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.
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I can relate to your thoughts and feelings as I too was in your position just 7 months ago. I had it all planned out but I also had a group of midwives who knew exactly how I wanted it done and took my personal choices very seriously. Unfortunately, I now see the 'birthplan' as a pre-birth expectation plan that most likely will go haywire when the time comes. My birthplan basically went to shit as I was two weeks and two days over due and ended up with a slight induction (which I didn't want). My midwife said we'll just give you a little to get you going and then we'll take you off. Then I let them break my water.....bad move.....up until then my doula, husband, and I were handling the pain well then I felt like Braveheart at the end of the movie when he is being gutted. So then I got the epidural (which I had planned not to) because the pain was so bad and I was only 1cm. Needless to say 31 hours later I had a wonderful little ball of love. I think the plan works well as a way for a woman to make her own choices, become educated about what she wants, and exert some control over the medical establishment that continually infantalizes pregnant women, but after that for most I think it flies out the window. This is not a bad thing of course because there is only positivity that comes from making a birth plan; the expectations just have to be a bit floppy!
I agree with mama-feminista. Birth plans are difficult, especially for a first-time birth. Labor is unpredictable. I believed that I did not want a male-controlled, western medicine birth where I would not be in control, so I wrote out a birth plan that said "no drugs." After 20 hours of labour, I was screaming for a gun to shoot myself, and only got an epidural at 26 hours, and only when the nurse took on the midwife and convinced her that it was the only way I was going to get through the rest of it. My baby was born at 30 hours. And she was healthy, but I felt like I had failed. Somehow, the birth had been tainted because I had given in on pain medication. It was only later, after I had had time to think my way through all of it, that I came to realize that I felt duped. The whole idea that "pain is empowering" is crap. Pain just hurts, and I'm not sure why we tell women that the noble birth is without pain medication. Is the noble tooth pulling without novocaine?
Anyway. Every labour is different. For some women, labour is easy and short. For others, it's intensely painful and takes them beyond their limits. It's not a moral reflection on these women--it's biology. Women are built differently and babies come out at all angles and and at their own pace.
So, birth plans are "ideals" but you do not want to be held rigidly to a birth plan when things change.
Good luck!!
I'm with the above posters--one thing to plan is that your plan might go "out the window"--best to have your delivery attended (in whatever setting) by people who understand you and your hopes for the experience, and who are also sensible enough to see when a change of plans is advisable.
My birth plan (from over a decade ago) is mostly an artifact of my own worst-case-scenario thinking--the birth plan included organ donation instructions for myself and the baby, should the whole thing go completely tragic. They weren't needed, thank goodness; but neither were most of the other details I specified. And I didn't bother writing one up for my second delivery.
My two children's births were as different as black and white; the first super birth plan "natural" which turned into a fiasco of pictocin induction, forceps and episiotomy. Everything I explicitly contraindicated vehemently before and during. I had felt raped by the completely medicalized/other managed birth So the second birth was at Pitiviers, France with Michel Odent with a completely open ended non-plan. The results were an astonishing three day labor where I was encouraged to keep walking and was able to endure the pain and then a standing/crouching birth with some tearing that was masterfully repaired. No doctor or midwife controlled what I ended up doing for which I am eternally grateful. However I did find it difficult to keep "listening to my body" and trusting it to do the right thing through so many hours of labor. The resulting baby was as healthy and wonderful as the first. My advice to any primipara (first pregnant) woman is not to plan too much. Like trying to plan what the first time you make love is going to be. We don't know our own bodies or levels of pain tolerance to be able to get into any aforementioned moral self righteousness about pain killers. We can have a goal to be as open minded as possible mixed with a "live in the moment" credo with as much knowledge gleaned from other women's experiences as possible. Then you hope that the medical environment, whether in a hospital or at home allows you some autonomy in decision making. Even a home birth can be too over proscribed.
I'm guessing you are a first time mom. You seem to have only horror stories about hospitals in your head. Just be open minded to how your baby and body react to labor. It isn't up to you. You can write a 50 page birth plan but you'll be wasting your breath. Just relax and go with it. The nurses are there to help you. Not control you. Many women seem to project their fears and anxities of labor and motherhood into being critical, cynical, and negative about hospitals. It is a wonderful, safe place and I think you will be pleasantly surprised to find how genuine the nurses and providers are. Yes, we are busy, but we love what we do. And yes, you aren't the first or last woman to have a baby, so you need to get over that a little, but you will get to feel special and like a queen for a day. And you are special. You are becoming a mother. I am a labor and delivery nurse. The reason I am up reading these blogs is because I can't sleep. I'm thinking about the baby that was delivered 2 days ago while I was working. He was a failed home birth. I can't get his sweet face out of my mind. A mother came in with her lay midwife after pushing for 2 hours. Her cervix was only half way dilated. Her lay midwife also told her that her amniotic fluid was clear when in fact her membranes hadn't ruptured. She was urinating. When we ruptured her membranes there was thick meconium- a sign of fetal distress. The baby was a beautiful 7 pound boy with blond hair. He was perfect and it was obvious that he hadn't been dead long. I can't sleep because I am so sad for the family and this baby, but I am also so angry. Lay midwives are skewing statistics and information to uninformed people. The death rate is high here because we try to recussitate 22 week babies. We count different gestation(ages) of babies. Comparing our stats to theirs is like comparing apples to oranges. HAVING A HOME BIRTH IS NOT THE SAME AS EATING ORGANIC OR SHOPPING AT CO-OPS OR WORRYING ABOUT THE ENVIRONMENT. You are a selfish woman if you care more about YOUR birth experience than your babies birth experience. Your baby needs oxygen to live in utero. This patient killed her baby. This poor baby has no rights. Please know that doctors and nurses do not want to CONTROL your birth experience. We are not coming into the room to INTERRUPT you. We are checking on you to make sure you both live and your baby has all of its brain cells after the birth process. Yes, many births can be completely normal and natural, and if that is you, you can have that in a hospital(which it is not up to you (or your dr.) If you are healthy, you can have no medication, intermittant monitoring, and a quiet, darkened room birth with calming music and incense. I've coached many women and have had natural births with them. Nurses prefer this. We don't want to hook you up to lines. Besides, how your baby comes is not up to you. It is up to something greater than all of us. You are a mother. It is no longer about YOU. It is about your baby. Start acting like it. Please don't have a home birth. Your precious baby should not be gambled with. If things go wrong at home, it is too late. I hope that one person reads this and changes their mind. I want to prevent one more unneccesary death. How can I change your minds? Please have a birth with a certified nurse midwife in a hospital. Your baby will thank you and will live to know you.
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