Obstetric Lie #94: We Care About Your Birth Plan

Ahhh, the birth plan.

I admit, I teach about how to make one. I talk about them. I encourage them. I actually think the birth plan is an important tool. BUT- let me tell you why.

A birth plan IS:

-A way for you to figure out what you really want, what is most important to you and to organize your thoughts.

-It can help you visualize your "ideal" birth and then find out if your care provider/birth place is on board with your desires.

-It can help you communicate in an organized way your desires and needs without forgetting something during your visit.

-A birth plan can help you and your partner talk about things, realize where you agree and differ and really discover the many many choices that pop up once you have conceived a child.

A birth plan is NOT:

- A guarantee that your provider will do anything that you have in it. (Yes, this is true even if they nod and smile, even if they give it lip service and even if they sign it.)

-It is not a non-combative, "I'm afraid of you and your white coat and I don't really want to question your authority" way to communicate with your care provider and magically get all your deepest desires fulfilled.

-It is not a force field surrounding you from typical, routine, and stupid hospital interventions.

-It it is also not a way to somehow control the birth experience.

Here are a few things to keep in mind as you make and execute a birth plan.

~If you are scared to death of your birth place because of X number of factors (call rotation, c-section rate, epidural rate, pitocin rate, etc), then please be honest with yourself about this. It is hard but you need to realize that your birth plan will not protect you from typical procedures. This is especially true with ROUTINE things that are done to EVERYBODY.

For example, I lived near a hospital in Texas with the highest c-section rate in the state. They also had everybody deliver on their back, everybody got an IV and all babies were separated from their mothers at exactly one hour post-partum.

You could write a beautiful, researched, glowing pink birth plan on real lace and scent it with your mothers perfume. It would be unique and sincere and eloquent. It would not however change their routine procedures and it would probably not spare you from an unnecessary cesarean surgery. The only thing that could do that would be running like hell away from that hospital. (By the way, always nice to tell them why you are leaving because in obstetrics, money talks. If enough people take their money elsewhere, then things will change.)

~Just because your care provider "agrees" to your birth plan, does not mean he will be agreeable when you are actually having your baby.

I really don't like to scare pregnant women because there is so much fear out there already. A birth class should empower a woman to be fearless about birth. This is really hard to balance though when it comes to the realities of modern obstetrics.

The truth is that many care providers have no problem with natural birth.....IN THEORY. It is fine if it works out- but most of them almost never see it work out. Their training is often in the problems and how to spot them. That means that all women are inevitably looked at as:
a) walking time bombs or
b) a potential lawsuit.

This isn't out of meanness, it is just a matter of training and caution and a deeply ingrained distrust in the natural process.

So, handing this person your special piece of paper is not enough. You must really talk to them. REALLY TALK. Ask real questions. (Think percentages, "when was the last time X happened", or "what would you do in this situation", type of questions.)

Next- get real answers from your care provider. A brushed off hurried answer may very well come back to haunt you. Vague is bad. A dismissive "Only when necessary" is also a warning sign. It might be an awkward visit. This person does know a TON more than you or me about anatomy and pathology. They went to school for a very very long time. They do have an intimidating array of knowledge which should be respected. It is better to have a awkward visit that makes you change providers than a horrid birth that makes you cry.

True Confession-
I only had a birth plan for my first birth, which was in the hospital. My other two I felt so at peace with my choice and my care provider that it didn't even occur to me to write one. I also had long visits with my midwives where I got to talk to them about my concerns and get their answers.

So, one of the end messages on birth plans is this: while they are great for a lot of things, if you really need one to protect you from your care provider, then what you need most is not a birth plan, but a different birth place or care provider.

I have a sneaking suspicion that the current acceptance (in some places) of birth plans is either lip service only or a clever marketing tool to get women to feel more comfortable when they should be running for the hills.

My dream is for women to be able to advocate for themselves throughout the process of pregnancy, labor and birth. My hope is that they can be kind but firm in their needs and desires. My desire is that they will be honest with themselves about the risks and benefits of delivering their babies in different places and that they will have the courage to birth in an environment that is supportive, not just in word, but in deed.

Preparing For Your Childbirth Class- Part 7, Birth Plans

(Note, this is part of an ongoing series on the blog to prepare students who are taking my childbirth classes.  This does not replace taking the class, but is simply extra info to help as you go along.)

Class 7-

One of the big things we cover class 7 is birth plans.  Birth plans are becoming so popular these days that I am starting to see students whose hospital gives them a birth plan to fill out and check off.  (This is also kind of disturbing, but that is another post).

One of the most important things to recognize about a birth plan though is that just because you write it down, does not mean it will happen.

One reason for this is that birth is just something you can not control.  Recognizing that is important.

The other reason you need to know that a birth plan is not just some piece of magic, is because sometimes moms have too much confidence in them.  Instead of actually asking their care provider tough questions, and then making changes (in hospitals, birth place, or care providers) they just want to believe that it will happen because it is in the plan.

A birth plan is not a guarantee.  It is also not just something you do and set aside.  It is the beginning of a conversation.  It forces you to walk into an appointment with things to talk about.  Then you have to talk about them!  Yes, you actually have to talk to, ask questions, and get good clear answers from your care provider.  And then you need to find a new one if they don't do that.

(By the way, dig for answers.  If you ask a doc what is episiotomy/ c-section rate is and his answer is, "Oh, I only do them when I need to," do not just let that go.  Your next question is, "How often do you think that is?"  If his answer is, "Oh, I am really not sure,"  then keep asking.  Do not be falsely comforted.  You will regret it later even though it is uncomfortable now.)

First, keep it to one page.  Second, imagine your perfect birth (really take time to talk this through with your partner).  Then pick the things that are most important to you about that birth and write them down.  Then take it in and ask questions.

Here is a sample birth plan, but make one that is your own.


We are so excited to be sharing our journey into parenthood with you!  We have chosen to have our baby with you and your staff because we know you respect the process and strive for both a good experience and a healthy mom and baby.  
Here are a few things that are especially important to us about this birth.  We have studied extensively to learn and have worked hard to stay low risk and healthy so that this plan can become a reality.  


For  Labor
-Freedom of movement for mom-
-Intermittent Doppler monitoring only, no continuous monitoring-
-Please don't offer medications for pain relief-
-Please do not refer to the birth process as painful-


For Birth
-Freedom of position for pushing-
-Natural delivery of the baby (no pulling or tugging)-
-Allow mother to naturally tear if needed, no episiotomy-
-Ample time for second stage if all are well-


For Immediate Postpartum-
-Baby to mother immediately-
-Baby to breastfeed immediately-
-Naturally delivery of the placenta (please no drugs or tugging to speed up the process)-
-Mama would like to have Daddy cut the cord, but only after the placenta has delivered-
-All tests done in the room-

Postpartum
-No shots or surgeries on baby, we will handle those with our pediatrician-
-Baby is to be breastfed only-
-No pacifiers offered-
-Baby to stay in the room with mother-

Thank you so much for your thoughtfulness.  We recognize that sometimes things occur that may change this plan.  Please allow us as a couple the time to confer and deal with any changes privately before action is taken.  We look forward to our babies birth!