My Birth Plan

I have been delivering babies now for 25 years.  Birth plans have been around for that whole time, but they are certainly presented by couples to their doctors more frequently today than they used to be.  The increase in birth plan development is a consequence of couples trying to influence what happens in a hospital where one frequently becomes swept along by events out of their control.

I certainly do not mind being presented with a birth plan and using it to review a couple’s expectations and preferences.  However, in my opinion, it is far more important that one find an accoucheur (birth attendant) whose default style is in line with your birth plan, than trying to get someone to change their style to match your preferences.  In light of this I decided to write down my birth plan from the perspective of the professional who is being entrusted with caring for an expectant couple.  Here are my goals and preferences:

  1. Give the couple the type of birth that THEY want to experience.  While most overt birth plans are produced from those who are looking for a natural birth experience.  Not everyone is looking for this.  I have some moms who want no medications at all and I have some who want an epidural placed in the parking lot.  Whatever the preferences, I will do my best to accomodate them.
  2. Explain all interventions and get the mother’s permission, before doing them.  One of the biggest complaints I hear about unpleasant birth experiences is that things were done to them without them knowing what was happening.  While it is easy for a doctor to go into automatic mode, I do my best to not let that happen.
  3. Alleviate fear.  One of my frequent statements about pregnancy is that it is the permanent state of paranoia.  Couples are often plagued by the “what ifs”  and modern obstetrics often adds to this with the constant pursuit of worst case scenarios.  While it is certainly true that bad events can occur during pregnancy, thankfully this is the exception and not the rule.  My job is to be alert for  problems without turning every visit into a worry generating experience and to reassure moms when there is no reason to worry.
  4. Avoid Inductions.  I hate inductions.  Sometimes, inductions cannot be avoided, but even then I still hate them and really try not to do them.  No one knows what actually triggers labor, but one thing I do know is that forcing a uterus not yet ready to labor to labor is asking for trouble.
  5. Encourage mothers to stay out of bed and in motion.  The best way to reduce discomfort and to move labor along is to stay out of bed and move about and frequently change position.  One can also use birthing balls, whirlpool tubs, showers, hypnobabies.  Doulas are welcomed as part of the birthing team and a great help in keeping the labor moving along in a productive manner.
  6. Prefer no epidural.  If women want to have an epidural, they may, but my preference is no epidural as this allows for the most physiologic beneficial labor possible.
  7. Keep the stirrups stowed.  When someone is ready to have their baby, the nurse’s automatically reach for the stirrups.  I tell them to put them away.  In my opinion, the stirrups serve no useful purpose and they impede a mother’s ability to find the most comfortable position in which to give birth.  I deliver women in whatever position they are most comfortable and have delivered ladies on their side, hands and knees, leaning over bed, standing, squatting, whatever works.
  8. No episiotomy.  I avoid episiotimies.  (Hint:  when a doctor says they only cut an episiotomy when it is needed, they probably cut episiotomies on most of their deliveries)
  9. Put baby on mother’s chest as soon as baby is born.  The baby goes from me to the mom, not the nurse.
  10. Delay cord clamping.  I cannot say, that this is something that I fully understand, but it is frequently requested so I have incorporated it into my routine.
  11. View Cesarean section as a negative outcome.  Again sometimes cesarean sections are unavoidable, but I never view them as equivalent to vaginal birth for delivering a baby.  Whenever, I have a pregnancy ending with a cesarean section I review the various aspects of the pregnancy and labor to see if I could have done something different to have ended with a vaginal birth instead of a cesarean section.
  12. Maintain a relaxed environment.  Sometimes things can get pretty tense in the birthing suite, but it is my job as the team leader to keep things relaxed and low key.  I have no use for all of the drapes and masks.  I do  not even wear scrub suits (though my wife wishes I would).  This is how I got my nickname “Dr. Polo Shirt.”  I work at calling everyone involved in the birth by their name and try to treat them the way I would want to be treated.  
  13. Care for the baby I deliver.  I really like it when I get to take care of the baby that I have delivered.  This is one of the services that is unique to family physicians who do obstetrics. Keeping the pediatric care with the same doctor who one has gotten to know throughout the pregnancy provides a level of comfort not available with most other care providers.
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42 Comments

  1. Elizabeth

     /  October 27, 2011

    I am so thankful that Julie introduced us. Thank you for all that you do for our family of four. Also, thank you for following our birth plan with our boys (which was a mirror of yours).

    Reply
  2. Dr. Stafford,
    I admire your attitude and skill in this area. I wish all care providers took this approach.
    Linda

    Reply
  3. Melanie C.

     /  October 27, 2011

    Nice!!! I never realized you weren’t a fan of epidurals! I think you need to write a book about how to keep the pregnant patient happy and confident. It’s one of the many reasons I miss you and your staff so much. No Dr. has ever put me at ease about my care and my children’s care the way you did.

    I look forward to future posts!

    Reply
  4. I love your birth plan Dr. Stafford! 🙂

    Reply
  5. well…I may have switched to Dr Stafford because I was trying to find a Christian Dr that would accept Medicaid, BUT if I had read that I would have picked him just for his birth plan. I don’t think I would have made it through Sean’s birth if I hadn’t had such a relaxed Dr and I wouldn’t have had to write a birth plan if I known all this. 🙂 Thank you Dr Stafford. It is so frustrating that most Drs these days want to make births easy for them and forget that the parents are involved and babies don’t come “on schedule”. You can be my Dr for my next baby too 😉

    Reply
  6. My favorite time was when you caught a baby while the mom was standing up in the itty bitty hospital bathroom. I think you only got one glove on!

    And I love the house calls you’ve made when moms were laboring at home before going to the hospital. Such an affirmation to have your care provider stop by to say “you’re doing well, carry on.”

    Reply
  7. Dr. Stafford,
    I have heard so many good comments about you from my clients. I feel very confident when referring them to you. Thanks for all you do.

    Reply
  8. Kelley C.

     /  October 30, 2011

    Thank you for actually doing what you say you will do. So many care providers say they support their patients desires but when delivery time comes (or doesn’t come when it “should”) what they do doesn’t really match what they say.

    Reply
  9. MomOf6

     /  November 7, 2011

    We LOVED our recent birth experiences with Dr. Stafford at Greer Memorial. As a mother of 6, I can not recommend him highly enough! I have heard it said that he is the closest thing to a “male midwife” there is. He allowed my husband and our older daughters to participate in the delivery creating special memories for our family. If you are looking for a natural birth experience in a hospital setting with an outstanding birth attendant, Dr. Stafford is the way to go! 🙂

    Reply
  10. Shanda Miller

     /  December 14, 2011

    Dr.Stafford, I just want to say that you have by far made my birth expieriences with my youngest daughter and my son as comfortable as possible and I never heard a complaint about anything come out of your mouth. 🙂 I think the funniest thing was when we joked about american pickers during cj being born lol! Thank you for being such a great Dr. and I highly recommend you to every mom I meet! If I have another I’ll be headed your way. I wish I would have known your birthplan before because i would have been more comfortable asking you about some things. 😀

    Reply
    • Amanda Humes

       /  February 9, 2012

      I am so glad I found you! I cried almost the entire time I was reading this. It is so important for us moms to feel heard & respected in our birth decisions, which is rare to say the least when one has a birth plan that fits yours! We are contemplating #2 and now I know where I will be coming!
      Thank you so much for your mother friendly views!

      Reply
  11. Carolyn Collett

     /  April 16, 2012

    Now that our son is nearing his second birthday, I feel the need to post how great of an experience we’ve had with you and your staff. I remember everything like it was yesterday, and you were so great to have as my OB and piedatrician. I recommend you to everyone I can! Thanks for being our family doctor. 🙂

    Reply
  12. Teresa

     /  January 7, 2013

    This video might help you understand why delayed cord clamping is important: http://www.youtube.com/watch?v=W3RywNup2CM&feature=player_embedded

    Reply
  13. marlahicks

     /  April 20, 2013

    A brilliant summary of all the reasons that family physicians who practice obstetrics are so often such wonderful providers.

    Reply
  14. Sarah

     /  April 20, 2013

    This dr. is the reason I have unassisted home births. Every sentence he write starts with “I”. It’s all about how HE delivered babies, not how he was there to help the woman if anything went wrong while SHE delivered her child. We are still a long way off from ideal, safe births for women in hospitals.

    Reply
    • Karma

       /  April 21, 2013

      Well, it is HIS birth plan. That might be why… Just a thought.

      Reply
    • racjel

       /  April 21, 2013

      Sarah, I’m a labor and delivry nurse x15 yrs and can honestly say that if every doctor was as dr.stafford appears to be, u should have no worries in hospital! However most do not practice this way, but its still muchsafer.all it takes is one bad thing and either u or baby is dead..I have seen it with my own two eyes! A cord prolapse is sure preventable death..wouldnt you be devastated if u knew you could have saved your babies’ life?

      Reply
  15. Dear Dr. Stafford! Thank you for this wonderful, thoughtful and insightful article that will help many pregnant women! What an absolute joy to read! Whew! You are a breath of FRESH AIR!!!

    Reply
  16. Dr. Stafford,

    This is amazing! As a newborn health advocate, I can help but mention something I’d like to see in more birth plans, and more education about during pregnancy: newborn care and newborn health decisions. I’ll be the first to admit I’m a strong newborn screening supporter and advocate, especially for CCHD screening, so of course I’d love to see that considered in a birth plan and during prenatal education, but I’d like to see more about newborn care in general discussed. The first few days after baby’s birth are so frantic and full of information, especially for first time moms. Thanks again for the great post!

    Reply
    • Correcting some typos! That’s what I get for commenting late at night. *I can’t help but mention.

      Reply
  17. JulieBeth Lamb

     /  April 22, 2013

    I would love to have you as a doctor and wish you were practicing in my community. It is so sad that very few physicians have this viewpoint. Those that do are booked up.

    Reply
  18. I wish all OBs came in your flavor, lol! Refreshing and, sadly, rare.

    Reply
  19. Karen DeCocker-Geist

     /  April 22, 2013

    Dr. Stafford,
    We have never met. I am a nurse midwife and mother who wishes each and every woman could have the type of care that you describe. Good for you and the community that you care for.
    Thank you for all that you do!
    Karen DeCocker-Geist DNP, CNM

    Reply
  20. Dr. Stafford,

    I am a birth doula in Canada and I absolutely adore your concern for the families you care for and the birth experience they have. You are a true gem! I love that you have also taken care to mention that families should find a care provider that aligns with their philosophies. That is such a humble supportive outlook. Thank you for this post! God bless you in your work!

    Michelle Maisonville, CD(CBI)

    Reply
  21. Thank you for this post. As a doula it is reassuring and refreshing to read something from the perspective of a doctor who trusts birth and respects the women and families they care for. If only all doctors took this approach!
    If you want to learn more about delayed cord clamping, you can check out this post of mine: http://labourdoula.com/2011/12/09/wait-just-a-little-bit-longer/ There is a link to the most recent randomized controlled study on the subject contained therein as well. I’d love to know your thoughts!
    I do have one question – while I think that it is wonderful that you recommend that clients seek out birth attendants whose default styles are aligned with their preferences, I’m not sure how clients giving birth with OBs in Ontario might be able to do this. Given the nature of the on-call system in hospitals, my clients rarely wind up having their baby with the OB that they saw throughout pregnancy. Midwives and family doctors (who deliver) are options where this can be controlled for to a greater extent, which is one of the reasons I recommend them for low-risk pregnancies. Do you have suggestions for high-risk moms or moms who prefer an OB for other reasons? In general when I work with clients who are having OB-attended births I encourage them not to get too attached to the idea of “their” doctor actually being there, because I have had clients feel disappointed and abandoned when they wound up being cared for by a stranger.
    Thank you for doing the work that you do!

    Reply
  22. Kimberly

     /  April 25, 2013

    Dr. Stafford, may more doctors adopt your views toward birth, mothers, babies and families!

    Reply
  23. Could you possibly train other caregivers to take on this philosophy when it comes to birth? I think everyone would benefit from your practices, practically. Thanks for what you do.

    Reply
  24. Grace Olvera

     /  April 28, 2013

    I agree. I wish Dr Stafford would humbly speak of catching babies instead of boasting that he delivers babies. The pregnant woman is the deliverer of the baby with the Lord’s enablement. She is the one who does all the hard work.

    Reply
  25. Dr. Stafford,
    I very much enjoyed reading your post. You sound like someone that I would love to sit down with, have a cup of coffee with, and chat about birth. As I follow my passion to help women and their families during this precious time in their lives, I am often troubled by what I see out of many doctors and nurses that I come in contact. For most I truly believe it is a lack of understand. Simply put, they just don’t know, they haven’t been taught. Some day I truly hope to have the opportunity to work along side a doctor of your caliber. Thank you for taking such wonderful care of women and their families. May God richly bless you in all that you do.

    ~Stephanie

    Reply
  26. Carrie Childers

     /  March 14, 2014

    [copy] and paste for our next birthplan :). Thanks again for being such an honorable doctor who we hope to see in the delivery room again!

    Reply
  27. Sarah

     /  December 27, 2014

    Wish I had known about you when I was pregnant!

    Reply
  28. Ashley Lovell

     /  April 21, 2015

    Dr. Stafford, thank you for your incredible gifts of care and concern to women in South Carolina. I wish I knew more doctors like you!

    Reply
  29. I wish you practiced in my area! There are not enough doctors like you 🙂

    Reply
  30. Marquita

     /  April 22, 2015

    sounds like a real plan, !

    Reply
  31. I would love to see this guy stop blogging already! He needs to be spending his time writing textbooks! And his textbooks need to be required reading for every med student and resident who plans to spend any portion of their practice treating women.

    Reply
  32. Yes! This is awesome! Thank you!

    Reply
  33. Reblogged this on All Things Baby, Plus A Bit More! and commented:
    Excellent insights here. If only all Dr’s thought this way!

    Reply
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