Birth plans: Taking a new look
2008-02-03 12:47:08
Do they really work?
Birth plans are written with great promise, but how often do they really deliver on that promise? Perhaps what you want is not routine for the doctor and hospital you've chosen. Sometimes a doctor or a nurse will go out of her way to accommodate you, but you can't count on it. These professionals will do what they think is best. Why should they act otherwise?
Be aware that birth plans often give false hope -- you may believe you will get what you want because you put it in writing, but the signatures of health care providers are not legally binding. Many women have discovered that their birth plans are not much more than wish lists. Still, you need to think about your options -- writing up a birth plan forces you to organize your preferences. After all, if you don't know your options, you don't have any.
Getting what you want
These suggestions will help you get what you want for your VBAC:
# Think of what each doctor offers as if it were as limited as a fast-food menu. What you can choose is what's on the menu. There's no point in asking for pumpkin pie or chicken and dumplings at a hamburger joint, pizza parlor, or Mexican restaurant, because the restaurant will never have it, not even if you say "pretty please."
In the same way, if 75 percent of the women who give birth with the doctor and hospital you're considering have epidurals, don't say you don't want to be offered any pain medication. Go elsewhere. If all of the patients of the doctor you're considering are hooked up to IVs as soon as they get to the hospital, don't write "No IV" on your birth plan. Find another doctor or midwife who doesn't have this protocol.
Many hospitals will plan to have you on an electronic fetal monitor (EFM) all during a VBAC labor, in part because prolonged fetal distress is the only indicator of the rare uterine rupture. (A rupture occurs in about one percent of VBAC labors.) If you want EFM flexibility, find a doctor and hospital who will give it to you. Don't just request it on your birth plan. If you want more flexibility in general, don't forget to interview midwives. A midwife offers a "menu" that is almost always longer than a doctor's, especially a midwife who works outside of hospitals.
Shop for what you want
# Look for the professionals who offer what you want, instead of trying to fit what you want into what they do. This is true whether you want a high-tech pregnancy and birth, or whether you're looking for a professional to assist you with unmedicated childbirth. As you interview possible doctors and midwives, eliminate the people who you know will not give you what you want. Remember, you're looking for cooperation and enthusiasm, not reluctance.
If some of the healthcare providers you interview tell you that your ideas are unsafe, unrealistic, or unnecessary,isn't it better to determine their attitude early while you can still change doctors more easily? When calling hospitals, ask about everything on your birth plan. Don't assume that if you're breastfeeding, for example, they won't offer your baby formula in the nursery. Don't take for granted that if they have a Jacuzzi for laboring women to help relieve labor pain, it will be available to you. Ask first.
"I started with a big upscale OB practice with seven OBs and, as I found out, seven different opinions on how to treat a VBAC. One doctor said external monitoring was fine, another wanted an internal pressure catheter, etc. At 32 weeks, I finally got the nerve to investigate the other OB practices available through our HMO. I actually interviewed the doctors about their VBAC procedures, quite a change from my 'trust your doctor' mindset in my first pregnancy. I ended up switching to a 'no nonsense' HMO group -- no fancy examining rooms, no classical music piped into the waiting room. They all knew me as the lady who wants a natural childbirth. But they gave me respect and treated me as an educated adult who wanted to be an active participant in her birth experience. I spoke to all four OBs in the group about my birth plan, brought my doula with me to an appointment with the doctor I was least comfortable with, and took a proactive role in my pregnancy." Alexandra G., Tennessee
Keep it minimal, keep it flexible
# Make your birth plan something that works for you, your birth attendant, and your place of birth. List your must-have items on your birth plan in order of importance to you. Discuss them on a regular basis with your doctor or midwife during your pregnancy. This will reduce misunderstandings during labor. Ask your doctor to put the items you've agreed on into your chart that will go to the hospital. If you've done your homework and found a person and place to fit your needs, why would your birth plan need more than a few items?
# Be flexible. You may need to deviate from your ideal plan. Birth is too unpredictable to feel convinced in advance that you know how the labor and birth will go, especially in hospitals that have their own rules and procedures independent of your wants and needs.
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