29 March 2011

Birth Plans, part 2

A reader comment from yesterday's post made me realize that I wanted to cover a bit more about birth plans and hospital birth in general.

She wrote:
I think that this whole "birth plan" era has also unfortunately ushered in a huge amount of antagonism between patients & nurses, which is just SO upsetting to me (as a nurse). Believe it or not, we WANT you to have the birth that you want, but sometimes things just don't go the way they are "planned." Welcome to parenthood, that's your first lesson that kids never stick to the plan!

Sometimes people have the impression that giving or receiving a birth plan is an opportunity for scorn and eye rolling. It certainly can be...I have clients ask me all the time if they will be annoying the staff with a birth plan. I've also heard care providers jokingly speculate that the people with the longest birth plans are the ones who get cesareans...and the implication is that it's all their own fault. I hate to hear this...the people saying it just have not met the right kind of birth plans (and the mindset that goes with them)! Just as I think birthing women should not be dogmatic, I would love it if care providers also took responsibility for not mentally penalizing people for their earnestness.

A big part of the equation that usually can't be planned for is the luck of the draw with the assigned nurse. Sure, some nurses can be invested in women having as few needs as possible, in them being quiet or not "suffering". However, I find that most nurses (and everyone really) can get on board with a just about any birth plan if they are approached from a place of respect and acknowledgment that they are there to help. Find your inner Dale Carngie: "We prefer that you don't offer us medication, but we sure would love some ice chips and another pillow!" or consider saying, "Here's what we would prefer/what is important to us...can you help us with that?". Most people are decent human beings.

When there is an adversarial approach, it is likely caused, in part, when people are not well matched with the care providers/birth place (you know what they say about not going to a fast food restaurant if it's fine dining you are after). But also when people are coming from a place of fundamental distrust. There is this fine balance, I think, between being prepared to advocate for yourself (as well you should) and going in looking for a fight. 'Cause if you look for a fight, you are more likely to find one. Hostility is not going to help anyone, including the birthing woman, who will surely need to be able to trust and surrender. An atmosphere of distrust or upset can actually stop labor from progressing...those stress hormones are like kryptonite to the hormones that progress labor.

Instead, iron out as many details before you go into labor and make sure you are comfortable with the answers you are getting from all your care providers. Ask what is typical, where there is wiggle room, under what sorts of circumstances interventions might be typical. Consider hiring a doula. Labor at home for a good long time if you can. And, as I have written before, picture your care provider telling you you need an intervention you really don't want...in your gut, do you trust them? If the answer is no, if you are finding that you are still anticipating an uphill battle, make peace with the fact that you may be with the wrong practice or planning to birth at the wrong place for you and then do something about it.

Again, I'm not suggesting you jump on a conveyor belt of unwanted interventions...I'm suggesting you find out whether the conveyor belt is there at all before you get there and then respectfully pick you battles.

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