An additional challenge that birth plans create for healthcare providers is a sense of loss of professional autonomy because women and their partners can now question providers’ actions and decisions. This leads, at times, to tension between the tow parties. In the United States, Lothian (2006) reflected on this potential conflict and offered various solutions to resolve it by placing emphasis on dialogue between expectant women and their providers, beginning at the very first prenatal visit. To ensure the birth plans is carried out, it is important to cultivate effective communication between the woman’s primary care provider and the hospital where she plans to give birth, to establish prior contact to assess the existing possibilities and limitations of providers, and the hospital’s ability to meet the woman’s requests outlined in her birth plan, and, if necessary, to enter into agreements to help avoid misunderstandings and false expectations. It has also been recommended that instructions and suggestions on developing birth plans be included in childbirth education classes for expectant women (Bailey, Crane, & Nugent, 2008; Kaufman,2007).