I'm going to give you some straight up talk about birth plans, from the L&D nurse point of view, ok?
It's not always going to be pretty, flowery, shooting rainbows out my butt kind of talk either. Because, let's face it: sometimes things don't go as we like or plan. I invite everyone to agree or disagree to any and all parts of this post.
Birth plans and the L&D nurse: most, but not all, nurses will laugh and poke fun of your birth plan. Without a doubt, the longer your birth plan, the more laughs it will get. It does not mean that the nurse is being mean. It does not mean that the nurse doesn't agree with all or part of your birth plan.
It simply means that the longer your birth plan, the less likely you will have that birth plan followed.
So, the shorter the birth plan = the more likely it will be followed.
(Yes, I know, and I totally agree that laughing at someone's printed birth desires is not nice. It's wrong, plain and simple.)
Back to the birth plan.
Actually, let's back up even more. Let's go to the beginning of your pregnancy.
Rule #1: CHOOSE YOUR PROVIDER(S) WISELY. I cannot state this enough. Choose someone or a group of someones that will mesh with your pregnancy/labor/birth wishes. (Hint: don't go to a big medical group of physicians if you want someone to support natural childbirth. Pick a group with midwives, or pick and all midwife group, or go for a solo midwife practitioner.)
Rule #2: SHOP AROUND FOR YOUR LOCATION FOR BIRTH. I know that sometimes this isn't possible. Maybe your insurance dictates who/where you can go for birth. Sometimes you're stuck with whatever is available in your location. Well then, call the nurse manager or charge nurse of the L&D unit so you can talk to them (face to face is ideal) about what the typical birth practices/protocols/guidelines are. If this person hedges and refers you back to your provider, this is a red flag. Yes, the provider is who "orders" (writes orders, that is) about what happens in labor (IV or not, oral intake or not, pitocin or not), but it is YOU who ultimately dictates agreement or not to these things.
Rule #3: TALK OFTEN ABOUT YOUR BIRTH PLAN/WISHES. Talk early, talk often with your providers.
Rule #4: BE FLEXIBLE. You have no clue how things will go down when labor (or not!) actually starts. What if your water breaks, but labor does not begin on it's own? How long will you wait before doing anything to stimulate labor? How long is your provider willing to wait? What options do you have to stimulate labor? What happens if you do absolutely nothing? What happens if you want a natural childbirth, but you find you change your mind in labor? What are your options? Know your options! Be open to options! Being open to options does not mean you are "failing" at your birth plan. You don't have to take an epidural if you really, really don't want to.
What if your baby shows signs of distress? Remember that a good provider cares not only for your birth wishes, but cares that your baby has a good outcome too. Ask your provider to explain to you what exactly they feel is going on with your baby, if the baby is showing signs of distress. A good provider, a good nurse will explain what is going on. If they don't explain - ASK!
Rule #5 - KEEP BIRTH PLANS SHORT. The longer the birth plan, the more rigid it is. I have noticed that the more rigid the plan, the more control a woman/couple is trying to exert over something that quite literally cannot be controlled BY ANYONE! Labor is unpredictable. Labor cannot be controlled, no matter how hard *we* try. (We = the woman or the provider.)
I have noticed that the longer the birth plan, the greater attempt at control, the more likely that the woman will not get the birth she desires. The increased chance of pitocin, epidural and eventual c-section.
Keep it short and sweet. Many things can be excluded from your birth plan/list.
Here is an example birth plan/preference list:
"I would like intermittent auscultation, as long as my/my baby's health status permits. I plan on natural childbirth, so please do not offer me pain medication, unless I request it. I have no required medical reason for an IV (GBS status is negative), but I have no problem with an IV only if and when it is medically indicated. My baby will not be separated from me unless it is medically necessary. I will remain flexible in my desires for my birth, pending my health and my baby's health status. I only want what is best for my baby and myself."
Don't go into great detail about freedom of movement in labor, lights down low, no students, plans to breastfeed, no supplements, etc, etc, etc. Many of those things you can control in labor. Get up and move in labor. Turn the lights down. Use the tub/shower.
Speak up, talk to the nurse who admits you to L&D about what your plans are. Many times, she's going to ask you some of those questions anyway!
Now readers, it's your turn. What have I missed? Am I off my rocker on some of these things?
PS - I, the L&D nurse, wrote a simple birth preference list (like above) for my 3rd child, when I was pregnant with her. I gave a copy to my providers early, talked about it frequently, and also gave a copy to the admission nurse on L&D. Each and every thing that I wished for my birth happened. Yes, I had to fight on some items, but it was a quiet fight - passive aggressive almost. My baby was healthy, as was I, and I simply kept her by my side and didn't allow the nurses to take her to the nursery. My kid, by my side. Simple as that.
32 comments:
I rarely write birth plans, or give them to anyone anymore. Last time the midwife said to NOT write one, really. You are right on picking your provider, because my midwife and I discussed my desires so much and she followed them to the T.
I personally requested stuff as we went, voiced my desires once in the hospital. When you say to a nurse, "I've never had the baby up on my chest and if it's possible, I'd like to hold my baby right away and I'd like all medical stuff done there" they listen. There was mec last time, and I got to hold my baby right away.
Now, I did have a TERRIBLE nurse as you know one time, and I didn't write out a birth plan but had in mind a natural move around birth. She didn't...she wanted me in bed on the monitor with water broken and monitor screwed in my baby's skull. Mo bathroom, and many cervical checks...many. She was horrible. I didn't ask for a different nurse, and I wish I did. So, I would be friendly and flexible, but if the nurse is NOT AT ALL NICE...send them on their way. You never know who you're going to get. I've had such nice, helpful nurses and I've had one real pain. Out of 7 babies, that's not too bad.
Blessings!
Dawn
For a lot of hospitals in our area, the signed birth plan stands as an order. So I tell women to be specific - if you want something besides clear fluids it needs to be on the birth plan. I think you're a little off on keeping those things off of the paperwork.
I'm on my third birth and my first birth plan. In my great state, there are no midwives working in the hospitals, so there's no chance of finding a group of midwives to work with unless I stay home. I'm over 45 minutes from the nearest hospital, so I'm just uncomfortable giving birth at home.
However, I'm working on a very brief birth plan and I've gone for very, very short format. I figure a good idea of my wishes can be gathered from about one page. The area I live in seems to be very slow to move away from a non-medical stance on L&D.
As much as I wish things were different---as a fellow OB RN, I agree with most of what you said. My biggest recommendation for women is exactly what you said above:
Don't bother putting in things you can control--lights etc.
We have a hospital issued check list type plan which is actually pretty helpful.
I'm not sure if I will write a plan for my second birth. I'll be with the same midwife group and same hospital as with my first. I think my ideas were respected but the plan wasn't really read by the nurse.
Or I'll do a really really brief one and leave out all the things I can probably just do myself (lights, tub)
Oh, how do you go about requesting a different nurse if it's just a bad fit?
My first nurse was not a good match, but the shift changed and I got a great one so that awkwardness resolved itself.
I think these are good guidelines and I advise my clients in a similar way. Narrow it down to 3 things for labor, 3 things for delivery, 3 things for in the event of a c-section, 3 things for immediate newborn care. Highlight the one "must-have" from each category. Attach the birth plan to a nice batch of cookies or something.
I think that the most useful function of a birth plan is so that a mom can get to know all of her options and talk about them with her care provider.
You know... I had a baby last year and one thing I had on my birth plan was that my husband was to announce the sex. But the jerky charge nurse announced it. Boo.
This was my birth plan for my second birth (planned C-section due to placenta previa - I had been hoping for a VBAC, but that wasn't possible with previa). I had been hospitalized for nine weeks when I finally had the baby.
Birth plan for E___ N___
Overview
As an overarching principle, it is very important to me that I be informed about what is planned and what is happening during my birth. While I am not a medical professional, I am a well-informed and well-educated layperson who is quite capable of understanding scientific and medical information. Please understand that while I may ask many questions, I do not ask them in a spirit of complaint, fault-finding, or lack of trust in my caregivers, but simply because I want to understand decisions that are ultimately made about my body and my child.
Requests
1. I want my husband, T___ N___, and my doula, J___ D___, to stay with me and the baby throughout the procedure. If it is necessary for us to be separated, T___ will stay with our baby, and J___ will stay with me.
2. I would like the medical staff present in the operating room to introduce themselves and briefly explain their roles in the birth.
3. Please keep me updated on what is happening during the surgery. In particular, I would like to be told when it is time for the first incision.
4. While I am willing to have one or both hands restrained during surgery, if feasible, please release them so that I can touch my baby with both hands after he is born. I understand the importance of maintaining a sterile field for the surgery and will avoid touching anything blue or anything I am told not to touch. Please allow me to hold my baby as soon as it is safe for both of us. If routine, non-urgent procedures (e.g., administration of eye drops) would delay my ability to hold my baby, then please defer them until after I have had this opportunity.
5. I would like to view the placenta before it is discarded or sent away.
6. I understand that the risk of hysterectomy is greater for my birth because of my history and because of the location of my placenta. If a hysterectomy is necessary, please inform me during the surgery of what is going on.
7. I want to try to breastfeed my baby as soon as possible, ideally in the operating room. If supplementation is necessary, I would first like to attempt to use a supplemental nursing system to augment nutrition received at the breast. Please do not give my baby a bottle or pacifier without first discussing it and obtaining explicit consent from me or, if I am not available, from my husband.
8. If it is necessary for my baby to be separated from me, please explain to me why and what procedures are expected to be performed out of my presence. (If the need is urgent, it is fine to wait until the baby is on his way, but please still explain to me what is going on.)
I'm curious whether you see many birth plans for C-sections, and whether this is in the "too long" category or not.
I am an independent Lamaze certified childbirth educator and doula. I love the six healthy care practices for Lamaze, and encourage my students to keep their birth plans simple, which is easy to do if your birth plan is the six care practices:
1. labor starts on it's own
2. freedom of movement
3. continuous support of mom's choice
4. no routine interventions
5. birth in an upright or non-supine position
6. no separation of mom and baby
more info on these, including some great little short videos can be found here:
http://www.lamaze.org/ExpectantParents/HealthyBirthPractices/tabid/251/Default.aspx
Keeping it simple, and letting normal birth happen!
Sharon Muza CD, (DONA) LCCE
New Moon Birth
www,newmoonbirth.com
It is SO MUCH more important that you pick your provider and facility wisely than what you write in your birth plan. Also luck of the draw on your L&D nurse has a lot to do with it too.
I gave my birth plan:
Mom prefers:
• To wear her own clothes during labor and birth
• To have the IV capped when not in use
• To consume clear fluids PO as tolerated
• To remain upright and mobile during labor
• To receive minimal cervical exams
• To push spontaneously
• To be coached quietly, firmly and calmly, please no yelling “PUSH”, counting or cheerleading
• To touch her baby’s head as he is born
• To have no drapes or towels over her while pushing
• To have her baby straight to her belly, skin-skin immediately after birth
to one of the practice midwives a few weeks ago. She said it was pretty much how they practiced anyway. I never went over it with my OB. I never needed to pull it out for L&D-my nurses were awesome. Even things I didn't mention like delayed cord clamping...happened ideally.
My choice of provider and hospital and luck of the draw on nurses made my birth, not a sheet of paper.
PS. I never went over the birth plan with my OB because he and I talked during the pregnancy. He knew what I was looking for and I knew his philosophy and I was pleasently surprised to find him even MORE natural, laid-back, mom-baby friendly than I had been led to believe.
My provider for my 6th baby encouraged me to write a birth plan at my 1st prenatal visit. When all was said and done, the short and simple plan I had written out (it couldn't have had less frills about it)didn't even matter. It was the worst delivery I ever had. My approach of being easygoing and open to how the process went seemed to suit me just fine in all my other labors and deliveries. I communicated quite a bit with my last doctor, too, but it just didn't go well. Good outcome, though, but very high emotional price paid. I do think a woman should think through her birth options and talk a lot to her provider about them, but be very open in every sense of the word. Great post.
"Remember that a good provider cares not only for your birth wishes, but cares that your baby has a good outcome too."
~~~I think that might be better phrased as "a good provider never loses sight of the well-being of the baby and mother, and as along as that does not conflict with the parents' wishes, will conform to the birth plan."
It's the baby that matters, NOT the birth experience. A good deal of the time, both goals are compatible.
I'm glad you make the point that, with birth plans, women are attempting to control the uncontrollable. Incidentally, at least 90% of the birth plans I've seen have been clutched in the hot little hands of primips. Multips know better.
Jeez... the reason I'm even reading this blog is because my daughter is due in 2 days and she was telling me about "birth plans". When I was pregnant in the 1980's, I don't recall anyone mentioning a "birth plan" to me, so this whole subject is new for me. My first thought when I heard about them is "Are they serious?" Is there ANYTHING left on this Earth that we don't have to try and control? Women have been giving birth to babies forever without the use of a birth plan, and things have been going along just fine that way. Whether you believe in the scientific aspects of birthing a baby, the divine intervention of birthing a baby, or both, the entire experience is a crap shoot. What will happen will happen, who cares about the lighting or what music might be playing? That baby is coming out one way or the other and it's pretty doubtful that the focus is going to be on the level of light or The Doobie Brothers Greatest Hits - the focus is going to be on the labor and delivery of the baby. No wonder the nurses laugh at birth plans, how could you not?
I was reading the cesarean birth plan and as always kept thinking...in my old hospital there was only 1 RN in the OR during a section...I did circulating and baby care once the NICU was done w/ baby. Of all the things I had to do I would have hated having this patient because she would have been adding on to everything I am responsible for and she was having a high risk delivery to begin with! Now before you say o how lazy...please realize that having a routine and sticking to it makes sure that I don't miss doing something important while on autopilot that still allows me to react to what is going on in the sterile field. I just hate it when things are not going well during the delivery and the staff is trying to handle it calmly and the patient is upset and demanding things that in the scheme of things are not a priority and can be put off for later...you have the whole rest of your lives to bond w/ your child if we are allowed to do our jobs!!!!
I think some Labor and Delivery nurses feel you don't trust them at the get go when you hand them the birth plan. Sort of like nonverbal behavior that says, "I need this written down because I know you will not listen and take me serious." So I think that insults and puts up walls right away.
I really enjoyed your birth plan post, since this is something that, in the ER, I am not familiar with. Great concept, especially when it is executed.
Well done. Made me think of what my wife would do...
Hope this finds you well, friend.
Interesting comments!
My (evolving) philosophy on birth plans is that they should be about what you can control, not what you can't. It's not a movie script, it's just a list of what you'd prefer. "I want to be allowed to push in a variety of positions, and to squat for delivery." You can't control whether you will deliver squatting. Maybe when it comes times to give birth, you're going to be too tired or baby only tolerates you being on your side or you're more comfortable on your hands and knees. You also can't control whether you'll be "allowed" to push in different positions - or rather, the only way you can control that is by 1) choosing a provider who is open to that and/or 2) actually GETTING in different positions to push, whether or not your provider likes it.
And, like you said, there are some things that are under your control without needing to specify them - you can turn the lights low and fill up the bath on your own. If you're concerned that you'll be too intensely in labor to think of things independently, then make sure your support people are ready to be proactive! And if you're not sure if they will be, hire a doula! ;-)
In the end, I think the best way to use a birth plan is for things you know people are fine with you doing, but it's not totally routine and they might need a reminder. In your birth plan: intermittent auscultation, no IV, no separation, no offering pain meds. In advance, you made sure that everyone was on board, and this was just a reminder that these were your preferences.
I will say, I think for some people, it doesn't hurt to put "no students" on there too if that's very important to them. I know as a nurse you might feel confident about recognizing and turning away students, but not all patients do. I talked to a mom recently who had people flood the room for her first birth as baby was about to crown and she was frightened. She thought something was wrong with the baby. When she asked the nurse later, the nurse said it was a group of students. This mom was surprised to hear that she could have declined to have students in the room. I think based on her previous experience, she might be more emphatic about that this time around, while other people might not care - if so it would probably help to state it up front.
I agree with all you say. I think that it depends so much on your care provider and birth location.
I have my doula clients and Hypnobabies Students write Birth Preferences - keeping them under a page. Bullet points are a great thing too!
I recently attended a 52 hour birth, mom had 4 different OBs. It was a great hospital which respects birth plans. The dad showed each OB and nurse the Birth Preferences at change of shift. They all read it and said, "looks good." Or it was a great starting point for a new topic. "Since your contractions haven't started yet, we may need to start thinking about pitocin."
Then they had a CONVERSATION about it. I LOVED it!!!
So it was a great springboard for getting everyone on the same page. Parents felt respected and were open to changing when circumstances necessitated it.
So I think Birth Preferences can be a great tool. However, if a nurse or OB laughs at it, then it isn't a tool at all.
I don't envy you at all.
I only wanted those kids out of me, oh and a nap after. Done and done.
Why not call it a "Wish List" rather than a "Birth Plan"?
I usually don't mind birthplans at all (I mention birthplans in one of my latest blogs). I know there is superstition among OB RNs about the "hex" of a birth plan but I still think it is important to mention anything u would wish thru labor. Point form is the best. Put stars by the most important "must haves". Definitely discuss with care provider ahead of time, and definitely I like what you said re: mostly it is out of a woman's control- the way a labor will progress..... :)
I'm not in the US, and was encouraged by my homebirth midwife to write a birth plan in case of hospital transfer (didn't need one for a home birth -my preferences, wishes, values etc had been discussed at every prenatal visit).
I agree that birth plan is a bit of a misnomer -to me, it always seemed like a list of preferences for the care provider to get a sense of who you are and what you believe, and maybe even to give them a sense. As such it makes sense to discuss only those things that you even have any choice about -as the Navelgazing Midwife said, if you buy the hospital ticket...I agree that choosing your care provider can negate the need for many of the items currently found on most typical birth plans.
I did end up with a hospital transfer during which my birth plan was taken seriously, but for medical reasons, a lot of things on it could not be followed. But then other things were done that I had no idea could be done, and they weren't really discussed with me and had me dissecting them in great detail in processing my traumatic birth experience.
As a result, my 'birth plan' for the next time will be fairly short:
1. As long as I am conscious and able to communicate, you must ask for consent for every medical procedure to be performed on me or the baby, including but not limited to placing IVs, giving injections, dosage adjustment on any medications, etc. If I am unable to communicate, you must ask my support person.
2. Immediate skin-to-skin contact with me is the first priority after the birth, whether it's vaginal or by cesarean.
3. Do not cut the cord. If baby needs to be resuscitated and the resus equipment can't be moved, move the bed with me and baby to the resus equipment.
This is just my personal list of priorities based on my previous experience.
I agree with be careful when considering providers. Pick one that routinely follows your ideals for birth. I didn't write birth plans for either of my children. I knew what I wanted, but also knew I was extremely flexible with what would happen. All I was rigid with was to be asked before anything happen, babies and me to be healthy, and babies not to leave my side unless there was an emergency.
All the other things I *preferred* I made sure were standard practice with my CNW and the hospital where I delivered (no routine interventions, encouraging natural birth, water birth option, etc). Around 34/36 weeks my midwife asked if I had written a birth plan. When I said no, she was surprised. I told her that I knew what I wanted, that we had been discussing it for the past few months, I trusted her and the hospital staff to follow my wishes as their standard practice, and I'd pipe up in labor (or my husband would) if I didn't like something. Anything else came up, I'd be flexible.
Also, I think it's good to remember that you can request (tactfully) a different nurse if you and yours aren't meshing during labor. You might not get one if things are busy, but it doesn't hurt to ask. When I was in labor with my second I wasn't feeling a connection to my nurse during in processing. I wanted a natural birth and a nurse who could help me achieve that goal. I started talking with the nurse about my/my husband's personalities, what kind of birth I wanted, and what I hoped she could provide (I needed a strong personality to make suggestions for other things if I asked for medical pain relief). Through our conversation she told us that she preferred working with c/s. Lucky for her, one came in shortly after I was in processed. She made the change request without me ever having to. Just voicing our preferences in a non-pushy manor got us what we wanted. She replaced herself with a nurse who preferred working with water births.
Wow, sounds to me like Anon 4:23 has a chip on her shoulder. I know AYC feels differently, but please allow me to vent for a moment.
Anon:
Why not take a moment to consider that your actions and words in the first moments of a baby's life and a woman's motherhood matter. Is it not too much to ask for respect and dignity during such an important and transformative moment?
Get over yourself.
I'm 34 weeks pregnant with my first child and am Canadian. During our L&D prenatal class, they gave us a birth plan outline and encouraged everyone to think about it and bring it with them. It is basically "what are the 3 most important things to you if.." and it goes through the different scenarios in labour and birth. I thought it was a good way for people to accept the realities of things that can happen during our deliveries (even if it is a bit unsettling to imagine).
I don't plan to dictate too much about something I have never experienced. I trust my providers and I trust my body to know what to do (call me naive), but am also mindful that what m might be easier for them may not be necessary and am not going to just go along with it to make it easier on them if it's something that doesn't feel right.
I want what is best for my baby and for me firstly and want to hold my baby as soon as possible - skin on skin and don't want to be separated if it's not necessary and if they can do whatever procedures on the baby while at my chest, that would be wonderful. And of course breastfeeding. Pretty simple in my opinion.
My struggle is more on whether or not I'm going to have an epidural. The epidural rate at the hospital is 90% (kind of blew my mind actually) and c-section rate is 35%. We now also have midwives practicing at our women's and children's hospital as well. I think I am most ambivalent about how to address the epidural in my plan. I would "like" to have a natural birth because to me, well it's natural, so it "must" be better than defaulting to drugs.
However, I am conflicted because (well, I'm a bit scared of the pain) and I have a (medical student) doctor friend who just finished his L&D internship (big pro, now right? :-D) who can't understand why I wouldn't just get the epidural to "enjoy" the experience more because there's nothing wrong with it. I haven't dismissed his point of view, but he (and his wife who is my great friend) have also never been pregnant even though they think they already have their decision on this made based on his experiences in L&D.
I'm also a bit afraid of making a decision before I really know what I'm getting into and want to keep an open mind that it's "ok" if I feel I want one. The nurse who lead the L&D prenatal class said that EVERYONE "wants" an epidural in transition regardless of what your plan is, so I'm afraid that I will try not to have one, then want one anyway and it will be the intensity of the moment talking OR I might really want one! I know that is ok, but I don't want to feel like I wasn't strong enough if I wrote it down on paper, ya know? I know it wouldn't matter, but I am really having a hard time with it!
~Signed, 34 week preggers and feeling anxious :-)
This is my birth plan. Probably too antagonistic, but honestly I'm frustrated by my lack of choices, and by the way I've been strung out by everyone on having someone DISCUSS this thing with me. I've gone through multiple revisions, and this is the one I'm probably going to stick with.
After multiple failed attempts at scheduling an appointment to discuss my birth plan, I have created a new one that is simple enough for anyone to read in a few moments.
I UNDERSTAND THAT THERE ARE HOSPITAL POLICIES AND AM VERY FLEXIBLE ON EVERY BIRTH PREFERENCE THAT I HAVE, EXCEPT FOR ONE THING: THE OPPORTUNITY TO EXERCISE MY RIGHT TO INFORMED CONSENT.
1- I am a survivor of childhood sexual abuse and have only recently escaped a 10 year abusive relationship. Please remember this when you are in the room with me.
2- The safety of my child is the most important thing to me. This is why I have chosen to give birth at a hospital instead of at home. We will work best together if we all agree on the fact that "The safety of the baby" is our primary goal. That being said, I still have preferences about birth and will be very grateful if you respect my preferences and my fears.
3- I would like an explanation and the chance to consent to even things that are hospital policy. This will make it easier for me to trust you. I understand policy and am flexible with all of my birth wishes.
4- I am deaf and often feel as though I am being treated as a veterinary patient rather than as a human being, as doctors sometimes find it easier to do things without obtaining my consent or explaining things to me. If I feel that my consent is not being obtained or that things are not being explained to me because of my deafness, I will file complaints.
5- I am the only one that can be informed and the only one that can give consent. I do not give my partner XXXX or any other support people the right to consent to any treatment or receive any explanations on my behalf. (Unless I am unconscious, in which case my attached signed and witnessed Advance Directive takes effect) During my previous birth, my abusive ex consented to many things on my behalf that I would never have consented to. The experience left me feeling violated, even though it was a mostly hands-off birth with no painkillers or interventions. If you obtain my consent for one thing and then do three things, I will request another nurse or physician.
6- My ideal birth would be described as "hands off". I would like a hep-lock, intermittent monitoring, and to have a physician or L&D nurse present when I am pushing. I would like to labor down and push in the position of my choosing. I would like assistance unwrapping the cord from my child's neck. Other than those specific things I do not want to be touched, examined, helped or coached in any way without my request. If you offer assistance that you believe to be necessary, please explain why you believe it to be necessary and allow me a chance to understand, clarify, and consent.
Please understand that the strong tone of this birth plan is simply because I am fragile, scared, and have issues with trust. I am very flexible and very easy to work with as long as my basic right to informed consent is respected and I don't feel as though I am being pressured to agree to things with scare tactics. I understand policies, and malpractice fears and have no desire to place your job at risk. Above all else, I have no desire to place the life or safety of my son at risk. His name is XXX. He has a big brother named XXX. And they are my life. Please be gentle with me today.
Angie, have you considered hiring a doula? Probably worthwhile insurance in a hospital with a 90% epidural rate. Also, could you develop a 'password' to use to indicate that you *really* want the epi, rather than you're just saying it cause you're in transition? DH and I used the name of a friend who's very pro-epidural and very vocal about it ;-) Have you heard about the homebirth epidural? It's hot towels, as hot as you can stand/want it. You might need to bring a kettle or a crock pot to the hospital but they're supposed to work wonders. Can be applied in and out of the pool/shower, on the back or the front or both.
So I did end up with the epidural (which I had really not wanted) and even before I was in active labor (long story!), and the thing that surprised me and that had never been mentioned to me before was how disconnected it left me from the whole birth process. Yes, the pain relief was amazing, but I also felt like I'd left my body and it had turned into some kind of machine, complete with wires and tubes coming out at every direction. When my daughter was delivered by forceps and had to go to the NICU straight away, that only reinforced the feeling...she was delivered, and I hadn't given birth to her. I had to work hard to build up a bond with her, and I felt like they could have handed me any baby in that NICU and told me it was mine and I wouldn't have know whether they were right. I'm not telling you this to scare you, but rather as something else to consider in the pros and cons with an epi. The emotional side effects are rarely discussed openly, as far as I can tell.
Good luck!
Sara, I hope you get a caring medical team who takes your issues and concerns seriously. I read in Penny Simkin's The Birth Partner that many admission documents in US hospitals contain a clause giving them full consent for any procedure they deem medically necessary (AYC, correct me if I'm wrong) so if you do want to make sure they ask for your consent every time they do something, you need to either cross out the clause before signing the admissions forms (and replacing it with "consent to be given at time of procedure), or if they won't let you do that, give your nurse a written note that you're withdrawing the blanket consent after you've been admitted. That way, they're legally obligated to ask you every time. All the best!
Sara -
I hope you can finally have a good conversation with your care provider about your birth plan! It seems like you have been very clear in creating boundaries, yet are flexible in appropriate areas, in your birth plan. Lots of luck to you with your birth!
I must say that although my birth plan ended up being unneccesary (daughter was born 20 minutes after arriving at the hospital), it was good because it made me research every decision/preference I wrote down. I didn't want to be asked about it look stupid when I didn't know exactly what everything meant, so I researched everything and ended up refusing a lot of the newborn procedures. In fact, that is what got me interested in natural/normal childbirth in the first place, and for that I'm very grateful :)
I think that birth plans are also not the best idea, although a simple bulleted list of birth preferences might be good. I felt like the birth plan I wrote for my first son's birth (after taking a Bradley class) was nearly useless, as I put things in that were unnecessary because what I wanted was already hospital policy. I do think you want to convey to the hospital staff that you favor a med-free delivery, for instance, but you want to make it clear that you consider the medical staff as helps to you, and that you appreciate their care. So, instead of "Don't offer me pain medications," for my 2nd son's birth I wrote something along the lines of "Please encourage me to change positions, use the tub or shower, use hot packs or other natural techniques to cope with the pain. I will ask for pain medication if I need it." I also found that so many of the things that are put in birth plans just don't matter a whit to me. I don't mind medical students, I don't mind bright lights, and I think it makes sense to work within hospital policy rather than against it.
Ended up never having the conversation. Also scrapped my birth plan when it became obvious that the hospital was not going to accommodate anything willingly. (They spent an ungodly amount of time attempting to force me to sit down on a wheelchair because of hospital policy). Since no one ever bothered to discuss hospital policy with me in all of the four appointments I had scheduled and been stood up for.. I wasn't that impressed and simply refused.
I had a great precip birth which took a half an hour after they first checked my dilation (which I had only planned on allowing once). I was 5cm dilated when they first checked. Apparently saying "no", yelling for everyone to shut up, and refusing to comply with physical force until they answered a question that I asked.. ("if the baby's heart rate doesn't look good, and I'm telling you that he's going to come out in a few pushes because I can feel him IN MY BIRTH CANAL, wouldn't it make sense to get baby out so you can work on him directly if he's in distress? And wouldn't that be MUCH more effective than 'deep breaths for baby?'") is a great way to press that big red "eject" button.
I really like the honesty of your post. I think the most important item you touched on was to pick your provider/hospital (or lack of) wisely. Many times women complain because their provider won't "let" them birth the way they want. Change providers...I had to @ 8 months with my 3rd child after my doctor changed his mind about "allowing" me to VBAC with no medical reasons for doing so. I ended up with an amazing homebirth with a wonderful midwife. Happy Ending.
I had the shortest birth plan my OB/midwife had ever seen. It had 2 things on it:
1. My husband is to be with me at all times and 2. If anyone ANYONE comes anywhere near me with a pair of mets scissors to give my an episiotomy, my husband will crash-tackle you to the ground and beat you to a bloody pulp.
That was all.
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