Sunday
Sep142008
Birth Plan: Yes or No?
Sunday, September 14, 2008
I take offense to being called pushy. So I already had my panties in a knot before I got passed the by-line on Katrina Onstad's article in Chatelaine about birth plans.
In her article, Katrina explains that she was keen to develop a birth plan when her midwife told her that "the best plan is no plan at all". While she was initially uncomfortable with the idea of things being unknown and uncontrollable, she eventually embraced it and submitted to the experience of giving birth and had exactly the birth she wanted, without having planned for it. She also mentions the disappointment of women that plan every minute detail of their birth and then end up with an emergency c-section.
What Katrina perhaps didn't take into account though is that there is a substantial difference between the model of care of a midwife and the model of care of an obstetrician. As Henci Goer explains in The Thinking Woman's Guide to a Better Birth, "whether you have a C-Section or any other procedure or medication in labour has little to do with your or your baby's condition. What happens to you depends almost entirely on your caregiver's practice style and philosophy".
For example, the Society of Obstetricians and Gynaecologists of Canada reports that more than 1 in 4 babies are delivered by C-Section. This is alarmingly high. The World Health Organization says any rate higher than 15 per cent signals inappropriate usage. I couldn't find a good statistic on the c-section rate for women whose primary caregiver was a midwife, but the midwives that I interviewed in my search for a birth attendant had a transfer rate of 6% to the hospital during childbirth, a portion of which would have ended up with a c-section. Much lower than with obstetricians!
Katrina had a midwife, so that was already a big step towards avoiding unnecessary procedures. Midwives view birth as a normal experience and epidural use, induction, c-section, vacuum or foreceps extraction, and many other procedures are less likely to be used in a birth where the midwife is the primary caregiver than in one where an obstetrician is the primary caregiver.
Being able to trust your birth attendant to make good decisions is important and can be helpful. I have one friend that had a birth plan for her first birth, but not for her second because she was using the same midwife and knew that they were in agreement about the type of birth she wanted, so she didn't need to write it down. If you agree with your birth attendant's philosophy and approach to birth, then maybe you don't need a birth plan and can "submit" to the experience and trust your birth attendant to guide things in the right direction.
Unfortunately, most women that have an obstetrician as their birth attendant (by choice or by default because it was the only option available to them), often find themselves in a "team care" situation. This means that whoever is on duty when they go into labour is the person that will deliver their baby. As if that isn't bad enough, that doctor will only show up for the last 5 minutes or so of the birth, leaving the patient with a resident, medical students, and nurses that they have never heard of and never met prior to being in labour. People rotate in and out of the room. You don't know them, you don't know their thoughts about birth, you don't know their personal experiences, and you don't know their aspirations. Perhaps the nurse attending your birth had two elective c-sections and thinks it is the best way to give birth. Perhaps the junior resident is really keen to pratice her skills with the vacuum extractor. Perhaps it is just so busy in the labour and delivery ward that evening that they tell you if you think you might want an epidural, you'd better get it now, even though you aren't feeling much pain yet.
In addition, obstetricians seem to approach birth as a medical condition that needs to be fixed and helped along, rather than something that is natural and normal and that will take place on its own time line. They approach problems that come up along the way with a series of high risk interventions, rather than considering low risk strategies for dealing with those problems. One high risk intervention, often leads to another. A woman's obstetrican may decide she needs to be induced even though her body isn't ready to give birth. They may first try breaking her membranes, which puts the birth on a timeline (the hospital often must deliver the baby within 24 hours of breaking the membranes due to risk of an infection). If breaking the membranes doesn't get things moving, they may use drugs to move it along. The induction can cause very painful contractions which may result in the recommendation of an epidural. The epidural means that the woman can no longer feel what is going on in her own body and also cannot walk around and do other exercises that might help the birth move along. As a result, her progress may be slow and she might end up in an emergency c-section.
The birth of my first child was not what I wanted. I used the approach Katrina suggested. I submitted to the care of my birth attendant, an obstetrician in a team environment at a hospital. I was scared of the pain and hadn't done much research about the birth or about the risks of various interventions. I didn't have a birth plan. I ended up with an epidural early in my labour when I wasn't experiencing any pain because the nurse said "if you want an epidural, you'd better get it now or it might be too late". I spent an uncomfortable night lying on a bed, restless and uncomfortable, hooked up to machines, waiting for things to move along. I was lucky that I didn't end up needing further interventions other than a vacuum extractor and my son was born the next morning. I was stuck in my bed after the birth, still unable to move around because of the epidural, really wanting a shower but not able to get up to have one. I couldn't get up to get a glass of water, to use the toilet, to change my son's diaper. I completely submitted to the care and decisions of my birth attendants and I wasn't happy.
For my second birth, I wasn't able to have a midwife (long and complicated story involving government red tape), so I opted for the same obstetrician environment, but decided to have a doula to provide support for a natural and normal birth. I knew that my doula would be there for my entire birth or on the odd chance that she couldn't be, I knew that her backup that I had also met would be there. She would be a consistent support for me, not part of a rotating cast of characters in the labour and delivery ward. Through my own research and with the support and experience of my doula, I did develop a birth plan. I made sure that my doula and my husband were familiar with it. I reviewed it with the obstetrician that saw me during one of my last appointments. I ensured that every person that was involved in my care in the labour and delivery ward had a copy of my birth plan. The birth went exactly as planned. It was quick, I was comfortable, I was able to move around, and I wasn't offered and didn't need any medical interventions.
For those that are interested, here is a copy of my birth plan (with some personal details removed). There are lots of great resources online and books that can help you to develop a birth plan and I highly recommend doing your own research and discussing your findings with your birth attendant(s) as you develop your plan.
If nothing else, the process of developing a birth plan led me to research and think about what type of birth was best for me and my baby. It had nothing to do with frivolous wishes. It had everything to do with having the safest possible birth for both of us and avoiding unnecessary medical interventions.
That said, if someone did have wishes for their birth that I think are frivolous, I think that it is their right. Some people spend tens of thousands of dollars making every detail perfect for their wedding day and I would argue that the birth of a child ranks up there with a wedding among the most important days of a person's life, so if someone wants specific music playing, wants the lights dimmed, or wants a toast when all is said and done, then I think that is their right and it is better to think about it in advance and plan for it, than to have regrets later.
I didn't have a problem with the idea of things being uncontrollable or unknown, but I wanted to be prepared for the possibilities and wanted to understand the options available to me and the risks of various approaches prior to being in the labour and delivery ward. There is no WIFI there that I am aware of, so Googling things at the last minute was not an option!
If you know that your birth attendant will make the right decisions for you, then go ahead and skip the birth plan. But if you aren't certain that is the case, then plan plan plan and plan some more. And don't let Katrina Onstad tell you that you are being pushy.
Making a "birth plan" is about more than being prepared. It is about being in control. Here's why letting go of all that is way harder - and that much better.
In her article, Katrina explains that she was keen to develop a birth plan when her midwife told her that "the best plan is no plan at all". While she was initially uncomfortable with the idea of things being unknown and uncontrollable, she eventually embraced it and submitted to the experience of giving birth and had exactly the birth she wanted, without having planned for it. She also mentions the disappointment of women that plan every minute detail of their birth and then end up with an emergency c-section.
Midwives versus obstetricians
What Katrina perhaps didn't take into account though is that there is a substantial difference between the model of care of a midwife and the model of care of an obstetrician. As Henci Goer explains in The Thinking Woman's Guide to a Better Birth, "whether you have a C-Section or any other procedure or medication in labour has little to do with your or your baby's condition. What happens to you depends almost entirely on your caregiver's practice style and philosophy".
For example, the Society of Obstetricians and Gynaecologists of Canada reports that more than 1 in 4 babies are delivered by C-Section. This is alarmingly high. The World Health Organization says any rate higher than 15 per cent signals inappropriate usage. I couldn't find a good statistic on the c-section rate for women whose primary caregiver was a midwife, but the midwives that I interviewed in my search for a birth attendant had a transfer rate of 6% to the hospital during childbirth, a portion of which would have ended up with a c-section. Much lower than with obstetricians!
Katrina had a midwife, so that was already a big step towards avoiding unnecessary procedures. Midwives view birth as a normal experience and epidural use, induction, c-section, vacuum or foreceps extraction, and many other procedures are less likely to be used in a birth where the midwife is the primary caregiver than in one where an obstetrician is the primary caregiver.
Being able to trust your birth attendant to make good decisions is important and can be helpful. I have one friend that had a birth plan for her first birth, but not for her second because she was using the same midwife and knew that they were in agreement about the type of birth she wanted, so she didn't need to write it down. If you agree with your birth attendant's philosophy and approach to birth, then maybe you don't need a birth plan and can "submit" to the experience and trust your birth attendant to guide things in the right direction.
Unfortunately, most women that have an obstetrician as their birth attendant (by choice or by default because it was the only option available to them), often find themselves in a "team care" situation. This means that whoever is on duty when they go into labour is the person that will deliver their baby. As if that isn't bad enough, that doctor will only show up for the last 5 minutes or so of the birth, leaving the patient with a resident, medical students, and nurses that they have never heard of and never met prior to being in labour. People rotate in and out of the room. You don't know them, you don't know their thoughts about birth, you don't know their personal experiences, and you don't know their aspirations. Perhaps the nurse attending your birth had two elective c-sections and thinks it is the best way to give birth. Perhaps the junior resident is really keen to pratice her skills with the vacuum extractor. Perhaps it is just so busy in the labour and delivery ward that evening that they tell you if you think you might want an epidural, you'd better get it now, even though you aren't feeling much pain yet.
In addition, obstetricians seem to approach birth as a medical condition that needs to be fixed and helped along, rather than something that is natural and normal and that will take place on its own time line. They approach problems that come up along the way with a series of high risk interventions, rather than considering low risk strategies for dealing with those problems. One high risk intervention, often leads to another. A woman's obstetrican may decide she needs to be induced even though her body isn't ready to give birth. They may first try breaking her membranes, which puts the birth on a timeline (the hospital often must deliver the baby within 24 hours of breaking the membranes due to risk of an infection). If breaking the membranes doesn't get things moving, they may use drugs to move it along. The induction can cause very painful contractions which may result in the recommendation of an epidural. The epidural means that the woman can no longer feel what is going on in her own body and also cannot walk around and do other exercises that might help the birth move along. As a result, her progress may be slow and she might end up in an emergency c-section.
My own experience
The birth of my first child was not what I wanted. I used the approach Katrina suggested. I submitted to the care of my birth attendant, an obstetrician in a team environment at a hospital. I was scared of the pain and hadn't done much research about the birth or about the risks of various interventions. I didn't have a birth plan. I ended up with an epidural early in my labour when I wasn't experiencing any pain because the nurse said "if you want an epidural, you'd better get it now or it might be too late". I spent an uncomfortable night lying on a bed, restless and uncomfortable, hooked up to machines, waiting for things to move along. I was lucky that I didn't end up needing further interventions other than a vacuum extractor and my son was born the next morning. I was stuck in my bed after the birth, still unable to move around because of the epidural, really wanting a shower but not able to get up to have one. I couldn't get up to get a glass of water, to use the toilet, to change my son's diaper. I completely submitted to the care and decisions of my birth attendants and I wasn't happy.
For my second birth, I wasn't able to have a midwife (long and complicated story involving government red tape), so I opted for the same obstetrician environment, but decided to have a doula to provide support for a natural and normal birth. I knew that my doula would be there for my entire birth or on the odd chance that she couldn't be, I knew that her backup that I had also met would be there. She would be a consistent support for me, not part of a rotating cast of characters in the labour and delivery ward. Through my own research and with the support and experience of my doula, I did develop a birth plan. I made sure that my doula and my husband were familiar with it. I reviewed it with the obstetrician that saw me during one of my last appointments. I ensured that every person that was involved in my care in the labour and delivery ward had a copy of my birth plan. The birth went exactly as planned. It was quick, I was comfortable, I was able to move around, and I wasn't offered and didn't need any medical interventions.
My Birth Plan
For those that are interested, here is a copy of my birth plan (with some personal details removed). There are lots of great resources online and books that can help you to develop a birth plan and I highly recommend doing your own research and discussing your findings with your birth attendant(s) as you develop your plan.
My name is _____ and I am accompanied by my husband ____. This is our birth plan for the birth of our second child (a baby girl named ___), due _______. We are hoping to have a natural and unmedicated birth with the assistance of our doula, _________ (or her back-up _______).
We are looking forward to working with the Doctor and staff to ensure we have a healthy baby. Below are our wishes for a normal and uncomplicated birth. If complications do arise we are open to making adjustments to our plan after we have been made aware of our options. We wish to have all procedures, tests and interventions explained and discussed prior to being performed if the situation allows.
First Stage
- Unmedicated birth: Please do not offer pain medication – I am aware of my options and will request pain medication if I choose to use it.
- Speeding up labour: I would like to avoid Pitocin. I would also like the amniotic sac to remain intact until it breaks naturally.
- Fetal monitoring: My preference is for intermittent external fetal monitoring.
Second Stage
- Choice of position for pushing: I would like to choose what position is most comfortable and appears to be yielding the best result. I may choose to change positions several times while pushing to increase comfort or improve the pace.
- Reduce Chance of Tearing: I would like to have a compress used on the perineum to reduce the chance of tearing.
Third Stage and First Hours After Birth
- Cord cutting: We would like to wait until the cord stops pulsing before it is clamped and cut. My husband does not want to cut the cord.
- Bonding/Nursing after Birth: Please place the baby directly on mom’s chest without washing and allow nursing as soon as possible. Please administer any necessary testing while the baby lies on mom’s chest. We prefer administration of eye ointment and vitamin K to be delayed until after the baby has had the opportunity to nurse.
- Checking for and releasing tongue tie: Our son was tongue tied and this significantly impaired our start at breastfeeding. Since tongue tie can be hereditary and we would like to avoid similar problems, if the baby does not latch on immediately after birth, we would like to have her tongue checked immediately and, if necessary, have the frenulum clipped as soon as possible.
- No artificial nipples or supplementation: We are planning to breastfeed. We would like to avoid all artificial nipples (bottles, pacifiers) and do not want the baby to receive any supplements (e.g. sugar water or formula).
- In event of unanticipated separation of mother and baby:
In the event that mother and baby have to be separated after birth for any reason, I would like my husband to remain with the baby and to make all decisions regarding the baby’s care.
Concluding Thoughts
If nothing else, the process of developing a birth plan led me to research and think about what type of birth was best for me and my baby. It had nothing to do with frivolous wishes. It had everything to do with having the safest possible birth for both of us and avoiding unnecessary medical interventions.
That said, if someone did have wishes for their birth that I think are frivolous, I think that it is their right. Some people spend tens of thousands of dollars making every detail perfect for their wedding day and I would argue that the birth of a child ranks up there with a wedding among the most important days of a person's life, so if someone wants specific music playing, wants the lights dimmed, or wants a toast when all is said and done, then I think that is their right and it is better to think about it in advance and plan for it, than to have regrets later.
I didn't have a problem with the idea of things being uncontrollable or unknown, but I wanted to be prepared for the possibilities and wanted to understand the options available to me and the risks of various approaches prior to being in the labour and delivery ward. There is no WIFI there that I am aware of, so Googling things at the last minute was not an option!
If you know that your birth attendant will make the right decisions for you, then go ahead and skip the birth plan. But if you aren't certain that is the case, then plan plan plan and plan some more. And don't let Katrina Onstad tell you that you are being pushy.
Reader Comments (32)
I live in the US where the c-section rate is over 30%. Because I am informed on the state of birthing and maternal care I knew I HAD TO have doula and a birth plan in order to have a natural birth in a hospital setting. I see a birth plan as a silent advocate in an aggressive field. Annie, have you read Pushed by Jennifer Block?
Oh yes, and I absolutely hate, hate, hate the "babies don't read birthplans" phrase that a lot of people spout. Birthplans are not a "plan" as such, I think everyone realises that things may change once labour starts but the very act of writing a birthplan and getting your "care-givers" to read it with you puts you all on the same page. As you say, in a hospital setting you may be labouring with midwives whom you have never seen before, and that's not exactly the time when you are in a fit state to discuss your worldview, so it's good to have a piece of paper you can give to them!
http://halfpintpixie.wordpress.com/2007/07/22/do-i-need-a-birth-plan/" rel="nofollow">Our plan was very similar to yours, quite basic, really just drawing attention to the areas in which we wanted to deviate from hospital routine.
I feel quite strongly about preparing for labour & birth, we did and I think it really helped. Knowledge is power as they say! We had an active birth and I delivered kneeling up, neither of these things would have been possible had we "gone with the flow" in our hospital which sports a 70% epidural rate among first time mums!
I believe that taking the time to form or roughly consider a plan helps tremendously. Even though life, especially labor, does not follow plans, dedicating some non-labor time toward a plan better helps those unknowns. You know that X is what you want but have taken the time ahead of the labor to realize it may not happen and you could accept Y.
This is part of the reason that my husband and I decided to see ONE OB out of our practice. Yes, we met all the OBs but we liked ours the best. We realized we might only see the OB for a short time when question asking was not an issue (and in our case our daughter literally "shot" out and was comming so quickly the OB was pulled off another patient and caught her no more than 4 minutes after he crossed the threshold of our room) so it was best to have the OB we had a good rapport with so that our questions were best answered before labor. It worked for us and the only things that I would change about our delivery were the questions answered on the spot by the nurses.
I adore your birth plan. Thanks for posting it!
Unfortunately due to a genetic condition, I am considered a high risk pregnancy and had to see a high risk team at a major hospital (I was specifically told when I went to a local hospital one evening after a scare that they didn't want to "touch" me). For my first (she came two months premature), I had no plan and flew completely blind. I was much more prepared for my second, even though my birth was not natural, my baby was three weeks early and I was in the hospital a week prior. I was able to control a lot of aspects of it although I did not have a written plan. In retrospect, I wish I had written things down.
I would love to have a natural, midwife homebirth, but I cannot have any more children.
Off topic completely, I do love your plan, and even with a more complicated birth you can have certain things in place with a written plan (regarding husband goes with baby if mom and baby are separated, aspects about feeding and intervention post birth), etc.
@earthbaby: No, I haven't read Pushed. I just now had the time to look it up and it looks interesting! Her blog is great too.
Ahhh... have not seen her blog, but the book is amazing. i will have to make a stop at her blog. The book is taking me a long time to read. It is a lot to take in and not a "relaxing" read but it is amazing, eye opening information.
My son's birth was full of medical intervention and was in all honesty pretty terrible. They popped my water, gave me picocin (sp?) has me hooked up to every crazy thing in the world and all that made an epidural necessary. I was in labor for 39 hours and it all ended with a c-section.
Next time around, I am NOT letting this happen. I will get a doula. My poor partner did the best he could but they were scaring him senseless and he was literally worried that I wouldn't make it through at one point. I think a doula, not having the same emotional connection, will be able to stay clear headed and be a stronger advocate for me whenever I decide to have my next child.
In my book pushy is better than pushover any day.
I think birth plans are a good way to think through decisions ahead of time and plan for different eventualities -- as long as the woman and her partner are aware that things can change and may not go exactly according to the plan.
My other comment is that midwife births will always have significantly lower rates of c-sections or other interventions because (in my community anyway) they do not accept any high-risk births and in some instances do not accept medium-risk births either.
I delivered twins in a hospital with a team of drs and it ended up in a c-section. Not by choice - but we were litterally out of option, my health was a concern at that point.
Having said that -- I would venture to say that everybody that delivers IN a hospital with drs SHOULD have a birth plan. It should be a requirement.
Why? I heard the nurses actually say "well, i don't have that in her birth plan..." about something that I REQUESTED. As in "if it's not written here, I don't really have to listen to you right now..." (and this nurse seemed 'good' at what she does. Perhaps they don't mostly react like that -- but she can't be the ONLY one that would do that?!)
So if I was delivering with midwives + doulas and had discussed in lenght my choices... and TRUSTED THEM -- to me, that would be enough for a birth plan if in fact I didn't write one. Otherwise, if you're going to be seen by a potential of nurses after nurses and dr after dr (they tried to enduce labour for 48 hrs before I finally had the babes -- and I saw A LOT of staff!) anyways -- they don't know me -- i'm nothing more than 'patient in that bed' -- so I feel comfortable saying that women SHOULD have plans in that setting!! Assuming that your wishes will be respected otherwise might not be enough.
I basically had the same birth plan as you. I got stuck with a bunch of medical interventions that I did not want (IV fluids, episiotomy, continuous fetal monitoring), but even as informed as I was, I was scared when they told me my baby could die (because my sac of waters had meconium in it) if I got up and walked. I was tied to the bed because of the continuous fetal monitoring. In the end, I had a healthy baby boy without ANY drugs, but I am still mad about the episiotomy and a lot of the overall experience, including not delivering with my OB of choice from the practice. Next time I am using a midwife, no ifs, ands or buts about it.
[...] 19, 2008 by phdinparenting Its turning out to be a good week. First, I was called pushy for having a birth plan. And then today, a commenter on my blog told me to “grow up and quit making such a big deal [...]
[...] me that meant reading a lot of the right books and developing a strong birth plan. It also meant having a doula to support me and ensure that my needs were met during the birth and [...]
[...] I had a natural, unmedicated birth & posted tips/thoughts [on my [...]
[...] to be able to let go. In the past, I’ve turned comments that upset me into great posts (like Birth Plan: Yes or No? and Lactivism and the Homelessness Problem), so I thought perhaps the best way to get past what [...]
"If nothing else, the process of developing a birth plan led me to research and think about what type of birth was best for me and my baby."
This, I think, is the most important aspect of a birth plan. I don't think normal birth belongs in a hospital at all, but if one must go to a hospital, they should at least be aware of what their options are. Birth plans are more for the mom than the doctor, I believe. (Although if you find that rare care provider who actually cares what you have to say and believes in your right to informed consent, a birth plan would be helpful to him/her.)
[...] policy on breastfeeding photos in Breaking it Down for Facebook. It motivated me to write Birth Plan: Yes or No?, to explain about Lactivism and the Homelessness Problem and to analyze the faulty logic of the [...]
[...] in Parenting wrote a lovely thoughtful (and a little irate) piece in response to the Chatelaine article. She makes an extremely valid point that when you trust your [...]
[...] in Parenting wrote a lovely thoughtful (and a little irate) piece in response to the Chatelaine article. She makes an extremely valid point that when you trust your [...]
[...] you should take what measures you can to avoid unnecessary interventions, such as hiring a doula, writing a birth plan, and taking other measures to avoid the medicalization of your [...]
[...] by WP Greet Box WordPress PluginIt’s turning out to be a good week. First, I was called pushy for having a birth plan. And then today, a commenter on my blog told me to “grow up and quit making such a big deal [...]
I think anyone who has experienced birth (or life, for that matter) knows very well that control is mostly an illusion and luck has a lot more to do with what happens to us than we might like to admit.
That doesn't mean you don't educate yourself on the options. That doesn't mean you don't set goals. That doesn't mean that you surrender and relegate yourself to the passenger seat....
Maybe having a plan makes you pushy... but not having one puts you at risk for a more fearful experience of birth. With both my kids, the birth plan was more about the process, not the end result.
I had a birth plan for my first which was ignored completely by the nursing staff who walked in and put in an IV before I honestly had a clue what was happening. I'd gotten to the hospital in transition and was kinda in my own zone and not aware of what was going on around me. I looked at my arm and told the nurse to take it out - she said "you need a full bag of fluid before your epidural" to which I replied "I'm not having an epidural, I'm having a baby... right now!" (long story short, had the baby 45 minutes later without any pain meds or other intervention. OB (DO) arrived and barely got gloves on as baby came flying out)
Fast forward to baby #2 -- TOTALLY different hospital (a birthing center feel) with a midwife. I had no written birth plan this time - simply an understanding with the midwife that I wanted a water birth with no interventions. Arrived at the hospital in transition again, hopped into the tub and within 20 minutes had birthed my daughter!
My belief is that the process of writing the birth plan for my son's birth (as well as, rereading it, rewriting it a few times and then handing it to the staff) helped develop and solidify in me the mindset I would need to stand firm in what I wanted for my labor and my son's birth. I had it in writing that I wanted the birth to go naturally. It was a fight from start to finish, but that was due to the location of the birth and not to my mindset or plan.
My midwife was reassuring from the first time I met her (at a Holistic Moms Network meeting - not in her office!) and I knew that my desire for a non-interventionist birth would be respected and acted upon - which is exactly how it went.
"If nothing else, the process of developing a birth plan led me to research and think about what type of birth was best for me and my baby. "
That sums it up for me. By reading about everything I could about giving birth and then writing up my birth plan it made me knowledgeable enough so that when my OB or nurses were giving me information I wasn't completely clueless. I had some interventions, but I was in agreement with the medical team and nothing was ever pushed on me. I also had the great help of my husband and my sister who had delivered 2 children naturally to help out and talk things through with me.
I'm going to have my second baby any day/week now and I'm going to write up a second birth plan and am very happy knowing where I will be giving birth that they will read and talk/discuss with me. They were totally against a c-section which makes me proud to be delivering at this hospital! And very VERY pro-breastfeeding.
I didn't really understand everything Katrina was trying to say. This quote: "Ellen Hodnett, a professor of nursing specializing in childbirth at the University of Toronto, says that when women report disappointment after a birth, it has little to do with the plan, and everything to do with feeling like they received impersonal care. "Over and over, when women say they're disappointed, it's not, 'Did I get the water birth,' or, 'Were the lights down low,' it's about, 'Did I feel I got the best possible support and involvement in decision making?'"" seems to validate the need for a birth plan -- to get the "best possible support and involvement in decision making", but Katrina seems to think a birth plan instead compounds the pressure for perfection in all areas of our life.
I was fortunate enough to have two out-of-hospital births with midwives I loved, trusted, and were incredibly respectful, so I can't speak from experience about the need for one. But from the experiences my friends shared with me, I would absolutely recommend doing one if you think your desires would be out-of-the-ordinary. In the U.S., I would also recommend checking with your caregiver and the facility you plan to give birth in to understand their policies. With my second child, I chose to have a home birth (paid for out-of-pocket because it wasn't covered by my insurance) because the only hospital within 100 miles of where I live would not make exceptions to their policies of IVs and continuous fetal monitoring. The first step to making sure your voice is heard is finding a caregiver who will listen.
I think my birth plan helped me feel prepared in that I could state my wishes while accepting that I can't control the entire birthing experience. When I gave birth to my daughter, I too was in the care of an obstetrician but also had a doula to support my husband and me through the labour and delivery process.
The best advice my doula gave me was to research all my options - which she helped me do - and then develop a birth plan that stated my intentions for labour and delivery with the knowledge that some things in labour and delivery can't be predicted.
Because my goal was to have a natural birth, my birth plan indicated that I didn't want any interventions suggested to me unless it was necessary to the health of me and my baby. Well I ended up being induced because I was 10 days overdue and my doctor's "standard procedure" is to induce at that point out of concern the baby's health. I did feel pressured to be induced and with my daughter born with quite a lot of vernix, I think she wasn't late so much as she was not ready to be born yet.
That intervention aside, my birth plan helped me to focus on my goal to labour without any pain management medication. My birth plan explicitly stated I was aware of the pain relief options available to me and didn't want them offered to me - I would ask for them. My doula suggested my husband and I come up with a codeword (ladybug) that I would say to indicate to them I was thinking I needed pain relief. Fortunately I never had to use it!
Should I have another child, I will go the birth plan route again most definitely.
I didn't have a birth plan for my first birth. I had a natural hospital birth, and looking back, I was lucky.
I wasn't planning on doing a birth plan for my second birth (midwife-attended) because I was pretty sure we were on the same page at the midwives. But they encouraged me to outline a general plan, specifying things like "no formula, no offer of pain medication, no pitocin" - the things that would be important if for some reason the midwives weren't there. Obviously if there was transfer of care it would be for medical reasons so some things may have become necessary, but it's good to have the basics documented.
Oh, and we didn't document everything, including the fact that we chose not to administer the eye goop. :)
The act of writing my birth plan was as much about getting my head around what was going to happen, some mental preparation for myself, as it was about listing things I did or didn't want, although those were included.
I had a homebirth with an independent (so known) midwife in the UK. I didn't need a birth plan as such for all the reasons you mention.
However, I did create a document that recorded my wishes in the event of intervention being required. There was a fair bit of 'I will not consent to' in there and some specific things that I know go against standard policy at our local hospital.
I never had to test it's effectiveness. I did transfer after my first birth with a retained placenta but there aren't really any options with that.
I think the issue of control is vitally important. Birth is inherently uncontrollable, what will happen will happen, but my reading has lead me to conclude that women who lose control of what is DONE to them tend to end up feeling traumatised.
[...] I had a smart doula who looked through my two to three page birth plan and helped me reduce it to a one page birth plan that could actually be read by the nurses and doctors who attended my [...]
ditto for me too, it was good prep ... and timely. i arrived in the hospital, only just recovering from acute visual loss, with the ink still drying on my birth plan. my platelet count showed a left shift, BP elevated - induction stat followed by C-section, but i felt well prepared and informed. despite appearances, i still regard our birth experience as positive and i think our doula's advice re: birth plan helped immensely.
[...] I had my mainstream birth. I saw an obstetrician. I had the tests done, I didn't bother with a birth plan, I timed contractions when the time came, and I showed up at the hospital when I was told to. I [...]
This is a great article, thank you. Also, the link to Onstand's article has changed, it's now at http://www.chatelaine.com/living/modern-times-dont-be-so-pushy/