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.

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