Sunday, September 23, 2007

Birth Plan

Definition of Birth Plan:
- A written outline of a woman's preferences for her labour and birth.

My Definition of Birth Plan:
- A way to guarantee that you aren't going to get what you want.

I have yet to see a woman come in with a birth plan that ends up laboring according to her wishes. In fact, I have yet to see a woman with a birth plan that doesn't end up having a C-section. If I were going to get a PhD I might research why.

Take Lisa (chill, it's not her real name). She came in for an induction with the most horribly annoying three page birth plan that basically included no intervention at all. She settled herself in her room and then refused an IV, pitocin and having her water broken. At this point it was necessary to stop and determine if she realized what induction of labor was, and if she wanted no part of it, send her home to wait for labor to happen on its own. She decided to stay and for the moment, get an IV.

Over the next four days she caved to each intervention one by one. First it was starting some pitocin to get the contractions going. After she had been there 48 hours and nothing had happened, I am sure she was getting antsy. I wonder if she thought her labor would start just by showing up to the hospital. The next day it was having her water broken. After the contraction got stronger, as they will when you no longer have that cushion, she was begging for an epidural when she previously wanted no medicine for pain at all. A whopping four days after checking into the hospital for "induction of labor" with what she hoped would be no help at all, she was rolling back to the OR for a C-section. Maybe it is karma for people that try and control everything?

More to come on this subject as I develop my theories.


Jawndoejah said...

What if she tried to wait it out and stay home...maybe she'd have had a normal labor. Someone should have told her that!

Lisa said...

That's interesting. I had a four page birth plan and it went swimmingly. In fact I've had two birth plans, and both births were with little intervention; the only real 'intervention' was rupturing of my membranes when I became fully dilated (or at least really really close) and with my first birth, catheterizing my bladder after an hour of being in the pushing phase but not being able to push because I wasn't fully effaced.

Both labors, my babies were born within a half hour of starting to push. Small tears, no episiotomies. Both my babies passed meconium so the neonatal folks were there to deal.

I wonder if my OB nurses looked at my birth plans with such disdain. I hope not.

kristin said...

how can you check in for an induction and not want interventions... and induction IS an intervention.

this is why i homebirth.

Its Getting Better All the Time said...

My birthplan was respected by the staff at the hospital i birthed at and I got everything I wanted, which was no interventions: no IV, no continuous monitoring, no drugs, no rupturing of membranes, etc.
I love your blog, but i hate it when Drs/Nurses say that a well informed woman who knows what she wants is just going to end up with a c-section.
In this case, its obvious she shouldn't have been induced. What was the medical indication for that?

Sil said...

My Definition of Birth Plan:
- A way to guarantee that you aren't going to get what you want.

yeah specially with very unsuportive nurses...I had one of those with my 3rd and I requested a new nurse or I swear I was going to smack her . After that my birth plan went along great.

kli said...

just found your blog - sorry this is an old post!

LOL I can't stand it when the overacheivers jump in and lecture everyone on how birth really isn't that painful and 4-page birth plans are the cat's meow.

(3 kids, really fast labors, and I had the last one in the front seat of our car. Birth plan Schmirth Plan. whatever. All I got was a big ole tear and a bunch of EMS guys staring at me.)

I'm adding you to my blog roll!

Kitty said...

I had a birth plan for both of my deliveries. A friend was an L&D nurse at the hospital where we were delivering (and, incidently, had had 2 medication-free deliveries there herself with my OB), and she gave our plan the "this will not annoy the staff" stamp of approval. While we were still in triage when I was having baby #1, the nurse took our birth plan out into the hall, and I overheard her say to another nurse, "This is a really good birth plan." I was flattered. We planned for a natural birth, hired a doula, and told ourselves to be prepared for ANYTHING. Fortunately, things went the way we'd hoped both times.

Love the blog, I've read it from new posts to old, and am looking forward to more!

Raena said...

Wow. I thought nurses would appreciate well informed patients.

Either way, I love your blog!

Annie said...

a patient who comes into L&D for an induction and doesn't want any intervention (since, as kristin said, induction IS an intervention) is not my idea of a "well-informed patient."

Stephanie M said...

The first baby, I had no plan, back labor, blah blah blah. Boring vaginal birth.

Second baby, I wrote a birthplan: I want a scotch as soon as I deliver AND a pink pony. Damn, but I ended up with a c-section. I should also mention I ended up with another baby, so how it got here is sorta past the point.

I blame the plan. It's all the plan's fault. That damn pink pony, particularily.

Holly said...

As a doula, I usually tell my clients that writing a birth plan is a sign that they aren't birthing where they feel safe. You don't make a list of directives for your mechanic - if you feel have to do that, you find a mechanic who you trust more instead. I personally think the birth plan to c-section phenomenon is a hormonal thing. Oxytocin (helps labor) and Adrenaline (stops labor) compete for receptors in the body. If a woman is defensive and suspicious of her staff, the adrenaline/catecholamines won't let the Oxytocin in. If she doesn't feel safe, she won't labor. Just like my cat goes into the closet to have her kittens.

I think birth plans are great for educating yourself and having a conversation with your care provider. I don't think they are the best thing to take with you into labor. I tell women that they, themselves, are their best birth plan. Just say no and yes when each choice presents itself.

That said, I did have one with my first child, before I got all heady and thoughtful about birth. And that birth was absolutely intervention free, which happens when you show up to the hospital in second stage (oops). Again, I obviously didn't fully trust the hospital with my birth experience and ended up laboring best where I felt safe (home).

And my second birth, I was still not fully confident in my homebirth midwife, so I ended up delivering before she arrived (oops again).

We have our babies the way we live our lives.

LDNurse said...

It is not that the nurses hate birth plans. It blows are mind to hear that you are trying to be well informed when you download them verbatem off some internet site you found. If you are coming in to the unit in labor it is really different than if you are being induced. If you don't want any medical intervention why not have a home birth.

Riewer family said...

OMG...most of the birth plans are carbon copies of one another from some website! annoying too because most of the time they are in complete compliance with what we do really people do you really think we don't let the father routinely cut the cord, or well one ever MAKES you get pain medication, and OF COURSE...don't schedule yourself an induction...that just shows how UNinformed you are!

Mirjam said...

I've been reading your blog from new to old posts and really enjoy it! However, this post kinda rubs me the wrong way a bit allthough the story coming with the whole birth plan makes me understand your opinion.

I had a birthplan with both deliveries (and will continue making one for future babies) and especially with my second delivery proved very beneficial.
I don't think the nurses had one, I can't remember because I was busy labouring, but my doctor did and he was absolutely cooperative, yet told me whether certain things weren't optional (depending on the hospital's policy).

I had a very good experience with the staff (except for one nurse, but there will always be that one you just don't get along with, heck we can't be friends with everyone) and felt respected and supported.

Keep posting, I enjoy your stories a lot!!

Linsey Erin Griffith said...

I am a Doula and I love your blog! With my clients I don't call it a birth plan - I call it a birth wish list. We go over every facet of birth and consider options for every imaginable intervention. That way she knows her preferences and what she will be okay with. During labor I remind her that she is free to change her mind and I am here to support her no matter what. Knowledge is power, but so is being flexible and able to deal with your situation in an informed, empowered manner. That way the mother has a choice to make rather than "giving in." Not all of your patients have doulas or supportive families though - as your tales so humorously relate.

Nichole said...

I just stumbled upon this when I put in "birth plans nurses hate" on google because I am a L&D nurse who wants to mess with my colleagues when I deliver my second baby in a month. Yes, we DO hate birth plans that are ridiculous I mean things that are unreasonable, such as the woman in this story. This kind of thing happens ALL the time...and more than 9/10 women who come in with a birth plan DO end up with a C/ is just a matter of time. Hilarious! Love the blog! Thanks for the laugh.

mewwsical said...

As previous comments state, obviously these people are not actually well-informed if they are thinking induction is not an intervention. Probably the 9/10 you all refer to are all of this same sort, or have not taken the time to educate themselves, but that does not mean that every single mother that has a birth plan falls into this category or will end up with a c-section (the c-section rate in this country is ridiculous, but that's a story for another day...) I took a 12 week Bradley birth class and did research on my own as well, I didn't just copy a birth plan off a website, and I certainly wouldn't expect anyone to take the time to read a 4 page plan when I show up in labor. Believe me, I am staying as far away from the hospital for as long as I can, if it wasn't that HBACs are not allowed in my state I just might consider it. As it is I recently had to change OBs since my previous one, and the hospital he delivered at, were not VBAC supportive (even though he claimed to be, his policies were not). Am I well informed? I guess we'll see in about 3 months!

Bree said...

Our childbirth educator suggested we make a Birth Preferences sheet and that is what we did. If labor goes normally (i.e. no fetal or maternal distress, 25 hour labors, malpositioned babies, etc.) we would like XY & Z. I like to think it gave them an outline as to what we would like under the best circumstances, not what we 100% had to happen. Birth (as well as parenting in general) is all about flexibility and rolling with the punches.

Lissa VB said...

How about a birth plan that reads something like:

My Birth Plan

As long as you introduce yourself, explain what you want to do, and get my permission before you touch me or my baby, we'll get along great.

If an emergency happens, I'm sure I'm in good hands.