Is your birth plan realistic?

When I was pregnant with my son I became obsessed with labor. It wasn't enough to attend birthing classes, I read everything I could get my hands on about labor, especially about "natural childbirth." I decided I needed a birth plan to communicate my vision of childbirth to my midwife and the hospital staff.

A birth plan is a document in which you describe what you want to happen during  your labor. My birth plan consisted of a long list of what I did and did not want to happen. In a nutshell, I wanted my labor to be as free of medical intervention as possible. I wanted to deliver without an epidural, standing upright, singing "I am woman hear me roar" if I could manage it, and I wanted to hold my slimy, newborn baby immediately after his birth. Most of all, I wanted to have full control over my labor.

(Image of Tlazolteotl, the goddess of childbirth, via College of the Sequoias.)

I presented this list to my midwife, a member of a practice I had chosen specifically for its woman-friendly approach. She looked at me like a time-traveller from the 1940s. Of course I could roam freely while I labored! Of course they would not be administering an episiotomy, or using forceps, or whisking my baby away from me! But... no one has full control over her labor.

At this point I began to feel a little foolish about my starry-eyed birth plan. But have a chat with a few of your mom friends and you'll see why some of us worry about what happens when the hospital takes over. My friend, Lindsey, delivered her first baby with a Planned Parenthood midwife. It was an empowering birth. The next time around she had health insurance and an ObGyn, but she was needlessly (it turns out) put on bed rest for the last two months, induced to fit her doctor's schedule, given a colossal dose of pitocin, ignored when she asked to have it turned down, and then was given an epidural so strong she couldn't feel a thing, even when it came time to push. She was immobilized for most of her labor.

(Image via Hmmbilical.)

"I felt gypped," she says, "gypped out of the last two months of my pregnancy. Gypped out of going into labor naturally.  And gypped out of a natural labor. I hated my second birth and felt resentful for months."

Lindsey had a birth plan; it just wasn't respected. But even when your midwife or doctor respects your birth plan, things don't always go as you expect them to. Some babies insist on getting into breech presentation and then wrapping their umbilical cords around their necks. (The little anarchists!) Labor is full of surprises. So what's realistic? How do you create a birth plan that's flexible but also true to your vision?

"I did have to let go of a lot of my expectations about how birthing would go," says my friend, Jane, about her birth plan. Hers was idealistic, too, but I think the most helpful section is this paragraph:

Because this is our first child, we do not know for sure what the whole thing will be like, and how we will feel.  We would like our childbirth team to be flexible and accommodating of our feelings and—perhaps changing—wishes.  No matter the eventual course of events, we would like consistent positive reinforcement and good vibes from all members of our childbirth team.   

Ultimately, I think a birth plan is an important exercise to help you think about how you want to give birth, and it's a great conversation starter with your midwife or doctor. Talk about the kind of birth you want to have. Make sure he/she understands your priorities, but understand that you may have to let go of some details. Hopefully, and that's a big hopefully, you can find the right practitioners who are also covered by your health insurance. (Sigh.) Under the best circumstances, your doctor/midwife/labor nurse can be your advocate through the process, without your having to wave a piece of paper at the hospital staff as you're wheeled into the labor room. 

As for my labor story: I had excruciating back labor. Surprise! I was lucky to get a labor nurse who had dealt with her own back labor -- twice, and drug-free. She was incredibly supportive. I managed my labor until an unfortunate taste of hospital soup set me vomiting for 20 minutes and stalled my labor for two hours. My midwife suggested pitocin, I asked for an epidural, and after an hour's nap my labor got started again. The epidural wore off just enough so I could feel myself dilating (from 4 cm to 10 cm in 30 minutes) and I could push productively -- that I could definitely feel. My husband cut the cord and I got to hold my son for a minute before he was cleaned.

I felt good, over all, about my birth experience. I know I got lucky -- with my reaction to the drugs and with the supportive midwife and labor nurse. However, I think educating myself and talking beforehand with my midwife played a large role in shaping my birthing experience.

There are several web resources available to help you create your own birth plan. Many of them are a little like What To Expect When You're Expecting: an invitation for neurosis. Don't obsess! Remember, this is just something to get you started thinking and talking.

i parenting

Baby Zone

Baby Center

She Knows Pregnancy and Baby

Comments

[Robin Elise Weiss, LCCE]

Well said! I think many people over look the fact that a birth plan is a communication tool first and foremost. It's a way to open a discussion between you, your partner, your support team, etc.

[Colleen O.]

Yes, totally.

We actually didn't have a birth plan b/c our midwives were totally respectful of our wishes, and if we ended up with someone other than our midwives, it would be because something major went wrong and well, why have a birth plan then?

We did have a post-partum plan though. It stated that we didn't want the hospital separating us from our baby (happened anyway because he was grunty after birth -- annoying), didn't want them giving him formula, and didn't want them bathing him without asking us first.

I definitely think women need to be educated. And I think a birth plan and a conversation with one's HCP are good ways to plan. But as you said, labor is unpredictable and the best thing to be is flexible.

[pam tam]

I agree that a birth plan made me feel somewhat empowered, and that in and of itself makes one more satisfied with their birth regardless of how it goes. I did end up using medication in the last of the 28 hours of my birth experience but it was very much on my terms. The hospital staff was so impressed that I HAD a birth plan that they were surprisingly accomodating (although still cautious) - I think the best way to really have full on grasp of control in your birth is to start laboring and birthing at home... if possible. Not for everyone, but the most control.

[Katie]

Adriana - I'm just seeing this post. Have you visited www.ChildbirthConnection.org? They offer evidence-based maternity care information for women and health professionals, that usually agrees with all that you are saying. Good for you for taking this route! Not having had a pregnancy yet, I hope to go the birth center route with no epidural, or MAYBE the home birth, depending on who is my midwife and possibly doula. Great article!

[Adriana Velez]

Thanks, everyone, for your comments. Katie, thanks for the link!

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