Isla’s birth was sort of a disaster and absolutely nothing went according to our birth plan. Between then and my current pregnancy, I’ve had 4 years to sit around and stew over all the things that went wrong with her birth, how things might have gone differently, and what if any value our birth plan had. Every baby book and birth professional I’ve read/talked to in the interim has been all, “YOU MUST WRITE A BIRTH PLAN.” However, as our second baby’s birth approaches, I find myself reluctant to sit down and commit a birth plan to paper.
Now I’m not one of those people who believes that a birth plan is completely useless because, “You can’t plan what will happen at your birth, so why bother?” I’m a Type A person. I believe you can, and should, plan for everything, including contingency plans for when things go wrong. (I’m a walking example of Murphy’s Law, so I usually have back-up plans for my back-up plans.) At the same time, I don’t think putting your focus on a 3-page document you thrust into your nurse’s hand upon arriving at L&D is necessarily the best way to plan for a positive birth experience.
When I think back on where things started to go wrong with Isla’s birth, it started months before the birth itself. I didn’t give much thought to who my OB would be. I went with the same OBGYN who’d been doing my annual exams for years. I had some vague notion of wanting a med-free birth and assumed that if that was what I wanted, it would simply happen in a modern hospital. I didn’t think at all about labor support. I thought the nurses would be able to guide me through laboring, not realizing that nurses have a lot of other things to do with their time.
I half-assed my birth prep. I didn’t take a real birth class. I didn’t exercise as much or as regularly as I should have. I didn’t eat well. I didn’t prioritize my health or my needs in general throughout my pregnancy, focusing instead primarily on work.
The biggest thing I screwed up, though, was seeing red flags in the care I was receiving while pregnant and ignoring them because I didn’t want to seem high maintenance or difficult or because I was just too busy with other things. I had an inkling my OB and her practice were not incredibly supportive and caring providers and that maybe they wouldn’t be as accepting of my med-free birth plans as I wanted them to be. I also knew I wasn’t taking great care of myself, but blew it off because I felt like almost everything should take priority over my health.
Instead of being proactive in getting what I needed from my doctor and from myself, I trusted in a lengthy birth plan, which I’m pretty sure no one other than my husband and I read.
This time, the plan has consisted of being picky about my care providers, my support people, the hospital where I will deliver. I’ve done some serious homework about what is entailed in a natural birth and how to achieve one in a hospital setting. I’ve asked tons of questions of my doctors and midwives, of my doula, of the hospital, all trying to establish that I will be in good hands during the birth, and I’ve stopped worrying if they internally roll their eyes at my obnoxious interrogations. (The good news: I’ve never gotten the eye-rolling vibe off any of my current care providers, which is part of why I love them so much.)
I’ve literally done the legwork to prepare my body for a med-free birth. I walk 2-ish miles almost every day, and I do prenatal yoga several times a week. I’ve been much more careful about what I eat and how much weight I’m putting on. I’ve seen a chiropractor weekly since I hit the 20 week mark. I’ve taken my Hypnobabies course more seriously, and we’re doing a birthing class through the hospital. And I have prioritized my health and my family over my job, which is not to say I don’t still work hard, but I recognize that where I am right now in my life, what is going on with my body and the people in my home is more important than what is going on at work.
In short, I realized that a natural birth isn’t likely to happen in a hospital if you don’t have the buy-in of a whole lot of other people well in advance and if you haven’t prepared yourself for a med-free birth. So this time, I made sure the bulk of my birth plan was taken care of long before I made it to L&D.
At some point, I know Kellen and I will sit down and write out a brief list of things we want our L&D nurses, doctors, and midwives to know. However, I’m not relying on a 3-page printed document to ensure I’m safe, supported, and treated with basic respect and dignity throughout the birth. And since ensuring you feel safe, supported, and are treated with basic respect is what a birth plan is at the most basic level–not a blueprint for how the birth must go–the most important part of the planning process is not going to be on a sheet of paper you bring with you to the hospital, but all the preparation you do in the months before.
Dover says
February 22, 2016 at 3:42 pmYou’ve got it exactly right. Evidence Based Birth just released a series of videos that talk about the “problem” with birth plans, and you hit the nail on the head. What matters the most is your care provider and the place you choose to deliver at. Studies have shown that if you clearly state “no episiotomy” in your birth plan, but you go to a hospital with a 25% episiotomy rate, guess what? You have a 25% chance of an episiotomy. The birth plans don’t seem to be protective at all.
It really sad to me to learn how ineffective birth plans can be, because women really should have a bigger say in their birth experience, and their preferences should matter, but we are going up against a big hospital system that is slow to change and overly cautious when it comes to avoiding risk. So they do what they usually do, regardless of any expressed desires from the laboring woman. And that is why it matters so much to pick a care provider who aligns with your preferences from the get go. If you don’t want an episiotomy, your best bet in avoiding one is to find a care provider who has a very low episiotomy rate, not to write it out in a birth plan. It sucks, but that’s the reality of maternity health care right now.
Katie says
February 22, 2016 at 4:11 pmI didn’t know that there were studies on whether doctors/hospitals follow birth plans, but I’m not at all surprised at the results. I’ve often described the pregnancy and birth experience with my daughter as being moved through a factory system. Regardless of what I wanted, I was always funneled back into how my doctor and the hospital did things. And the methods they used to keep me moving through the assembly line often involved not being completely truthful about my treatment options or even what exactly was happening and flat out bullying and terrorizing me when I asked too many questions. While informed consent is supposed to be a key component of modern healthcare, what I’ve heard from parents time and again, and what my own experience confirms, is that many L&D doctors and nurses view informed consent as an inconvenience. This time, I wanted to find a practice where informed consent is part of the philosophy, not just an ACOG bulletin that could be brushed aside when they feel like it.
Amber R says
February 25, 2016 at 9:16 pmGreat post and insights, Katie! Well timed, too, because we’re starting to discuss our plan for our May delivery. We were just talking about how much trust we have in our hospital-based midwives and our chosen doula to guide us through the process – it is up to us to do the prep work in advance. (Like you, I’m also a Type A advanced planner.) For us, our hopes for natural birth require keeping up my regular exercise and squats, practicing active relaxation daily, discussing decisions we’ll need to make it advance, and even the weirder, ahem, “hands-on” prep. The Birth Partner has been a great book for this – understanding really what is happening at every stage, potential coping strategies for mom and helping strategies for dad. All that said, I’ll still totally fill out the detailed plan,because I do love a good form. 😉