according to that plan. We’ve lived it.

Labor and delivery is wildly unpredictable.  Like parenting. Flexibility is key to both. (Flexibility, loving acceptance and a good friend who makes a mean martini will get you through most of parenting’s challenges.) When life rains goose poop on your parade, it’s time to adjust.

My take on a birth plan is that it can be a valuable conversation starter. Ideally, this discussion should happen in the office, long before massive uterine contractions are occupying the majority of the mom’s attention. We can talk about what is truly important to you (the mom) (and whomever you want included) versus things that you’d like, but can live without, during your labor and delivery. I’ll tell you how I usually practice and what is important to me. We can discuss things like Cesarean sections, episiotomies, eating in labor and who you want in the room with you at delivery.

For instance, I tell moms, “You are the only person in the room in pain. I will offer you ways to handle the pain that are as safe as possible, but which one you choose, if any, is up to you. And you can change your mind if things don’t go according to plan.”

Here’s the analogy I use: Think of me as the pilot of a charter flight for you and your baby. You choose if we fly over mountains or lakes, if you sit in a window or aisle seat, if you have chicken or fish for dinner. I might make a suggestion or two (I’m not a big fan of fish on airplanes), but those decisions are yours.

If the plane is going down though, you need to trust me to fly the plane. If however, you fundamentally don’t trust me to fly the plane, the time to figure that out is long before the plane is dropping out of the sky. If you’re not happy with your pilot, a piece of paper won’t protect you or your baby. You need to get a new pilot, preferably before you board the plane.

A nosedive is also not the best time to knock on the door of the cockpit and share your thoughts on flying or a list of flying suggestions printed off the internet. In an emergency, please let us do the job we are trained to do, to keep you and your baby safe.

You need a pilot who will let you make the decisions you can, use her/his best judgment to make the decisions you can’t and has the wisdom to know the difference.

My motto is “happy mom, healthy baby.” Our commitment to you is so much greater than a list with check boxes. We won’t always get to the destination exactly as either of us had planned.  In the end, though, if your new family gets there safely, it’s been a good flight. The great news is when you get off the plane, you get to take home the best souvenir on earth.

K. M. Walker is an obstetrics-gynecology physician.

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