Many of my obstetrical colleagues groan when a patient presents a birth plan during prenatal care, but I do not. I see it as an opportunity to do what Frank Chervenak and Laurence McCullough have called “preventive ethics”—avoiding conflict later by addressing issues before problems arise. Prenatal care is unique in medicine in that we spend so much time with generally healthy patients seeking to prevent medical complications that, if they arise at all, are likely to arise much later during labor. The same mindset that propels and justifies prenatal care should direct our response to birth plans: this is an opportunity to prevent problems, and misunderstandings during labor, and the fact that the patient has well-formed opinions about what kind of care she wishes to receive during labor means she is engaged and seeking to educate herself. In short, women presenting with birth plans are generally our most conscientious and informed patients.
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