Over the last few years, I have noticed an increase in expecting families planning to "go with the flow" for their births. This trend seems to be an attempt to maintain flexibility and avoid disappointment due to the unpredictable nature of childbirth. While admirable, I fear that this trend does more harm than good.

In addition to "going with the flow," it seems that most families with this plan also forego childbirth education and preparation. If you are letting your baby, body, and birth take the lead, then it makes logical sense to laypersons that you can just let your mind take a backseat to the process. However, doulas, nurses, midwives, and other birth professionals worldwide know that our minds can, and do, get in the way of the physiological process of childbirth, particularly when we do not understand what our bodies are doing, or are fearful and apprehensive of birth. This is why I think that a "go with the flow" birth plan must include prenatal preparation in the birth process, coping skills and comfort measures, and the major variations in normal and abnormal childbirth, including indications for Cesarean.

Families who take this attitude often mean they want to go with their body's flow, they want to cope as long as they can, and see how it goes before they commit to a medication plan or not. However, in the majority of birth settings in the United States where I live, families giving birth are not going with the flow of childbirth; Families giving birth in United States hospitals are really going with the flow of the hospital. Hospitals are a vital part of a healthy maternity care system, we need hospitals! However, most hospitals impose time limits, routine interventions that may be unnecessary to a particular motherbaby pair, and certainly include settings, sounds, smells, and people unfamiliar and potentially distressing to the birthing family. All of these interventions can disrupt the physiological flow of childbirth, making the hospital flow necessary, as may be the case for your third stage (birth of the placenta). Therefore, I think that a "go with the flow" plan must be accompanied by a thorough understanding of their chosen birth setting's typical care plan and quality statistics, and how that will impact the flow of childbirth.

Hospital procedures impact the flow of a birth, but so does the chosen caregiver. A real-life example of how a particular caregiver's care plan can significantly impact a birth experience is how they define intermittent fetal monitoring. In Lincoln, NE in the past year, I have worked with caregivers who define intermittent fetal monitoring as monitoring 40 minutes out of every hour, and caregivers who define it as monitoring 20 minutes out of every two hours, and everything in between. The caregiver dictates your hospital orders, so in the same hospital, one birthing patient may be restricted to only ice chips by mouth, while in the next room, a patient with similar risk factors has no restrictions on food or fluids imposed by their caregiver. In order to "go with the flow," I think you also need to know your caregiver's typical care plan for childbirth, because your caregiver will significantly impact your birthing process.

Going with the "flow" requires a thorough understanding of all the factors that will influence that flow. Flexibility is important as you approach childbirth, but it is a poor substitute for carefully selecting the birth setting and caregiver who will both significantly impact your birth experience and how much you are reasonably able to follow your body's lead during your birth. You still need to understand how birth works, and how to work with your body and baby, if you plan to "go with the flow."