Pregnancy and childbirth are important milestones in the development of a family. Birth
plans allow childbearing women to plan and express their wishes for their birth experience.
Labour and delivery nurses play a key role in providing care on birthing units in Canada and are
uniquely placed to enact a woman’s birth plan. A focused ethnographic study was undertaken to
examine birthing unit culture and its impact on how labour and delivery nurses care for women
with birth plans. Findings revealed three overarching themes (ensuring safe care, teamwork, and
connecting with patients) that shaped birthing unit culture and impacted how labour and delivery
nurses viewed and enacted birth plans. Organizational influences and individual healthcare
provider preferences influenced how birth plans were enacted on the unit. Patient safety was a
dominant driver of care. Challenges exist on how to partner with childbearing women and their
families while assisting them in the goals for their birth experience. Collaboration is key as
providers strive to embrace a woman’s birth plan expectations and work toward a shared
understanding and partnership in childbirth.