For those of you who might not be familiar with this term, a birth plan is a set of notes that are prepared by the mother, with the advice of her midwife, to be followed during labour- for example 'no drugs of any kind', 'immediate skin contact after birth' etc...Now until I got to Chapter 11 of Kitzinger's 'Politics of Birth', I completely assumed that birth plans were inherently good for mothers. Not only does it require finding out about what is actually going to be happening to a woman when she gives birth, but it should give a woman some sense of control of what is being done to her body, especially if she is giving birth in a medical environment (i.e. not a home labour). However, Kitzinger tells a different story that has now made me doubt my own opinion of the use of birth plans and my own personal use of a birth plan.
Kitzinger herself was one of the strong campaigners for birth plans in the UK, but she admits that the method with which they were introduced was not at all what she had imagined. She presents several ideas for why birth plans need to be reconsidered: they are often used as a way to assert control over a woman; they take away control from the midwife, making it often difficult for them to give strong advice when needed- keeping doctors in the position of authority; and finally birth plan forms (most commonly used now and what Kitzinger calls 'shrinkage') are so basic, in a multiple choice form that in fact it limits a woman's options and understanding of what happens.
I haven't actually prepared my plan yet. It is left to much later in the pregnancy, when more information is available to you about your situation (i.e. if it is clear that you need a caesarian by the third trimester, your birth plan will have to based around that fact). However, I have found that in the two meetings I have had with my doctor and midwife over the past four months, numerous questions have gone unanswered because apparently "we will get to that when we do the birth plan at a later date....". If you are feeling especially cynical, you could interpret this as "we are so squeezed for time and resources on the NHS that I can only answer those questions during a specifically allocated time in the third trimester". And even though I think my midwife is great and my GP is too, there are times when I am suddenly faced with the realization that I am just a file number- what has demonstrated to me the extreme formality of the system is that my own knowledge of women's health and maternity health to be specific goes completely ignored by them. I realize that this mainly to ensure that they provide me with all information necessary, but it also demonstrates that establishing a relationship with their patients may be secondary. I would like to note here though that I am aware of how ridiculously overstretched midwives are in the NHS and that the NHS itself is an extremely bureaucratic system.
My point is that I feel somewhat duped, because I know that I am relying on my birth plan being rigidly followed in order to guarantee that what I want happens. It is my only defense fro having the labour being completely overrun by healthcare providers. I have this impending sense of doom that giving birth in a hospital can be equated to going to a garage with your boyfriend to get YOUR car fixed and having the mechanic ignore you to talk to your boyfriend. My belief in the health system treating women as thinking, rational beings is practically non-existent.