BIRTH PLANS

As I read articles such as “Who controls childbirth — expectant moms or doctors?”  and blogs and articles of how to write a birth plan, the benefits of a birth plan, the downside to writing a birth plan – I began to wonder if my definition of “birth plan” is different than most physicians and mothers. So I looked up the definition of “birth plan” as listed online.

The first definition I found was, “A written outline of a woman’s preferences for her labour and birth.” …the next website, “The birth plan is a written list of your preferences to be used as a guide for how you would like your labor and delivery to go. As labor can be unpredictable, you may need to deviate from this plan at times during labor.” And the next, “A written set of directives created by expectant parents that expresses how they’d like labor to be managed. A birth plan might mention preferences about walking during labor, induction, cesarean section, use of camera/video, pain medication, etc.”

Just as I suspected…my working definition of a birth plan is actually a bit different than most are currently using.

MY DEFINITION OF A BIRTH PLAN

I think that most people who are writing a birth plan realize that all events in life can be unpredictable. We never know when we will be in a car accident, or fall down and break an arm, or, or, or….. Crap happens and we deal with it when it occurs. Most birth plans start with a disclaimer paragraph acknowledging that birth is an unpredictable event (but, um, isn’t everything in life?) and stroking the care providers ego by saying things like, “Understanding that birth is an unpredictable event we have chosen to put our trust in you and your experience and skills to be able to handle any unexpected emergencies that should arise. While we completely trust you with your medical care, below are some of our desires and wishes should it be possible…”

I’m sure a lot of care providers eat that up and take pride in the acknowledgement that you believe they have skills. Me? I assume you trust me or you would have hired someone else!

This is usually followed by a list of pleading desires stated in a way as to not appear to demanding – “I would like to eat while in labor if at all possible.” “If the situation permits, I would like to be able to walk around.” “I do not want an episiotomy if at all possible.”

I have heard some argue that a birth plan is trying to control the uncontrollable (the birth)…that it is almost guaranteeing that you will have problems because you are trying to dictate the way the birth will go.

First off…I can not disagree strongly enough – although, as I stated above, I concede that my definition of a birth plan is different than most are currently using. To me, a birth plan has nothing to do with controlling the birth or how the birth will unfold…it is ONLY about how you are treated throughout this journey. I haven’t read a birth plan yet that addressed the BIRTH (“I want to be in labor less than 10 hours” “I will feel it only in my hips and cervix, not in my thighs or back.” “My contractions shall not become closer than 5 minutes apart”)…..NO! The birth plan is addressing the choices and actions of those around you!

Most birth plans can be summarized thusly: “You will treat me with respect at all times and I will maintain the autonomy that I had before entering your hospital. Before you touch me or intervene in the normal course of my labor/delivery, you will discuss it with me and obtain informed consent.”

**stands back and looks at the birth plan**
Yep…that’s pretty much it in a nutshell. This in no way states anything about how the birth will unfold or trying to control events – it’s about how you are treated and the respect you are given in the process as an adult autonomous human with rights and freedoms. We aren’t treating a pathology…we are overseeing a biological function.

Why would they think it would be more likely that you will have problems if you have a birth plan than if you didn’t? Well, because in their hospital you probably are. When we feel unsafe, disrespected, judged…it has an effect in our labor! When you are on the defensive and having people pressuring you and making you feel like they are “the enemy” – your body will not effectively surrender to the process of birthing your baby! And what do we do if this happens? Pitocin, of course…or sometimes breaking your water. In other words, one of the interventions you’d hoped to avoid. It’s a vicious circle….

And why does it come with judgments to begin with? Why does that L&D nurse give a hoot whether you want an IV or not? What difference is it to them if you have a fast or slow labor? They are on a shift so it’s not like getting your baby born gets them off work sooner…so why is it such an us-vs-them thing anyways?

One thing I can say as a care provider is that I do understand how a birth plan can be a physical manifestation of the lack of trust they have in you. Being presented with a birth plan is like someone saying, “I don’t trust you to respect my decision in the moment, so here is my list of demands for how I am to be treated by you so that you can get used to the idea ahead of time.” It’s like being engaged to be married and having your fiancée hand you a “marriage plan” that says things like, “You will not have sexual relations with anybody else but myself.” “When you are upset with me, we will discuss things and continue to talk.” “You will not hit me with any object, including your fist.”

Can you see how that could be insulting? If you feel I would HIT you or cheat on you…why are you marrying me?? But the sad truth is that there is a lack of trust in our care providers in obstetrics – and often with good reason. We have somehow lost the ability to respect each other, to communicate and trust….and yes, sometimes we need the reminder that anything less is unacceptable.
A birth plan is not about the birth – it’s about those we have hired to attend to us. A birth plan is simply a reminder that you are an autonomous person who is worthy of being respected even though you are giving birth to a baby (as you wouldn’t have to remind someone to treat you with this level of respect in other aspects of life).

My favorite birth plan I have ever been given was hand-written on an index card and said simply, “Don’t F*** with me!” I happily signed this birth plan, hole-punched it and put it front and center in her chart.

15 Comments

  1. Hah, that’s great! The index card thing, I mean. And that is exactly how I approach it as well. A birth plan for homebirth is somewhat irrelevant as we have just spent 9 months discussing choices and learning to trust each other. My clients know I am not going to “do” anything unless they want it, or it is an emergency. And in providing counseling for couples planning a hospital birth, I have come to a similar conclusion. Rather than encouraging them to bombard their doctor with a 3 page written plan, I ask them to go thru a birth plan first by themselves and discuss/discover that issues they really are passionate about. (And sure, if there are enough of those, I have no problem saying, “Now why are you planning to birth there?”). I think that allows women to go in and have a civil discussion about what it is that really matters..to them. IF the doctor cares at all of course. But even that can be quite illuminating….
    Thanks for your post.

    Wednesday, July 14, 2010 at 1:08 pm | Permalink
  2. Amy Drorbaugh wrote:

    Awesome post. With my first 2 hospital births I had very detailed birth plans. With my last baby my birth plan was , “Hire a homebirth midwife I trust.” It worked perfectly.

    Wednesday, July 14, 2010 at 1:21 pm | Permalink
  3. Noelia Waldo wrote:

    I did have an awesome birth plan, didn’t I? 😉

    Wednesday, July 14, 2010 at 1:22 pm | Permalink
  4. Sara wrote:

    I had a lengthy birth plan with my last baby (I’d had one with all of them but I had a new provider last time so I wanted to make sure he knew where I stood) and it helped me decide to change providers at 21 weeks. He was laughing at a lot of my desires, very patronizing. My next provider looked at it and asked why I thought I needed to be at a hospital. He was VERY supportive and even told me to go for the home birth if there’s a next time! I needed to have that birth plan because I did not trust the first provider I was with, apparently with good reason.

    Wednesday, July 14, 2010 at 1:58 pm | Permalink
  5. Jennifer wrote:

    I am seriously considering copying the idea in the last paragraph but I’m pretty sure my perinatologist will go nuts on me LOL.

    Wednesday, July 14, 2010 at 3:22 pm | Permalink
  6. Michelle H wrote:

    Noelia’s birth plan wins for best birth plan ever. 🙂

    Hey, I created a very specific (verbal) birth plan while I was pregnant the last time. “I want a faster birth this time. So when labor starts, I will get in the tub and wait for baby.”

    I got the tub part, but the “faster” part didn’t happen. Oh well.

    Wednesday, July 14, 2010 at 3:24 pm | Permalink
  7. Nancy wrote:

    I love this! If I had you as my midwife, I probably wouldn’t have written a birth plan, but rather discussed my preferences with you in advance. While I had a wonderful unmedicated hospital birth, and I felt well cared for, I was not to know which of the 10 midwives in my practice would be on duty when I was in labor, and I had never once met any of the nurses who work in L&D. I felt a birth plan (which I called “birth wishes” as a way of appeasing egos) was necessary. I am considering a home birth for number two (who does not yet exist!) for the exact reason you mentioned: KNOWING my birthing team and trusting them fully.

    Totally love this post, by the way!

    Wednesday, July 14, 2010 at 3:43 pm | Permalink
  8. Angela H wrote:

    You know Stephanie, you make some really great points above. I can’t count the times I’ve spoken to families about how Obstetrics seems to approach labor and birth from the “lowest common denominator” perspective. Meaning we treat everyone like the least of them. It doesn’t matter what interventions you do or don’t want, we assume you want them all, so we approach your labor in that way.

    This really does get to the heart of the matter. Treat me dignity, respect, and before you do anything assume that I will exercise my right to informed consent or informed refusal. So open up a dialogue with me as to what you want to do and why, and then respect my decisions and don’t throw dead baby cards at me.

    Wednesday, July 14, 2010 at 4:34 pm | Permalink
  9. Tiffany wrote:

    Great post….sharing!

    Wednesday, July 14, 2010 at 4:37 pm | Permalink
  10. Absolutely!! Could not have said it better myself! I am so tired of the Birth Plan debate and the constant battle. This if fantastic!

    Thursday, July 15, 2010 at 5:58 pm | Permalink
  11. Me wrote:

    After four revisions of a birth plan and four appointments where I had been stood up, I basically re-worded my birth plan to explain that I was the victim of childhood sexual abuse, and that I had just escaped a 10 year long relationship where I was the victim of domestic violence. I said that I had one wish: to maintain autonomy and be able to practice my right to informed consent. I ended it with a plea to “be gentle with me today.”

    Upon entering the hospital and getting into a lengthy debate about my “needing” to sit in a wheelchair, I totally forgot my birth plan existed.

    I was 5cm dilated, 15 minutes later I was 7cm dilated, 15 minutes later my baby was born.

    I had to fight my way through things with nurses that would not answer my questions and that manhandled me at one point when I insisted on an answer before I’d do what they were asking.

    My body decided that the only way to deal with the situation was to get the baby out FAST.

    Tuesday, July 20, 2010 at 2:23 pm | Permalink
  12. Tammy wrote:

    Love the article… I’ve been a L&D nurse for 22 years and have worked as a travel nurse. Women should be allowed to birth how they wish… Bad things can and do happen, a good nurse and doctor will always respect the mother in those situations.. Different hospitals have different philosphies.. Go talk to the nursing staff ask questions before delivery day.. You can often get a feel for a place.. Ask about c-section rates.. I’ve worked at hospitals where the operating room had revolving doors… And at places where the docs prided themselves for having the lowest c-section rates and best birthing outcomes.. A midwife isn’t always your best advocate.. Some like all the bells and whistles and I’ve know docs who practice like “midwives”. And it’s never to late to dismiss your health care provider, as Sara did at 21 weeks.. Thanks for the article.. Very well put..

    Friday, November 12, 2010 at 7:39 pm | Permalink
  13. Jill wrote:

    This is one of the best blog posts I’ve ever read…

    Tuesday, February 1, 2011 at 10:10 pm | Permalink
  14. Leigh wrote:

    This week I gave the birth plan for my second child to my midwife. Mostly I wrote about me. What I am like and what I learned from my first labour (boiled down to bullet points).
    I trust that they will respect my wishes on induction etc. but they also need to know that I like having dialation checks, counting and concrete progress markers. Some people like touchy feely, I just want the puke bucket when I need it and to get down to work.

    When I reasearched birth plans most were check the box pain management things, which is an important decision, but it is far from the only one.

    Sunday, February 13, 2011 at 5:23 pm | Permalink
  15. Foxy wrote:

    For me it was important to have my specific desires documented so that my husband and birth team had reminders and so that I didn’t have to be the one reminding them in the moment. It allowed me to relax knowing that they were on the exact same page as me. And when there was legitimate discussion during labor about the possible need to choose a a section my team was able to review specific preferences with the surgical team. I knew that thy would fight for me so that I could continue focusing on my labor and delivery.

    Friday, June 7, 2013 at 4:35 pm | Permalink

3 Trackbacks/Pingbacks

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    […] Love this link about birth plans and the attitude Care Providers SHOULD have about them. […]

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    […] My OB Said What?!? I found a link to this blog post. Which is, quite possibly, the best expression of birth plans I have ever seen. I mean, […]

  3. Birth Plans | Giving Her All She's Got on Monday, March 14, 2011 at 1:11 am

    […] My OB Said What?!? I found a link to this blog post. Which is, quite possibly, the best expression of birth plans I have ever seen. I mean, […]

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