Birth Plans

[eema.gray]

Birth plans are trendy these days. Even in a lot of OB offices, women write up birth plans and discuss them with their doctors. The idea is basically to communicate to your care provider what you hope for, under ideal circumstances. A well written plan acknowledges that this is not a script, it is basically a wish list. There are a lot of pitfalls with birth plans though.

Many women write them expecting their birth will go exactly the way they've documented on paper. Since birth is outrageously, wonderfully unpredictable, they come out disappointed, not because they had a bad birthing experience but because they weren't able to follow the script exactly. Some of this problem can be aleviated by knowing your hospital's policies and available equipment. A water birth just ain't happening if your hospital doesn't have tubs big enough to effectively labor in them.

I've read birth plans that are far too wordy. Wordy is fine in your care provider's office since the more you discuss points of view, the better s/he can take care of you. But respect the hospital nurses! Long gone are the days when a nurse had one laboring woman at a time. Today, you're in a good place if the ratio is one nurse to 2 laboring women. In some places, a single nurse looks after three or more! Nurses quite simply do not have time to read a multi page document formated in paragraphs. Keep hospital copies simple. One page, one page alone, formatted in one or two sentence bullet points. Despite the fact that many templates include newborn baby care, this is not information the L&D nurse needs to know. That should be a separate sheet for the nursery staff and pediatrician to deal with.

Birth plans are not the word of G*D, no matter how much you've talked them over with your care provider. Verbal consent to your desires is not enough either. Remember that in multi-provider practices, the person you see during your pregnancy is only one of several people who take turns on call at the hospital. Not every provider in a practice has the same point of view. Therefore, what you and your provider agreed upon may be widely different from what the provider on call when you go into labor believes. If your birth plan is important to you, have it signed by one or more providers at your practice. A signature says that you've discussed all points thoroughly and that they are willing to abide by what's on that page as long as medical circumstances don't interfer.

There are some, doctors, midwives, doulas, and childbirth educators, who would like to ditch the birth plan trend altogether. They don't say this because they want women to quietly accept whatever the doctor says. No, they say that birth plans set up false expectations of labor and delivery. Since we've already remarked upon the glorious unpredictability of birth, having a "plan" implies control that nature simply does not allow us to exercise. Many of these people point out that plans can create an unnecessarily adversarial relationship between a laboring woman and the attending nurses/care providers. Lastly, they say that birth plans, no matter how carefully desires are couched, are basically lists of negatives - fighting against policies that may not even exist any more at that hospital and telling staff members what not to do.

I'm not sure I agree with this last group of professionals, although I do agree that birth plans tend to focus on the negative. I think it's important that women have a voice. Childbirth is an incredibly vulnerable time in a woman's life, a transforming time, and it's too easy for nurses and care providers to take advantage of that vulnerability, whether purposefully or not (in most cases definitely not on purpose). I think it might be more important for labor support people to know what you want in birth than for attending medical professionals. Those who are supporting you can speak for you because they know what you want and the professionals can explain why or why not something is necessary. There's more room for dialogue and professionals don't feel like they're being dictated to.

I'm supposed to bring a rough birth plan to one of my next prenatal appointments. I'm not sure what I'm going to do. I have a plan. I've been writing it for months. But it is frighteningly negative. It's basically a list of thou shalt not's. Every time I look at it, I feel more depressed and fearful of walking into a hospital. I want the calm, peaceful, untroubled birth I didn't have with Yeled. But my birth plan in it's current state is antagonistic in the extreme. It expects the worst out of every person I come in contact with. That's not like me at all. One of the vestiges of my former Christian belief is that of putting the best construction on all things a person says or does. Ranger Daddy and I have already agreed that those things most important to me will be written down in one of his police memo books and placed in his pocket prior to departing for the hospital. I depend on him to be my advocate, not because I'm unwilling to voice my opinion but because during birthing I need to focus my energies within, not without. That may be all the birth plan I arrive with.

[IrishMommaC]

Jul. 17, 2009 at 6:18 PM

Meri, I hope and pray you get the birth you deserve this time. 

[Kodeekins]

Jul. 27, 2009 at 11:06 PM

 I think for some women, birthing is spiritual. I envy them, in that aspect. For me, it was painless (I never felt my contractions) and quick (I pushed four times). I am perhaps under-qualified to compare birthing stories. To me, birthing was more of "alright, here we go, tell me what to do!" mentality. Still is. I only plan to spend a few hours with these people who do this dozens a time a day. When they asked for my special instructions I sarcastically said "Just don't hold him up and chant Satanic incantations" and was later surprised to see they'd actually written that down. ^_^ I hope you get what you need from your car provider this go around.