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.

If men had uteruses

There is an excellent NY Times op-ed piece by always-impressive Nicholas Kristof called "Crises in the Operating Room" about the utter lack of focus by world powers on birth resources in developing countries. While our fight here is against too much and unnecessary intervention, in other countries life-saving intervention can be hard to come by for those in poverty...the single birth story in the op-ed is chilling.

Here's the meat of the piece:

If men had uteruses, “paternity wards” would get resources, ambulances would transport pregnant men to hospitals free of charge, deliveries would be free, and the Group of 8 industrialized nations would make paternal mortality a top priority. One of the most lethal forms of sex discrimination is this systematic inattention to reproductive health care, from family planning to childbirth — so long as those who die are impoverished, voiceless women.Thankfully, there is the dawn of a global movement against maternal mortality. Prime Minister Gordon Brown of Britain and the United Nations secretary general, Ban Ki-moon, are trying to work with the United States and other countries to hold a landmark global health session at the U.N. focusing, in part, on maternal health. If that comes to pass, on Sept. 23, it will be a milestone. My dream is that Barack and Michelle Obama will leap forward and adopt this cause — and transform the prospects for so many young women like Shazia.

Also check out a follow up piece, in which Kristof says,

"Interestingly, in the U.S., maternal mortality remained very, very high even as the United States enjoyed economic development and improved overall health in the 19th century."

Seriously, read all his stories on birth - I hope those in power start listening.

fear factor

When women are told they are carrying a BIG BABY, it can be a complete mind, um, trip. It's rare that a woman will actually hear (if she is even told) that estimates by ultrasound late in pregnancy are not particularly accurate and can be off significantly (around 1-3 pounds in either direction - I've been at plenty of "big baby" births where the kid comes out at 6 lbs)...her mind is stuck on the image of the Charlie Brown-headed toddler and how it can possibly pass through her pelvis.
Now of course there are sometimes babies who are actually really big and have problems being born, but I think we need to remember that this is rare & that nature wants birth to work - it needs birth to work. And it usually does work out just fine if allowed to happen without unnecessary intervention. Ah - but there's the issue - it's usually not our inadequate pelvises or our gigantor babies...it's more likely how we treat women in pregnancy and labor. Whether we make them feel afraid and intimidated and do all sorts of things so they can't move their bodies and work with labor to birth their babies, whatever the size.
This post was inspired by Corin at The Human Pacifier and her post on bigbaby.org.uk
She quotes from the website:

The female pelvis is PERFECTLY designed for birth.....no matter the size of the baby.....it is designed to open up to make more space for the baby.....and a baby's head is PERFECTLY designed to gently mould, to make it smaller, so that it passes through the female pelvis with ease. Babies know how to get into a good position for birth, tucking their head tightly so that the smallest part presents first...

But when a women reduces her pelvic capacity, by being immobile on a bed, perhaps due to an induction - for a "big baby" or an epidural, because of the pain caused by the induction, or the fear caused by the constant "big baby" conversations everything gets a lot harder, words like "cephalopelvic disproportion" (CPD) - where the baby's head is too big to pass through the pelvis, get used - needlessly.

If a woman enters labour free from fear and anxiety oxytocin (the hormone of labour) will be free to flow, her uterus will contract efficiently, endorphins (natural morphine like pain relievers released during labour) will flood her body, adrenaline will be kept to a minimum ensuring that her uterus is well oxygenated and making her as comfortable as possible.

She will move instinctively into positions which freely open her pelvis, such as a squatting position (where the pelvis is said to have up to 30% more capacity) or perhaps on all fours - both superb positions for birthing a big baby.

The size of a baby in a normal, physiological birth - where anxiety and "big baby" talk is not present - is largely irrelevant, it doesn't make it more painful and it doesn't make it harder!"

And Corin says,

This last part makes so much perfect sense to me and I've thought this exact same thing many times in the past; that a large part of our supposed "inability" to birth "big babies" stems from the fear that is instilled in us very early on. This is a big reason why I feel like ultrasounds should be kept to a bare minimum. It seems like we're often set up on the path to failure the minute our ob senses that the baby may be over what is considered "normal". And the topic of "normal" size babies is one all of it's own; it's amazing how many natural birth videos I've seen and stories I've read in which mama gives birth at home naturally to a baby over ten pounds. So, is it really all that "abnormal" after all?

___________
So it's less about the actual size of the baby & more about the mind, um, trip (in the woman and in her care provider) that the thought of a big baby causes.

Maybe all woman who have had a big baby without problems should go around and tell those stories! While we're at it, let's make pregnancy and birth a fear+intimidation free zone.

doulas in the news!

Check out USA Today's "Maternity Care Failings Can Be Remedied With Cost-Saving Fixes" to see how doulas are part of the solution!... Also information on cesareans and informed consent.

The article refers to the release of this report by Childbirth Connection, entitled, "Evidence-Based Maternity Care Report, 2008".

Of doulas, family-practice doctor Valerie King of the Oregon Health & Sciences University in Portland says,

"If a doula could be put in an IV drip, everyone would get it."

Also in USA Today, "Study: High-Tech Interventions Deliver Huge Childbirth Bill". I think the title speaks for itself.

control

Withholding (age-appropriate) information regarding reproduction and contraception clearly doesn't work much of the time. But it makes sense, I guess, in a culture in which birthing women are often given information selectively or with such strong spin so that they will just do as they are told, even if that means lining up for a host of unnecessary interventions. Actually, this seems to be working out as intended much of the time regarding birth - so many (but not all!!) women have completely abdicated decision making under great pressure from our culture and system. But we need only look at the family situation of the RNC's best & brightest (said with unkind scorn, I admit it), Sarah Palin, to see that a back up plan to abstinence is needed. (Check out this great post for more on this topic)

Why can't we trust people to know all the facts and options and then make informed decisions based on their family creed or the advice of their trusted care provider? It seems curious to me that some would rather trust a teen to make good decisions as a teen parent, altering the course of their entire life, than to trust them with knowledge of contraception in case abstinence isn't the ultimate choice they make.

Seems like many parents, churches and care providers don't feel secure in their positions as leaders and are withholding information, clutching at control, out of fear.

And it's not working.

Me? I like the wisdom of 38 Special: Hold On Loosely