Don't have a baby without this one document
What we can learn from a tragedy in Georgia
This is a special edition of the Birth Book Companion because, amid all the discussion about the heartbreaking case of Adriana Smith, I haven’t heard enough about the one thing I urgently need every pregnant person in America to hear: You must have an advance directive before you set foot on Labor and Delivery.
If you haven’t heard Adriana’s story: she was nine weeks pregnant when she suffered a stroke in Georgia. She’s since been declared brain dead, but remains on life support—which she was placed on without any input from her family, according to her mother. For over 90 days, her body has been kept alive with the goal of delivering her baby by C-section at 32 weeks.
Much of the public conversation has focused—rightfully—on Georgia’s abortion laws and how they are affecting her care. But what’s missing from the discussion is something every pregnant person needs to consider: an advance directive. This simple document ensures your wishes are known and respected if you can’t speak for yourself.
It’s a heavy topic, I know—but it’s too important to ignore.
Thanks for reading,
Dr. Jen
What is an Advance Directive?
An advance directive—sometimes called a healthcare directive or living will—is a legal document that outlines your preferences for medical care if you’re ever unable to communicate those wishes yourself. It often includes instructions about life support, pain management, and who you want to make decisions on your behalf (also called your healthcare proxy or power of attorney).
You might be thinking: “I’m young and healthy—why would I need this?” I hear you.
Let me reassure you: most deliveries are safe and routine. But as we’ve seen with Adriana’s story, and with the United States having the highest maternal mortality rates in the developed world (and highest for Black women), I want to ask you to please be proactive and take this step.
You’d think that in a two-physician household—where both my husband and I have cared for dying patients and witnessed the heartbreak of navigating family wishes with or without an advance directive—we would’ve had our own from the start. But we didn’t. I delivered two babies without one, and thankfully, everything went smoothly. It wasn’t until COVID hit that we finally sat down and put ours in writing. Caring for COVID patients made it painfully clear: we didn’t want our children’s futures left to chance. Morbid? Maybe. But preparing for the worst gave us a sense of control and peace in a world that sometimes offers very little of either.
Why this matters in pregnancy
Please don’t let this information freak you out. Pregnancy and birth are often routine and beautiful. But complications like hemorrhage, preeclampsia, amniotic fluid embolism, or anesthesia reactions—though rare—can require urgent interventions, including blood transfusions, intubation, or even emergency surgery.
If something unexpected happens and you're unable to speak for yourself, your advance directive will guide your care team and loved ones. It’s a gift of clarity and peace in a moment that could otherwise be filled with confusion and pain.
How to create one
Creating an advance directive is simple and often free. Here are some places you can start:
Ask your doctor or hospital. Most hospitals and clinics have standard forms. You can ask at your next prenatal visit or see if the forms are available on your hospital system’s website.
Go to your state’s health department. The American Bar Association has a great website with information on the process to walk you through it, as well as links to state-specific forms.
Photo by Martha Dominguez de Gouveia on Unsplash
What to do once you have one
An advance directive is only useful if people know about it and can access it if it’s needed! Here is what I recommend:
Give a copy to your OB provider. Ask them to review it and scan it into your medical record.
Bring a copy to the hospital. Include it in your hospital bag with your birth plan and insurance card.
Share it with your birth partner and family. Make sure the people most likely to be with you during labor know what it says and where to find it. This also gives you time to discuss it with them, answer any questions they may have, and ensure you know your wishes will be carried out as you’ve asked.
Give a copy to your designated healthcare proxy. This is the person you trust to make medical decisions on your behalf if you're unable to.
Review it regularly. If your preferences change—or you move, switch providers, or deliver at a different hospital—update it and re-share.
Keep a copy accessible. Some people upload it to their phone or carry a card in their wallet with instructions on how to access it.
Would this have made a difference for Adriana?
If you're wondering whether an advance directive would have changed what’s happening with Adriana—especially given Georgia’s abortion laws—the honest answer is: it's hard to say. It might have helped doctors feel more confident in respecting her mother’s wishes, rather than defaulting to life support out of fear of legal consequences. But these laws are intentionally vague and confusing, and clarity isn’t their goal.
What I can say is this: having an advance directive is one way to take back some control—especially in states where abortion is banned or restricted, and where doctors may hesitate to act out of fear.
That’s a bigger conversation for another time, but I hope this gives you a small sense of agency in a system that often makes us feel powerless.
Until next time,
Dr. Jen