The “Birth Plan” — a lesson in futility
September 17, 2009 by Dr. Heather
Filed under Babies, Motherhood
A first-time expectant mom asks:
“Do you recommend any techniques for my upcoming labor and delivery? Does anything, in your experience, make things easier or more manageable in the delivery process? I’m trying to develop my Birth Plan. Thanks for your help!”
Seeing as though we’re expecting my FOURTH labor and delivery in a few weeks, you’d think I’d have loads to suggest to this first-time mom. But you know what? I GOT NOTHIN’. Nothing! Each time I go through it, I’m reminded at how utterly out of control we are…in life in general, but in the birthing process in particular. Now yes, I know there are all sorts of techniques and approaches out there. And I know many of you have fruitfully used Bradley, Lamaze, hypno-birthing….yadda yadda. Whatever. The truth is: NONE OF IT REALLY HELPS. It’s all an illusion to help us feel like we’re more in control.
Well, let me backtrack a little here. See, I’m up at midnight right now with a terrible case of heartburn, an aching back, some weird pregnancy-related skin condition and no way to sleep comfortably. There’s a wriggling, basketball-sized being in my belly, and I’m sick of my maternity clothes, many of which are starting to get tight. So I admit it: I’m a little cranky. But when I get on the topic of labor and the infamous “Birth Plan”, I get a little MORE cranky.
Let me break it down for you: Labor is unpredictable. Labor can be dangerous. Not so long ago, women used to die all the time in labor. The point is this: We shouldn’t get too picky about the labor process. Thankfully, the vast majority of women (in developed countries), today, survive the process just fine. But the notion that we can control for all the possible complications that can happen is just plain wrong. And it’s human nature to react to an out-of-control situation with the fantasy that we really CAN control it. But it’s harmful to mothers out there who buy into the notion that they CAN and SHOULD control their delivery process…because many of us CAN’T, and then feel inadequate as a result.
I’ve heard heartbreaking stories from moms who felt guilty and disappointed because they couldn’t live up to their “Birth Plans”. Moms who felt scolded by their doctors, nurses, or midwives for going against the particular birthing approaches of the practice…mothers who changed their minds about pain control, or what kind of labor support to use, or even whether to scream and yell during labor. Mothers who had to have emergency C-Sections, who delivered prematurely, or who had bleeding problems. A close relative of mine recently delivered and had a really unusual — and completely unpredictable — complication that left her bedridden for more than a week, and on a walker for another two weeks. These things happen, and Birth Planning can’t prevent them. And many moms feel inadequate if they can’t live up to this supposed “ideal”.
There is a mistaken notion that labor and delivery are somehow the culmination — the end point — of a process. After all, we go through a 9-month process to grow and deliver this child, which is truly a miraculous experience. But the truth is, LABOR AND DELIVERY ARE ONLY THE BEGINNING. Choices we make during pregnancy and delivery are actually the first parenting decisions we make. And that’s the beginning of a life-long process; how to best parent this child we deliver, in whatever manner we choose to, on that miraculous day of delivery. And how best to roll with the punches of life, and still feel confident and satisfied with ourselves. After all, that’s an important life lesson to impart to our children — the ability to be flexible and adaptable to life’s curve balls. The attitude that we can and will be “light on our feet” in the face of the unpredictable changes of life.
When seen that way, I think it’s easier to see the process in perspective: The ultimate outcome is what’s most important about labor and delivery. Forget techniques: You want a healthy baby and a healthy mom at the end of it all.
So, if a rigid Birth Plan isn’t helpful, what IS? Here’s what I recommend:
Thorough education about the process of labor and delivery. It really helps to understand what the “transition” phase is, in particular, and how you’re likely to feel during that challenging time. I always vote for more knowledge and education to help get through a novel situation.
First-time parents really benefit from Infant Care classes, at least as much as from Labor and Delivery-type classes. Infant Care class helps answer lots of the questions you’ll have about your new baby, and will take some of the overwhelming mystery out of caring for this new creature. It also helps to keep your focus in perspective; this is all about becoming a parent and taking care of your child, after all. Labor and delivery are just a momentary blip at the beginning of that process. The REAL hard work is the parenting!
Working knowledge of some type of breathing exercises. I’ve tried them all, and for me, the breathing techniques I learned in my regular yoga classes helped the most. Experiment with several. During labor, see what works. Often, breathing techniques are only useful UNTIL you get into “transition”. At that point, do what comes naturally. I recently read a study that says swearing and cussing actually help us decrease our experience of pain. I plan to try that this time!!!
Accept the fact that you’re jumping off a cliff here. Things will feel out of control at some point in your labor and delivery; maybe more so than you’d like. Keep focused on the outcome and don’t worry about the process. It’s temporary!
If you want to read more of my Birth Plan rantings, check out this post here. And I’d love for experienced parents to please post about your birth experiences, and whether your Birth Plan proved useful to you. Also, let us know your suggestions to first-time expectant moms!
Aloha,
Dr. Heather
The BabyShrink
I really struggled with my “birth plan” with my first baby. I read just about every book I can find, and listened to every podcast, and really struggled with what I should plan to do for the birth of my baby. At some point, though, I realized the real issue was that I was scared of giving up control to the doctors and nurses in the hospital. Yet, there was no way I was going to avoid it (a home birth is definitely NOT for me). I realized that for me the most important thing was just to make sure that I really trusted my doctor(s), and that if I could do that then everything else would take care of itself. I planned what choices I could make, and what choices I would make if I could, but I stopped worrying about controlling every aspect of my experience.
Now I am pregnant with #2 and am finding the thought of giving birth hardly scary at all. And, while I trusted my doctor before, this time (thanks to better health insurance and a move) I have a doctor who I absolutely love, and that makes me feel even better.
I remember when, in one of the many books I read, I found a chart showing a survey where different women rated the pain they felt in labor, and the percentage that rated childbirth at the various levels. This chart shocked me because I finally realized different women experience pain differently in labor. Yet every book and person I talk had talked as if labor was a single experience that everyone experiences the same! And, I had read a lot of books! Until I went through it I could not know what to expect, but no one wants to tell you that because most people assume that everyone’s experience is just like theirs, despite the huge amount of evidence to the contrary.
Fantastic advice and so true! It’s great to go into labor with a game plan, as long as you’re prepared to let go of it if your body and your baby decide to throw you a curve ball.
I also second your advice to take an infant care class. I wish I had done that.
Excellent advice. As one who had some major complications thrown her way in both labors, I know that you need to be flexible.
Labor #1: Went pretty well until I hemorrhaged at the end and was on 2 weeks bed rest afterwards. I was VERY, VERY sick while in the hospital (BP of 90/40 made me pass out at one point) and don’t really remember my son’s first day of life. Hubby held him most of the day. I used to feel guilty about that, but honestly, if I had tried to have this kid 50 years ago, hubby would be a single father, so I have to give myself a break for not being totally with it that first day.
In between baby #1 and baby #2 I found out I had a blood clotting disorder (I clot slow, which explains what happened after labor with baby #1). Because of this, I cannot get an epidural. So, 40 hours of on and off labor and 6 hours of hard labor (baby was not coming down, he was stuck), with NO epidural, I was screaming with my contractions. I swore I’d never do that. Breathing worked until my contractions hit 110 on the monitor thing (80 is a good productive contraction according to the nurse) then all bets were off and screaming worked better LOL He was eventually born vaginally (almost a c-sec though!). But again, birth plan out the window as complications set in!
It’s great to have a plan, but don’t feel guilty for adjusting it as all hell breaks loose in your body and you have little control over what is happening.
My emergency section threw my plan out the window. I was glad I had spent a lot of time learning about labor because I was able to rationally follow what was going on rather than feeling bullied by the OB.
I remember a friend whose birth plan (for baby #3) was “I will have a baby.” The midwife really pressured her to add more details as though it were some flow chart that needed every possible permutation covered to the level of how many candles should be lit and when. It was a bit bizarre.
I personally think the whole “birth is unpredictable – you shouldn’t try to control it yada yada yada…..” thing is about doctors wanting to have as much control as possible – and not wanting patients to ask too many questions or insist on things like evidenced based care or truly informed consent. I’m sure this isn’t the case with you Dr. Heather – you seem lovely. But I do think that all too often behind “birth is so unpredictable” is the doctor thinking/believing and maybe even saying “just leave it all to me – I’ll take care of this messy uncontrollable business.”
Birth is predictable to the extent that, according to WHO estimates, 85%-90% of the time a woman can safely deliver her baby vaginally if given adequate support and subjected to minimal interventions. The roads we take to get there may vary – but in most cases the destinations can be pretty much the same.
Hi Louise!
Just to clarify, I’m a doctor of psychology, not an MD, so I don’t do deliveries myself.
Your comment underlines the importance of seeking out an obstetrical provider who works WITH YOU…medicine is just like any field; there are “the good, the bad, and the ugly”, in terms of quality of providers. If you have a provider who is condescending or patronizing — keep looking. There are great providers out there — doctors AND midwives.
Hi Dr. Heather,
Thanks for the clarification on your professional status. I did pick that up when I read your profile – after I left my comment. Oops!
You are so correct that there are “good, bad and ugly” in every profession. The thing is, the national c-section rate is over 30% – more than double WHO’s recommended maximum c-section rate. And as I’m sure you’ve heard a million times, the women and babies of this country are no better for it. So, it seems to me there is more going on here than a few “condescending or patronizing” health care providers. Imho disrespect for the NATURAL birth process and women’s ability to birth without technological interventions has become institutionalized. It is what the medical establishment believes is true and right. They don’t have to be bad or ugly to practice their art in the way they have been trained to believe is best. But for most low-risk women, studies show, they are wrong.
So when a woman who comes to birth with only her own research and an intuitive belief in her body’s ability to do the work before her, is confronted with authority figures who believe just the opposite – all too often she is set up to “fail”. Imho birth is considered universally unpredictable, frightening, and dangerous because our care providers tell us it is. And I assure you, as a woman who has given birth to a full term stillborn son, along with three other living children, I have great respect for the risks.