Belly Up

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Tuesday, April 19, 2011

Birth Planning

Have you heard this comment or one similar from a nurse or other careprovider?  "When a mom walks in with a birth plan, we just go ahead and set up the OR. Those moms always end up with c-sections."  This line has been said to some of my clients and I myself have heard it said by my friends who are nurses and OBs.  So is it true, do birth plans cause c-sections or at least increase a mom's likelihood of having one?  Should couples try to plan their birth?

First of all, let me just be blunt, these "birth plan" c-sections usually happen at hospitals where statistically a high proportion of women will deliver surgically because that is the birth culture of that hospital.  Basically the odds are stacked against a vaginal birth regardless if a couple walks in and hands the nurse a copy of a birth plan or a copy of a Tolstoy novel.  Furthermore, if this is a widely held view at any given hospital, it is probably not a place that is providing mother friendly care,  I mean it isn't nice to be dismissive of your patients requests and then to blame them for the need to perform a surgical procedure.  

However, where birth plans legitimately get a bad reputation is when a couple's birth plan is a poor match between the care provider they have chosen and the plan they have created.  This represents poor prenatal communication and will usually lead to tension between the various parties present at the birth, not to mention disappointment on the part of the parents.  A well developed birth plan should serve as a tool for communication prior to labor so this doesn't happen, in fact, when a birth plan is supported by everyone going in, it really is not even vital on the big day. 

So first things first, mom and dad have to figure out what they want.  This of course can be challenging as it is hard to know what your options are....when you don't know what your options are.  It is a bit like being at a restaurant and not being given a menu.   However, this is exactly why taking the time to think through your goals important.  Once you have researched and written out your concerns and desires for childbirth, it is time take this loose birth plan and go chat up your careprovider.  (Ideally this should be done when you are not half naked because nothing makes you feel less empowered than asking questions while you are nude and the other person is fully dressed.)  Then examine how you feel about your careprovider's reaction to your ideas.  Was he encouraging, did his answers make you feel supported and confident?  Did your priorities and vision of labor match in most areas?  If yes, congrats, pass go and collect your baby. 

If not, this is where the road is rougher, but make no mistake *you* are still in charge and the choices are straightforward.  You have three options: 1) decide that you will accept the way your careprovider does things 2) try to compromise with your careprovide to find some areas of give and take or 3) start looking for a new care provider  What you can't do is hope and pray and wish upon a star that somehow when you go into labor or reach your EDD that things will magically happen the way you are hoping.

Obviously choosing the first option means doing nothing (except maybe tearing up your birth plan), basically it is the default choice.  At this point mom is often late in her pregnancy, perhaps money has exchanged hands or it may seem overwhelming to start all over again with someone new.  The second option, trying to find areas of compromise, may or may not be easy depending on your comfort level negotiating with someone who will likely counter your attempts with sincere (albeit often biased) concerns about how your requests will jeopardize your baby's health.  However you may be able to get a bit closer to your goals and that is good.  Finally there is the option of switching to a new careprovider.  Most moms think this is the most daunting option, though those that have done it are usually surprised how easy it actually is and the benefits are huge.

Which brings us back to the birth plan.  Research consistently shows that couples that express the deepest satisfaction with their birth experience, no matter the type of birth or the outcome, are those that felt supported by those who served them and that the experience met their expectations whatever those expectations were.  Therefore the birthplan at its best is not a list of instructions for your careproviders but rather a tool to gain information and communicate beforehand so that you can have realistic expectations for your birth.  If the plans you have in mind are different than those of your careprovider it is better to know this beforehand.  Knowing your options and having realistic expectations can increase both your confidence and your chances of having the birth experience you want and a positive birth experience will have a positive effect on the family that can last a lifetime.
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1 comment:

  1. I think it's a shame so many women let their provider dictate their choices (or lack thereof) instead of deciding what kind of birth they want and finding a provider that will do their best to make that happen. I'm certain given my long labor I'd have had a very different experience if I had stuck with my original OB's office. Either I'd have been given pitocin and/or a C-section, or I'd have gotten a lot of grief for turning those down. Ideally a mom-to-be would go provider-shopping with a general birth plan in mind.

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