In this episode of the Pulling Curls Podcast, Hilary Erickson chats with Dr. Nicole Rankins about birth plans. Dr. Rankins, an OB GYN with over 20 years of experience and host of the All About Pregnancy and Birth podcast, shares invaluable tips on creating effective birth preferences and understanding hospital cultures. Whether you’re crafting your birth plan or navigating the intricacies of labor and delivery, this episode is packed with expert insights to help you achieve the birth experience you envision.
Find it here on Apple or Spotify Podcasts
Big thanks to our sponsor The Online Prenatal Class for Couples — if you’re looking to get prepared for ALL of birth, it’s the class for you!
Today’s guest is Dr. Nicole Rankins.
Giving birth in a U.S. hospital can be scary, but it doesn’t have to be—especially with Dr. Nicole Calloway Rankins in your corner.
Dr. Nicole is a Duke University-trained, board-certified, practicing OB/GYN and mom of two who empowers first-time moms to have the beautiful birth experience they deserve. Over her 20 year career, she’s helped more than 1,000 babies into this world, and is a proud HBCU grad (Spelman College & North Carolina A&T State University).
Her popular podcast, All About Pregnancy & Birth, is a top 50 parenting podcast with over 2 million downloads. Here is her website: https://drnicolerankins.com/ Grab her birth plan here: https://drnicolerankins.com/birth-plan/ Find her on Instagram @drnicolerankins
Links for you:
Timestamps:
00:00 Increasingly common in OB GYN for safety, efficiency.
06:00 Ask doctors about birth perspectives and doula views.
06:45 Ask questions about birth approach and doulas.
10:52 Ensure your birth plan aligns with hospital practices.
13:19 Birth plans help streamline initial medical assessments.
Keypoints:
- Introduction of the episode focused on birth plans with guest Dr. Nicole Rankins, an experienced OB GYN and host of the All About Pregnancy and Birth podcast.
- Dr. Nicole Rankins highlights her role as an OB hospitalist in Richmond, Virginia, and the benefits of hospitalists in labor and delivery settings.
- Discussion on the term “birth plan” and why it should be referred to as birth “preferences” due to the unpredictable nature of childbirth.
- Importance of ensuring that birth preferences align with the practices and capabilities of the selected hospital and healthcare provider.
- Common issues with birth plans, such as requests that may not be feasible due to hospital policies or lack of staff training.
- Advice on how to approach creating and communicating birth preferences, including engaging with providers during prenatal visits and hospital tours.
- Emphasis on the significance of labor nurses and how they can impact the birth experience positively by advocating for the patient’s preferences.
- Tips on how to discuss birth preferences with kindness and mutual respect to foster a cooperative environment between patients and healthcare providers.
- Information on Dr. Nicole Rankins’ live birth plan class, which includes interactive Q&A sessions to address participants’ queries.
- Mention of additional resources, such as the Online Prenatal Class for Couples offered by Hilary Erickson, to prepare for birth in a simple and effective manner.
Producer: Drew Erickson
Transcript
[00:00:00.740] – Hilary Erickson
Hey, guys. Welcome back to the Pulling Curls Podcast. Today, we are talking about birth plans with an OB/GYN, so let’s untangle it.
[00:00:10.180] – Hilary Erickson
Hi, I’m Hilary, a serial overcomplicator. I’m also a nurse, mom to three, and the curly head behind Pulling Curls and The Pregnancy Nurse. This podcast aims to help us stop overcomplicating things and remember how much easier it is to keep things simple. Let’s smooth out those snarls with pregnancy and Parenting Untangled, the Pulling Curls Podcast.
[00:00:39.290] – Hilary Erickson
Today’s episode of the Pulling Curls Podcast is sponsored by the Online Prenatal Class for Couples. If you are looking to get prepared for your birth, it is truly the easy way to do it. So come join me.
[00:00:48.160] – Hilary Erickson
Today’s guest has been an OB/GYN for over 20 years in the Virginia area. She is a proud HBCU grad and is a practicing OB/GYN who has delivered over a thousand babies. She is also the host of the All About Pregnancy and birth podcast, I want to introduce today’s guest, Dr. Nicole Rankins. Hey, Nicole. Welcome to the Pulling Curls Podcast.
[00:01:08.450] – Nicole Rankins
Thank you so much for having me. I’m excited to be here.
[00:01:11.180] – Hilary Erickson
Yes. A real doctor, guys.
[00:01:13.990] – Nicole Rankins
Yes. I am indeed a real doctor. I’ve been in practice for 20 years.
[00:01:18.970] – Hilary Erickson
And now you are online. And I’ve seen you before. They emailed me wanting to, and I was like, Oh, I think I’ve seen her on one of the social medias. So it’s exciting for you to be here. Where do you practice Where are you at?
[00:01:30.950] – Nicole Rankins
I’m in Richmond, Virginia.
[00:01:32.710] – Hilary Erickson
Okay. All right. And are you accepting patients?
[00:01:35.270] – Nicole Rankins
I’m not, but that’s because I only practice in the hospital. I work as an OB hospitalist. So as an OB hospitalist, I’m only in the hospital on labor and delivery. I take care of anyone who comes in during my shift. So I can’t accept patients even if I wanted to. But if you happen to come while I’m working, then that’s lovely.
[00:01:53.050] – Hilary Erickson
Yeah. A lot of people don’t understand how a hospitalist works. It’s just like a doctor that’s just there all the time. So I’m glad we’re discussing it. More and more hospitals are having them. There were none when I started.
[00:02:05.060] – Nicole Rankins
Yes. Becoming more and more common in OB/GYN for a number of reasons. One, it increases, and I’m going off topic here, but it increases safety because there’s a doctor in the hospital 24/7. It also decreases the C-section rate because there’s not this pressure that the five o’clock C-section thing decreases C-section rate, which will subsequently increases the chances of vaginal birth.
[00:02:29.270] – Nicole Rankins
Then for the doctors, it helps them have a more predictable lifestyle where they can be in the office, and when they’re home, they’re home. For us, I do my shifts, and then I’m off, so it works well for everyone. Patients, doctors, all of us.
[00:02:41.610] – Hilary Erickson
Yes, I 100% agree as somebody who’s on the other side of a hospital. Today, we are here to talk about birth plans, which is interesting because you haven’t seen people in the office. So a lot of times people say their birth plan got derailed at the hospital because they ended up seeing a new doctor. What are you- Tell us what you think about birth plans.
[00:03:02.670] – Nicole Rankins
Yeah. So birth plans are really an important part of helping you have the birth experience that you want, but they need to be done in a way that actually supports that.
[00:03:11.210] – Nicole Rankins
So one is that we actually should not use the word plan. I know we use the word plan very commonly, but birth can’t be planned. You can’t plan birth. Your doctor cannot plan birth. The person who has the most control of the birth process is the baby. They don’t tell us their plans. So you can’t really plan birth. But of course, you should have wishes and preferences for how your birth should go. So instead of thinking of it as a plan, think of it as the things that are important to you that you want for your birth experience.
[00:03:40.460] – Nicole Rankins
And then along with that is you want to know well before you get to the hospital, whether or not the doctor and the hospital actually support what’s in that plan. So if you’re just pulling up a Google template or a form, printing that out, you fill it out, you’re like, great, I filled out my birth plan, and you bring that to the hospital, what happens when either that piece of paper just gets tossed out to the side or they look at it and say, Yeah, we don’t do that.
[00:04:05.780] – Nicole Rankins
We don’t do intermittent monitoring. You have to have an IV. They don’t honor the things that are in your birth plan. It’s so much more than just filling out your preferences on a piece of paper. You really need to do a little bit of work in order to make sure that you have the support that you need for what’s in your birth plan.
[00:04:25.420] – Hilary Erickson
Yes. I love that you said, Some hospitals say they don’t do it. I mean, That’s always so tricky. Now, the one thing that I have seen people say is they want to have a water birth. And I’m always like, do you know if your hospital has tubs or tubs that are allowed to birth in? That is something that the hospital is pretty much a stickler on for infection reasons and other reasons. But you think there are a lot of things that people put on their birth plan beyond the structural needs? Because if there is no tub, there is no water birth, that cannot be accommodated in the hospital?
[00:04:55.890] – Nicole Rankins
It’s not that they can’t be accommodated. It’s just that sometimes the culture the hospital makes it so that they don’t feel comfortable or they’re not used to doing it. A good one may be fetal monitoring. Some hospitals just don’t feel comfortable at all with intermittent monitoring, and they want you to stay strapped to the monitor all the time, even if you’re low risk and even if you would otherwise be a candidate for it. I think it’s not that things can’t be done. It’s just that the culture of a particular hospital may make it so that those aren’t things that they’re used to doing. Yes. And you want to know that beforehand so you can prepare yourself accordingly.
[00:05:32.930] – Hilary Erickson
Yeah. Because some nurses don’t even know how to do intermittent monitoring. It’s just not something they’ve been trained on because we never see it, right? And so you don’t want to come in, and that’s the first time this nurse has ever even tried intermittent monitoring. Nobody wants to be the first in health care.
[00:05:49.270] – Nicole Rankins
Right. Exactly.
[00:05:52.130] – Hilary Erickson
Yeah, I think that’s an awesome tip. How do you think is the best way? Do you recommend people call the hospital or review it with their provider? What do you think is best?
[00:06:00.550] – Nicole Rankins
Yeah. I teach a whole class, and I actually do it. I’m starting to do it live where there’s some questions you can ask to help you get a sense for the way that your doctor approaches birth, the way that the hospital approaches birth.
[00:06:11.100] – Nicole Rankins
Some of the questions, and I’ll just go through a couple of them, and some of them are things that people may not even think of. They’re like, What does this have to do with my birth plan?
[00:06:19.220] – Nicole Rankins
But for example, you can ask, What are your thoughts on doulas? The reason I say that that’s a great question is because doulas, we know that type of continuous labor support improves outcomes. It decreases the chances for C-section, increases the chances for vaginal birth, decreases your chances for needing pain medication. It can shorten your labor.
[00:06:38.780] – Nicole Rankins
If you have a doctor who’s like, Oh, I don’t know about doulas, or I’m not comfortable with doulas, or I don’t know why people need a doula, that gives you a clue to the way that they approach birth, and is it going to be in line with the things that you want for your birth? Even if you don’t plan to have a doula, I think that’s still good information to know.
[00:06:57.180] – Nicole Rankins
On the flip side, if they’re like, Oh, yeah, we work with doulas in our hospital, or here are a couple of doulas that I work with that I know that come to our hospital a lot, that’s going to make you feel better about knowing that, Oh, okay, this is the type of things. This is the way that they approach birth and look at birth and the hospital approaches birth.
[00:07:14.880] – Nicole Rankins
So asking questions, yes, calling up to labor and delivery is going to be another way to find out information about the hospital. You can certainly do that for sure. Go on a hospital tour, ask those questions while you’re on a hospital tour is also very important.
[00:07:30.140] – Hilary Erickson
Yeah. I love that. There are some sneaky ways that we can try and get in questions without being so like, Are you willing to support natural birth? That’s a hostile way, but I love the idea of, Do you support doulas? That a thing. So I think that’s awesome.
[00:07:47.490] – Hilary Erickson
Nicole, what are some other tips that people can use as they’re making their birth plan or preferences or however people want to term it?
[00:07:54.570] – Nicole Rankins
Yeah. So one thing I would say is approach it from a place of kindness. And what I mean by that is sometimes I see people come in and they’re demanding and like, Here’s my birth plan, and you better listen, and you better do it.
[00:08:06.080] – Nicole Rankins
And think about if someone comes at you that way, that doesn’t necessarily foster an environment of trust, because there has to be trust between the doctor and the nurse is in the hospital and the person giving birth. So start from a place of kindness and things like, These are my preferences. These are my wishes. I’m glad that you’re here to help me with the birth of my baby. So start from that human connection.
[00:08:28.880] – Nicole Rankins
Even you can say, I’m scared. I’m a little bit worried. Make people see you as human. Sometimes in medicine, that kindness has been beaten out of us because of just being overworked, or we just sometimes need a reminder of why we got into it. So start from that place of connection and kindness. Now, if people don’t listen or respond, then definitely take it up, but start from connecting on a human level.
[00:08:50.860] – Hilary Erickson
Yeah, I definitely love that part, too, because when you come in demanding that this is your birth plan and you will absolutely follow it, it makes us like, obviously, we’re just there to help you. We want to do our best.
[00:09:02.390] – Hilary Erickson
But when you start off the relationship in an aggressive way-
[00:09:05.360] – Nicole Rankins
That’s not a great way to start it off.
[00:09:08.320] – Hilary Erickson
No, it definitely deflates me as a nurse because you’re really a lot there to help them. You’re just hoping for a great day. Yeah. All right. Any other tips for birth plans?
[00:09:17.840] – Nicole Rankins
Yes. Another thing is it has to be on one page. Please don’t come in with the 15-page birth plan because nobody’s going to read it. I’m not trying to be rude or just dismissive or not respectful, but we are all busy people, and no one’s going to read a long birth plan.
[00:09:35.680] – Nicole Rankins
You really can get the things that are important to you in a page on a birth plan. So make it a page, and it’s much more likely to be respected and listened to and actually looked at and not just stuck in the chart somewhere.
[00:09:50.610] – Nicole Rankins
And a lot of that will be if you have that discussion during your office visits about what’s in the birth plan and going through, you won’t need a 15-page birth plan because it’s extra. Yeah.
[00:10:00.950] – Hilary Erickson
And a lot of people are surprised that the basic birth plan is what we’re all hoping for in the room. I really don’t want to bring it in. I definitely don’t want you to have an episiotomy. I don’t want to go for a section. The basic birth plan is what your nurse really wants to follow either way.
[00:10:15.120] – Nicole Rankins
I think part of that, though, is that actually that, unfortunately, is not the case for everyone, and people don’t know that. I’ve discovered that in teaching my birth plan class, one of the questions I teach is to ask the doctor, How many of your patients having their first baby have a C-section?
[00:10:30.720] – Nicole Rankins
Just curious, not just trying to get information. She told me that her doctor looked at her. She said he was very nice, but he said 70% of his patients having their first baby have a C-section. It was like, whoa, wait, what? First off, I can’t believe they actually responded and answered the question that way.
[00:10:52.150] – Nicole Rankins
But clearly, they’re doing a lot of C-sections in an environment where the hospital isn’t necessarily stopping them from doing that. Sometimes, unfortunately, people don’t know that, yes, your nurse is on your side or your doctor is on your side. That’s why you need to ask ahead of time so you feel comfortable going in. That’s why you bring out the birth plan in the beginning and say, Hey, of course, the thing that’s most important to me is that I’m healthy and my baby’s healthy, but here are some things that I want for my birth.
[00:11:23.690] – Nicole Rankins
You get everybody all on the same page and knowing that they support the things that you want for your If they don’t, then you have people to advocate for you. You have a doula who can really help speak up for you, or your partner is there to really help advocate for the things that are important to you if you don’t have other options, because not everybody has options.
[00:11:41.990] – Hilary Erickson
That’s true. A lot of people probably can’t switch because a lot of our doctors that were on the higher end of a C-section rate were Medi-Cal or whatever, Medicaid type. That was who they could see. I think that’s a great idea, especially going over it in advance with them so that you knew that. I love that going in.
[00:12:00.670] – Nicole Rankins
Yeah. Because then it’s like, Hey, maybe I need to wait as long as I can before I go to the hospital. So I’m in really good, strong labor. And then it’s a lot more difficult to say, Hey, let’s just go do a C-section, or maybe I need to try and find a doula, ask for a doula on my registry so that I can get some support for a doula so I can have somebody who can help advocate for me.
[00:12:22.590] – Hilary Erickson
Yeah, because sometimes that can be a struggle to even find a doula, find a doula in your price range, stuff like that. Great, great advice for the birth plan.
[00:12:29.650] – Nicole Rankins
I have to I just want to say one more thing. Some people also underestimate the importance or the power of your labor nurse in your birth experience because she’s going to be the person who’s with you for 95%, and your doctor is going to be there for five. So they’re going to come in in very brief moments.
[00:12:45.410] – Nicole Rankins
So if you can get a labor nurse or even ask for a labor nurse, Hey, is there a nurse who really likes to do unmedicated birth? Is it possible that I could work with her? Or a nurse who will really be on your side if you tell her, I really don’t want an episiotomy.
[00:13:01.550] – Nicole Rankins
I mean, I’ve seen nurses who like discreetly move the scissors off the table because they know that that particular doctor can be a little bit scissor-heavy. So definitely utilize or connect with your labor nurse as a resource. So many of them are willing and want to do so.
[00:13:19.550] – Hilary Erickson
Yes. And I was going to say that when we look at your birth plan, a lot of people think that it’s bothersome to us. But a lot of what you put on your birth plan is what we have to go over in the ginormous amount of charting we have to do at the beginning.
[00:13:30.880] – Hilary Erickson
We chart, are you planning to breastfeed? Are you hoping for an epidural? It’s just one less thing I have to ask you, which I’m not sad about at all because there’s so many questions in the beginning. I 100% agree, especially, sometimes you don’t have a lot of say over who the first nurse is that gets you.
[00:13:47.010] – Hilary Erickson
But if you’re looking at a shift change, always ask when the shift changes and just say, Hey, I’ve loved you. Obviously, you don’t want to turn off the labor nurse that you’ve had. Do you know if on the next shift, there’s a nurse who loves supporting natural birth or whatever like that? Is Is there a chance I could get assigned to her? That type of thing. That is a super pro tip about being in the hospital.
[00:14:05.880] – Nicole Rankins
Definitely.
[00:14:07.620] – Hilary Erickson
Yeah. Well, thank you for coming out. Now, Nicole, you teach a birth plan class, and we’re going to put that link in the show notes. She does it live. I guess, can you do it on demand also? Is there an option to just watch it whenever?
[00:14:18.340] – Nicole Rankins
I used to do it on demand, and now I’m going back to doing it live just because I like the interaction with people. And I also do Q&A afterwards where I just answer whatever people’s questions that they have about pregnancy and birth, which is really helpful for everyone in the audience. So it’s just a great way to connect and have that connection and not just watching me on the screen.
[00:14:42.150] – Hilary Erickson
I love teaching live, and I’m sure you get a lot of joy out of doing that, too.
[00:14:46.080] – Nicole Rankins
Yeah, I do.
[00:14:47.110] – Hilary Erickson
All right. Thanks for coming on. I hope this helped people understand how to use a birth plan. Honestly, I think a lot of these are very hidden tips that people don’t talk about. So I would definitely check out Nicole’s birth plan class. I think that would be so helpful.
[00:14:59.290] – Nicole Rankins
All right. Thank you so much for having me.
[00:15:01.240] – Hilary Erickson
Thanks for coming on, Nicole.
[00:15:02.520] – Hilary Erickson
Okay, I hope you guys enjoyed this episode. There were so many great tips that you can only find from people who have delivered lots of babies. So I’m so grateful that Dr. Rankins came on. So many great tips. Be sure and find her free birth class. You can find it on our website, and we will have that link in the show notes.
[00:15:20.100] – Hilary Erickson
And if you are looking to really get your easiest birth, come join us in the online prenatal class for couples, where we get you prepared in just three hours for your upcoming birth.
[00:15:29.370] – Hilary Erickson
Stay tuned. We’ve got great episodes coming up next week. We’re going to be talking about voting in some of the smaller elections around us with my friend who is on the school board. So stay tuned.
[00:15:39.450] – Hilary Erickson
Thanks for joining us on the Pulling Curls Podcast today. If you liked today’s episode, please consider reviewing, sharing, subscribing. It really helps our podcast grow. Thank you.
Keywords:
birth plans, OB GYN, prenatal class, pregnancy advice, labor and delivery, hospital birth, natural birth, water birth, birth preferences, labor support, birth experience, fetal monitoring, intermittent monitoring, c-section rate, vaginal birth, doulas, hospital policy, patient preferences, pregnancy tips, newborn care, online classes for couples, birth preparation, hospital tour, healthcare advocacy, labor nurse, episiotomy, birth plan class, breastfeeding plan, labor nurse tips, hospital infection control.
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