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The “Birth Plan”: What NOT to Expect
There is a strain of
pregnancy propaganda out there that sets new moms up for failure. It says that
unless you “achieve” some particular kind of delivery perfection, well,
then…you haven’t quite made the cut, as a Mom. And that makes me angry.
It’s in all the standard
pregnancy books. Something along the lines of, “Create your own birth plan. Be
in charge of your delivery. Don’t let that mean, nasty doctor force you to
deliver in some way that’s NOT in your plan. Decide in advance if you want to
use pain medications for the delivery….or not.”
What they don’t say is that
the birth process is usually so unpredictable that your carefully crafted
“Birth Plan” gets left at the bottom of your carefully packed “Going To The
Hospital Bag”…that got left at home, in a panic, as you rushed to the hospital.
Now, I’m a recovering control
freak, so don’t get me wrong. Anything that’s called “a plan” looks fabulous to
me. I did it myself, with our first baby. Here were my rules, when I was
cluelessly buying into the notion that I could actually control the birth
process by planning for it in advance: No induction. Lovely, inspirational
music playing in the background. No pain meds. No pitocin. No c-section. (Oh
yeah: no binkies or bottles for the baby either, but that was a different
lesson for me to learn, for a different post!)
What happened, you ask? Oh,
surely you must have guessed by now. I had it coming to me, big time. The
control freak gets hammered. The doctor wanted to induce labor, since the baby
was getting big, and she was overdue. But oh no, that was not in my Birth Plan.
So we waited. And waited. When labor finally did begin, the early stages went
well. But when it came time to push…not so well. I pushed and pushed and
pushed…and nothing happened. I stood up to push. I squatted to push. I pushed
and pushed for hours. The doctor wanted to add pitocin in order to add strength
to the contractions, to help me along. No way. Not in the birth plan. She
wanted to add an epidural, to relax me. No dice, doc. Finally the doctor had to
go and do an emergency c-section on another lady. I had some time. The nurse
convinced me to have the epidural and the pitocin, and then our baby was
finally born. After four solid hours of
pushing.
I was so sore after the
delivery I had to sit on two huge pillows for weeks, and I still was miserable.
of “Birth Plans” that didn’t “pan” out:
· The
alternative-medicine-practitioner who swore she’d never use pain meds, who
begged for (and got, with huge relief) an epidural after 12 hours of
excruciating labor
· The Maui-Hippie-type who
arranged to have a birthing bath (with doula) brought to her home, only to need
an emergency c-section at 34 weeks
· My pain-fearing friend who
hoped for every drug in the hospital, but delivered in the hallway of the ER
while her husband was parking the car
Now, I’m all for planning, to
the extent that planning is possible.
But I’m really against the notion of
feeding new mothers the idea that there is somehow an ideal birthing situation
that they should be aiming for…other than the delivery of a healthy baby, with
a healthy mother. Because that sets us up for comparisons, judging, and disappointment.
The labor and delivery process is so unpredictable, and so individual and
varied, that you really cannot plan for every possibility.
Many of you have expressed
sadness, even a sense of failure, because you had to have a c-section. Or if
you “caved”, and got an epidural. Unrealistic
expectations can lead to big problems. For some, this disappointment can even
lead to postpartum depression.
Lamaze Shlamaze; use whatever
works.
The breathing techniques I
learned in yoga and exercise classes helped me way more than anything I learned
in the actual preparation to have a baby. That said, I still pushed for four
hours! The only thing that is important in delivering your baby is that both
you and baby are healthy. I don’t care if a Martian comes down and performs
some kind of weird alien delivery for you, as long as you and your baby are
healthy at the end of it.
Did you have any surprises in
your delivery? Do tell!
Well, I had a perfect pregnancy, up until about 1 month from my due date. First off.. my daughter refused to drop… she was head down and all, but just didn’t want to drop!! So I go in for a regular check up, when all of a sudden my blood pressure shot up. Since I never had any high bp before, my Dr. was somewhat concerned. They said to come back after a few days and they would check it again, but it was still high then. So my Dr. scheduled an ultrasound to check to baby and maybe see why she wasn’t dropping. The ultrasound looked fine, so they told me to come back the next day to check my bp one more time. Yet again, it was high and it was climbing.. so my Dr. turns to me and my mom who was there for support and says,”So, wanna have a baby today?” My jaw just about hit the floor. She admitted me to the hospital right then and there and I had to call my husband and tell him to go home, get our bags and get to the hospital ASAP. I was still 2 weeks from my due date, but the Dr. said that our baby was plenty big enough, so she went ahead and did a C-Section (which was not planned). Turns out the cord was wrapped around our daughter’s neck twice!! She was fine though, a healthy 8 lbs. 4 oz.!
A Birth Plan what is that we never made it that far.
At the 23 week mark (and honestly earlier then that as well) my feet were swelling then my face and hands would be swollen in the mornings when i got up it got to the point where my hands would swell so much that i could not make a fist or type (not good when you work on a computer all day) and at first i thought this was all normal part of pregnancy at 26 weeks and 5 days i called the dr and will i was waiting for a call back i got really sick and my side was killing me. So they have me come right in my blood pressure is sky high so they have me lay on my left side to see if it will come down no good we end up doing and ultrasound to see how big my baby is and if she is head down. This is when we found out we were having a girl and my baby girl looked like she only weight 3 pounds at the most. We were told that i would be having the baby that day and to go to the hospital. Thankfully they were able to get my blood pressure under control and i was able to spend a week in the hospital and at 27 weeks and 5 day my liver was going into failure and i was rushed in for a c section. My baby girl weight 2 pounds .02oz, and spend 6 weeks in the nicu. So not at all how i planned it and after 3 years i still feel bad about it not so much the guilt of not how i planned it but more of what we missed out on. But i have a beautiful healthy 3 year old and that makes it all worth it.
First of all, AMEN to this post. If expecting moms out there take only ONE thing away from this discussion, it should be JUST HAVE THE BABY!
Like the other commenters, I had a big surprise for delivery, even though I had “planned” what I wanted! Since this was the only baby I was going to have, I was determined to tough out the contractions as long as possible, then get an epidural, then delivery the “normal” way. I also wanted the lovely music, the soft lights and my favorite pillow. I even had my “focus” picture picked out.
Of course, none of that happened! I’d had a difficult pregnancy all along, and close to the end, I developed gestational diabetes, which contributed to me having TONS of extra amniotic fluid. At 32 weeks, after major Braxton Hicks contractions and a positive FFN test, I was put on bed rest… for two months!
Finally, after all that waiting and worrying, my doc decided to induce me at 38 weeks. Since I had so much amniotic fluid, she wanted to be the one to break my water so the cord wouldn’t prolapse (come out) before the baby! So, after she induced me and broke my water, I had some horrendous contractions, and “gave in” and had the epidural.
Awhile later, the nurse came in to check me and when she pulled back the sheet, there was blood EVERYWHERE. Suddenly there was all this activity and monitors and people asking me if I felt okay. Both the baby’s and my blood pressure dropped dangerously low, and next thing I know the doc is saying “We need a c-section STAT.” Definitely NOT in my plan! They put me under completely (even though I’d had the epidural) and I woke up later being told I had a daughter who was struggling a bit (her apgar score was 3 the first time and 2 the second, and she was on oxygen).
Anyway, it all ended well, and I have a beautiful 2 year old sweetie pie. But I always felt so “disconnected” from the delivery. The hardest part was that it felt so unreal that I had had her, and I didn’t get to see her until 8 hours later. I think that really contributed to my PPD and guilty feelings that I didn’t “bond” right away with her. I wish I’d just “gone with the flow” as it were, and relaxed about the process.
I’d seriously be surprised if anyone had the delivery they were expecting, so THAT is what the “norm” is! Just talk with your partner and your doc about what the possibilities are, and remember the goal is a healthy baby!
A few points:
Just to chime in for the PP, I actually *did* have my ideal birth (short of unrealistic hopes and wishful thinking that I’d only labor for 4 hours!). I took a combo of the alternative-medicine and the ‘Maui Hippie’…no drugs/no IV, free-standing birthing center, baby didn’t leave the room, etc. I realize that I was lucky, and yes, there was talk of the hospital after I’d have contractions every 5 minutes or so for 14 hours of getting a shot of some drug so that I could get some rest before pushing time. But then I sat in the tub and I was in transition a bit after that.
Second point, I find the description of ‘Maui-Hippie type’ quite rude. I’m planning a home birth w/ my MW for my second child, and I don’t feel that I fit into that category. I think it’s not helpful to put people who might want a birth like that into some bucket that doesn’t describe them well. If you were speaking of a particular person that you had in mind (as in your ‘pain-fearing friend’) then you should say so.
Third, I agree that having a healthy baby should be the primary concern, but I don’t think there’s anything wrong with advising people to think about what they’d like instead of just following the doctor/nurse/hospitals. There are still plenty of hospitals out there (not necessarily with ‘mean, nasty doctors’) which simply have out-dated or overly ‘hands-on’ (ob’s) policies or procedures regarding birthing. I have several friends I personally feel had emergency c-sections that were not necessary. The increasing number of midwives in the US is helping to change this. Maybe our c-section rate will eventually decrease to match those of other industrialized countries.
Last, a technical point: In Google Reader (running Firefox 2) your double quotes and your bullets are showing up oddly, as sets of question marks.
Ahhh, yes. I’ve stepped on some toes. I knew I would. But you’re not reading “Parent” magazine, are you? You’re reading BabyShrink. And since I only this weekend started making coffee money from this site, I’m beholden to myself alone for my posts.
I guess the “Maui Hippie Type” reference is mine to make, since I grew up with the flower children and shop at Mana Foods in Paia every week. (They are my peeps!) And of course you want to be advised of your options, YES, there are great birthing centers out there, OF COURSE there are wonderful doctors (mine among them), yadda yadda. That’s not my point, and I think the other commenters are seeing that.
My point is this: Society puts too much pressure on us to have that great birthing experience that you, luckily, had. Many of us are not so lucky. I hope people will see that the pressure to somehow “perform” up to this unrealistic standard is contributing to the increase we are seeing in postpartum depression.
But I do appreciate your comment, and I hope you’ll stay tuned, but you might want to take a deep breath, because I’m about to write about the whole breastfeeding thing.
(And thanks for telling me about Google Reader. I’m clueless about that. Can anyone help? I’m sending out an “IT SOS”!)
Sorry in advance this is so long- it’s just such an important topic. I have yet to see anyone with a birth plan that goes off without a hitch. Everyone I know has run into Mother Nature, who always has another idea about how your experience will go.
First baby in 1992- Moved 1000 miles to a new town less than 4 weeks prior to delivery. Started over with a new (very old, old school) doctor. He completely ignored my idea of a “birth plan”. He also used a vacuum on my baby to get her out when I’d been pushing for two hours straight after a non-induced labor. He also did an episiotomy because it was “standard procedure”, and then everyone forgot to tell me how to care for it upon our discharge from hospital. Drugs: none. No time for them. Total time in active labor/delivery mode: 6 hours.
Second baby in 1994- PCP was a pair of certified nurse midwives working in partnership with a male OB/GYN. Baby was a week late, so we opted to induce with the gel on the cervix. This was really low-key. Lots of walking, in and out of the tub, etc. My CNM was on vacation (of course) and her partner CNM was not available all day due to a seminar she was attending in another county. This led to me having my water broken without my consent or even a warning he was going to do it by the male OB/GYN of the practice. He just reached up in there with his handy-dandy orange stick and popped it open- no warning, no nothing. Naturally, active labor started like a freight train coming down the Rockies after that. Nice bonus, only two pushes and the kid was out. Drugs: none for pain, only the gel for induction (which wasn’t very effective). Total time in active labor/delivery: 45 minutes.
Yes, I know full well I had it easy compared to many of my friends who endured 36 hour labors. I don’t judge those who use the epidural- I would have if it was an option for me in either case.
Birth plans serve a purpose of making you really think about all the things that could happen during your birth process. Just because you get it down on paper doesn’t mean it’s going to happen (or should happen) that way. Most importantly, a birth plan should not be used as an instrument to measure the success of your birth process, your future success as a mother, or as a measure of any kind. No one should be criticizing themselves or others for failure to adhere to a birth plan.
Every birth is different, and women should be less critical of other women’s choices in how they give birth. Both of my kids were born in hospitals because I felt safer that way. That does not mean I don’t support people who home birth. I know people who have done home birth successfully, and those whose home birth plans went terribly awry.
In that case, the mother ended up at the hospital with a c-section (cord around baby’s neck 3x) after two days of laboring at home with a doula, acupuncturist and midwife. She was convinced she’d “failed” at birthing, and was so depressed about it. We made every effort to assure her that her beautiful, healthy baby girl was all the “success” she needed, and the process itself was far beyond her control. Mom was so focused on her “failure” she didn’t get to experience the full “wow” factor of having her daughter.
Is the birth plan really just another means to lull moms-to-be into the idea they can achieve some kind of perfection? Is this part of those first steps moms take in becoming more concerned about controlling how things go rather than enjoying/experiencing the journey itself- from the birth through their kid’s childhood? Choose your battles, ladies. When it comes to birthing, Mother Nature’s gonna have a big edge over your birth plan.
MBD
My partner and I took birthing class at a local birth center but delivered in a hospital. The best advice I took from the class was that if you want to know how your labor and delivery will proceed, ask your mom and sister. Your neighbor/friend/stranger in the grocery store’s horror story of a 60 hour labor is just not a good indicator of what will happen for you.
Sadly, I have no sisters and my mom had two c-sections so I had no clue what to expect. Writing a birth plan was a way that I could visualize a positive experience and calm a lot of fears.
The birth plan also gave my partner and I an organized way to discuss our feelings and set expectations on different aspects of the birth. We considered it practice for developing parenting skills.
Finally, the birth plan was a great way to inform the hospital staff that the women in my family have a history of reacting strongly to narcotics (as in paranoid hallucinations) which was the major reason I wanted to avoid drugs. I don’t know if I react the same way and didn’t want to find out in the middle of labor. The hospital staff does ask around a million times if you are allergic to any drugs but when you are in the middle of a contraction, it is nice to be able to point.
I don’t think the major point here is to NOT have a birth plan, it’s just that you shouldn’t get hung up on your delivery going according to that plan. I think it’s extremely helpful to have in mind what you want (no drugs, soft music, midwife, etc.), but if you are holding that as the absolute, then you WILL find yourself disappointed.
This is not about choices or personality types or anything like that. It’s about us, as women, giving ourselves a break during one of the most stressful, painful, unbelievable moments in our lives, and finding in that moment the unbelievable joy of our accomplishment, no matter HOW it was achieved.
…can’t wait for the breastfeeding post…
MBD:
As always, your perspective is so helpful. Yes, choosing our battles is what I am all about!
JD:
Yeah, I have some drug allergies too. I did write it down originally on my birth plan, but we couldn’t find it! I do also agree that thinking things out ahead of time is extremely valuable. It’s just hard not to get stuck on those ideas, then disappointed if it goes a different way. So yeah: think ahead. But remember to go with the flow, once you get there.
KATIE KAT:
Thanks for cheering me on! I must admit, I’m getting a little nervous about the breastfeeding post! I am letting it percolate a bit so that I can figure out how to get my point across, without getting flamed too very much. Look for it (hopefully?) late tonight/early Tuesday.
Wow - Someone who WANTS to hear my birthing story! All my friends are so “shut up already!”
I too was a control freak who was very focused on the “Birth Plan”. My plan was to not go to the hospital until my contractions were no more than 2 minutes apart and have a drug-free, pitocen-free, no episiotomy, and midwife delivery.
Three-days after my delivery date at the Italian restaurant for Eggplant Parmesan (7:00pm). I placed my order and stood up to greet my husband, and my water broke – gushing down my legs. Not to worry! I had PLANNED and had pads and a change of clothes in the car “just in case”. So, the natural birth books said be sure to eat a good meal (although nothing heavy) because once you get to the hospital they’ll stick an IV in you and won’t let you eat for hours blah, blah. So I partook of the salad and rolls. Let me just say, I’ve not eaten Italian dressing since! I leisurely returned home to take a nice shower, fix my hair (so I’d look great in the birthing pictures!),cleaned up around the house, did some laundry etc… We showed up at the hospital at 3am where they proceeded to IV me and stick in the cervix softener thingy since I wasn’t dilated (at all!)
My contractions kicked in and I continually refused the epidural even with contractions maxing out the monitor (120+!!!) and after six hours hadn’t even dilated to 1cm! By then I had been vomiting for four hours straight and was running a fever of 102. They said they HAD to get my contractions to go longer and stronger (are you kidding me!) with the help of Pitocen. Since my contractions were already off the charts and it felt like my pelvic bone was being broken in half over and over, I consented to the epidural. What they don’t tell you is if you wait that long you have to have two bags of fluids BEFORE they will give you the epidural – it took TWO HOURS. Then 8hrs later and 4 bags of pitocen, I had dilated to a whopping 1 ½ cm, running a 104 fever, and the baby was beginning to show signs of distress. Needless to say I consented to a c-sect because I knew even if I magically dilated right then, I had no energy left to push.
If I had to do it all over again my plan would be:
-Schedule my c-sect two weeks before my delivery date
-I would still breastfeed but I would pump and allow bottle feeding from the START (yes – the book says not to introduce the bottle until 1 month – however you could end up with a child who refuses the bottle until they are FIVE months old.)
-Hire a MUTE cook/housekeeper to stay with me for two weeks AFTER we came home from the hospital so that there would be someone there to focus on ME not the baby and who would not bombard me with constant advice.
-Delay telling my mother that the baby had been born for a month after the fact to give my hormones time to settle down.
-In the first few weeks after the birth, if the baby was sleeping, I would NOT wake her up to feed her. I would continue to sleep myself, because I now know it is the calm before the storm!
I’ll just sum up my delivery:
Hospitalized for a week due to toxemia.
Induction.
23 hours of hard labor.
Baby wouldn’t descend.
Heart rate started to drop.
Emergency C-section.
Best part? Being given a magazine to read in recovery (before I even got to hold Little Boy) that featured a prominent article about how c-section babies would never bond with their moms as well as natural birth babies would. Stupid male nurse.
Lorie D-
Oh, honey, you have my sympathy. Sounds like sheer agony. You know, if men had to give birth, the human race would die out within two generations.
BabyShrink- I’m so glad to see women telling the real truth about their birthing experiences. Women need to hear the good and the bad. There was a post back when BabyShrink first started where we talked about how some folks tell moms-to-be how perfect everything will be, how it will be so “natural” to be a mom, how you’ll simply glow from the joy of being a new mom, etc. Now, don’t get me wrong, I love my girls and I wouldn’t change a thing, but the transition to new mom was not easy, not glowing, and more exhausting than anything else. I don’t want new moms to be terrified by scary birthing stories, but they do happen, and it’s better to be prepared. I want to see new moms be less tense about the control thing, and just take in what’s happening without feeling like they’re being cheated out of the “perfect birth”. I know, sounds a little “Maui Hippie”, right? Well, so be it. I’d rather be the Maui Hippie (which I don’t find offensive, as a West Coaster) in that case.
MBD
I’d just like to add my vote to the sentiment that being prepared for what might happen at the birth is different than having a list of things that *must* happen for your baby to be born in the “right” way. The first is just educational, the second sets new mothers up for a fall.
Since we’re all sharing, I had an induced birth because they were “relatively sure” I was developing preeclampsia/toxemia…
Well, after my longwinded comment…I failed to mention the psych aspect… Even after what most would consider a dificult birth, in the middle of it I didnt think it was that bad.
What bothered me most though was even after all the reading & researching during pregnancy, once there were complications it was hard to stick to my “plan” because there was someone else’s life to consider other than just my own (the baby!) I may be willing to take risks and “go with my gut” with just myself but to risk my baby was unthinkable.
The problem was - how to know what’s best - what the books had said, what the doctor right in front of me was recommending, or go with my gut…
Now if that doesnt sum up the quandry of parenthood in general, I dont know what does!
yes, Yes, YES!
There is too much pressure on women to have the “perfect” birth. People who think the only way to give birth is the “natural” way forget how many women (and babies) DIED before there were hospitals. I am always so afraid when I hear my friends saying they will be having their babies at home — I ended up with an emergency C-section, and I was so glad the doctor was right there. Today I have a beautiful, healthy baby, and that’s all that matters — and the scar is even below my bikini line!
JESSIE:
Ugh. Just what you needed, after what you’d been through!
ATTITON:
I agree. I do wish that the way the “Birth Plan” is often presented would be more along what you suggest; educational as to what COULD happen, as opposed to implying what WILL happen. It really should not even be called a PLAN, should it? Really, just some preferences, given a choice.
LORIE D:
Yeah, that’s about it!
I do hope to address just that issue more over time here at BabyShrink…How to know what our “gut” is even saying, and is that gut feeling coming from fear? Defensiveness? Or Mother’s Intuition? That question is raised a lot here, and I will tackle it soon!
Well, along with everyone else…
I lost my plug at 32 weeks. I called the doc to let them know, the nurse said, “No problem.”
At 33 weeks, I was put on bed rest for pre-term labor. At 35 weeks, I started full-on labor, although because I wasn’t dilating, they didn’t believe me. After 8 hours in the triage area, a nurse ACTUALLY SAID TO ME: “If you think this is labor pains, wait until you actually feel them.” Had I not been having a contraction, either I or my hubby would have knocked that woman out.
At hour 22, they figured out that I had an infection. I had a hig fever, baby had a high fever, and my WBC was skyrocketed. My doc was ready to get him out. Yes, 22 hours of actual labor (not counting the per-term contractions) before I GLADLY welcomed the epidural. (Anyone who says you are less of a person for having one deserves to be smacked.)He was delivered “naturally” after 28 hours of labor. Avery was 5 weeks early, spent 11 days in the NICU, and is now a relatively healthy (albeit short) 18-month-old. What a beautiful tow-head he is!
ILIMA99:
Oooooh, the “home birth” issue. How many other controversial topics can we raise? Let’s just say I’m glad YOU did, not me!
But your point is important: We have the luxury of arguing over these issues today. We are worrying about whether we have an epidural or an episiotomy or a c-section today; we’re NOT worried about dying in childbirth, (at least in this country).
AMY:
I would be more upset about that nurse and your situation if I hadn’t heard so many similar stories. It’s pathetic that ANY patient could be treated that way, let alone a laboring mother. Ugh! Thank goodness everyone is OK now.
Great topic. Again! If I had not been so attached to the idea of having a natural birthing experience I would not have laboured for 31 hours only to end up with an emergency c-section anyway. When things started going badly, instead of going along with the suggestion of a c-section, I dug my heals in and WOULD NOT GIVE UP. For some stupid reason I had this idea that by having a C-section all of my labouring would have meant nothing. All of the lamaze, yoga and god awful kegel excercises would be rendered pointless. I would say that lamaze classes might be useful for some people but they left me totally unprepared for the reality of childbirth in today’s medical practice. I was one confused woman when my water broke and I was feeling no signs of labour. It went downhill from there. I didn’t want a c-section and therefore imagined it simply would not happen. It was chaos when it did and I was faced with going home with a baby and needing far more help than I expected. Perhaps if I’d considered the possibility more I would have put some plans in place. The first few months are so hard and spending even a minute feeling badly or guilty about the birthing experience is pointless. Yet, so many of us are doing it.
HI LORI:
It seems that those of you who both had to go through labor and THEN have a c-section have much lenghtier (and more painful) recoveries. And you’re saying that the misinformation (or lack of information) you received contributed to that outcome.
Isn’t that a shame? What a setup for a sense of failure, at a time when we should be focused on how miraculous it is to have a healthy baby (and Mom!) when the process of childbirth in other parts of the world is still so dangerous.
I do want to say, for the record: My sister delivered in a birthing-center and had a great experience with the midwives there, and many of you have similar experiences, so I don’t in any way want to send any negativity in that direction. I just wish that more childbirth professionals of ALL stripes would provide more realistic information about what to expect before, during and after delivery; what the possibilities are, and to try to minimize unrealistic expectations.
BabyShrink,
Thanks for telling it like it is! My “plan” when out the door when I was induced and having contractions less than a minute apart and only 2 cm dilated. The nurse was supportive but leveled with me that it was going to get worse- yeah, epidural please. I didn’t feel guilty because I knew I would have been exhausted and it was a hard enough delivery (almost emergency c-section) as it was. So when number 2 was on his way, I did go into labor on my own so I had an idea that I might be able to pass on the epidural. The contractions were just like before. Really close together right from the start. I had no problem asking for an epidural on my own this time. A lot of women wear the “natural birth” experience like a medal of honor, when asked ( or not ). I have refused to feel ashamed. Now breastfeeding, lots of guilt there, I’ll head over to that post…