The Birth Plan Trap

The Birth Plan Trap
By Emily Jones March 31, 2008

A current fashion is the birth plan. Women write a birth plan with the intention of familiarizing themselves as well as protecting themselves from unnecessary interventions. Birth plans are encouraged as a sort of insurance policy against unwanted procedures.

There are some benefits to making a birth plan. It enables the woman to look at what all her choices are and find out for herself why she might want (or not want) a certain choice. It also may be a good idea to give the doctor a “heads up” to the mother’s intentions. Birth plans can give women a sense of empowerment and encourage them to be more vocal about what they will or won’t accept in the management of their labors.

But there are flaws with this concept. First of all, there is no guarantee that her wishes will be honored. The birth plan is typically addressed to the doctor, who will not be one she will have to answer to in labor. The doctor will sometimes not show up until the woman is ready to push, so she has no real ally in him (or her) throughout the rest of her labor. And as is standard practice in many large practices today, there is not even the guarantee that her doctor will be the one on rotation that day.

When a woman enters the hospital in labor, she must deal with the nurses and staff that happen to be on shift that day. These nurses do not know this woman, and are not aware of any agreement or discussion she has worked out ahead of time with the doctor. Nurses are often very reluctant to contact the doctor, as doctors are typically so busy that they discourage being contacted for “trivial” questions, such as questions about routine procedures. So typically, a laboring woman must argue with nurses and staff who insist on certain procedures because it’s “policy” and can’t be changed without the doctor’s permission (which they are unwilling to get).
When (and if) the doctor appears during the woman’s labor, there is still no guarantee that he or she will respect the woman’s wishes. Agreeing to a birth plan in his office and adhering to it in an unpredictable labor on his own turf are two different things. Doctors typically have the attitude of, “Well, that’s nice, but we’ll see what happens.” There are literally hundreds of different scenarios that a doctor can present that will negate her original birth plan. For some reason or another, the doctor WILL find a reason to insist she has some procedure or test performed contrary to her birth plan.

Besides the practical problems with a birth plan, there are psychological problems with writing a birth plan as well. In reading the book Birthing from Within, written by Pam England and Rob Horowitz, I came across the following passage:

In writing a birth plan, a woman focuses on fending off outside forces which she fears will shape her birth. This effort distracts her from trusting herself, her body and her spirituality. Rather than planning her own hard work and surrender, her energy is diverted towards controlling the anticipated actions of others. There are no unique birth plans. While your birth plan is unique to you, it won’t seem that way to your hospital or doctor. All women ask for the same thing: respect, dignity, support to birth naturally with minimal routine intervention and no unnecessary separation from the baby. Trying to change the medical system risks creating defensive, resistant, and hyper-vigilant mindsets. You may feel a sense of power during this process, but it’s an illusion, and more importantly, a distraction from developing genuine personal power. This fear-based, externally directed preparation (”I don’t want this,” “I don’t want that”) flows unproductively through the mind-body connection; it’s harder for your body to let go when your guard is up…Another hidden danger is when an authority “accepts” a birth plan during pregnancy. At that point, there’s a strong tendency for women to stop worrying, stop exploring, and stop accessing personal resources

Making a birth plan can create a false sense of confidence for women, as if their fighting is over once the plan is written and discussed, when in fact, the birth plan is simply the first of many battles.

There is something inherently wrong about having to ask permission to not be abused or taken advantage of. Although there may be doctors and nurses who respect the birth plan, and women for whom the birth plan worked in achieving their goals in a hospital birth, it just doesn’t seem appropriate for a woman to have to protect herself from the system.

It is like meeting a man who has a prior conviction for domestic violence, and agreeing to date him if he signs an affidavit promising not to lay a hand on you. Does the affidavit excuse his past behavior? Or even guarantee his future behavior?

Along the same lines, I am hearing suggestions to bring gifts or treats to “bribe” the nurses and staff on shift when you enter the hospital, to encourage them to be more amenable to conceding to your wishes. Again, it isn’t appropriate for a woman to have to resort to bribes to protect herself during the most vulnerable time in her life.

Birth plans have their place. A birth plan can be as important for the person who writes it as the person for whom it’s intended. For many women, a birth plan is their first exposure to hospital procedures, and helps many women to understand what is and isn’t necessary in a normal labor. I think a birth plan is an excellent tool for self-discovery, and education about the labor and delivery process. However, I think birth plans should be made with caution: mothers should make the birth plan with the understanding that the birth plan is more symbolic than anything, and that she herself must be proactive in actually getting the choices she desires.

I think overall, birth plans are counterproductive and ultimately do not result in any real positive effect in hospital routine and policy. I think doctors and nurses are generally disdainful of birth plans, and view them as a woman’s security blanket and subject to change in labor. There are the rare professionals who view a birth plan with respect and appreciate a well-informed patient, but I believe these to be the exception rather than the rule.

Women should not birth in a hospital at all if they are concerned about their rights being violated, as there is no guarantee, not even the birth plan, that their rights will be preserved. However, if you feel that you have no choice but to birth in a hospital, and a birth plan is your only option for protection, I have some suggestions for you:

1. Don’t get too complicated and long with your birth plan. The longer it is, the more likely the doctor is to simply gloss over it and not concern himself with the details. Put the most non-negotiable issues in to be sure they are seen. Also, doctors and nurses view a longer, more complicated birth plan as a ticket to disaster, as they perceive the woman who writes it as “unrealistic” in her birth expectations.
2. Know why you are requesting/refusing certain procedures and tests. Some nurses often don’t know why procedures are done, or even that they can be harmful. They are simply following the rules. If you are armed with the correct information, you can educate, as well as be taken more seriously as an informed consumer.
3. Make three copies of your birth plan and have your doctor sign each one. Leave one with your doctor, put one on file in the hospital, and keep one on you to bring with you to the hospital when you go into labor. Nurses are a lot more likely to acquiesce to your requests when they see you already have signed permission from your doctor to go contrary to hospital procedure.
4. Be prepared to fight. Your fight for your rights just begins when you enter those doors. If you don’t know if you can argue during your labor, bring someone who knows your birth plan and will fight for you.

Good luck with your birth plan. I’m not convinced that using a birth plan will result in better outcomes for laboring women, but I hope that they might. We need all the help we can get.
Written by Emily Jones · Filed Under Editorials

http://www.truebirth.com/2008/03/the-birth-plan-trap/