The Birth Plan Debate

Birth plans are under fire. I did not realize this until doing a bit of research for this blog post, only to find a barrage of discussion about the effectiveness of birth plans.

In a nutshell, some OB/GYN's are offended that a woman without a medical degree would be so bold as to insult them with a laundry list of demands concerning medical treatment during labor and delivery. This perspective often highlights the use of out-dated information included in these demands, such as the request to avoid shaving which has not been a standard hospital procedure for decades. Likely, birthing women do not have the depth of information offered by almost a decade of study and daily application of knowledge as OB's enjoy. Clearly, this vast informational gulf deserves respect.

On the other side of the proverbial fence, mothers have ideas about how they would like the birth of their child to go, based on their understanding of childbirth either from literature, filmed births or previous birthing experience. The birth plan is an attempt to communicate these thoughts to healthecare providers. It seems reasonable to make a plan for such an important life event. After all, I make a plan just to go to the grocery store. Surely childbirth is a more significant event than that, deserving of some undivided attention.

Complicating this matter, recent research suggests that a birth plan can create disappointment for mothers due to unrealistic expectations. We all know what it is to have a plan that goes awry. The more important the event, the more disappointing an unexpected turn of events can become. This can have a dominoe effect in the delivery room, as a mother experiences higher levels of stress as a result of unplanned interventions which can lead to futher interventions. The last thing that women want is to feel like a failure as a result of the birthing experience. Yet, that is the caution surrounding birth plans - if things don't go as planned, woman may find that they only have themselves to blame.

I'd like to reach for some middle ground in this debate.

Some women have been led to believe that they need a medical degree in order to understand the very natural process of child birth. I'd like to point out that women's bodies were designed for the specific purpose of reproduction of the human species. Our position as birthing mothers is the result of evolutionary millenia. The task of the OB/GYN is one of support and understanding as well as medical expertise. I am not suggesting that doctors are unnecessary - not in the least. I am merely suggesting that a pregnant woman need not have a medical degree to understand the process of child birth and be confident in her plans for labor and delivery. Women DO have choice in the process of labor and delivery. One role of medical providers is to help women understand their choices rather than to make choices for them. I suggest that women ask their doctors about the standard practices during labor and delivery at their hospital of choice (if they so choose to go to hospital) and then develop a plan, taking these standard procedures into consideration.

When women deveop a birthing plan, it is also important to note that plans change. It is an important lesson for mothers to learn to be flexible - to be able to go with the flow. Understanding the process of child birth means understanding unpredictability. As a recent blog post from Dr. Amy Tuteur suggests, there are so many things about child birth that can not be planned or controlled. We don't know when labor will begin. We do not know how long labor will last. Sometimes there are unforeseen birthing problems. Women need to be open and understanding towards these possibilities, trusting their doctors to act in the best interest of the mother and child should these situations arise - letting go of "the plan"without labeling the birth as a failure of their own. It is this attitude of acceptance and openness that will serve women well in the rest of their years as a mother.

What it comes down to is commuication. Communicate your understanding and your birth preferences with your partner, your doctor, your midwife, your doula. In turn, those assisting with your birth should be able to communicate openly with you about said preferences. Have these conversations EARLY ON in your pregnancy - the labor and delivery room is not a good place begin the discussion. The tone of these conversations is a good indicator of the relationship you have with your birthing partners. If you feel uneasy about the tone of these conversations, if your doctor is unhappy with your preferences, talk MORE! Understand each other. Then, make a personal decision about what is best for you and your baby. You may need to change doctors. This is better to discover sooner than later.

I was lucky to have very open practitioners for the birth of both of my children. We had discussions and then we had more. I did my homework - finding out hospital procedure to compliment my understanding of my doctor, the maternity nurses and my birthing preferences. My doctor or midwife was always willing to schedule extra time to talk to me about my concerns and answer my questions. Using this knowledge, I made a birth plan with an understanding that labor and delivery may take a different route. I had to be open to that possibility.

Both of my births went well. Did they go as expected? No. Becasue I didn't "expect" anything other than to have a new baby at the end of it. Did I have preferences? Yes, with the caveat that they are just that - preferences. They may or may not be available depending on a given situation.

You can't always get what you want. But if you try sometimes, you might find, you get what you need (Rolling Stones). The birth plan is a good step in this direction.