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Aug112006

When You Buy the Hospital Ticket...

... You Go for the Hospital Ride

aka Birth Plans and Their Uselessness

Once upon a time, doulas were in the birthing arena to help women achieve the births of their dreams. I distinctly recall telling women I would be a go-between for them between the medical staff and themselves, the laboring couples. At doula trainings and gatherings, I know I heard doulas teaching each other how to be manipulative with the staff, yet soft-spoken and seeming demure and obsequious.

Doulas had code words to use that meant "Time out! Ask the medical staff to leave so you can talk alone (and by alone, I mean with me, too!) before deciding yay or nay."
Doulas right in front of my face (was that a mirror I saw?) - and the doctor's - said things like, "Remember when we talked about your birth plan last week and you said no matter what, you didn't want an epidural?" or "Do you want me to remind you of the risks of that position before they put your legs in the stirrups?" or "Doctor, doesn't pitocin rupture uteruses?"

It wasn't a decade before the role of the doula began shifting. Once DONA (Doulas of North America, now DONA International) jumped and incorporated the concept of a doula into a profession, we'd already heard about "renegade" doulas that commandeered labor rooms and antagonized the staff so dramatically, doulas were threatened with expulsion from labor and delivery rooms around the country. Therefore, DONA grabbed the opportunity to squelch such power-tripping by insisting that doulas did not speak on behalf of the client or her family.

Doulas were not permitted to do anything that smacked of medical or midwifery care - no fetal heart tones, vaginal exams or blood pressure checks (something many doulas had been doing for years). DONA snapped the profession's back into sharp attention, kept her hands stiff at her sides and instructed for her (the multitude of doulas) to keep her eyes straight ahead and not look around.

By doing this, DONA saved the role of a doula, if not the very word itself. Doulas began changing their spiels to encompass words such as "supportive," "reminder," and "belief in you" - removing forever, at last in any literature or in public venues, the implication of advocate or director. Accepting that the changes were the only ones that could be made, women were suddenly back in control of their own birthing destinies.

Or were they?

Back to the beginning once again, the issues that brought doula-dom into existence in the first place - archaic birthing practices, patriarchal attitudes towards laboring women and unsubstantiated reasons for a plethora of rules and regulations - remained.
What's an enlightened woman to do?

Why, create a birth plan, of course.

Birth plans, in existence long before there were doulas (either in name or in idea), over time, have become more and more explicit and restrictive. I have easily read over 3000 birth plans and can tell you the grand majority of them are the same in 98% of their content.

• No episiotomy
• Allowed to move around in labor
• Allowed to eat and drink
• No formula or pacifiers
• Dad to stay with me the entire time
• No enema (yes, I still see this on birth plans)
• No shaving (unless you live in the backwoods of medical care, this is so absurd to put on a birth plan it is laughable - mostly laughable to those you are speaking to, the nurses in labor & delivery)

... and the litany goes on and on.

Interestingly, there are dozens of websites and hundreds of baby-oriented books and websites that make a birth plan into a formula for folks to fill in the blanks. How creative of them! It is extremely frustrating getting a cookie-cutter birth plan - as mentioned above, so many are exactly alike, why does anyone write one at all? I'm all for using one of the pre-planning birth plans as a template so your own needs and desires can come out of hiding. Sure, if you don't know what your options are, how will you know what to choose? But, my point is, once you have chosen, dump the look-a-like and create your own plan... with your own words... your own personality.

And make the thing SHORT. I mean short short. A 3x5 card on one side. Double-spaced.

(I can hear the ruckus even now. "But, you're just saying you don't like them because it limits you!" or "You would say that, you medwife person. You don't want anything individual interfering with your care." Bull. I'm telling it like it is to save your butts in labor and delivery! I'm trying to help you understand how tired they are seeing birth plans, how they never read them [unless you get some alien nurse who happens to be in midwifery school] and how it is a waste of your energy to write the same same same same same same same same thing as every other person that comes onto their floor. Dispense with the extraneous and write what matters!)

• I will ask for pain medication. PLEASE DO NOT OFFER IT TO ME! (Make a pretty sign and tape it to the outside of the door. Make a couple in case it disappears.)

• Please, keep lights low unless it is crucial to my life or that of my child's. (Another great door sign.)

• Please KNOCK before entering (Door again.)

• Risks, benefits, consequences of refusal and alternatives are to be discussed before EVERY procedure on myself and my baby. (I learned that "informed consent" does not legally mean discussing risks and benefits. Watch that blanket form you sign upon check-in!!! It allows them to say they obtained informed consent.)

It’s important to remember you attract more flies with honey than with vinegar; be kind, but be direct.

So, looking at that list, doesn’t that set the stage for retaining autonomy and letting the providers know your wishes? It’s also important to be open to listening to what they have to say. They absolutely might have something valid to share. It's been known to happen.
If the above points aren’t your hot button issues, make your own points - but make them succinctly.

I believe the main reason for a birth plan is to facilitate communication between the parents... allowing them to see how each other feels about such important things like pain medication, circumcision and even vaccinations. Birth plans are great for everyone talking to each other. If it worked with the doctors and nurses, all the better, but it usually makes for some pretty antagonistic and stiff discussions in a prenatal visit and a bunch of rolling eyes in labor.

Once again, if you buy the hospital ticket, you go for the hospital ride.

If you buy a house and stand inside your palatial mansion saying to the builder, “But, I wanted a log cabin!” - the builder might wonder what the heck you were thinking going to a master-palatial-home-builder instead of a log cabin specialist.

If you want soy milk, don't milk a cow.

Why... why oh why... if you want a "home-like birth inside the hospital" aren't you considering a home or birth center birth? If you want control, why go where egotistical birth is the norm? If you want autonomy, why go where lawsuits and defensive medicine are the rule?

Ohhhhhh, because it's safer? Is that what you think? Oh!! I see. Well, if you believe hospital birth is safer and that's why you want to be there, then BE THERE - with all it has to offer... in all its guises... in all its paranoid glory. Why would you try to manipulate a hospital's/doctor's/nurse's actions any more than you would try to manipulate the car mechanic's? If they aren't good enough for you, find another! (This is, of course, where choice is an option. I don't live in a dry well.) You're hiring someone to do the best they know how to do. LET THEM DO IT.

It is so funny hearing me say this. I really did used to be the doula who could get it all for her client - I am a great doula and monitrice - but it is more frustrating than words can say when a client says things like, "No drape between me and the incision during my cesarean because I want to watch." How the heck are you going to see your pubic area? You even can't see it when you are standing upright and leaning over! The curtain isn't just because you might not want to see the surgery (if you could remotely see down that far in the first place), but it is also in case you projectile vomit into your incision.

Note: Hospital rules are not in place to annoy you. Some are really important to the life and health of you and your child. Do people forget that? (Yes.)

I do understand that a number of women don't have a choice about where they deliver... there aren't midwives, the doctors are all the same, hospitals won't let them do VBACs... I do understand. However, in that case, I have found that going along for the ride makes for a much better experience instead of fighting the whole way. I don't want that to be a rape or abuse analogy at all, but one of "if that's what I have to have, then let me be gentle about it and see how good the experience can be."

I have seen women who go in without pre-conceived plans have far better birth experiences, with less tension and worry, than women with elaborate desires and wishes written down or vocalized. Women tend to be treated more kindly if they seem to be on the same page as the nurses' and doctors' agendas. This might be wrong or unfair to some, but is the truth.

So, how would I counsel someone who medically needed to be in the hospital? I would encourage remaining open to what the nurses and doctors had to offer. If they offer something the woman doesn't want, say, "No thank you." Simple. Concise.

I’ve been to births where my clients had no scripted birth plans and who had beautiful hospital births - ones where the nurses were respectful and we were left alone a great deal of the time to talk and laugh and spend time with each other.

My concern, and the reason for writing this piece, is in unrealistic expectations - across the board... with the client, her family, the doula, the childbirth educator... even midwives. Sure, docs and nurses also have unrealistic expectations, of another sort; many (most?) believe every woman has to have an epidural to have a happy birth experience, or that no one should have a VBAC. Those untruths are as incorrect as the ones that say if a woman has a birth plan she'll have a better birth.

I simply do not see that as realistic - or even close to happening in real life world. Far more often, I watch as hard worked-for plans fall away and women feel more and more guilty and sad for the draining away of their desires. What if we worked on changing the reality of those desires? What if doulas and birth assistants and childbirth educators bluntly laid things on the line and said, "Just because your doctor agreed in the office doesn't mean it's going to happen in real time. You might never see your doctor again. Your doctor, after listening to your birth plan in the office, might know he will have to convince you once you are in labor that his/her way is the way to go. It is almost impossible to tell what someone will do (midwives included) until after the fact.

Doctors often say there is no such thing as normal birth except in retrospect. The same can be said for a provider doing what they say they will do.

Maybe if we (doulas, childbirth educators, midwives, nurses, doctors, etc.) all got real with women, they might make different choices altogether. Maybe they would get really cranky and start demanding more humane births instead of the lip service paid touting million-dollar renovations in lieu of hiring more nurses with compassion and a gift for listening to women in labor... not just wanting to get them drugged and quiet.

I don't know what the absolute answer is, but I do know it can't keep going the way it is... everyone fake dancing that each side is listening. Really, knives are stabbing each other, scalpels cutting bellies, women medically paralyzed, drugs given to women begging for natural births - doctors and nurses working in a haze of "what will this look like in court?" and really, really believing they are doing the best thing for the health and safety of the mother and child.

Someone needs to just speak the truth. And it starts with me.

Reader Comments (29)

plenty of sense, sistah...I've been saying the same thing for the 12 years I've been a doula/monitrice/midwife

Love your blog

hattelatte

August 11, 2006 | Unregistered CommenterDee2

As an ex L/D nurse I have to say I agree with everything that you wrote here. I hated when women would come in wanting a "home" like birth but wanted to be safer in the hospital. I have no problem with women wanting all natural child birth (not for me) but if you come into our home (the hospital) you have to follow our rules. Sorry.

August 11, 2006 | Unregistered CommenterMaggieMae

Wow...ok, where did this come from?!?

Having been on that hospital ride, and having had you as my own montrice....I agree 98%....

And had you belived a homebirth would have been a safe option, I would have much prefered that ride.....unfortunately, I'm in the 2% who probably really does need a hospital birth.....

Which is why there probably will not be a baby #3...that, and I'm not sure I could go through lactation failure again without going completely out of my mind....

Going back into my hole to plan a wedding cake

August 11, 2006 | Unregistered CommenterOpening Pandora

Awesome thoughts. I am in total agreement. I get thoroughly disgusted when I hear, "I am having a hospital birth because its the safest place, but I have a very hands off doctor that is going to respect my birthplan"

I fail to understand why in this day and age where information is so easily obtainable people still refuse to educate themselves about something so important as the birth of their child. My doctor knows whats best for me and my baby because they went to school, so I should just listen to them without questioning.

Also that people don't understand that doctors and hospitals must first cover their own behind at all cost so they do what is right for them not to get in trouble first and then the patients interest comes after.

August 11, 2006 | Unregistered CommenterAnonymous

Excellent essay, I'm going to read it at my doula meeting next week. Great food for thought. As an L&D nurse, I used to always cringe when I'd hear the nurses say, "why do they come here if they aren't going to do what we tell them?" Your essay sheds a whole new light on things.

August 12, 2006 | Unregistered CommenterLaborpayne

Hear, hear!

I would add: Find out what the norms are in *your* hospital. If the norm is to keep the lights low, then you don't need to put that in your birth plan (or on a sign on the door).

I would also add that a little politeness goes a long way. "Please keep the lights low unless bright light is necessary for our safety." You can be assertive without being aggressive.

August 12, 2006 | Unregistered CommenterAnne

we had a hospital transfer too... they were so busy they mostly left us alone until- a nightmare of the delivery

August 12, 2006 | Unregistered CommenterAnonymous

I moved to a new state when I was 6 months pregnant, and had a very difficult time finding a midwife. After almost a month of searching my husband brought up the idea that we might have to do it in the hospital--we'll just get a doula and try to find a good OB. I was terrified! The C/S rate in our state is 44% (highest in the country). If your hospital has a 44% C/S rate, then your chance of having a C/S is 44%. I can't imagine a birth plan & a doula protecting you from that when the entire hospital mechanism is working against you.

The pessimist in me thinks that birth plans are just a way of placating women. "My birth plan says no episiotomy unless absolutely necessary" so when they get one they think that it must have been really necessary.

August 12, 2006 | Unregistered CommenterJoanne

You made sense. I wish you would elaborate more on the changes the "doula profession" has undergone.
It's a sad state of affairs.
On the other topic - why are women trying to control thier hospital births? because they are afraid.
why don't they just have a homebirth?
because they are afraid.
hell, why don't they simply switch caregivers?
you got it.
women are paralyzed with fear.
we are afraid of our own power.

good post!

August 12, 2006 | Unregistered CommenterLesley

I hope you all will go back and re-read what I wrote... I added some things... and especially to my monitrice client... please note that I addressed your concern directly.

I thought this post was going to bring busloads of hatemail. I am shocked I have people who think I am saying something right and truthful. Absolutely gobsmacked (as one regular reader says).

I am so glad I could say something that resonated with so many.

I do hope this post makes it onto the doula boards as well as Mothering.com and I will surely submit this to Grand Rounds. I like what I wrote... feel strongly about it... and am glad others can understand where I am coming from.

Thanks to all of you.

August 12, 2006 | Unregistered CommenterNavelgazing Midwife

It is all about the fear. My husband and I are beginning to plan for a baby, and have discussed hospital/birthing centers/at home births ad nauseam. While we both want all the benefits of a home birth, the fear always gets in our way. The what ifs that are out there are so huge. Reading your blog and your very articulate opinions has helped me to begin to realize that a hospital does not guarantee my safety. Keep up the honest talk; it's having an impact in at least one person's future choices.

August 12, 2006 | Unregistered Commenterkati_girl

Excellent, excellent post. As an ex-L&D nurse (often made fun of as "the doula-nurse" and the "oh give her the birth plan lady - she loves those" nurse) and a Mom of 5 who wanted home birth in a place where it is not an option, I so totally agree. Thank you for saying exactly what I've thought for years.

August 13, 2006 | Unregistered CommenterMama Mia

i am curious about what you would have to say about those of us who ARE planning a homebirth and have a birth plan in case of transport. ???

August 13, 2006 | Unregistered CommenterChandelle'

ok, that probably sounds stupid because the idea is that you'd only be transporting for an emergency. but i transported for a non-emergency with my first (60 hours of labor going nowhere), hit transition as soon as i got there, and became more or less useless in serving my own needs. the experience was as awful as it could have been and in retrospect i wish i'd had SOMETHING stating my needs and desires, but i never considered transporting for anything but an emergency. that's why i asked that question.

August 13, 2006 | Unregistered CommenterChandelle'

For so many women I believe their choice related to their caregiver and place of birth comes well before they take the time to reflect on their own personal values and expectations for their birth experience.
I see women late in pregnancy who are beginning the process of introspection regarding birth for the firs time. Well beyond the point of making a decision regarding their caregiver or place of birth. It is at this moment many of them experience a dissonance between their expectations for their birth and their selection of a caregiver or place of birth. It takes quite a bit of courage and conviction to switch providers this late in pregnancy (although we all know courageous women who have done this).
I think that if the women had an opportunity to truly become informed and reflect on their expectations prior to conception or in early pregnancy some of them would be more informed about how the selection of their caregiver (which essentially is related to their place of birth) is going to effect the care they receive.
Unfortunately many women don't begin to reflect on the birth process until late into the pregnancy, well into the 3rd trimester for some, and at this time the process of switching providers is very frightening (and can be complicated) whereas if they had "known then what they know now" they may have never selected their provider (place of birth) to begin with.
The use of a birth plan and the ensuing dialogue sometimes brings these issues to light. Where the patient wasn't aware of the differences in values and expectations for their experience beforehand, now that they have discussed their desires with their caregiver it becomes glaringly obvious that the provider practices in a way that contradicts their expectations.
Now what?
Well, you know BFW so they just do 'The Next Best Thing'.
I think a lot of this might be avoided if we could increase education in our country regarding the differences in care practices and increase the awareness of the overall signifigance of the birth experience itself. Then women may become more engaged at an earlier time (before pregnancy or before selecting a provider) and make a more informed decision about who will care for them and potentially (not in all cases) avoid some of this conflict.
You know the saying "When the only tool you have is a hammer everything becomes a nail." We have done such a fabulous job in our culture of persuading women that pregnancy and birth are unsafe and they need to be rescued from this by being surrounded by people who can 'manage' the risk (i.e. birth belongs in a hospital with a Dr). We must do something to counter this falsity that continues to be expressed.
I see birth plans as another tool for a mother to express herself. For people who are interested in listening to what the mother is choosing to express the birth plan can be considered a tool to provide insight. I agree they should be succinct but this is for the benefit of the staff, not because I believe that the mother should only 'briefly' express herself, but because I believe the staff doesn't typically embrace birth plans that are the length of a novel. I think we owe the mother patience in regards to allowing her to express herself.
Sorry so long :)

August 13, 2006 | Unregistered CommenterAnonymous

I love this topic because it is so much deeper than first glance.

I do think BFW is the closest thing to the truth than what most CB advocates/activists espouse. Because what we are talking about here is Life.
Why do women make the "choices" they make?
and what anonymous said about late pregnancy is so very interesting...what is it about late pregnancy that brings up these questions (I think it's more than the fact that labor/birth is on the horizon)? in our bones we know that we are birthing so much more than our baby...
Could it be that we as birth activists are here to learn about is compassion?
about no judgement/no fear?
about how to Love, really Love with firmness and with letting go?

As a homebirth midwife, I know birth is safest at home...
but as a human being I know about fear.
and I know about "plans" and how utterly ridiculous they are in life.
As a woman I know about outside forces, and life experiences, and culture, and dogma, and oppression..
as a strong woman, I know about following my heart and to keep going regardless of how the "plans" unravel.

there really is nothing to hold on to. life just is. and we get to learn to be compassionate with ourselves and others. and that's the beauty of it.

August 13, 2006 | Unregistered CommenterLesley

navelgazer,
I posted my thoughts on how this blog has impacted my thinking. This may change everything for me. Thanks for the courage to say it.

laborpayne

August 14, 2006 | Unregistered CommenterLaborpayne

Birth plans.....I have had 8 babies, and I have never written one. I have seen plenty, and I always felt that when women made it a point to list every incident (no shaving, no enema) that it sounded so much more adversarial than it needed to. Really, in all three of my hospital births (back in the mid 80's-1990), I simply asked if such and such were still the practice when I got to the hospital (do you still shave women here? Are you going to ask me to have an enema?), and then tell them at that time that I did not want it done. Shaving has never been a practice in any hospital I was in, although the last hospital birth I had did offer enemas, but didn't require them. I declined.

My own daughter gave birth to her first baby last year. She was in a local hospital, but never thought of writing a birth plan. Her baby did not get eye ointment, or and vaccinations. My daughter agreed to Vit K because of the birth experience, (after asking the midwife the risk and benefit of it, and exactly WHY she felt it was a good idea).

My thoughts on birth plans....I think they are GREAT for parents. It can help them gather their thoughts, figure out what is really important to them specifically. And it is helpful to talk with their care providers ahead of time about their desires. But really, I think it should start way before the third trimester of pregnancy.

August 14, 2006 | Unregistered CommenterAnonymous

I feel two ways about birth plans. First, I agree that the laundry lists that includes a lot of trivial things that probably won't be an issue anyway and are mostly a list of I-don't-wants are pretty useless, often adverserial, and seemm to bring out the worst in hospital staff.
On the other hand, I think a well-thought birth plan can help hospital staff and care providers to view you as an individual. I also think that as a culture and society we need to make such sweeping changes in the way we birth babiesi n the hospital that I'm not willing to encourage women who choose to birth in a hospital to just "go for the hospital ride."
In my community there is one hospital, and 6 physicians who attend births - 3 OBs and 3 FPs. There are no hospital based midwives. There is one homebirth midwife who takes clients anywhere in the area, and she travels quite a distance to come here occasionally - but although she is one of the few legal homebirth midwives in our state, it isn't widely known that she exists. Folks who want are having a baby around here are pretty much stuck with what we have unless they want to travel pretty far.
I think women who insist are better treatment, true informed consent, and being treated with dignity help push the envelope of what is normal care. If everyone insisted on true informed consent, maybe some care providers would start expecting to have to have a valid reason for things they recommend.
I also think it's terribly unfortunate for those women who do have a medical need for a hospital birth to have to take every intervention when they truly only need some of them.
For example, someone in preterm labor with a 32 weeker probably ought to birth in the hospital - but why should they have to lie flat on their backs, have an episiotomy, be forbidden to eat? And why can't they expect to be educated about what interventions may be necessary and have input into accepting or declining them?

August 14, 2006 | Unregistered Commenterfpmama

I had this exact same discussion on my local LLL list at the beginning of this year. Someone posted their birth plan as an example and I said if you need a birth plan, you need to evaluate your desires for your birth vs what your provider offers *and* why you don't trust your provider(s). I was flamed OVER AND OVER again and nearly thrown off the list. Funny, though, the two women who were most against what I said (b/c their birth plans resulted in GREAT hospital experiences! *gag*) have now both had wonderful homebirth experiences. Of course, no credit was given to the raging mad birth plan fight for their decision making process there, but maybe my bitchy honesty about birth plans accomplished something.

For what its worth, I LOVE what Pam England has to say about birth plans and agree with it 100%. If your provider doesn't do what you want done and you feel the need to "change" the norm, then maybe you should change providers instead of changing your provider!! What a novel idea!!

Keep up the good work. Little by little us honest women (the ones who say a birth plan is just a piece of paper!) ARE making changes, even though it can be painful!!

August 16, 2006 | Unregistered CommenterCharlotte

I've noticed that nearly everyone here is making commentary about birth plans, and I'd like to add my two cents... but maybe for a different reason than you'd think.

I am pregnant, and reading your post was very educational because I wasn't aware that birth plans are frequently contemplated with such negative and sometimes sinister attitudes. I haven't written one (yet) but I do think a small list of requests is better than assuming your nurse or doctor is going to know what you want. I'm also not terribly concerned about it because I expect my husband to be just as assertive as me (or FOR me if I am unable) : something that is going to make more of an impact than a list can ever make.

My list is short. I do not want an episiotomy.

My reasoning is that though it is common enough practice, there is very little medical information about it's usefulness, and I've heard plenty of horror stories about doctor's saying "now I'm just going to make a little cut..."

I do not consider that informed consent. As you so decently pointed out, beware the blanket consent to medical or invasive treatment form you fill out when you get to the hospital.

For me, a birth plan is a way to express what I want: not to stop the doctor from doing what is right, or medically necessary, but to stop him or her from doing what is "common practice".

August 17, 2006 | Unregistered CommenterCourtney

But it isn't common practice to do an episiotomy! There isn't ANY doctor that will tell you they do them as a matter of course. None. They will tell you it is for your baby's safety... and your telling them you don't want one is not remotely enough to keep them from doing one. I am really sorry to tell you this, but it is true.

The best way to keep scissors from your bottom is to keep your perineum out of range of them - remain standing, hands and knees, on the toilet, in the shower... that is how you do that. Putting your feet in the leg holders (stirrups) makes you a(n) (un)willing victim to the steel.

You really need to know that your "no episiotomy" request is included in those 98% of the exact same thing women ask for. I would say 100% of the birth plans I have seen say "no episiotomy."

It doesn't matter.

August 17, 2006 | Unregistered CommenterNavelgazing Midwife

I have to agree on the episiotomy issue. If you don't want one, go to a provider who doesn't do them. And if you truly have no choice, don't get in a position where they can do one.
One study tried to find out what maternal characteristics predicted the "need" for an episiotomy and found there were no predicitable characteristics. The only thing that predicited episiotomy was the characteristics of the attendant. Those who did a lot, did a lot no matter what women they attended and what happened during the birth, and those that didn't do a lot, didn't no matter what happened.
I still think that birth plans (maybe not the cookie cutter, check box variety) have a chance at pushing the envelope of what is normal, especially for those who don't have a choice about where to birth, or with what attendant, and can be a tool to communicating your wishes and plans to your providers. I am known to be overly optimistic, though!

August 18, 2006 | Unregistered Commenterfpmama

Fabulous! How I wish I would have thought to Change Providers instead of trying to Change My Provider during my first pregnancy. It was a lesson learned though and I've had two beautiful homebirths since then- oddly enough (ha!) I did not feel a need for a birth plan/transfer birth plan for either.

Thanks for the thought-provoking essay.

Michelle- aspiring midwife

August 19, 2006 | Unregistered Commenterbusybusymomma

I will be giving birth at a hospital that is very supportive of and promotes natural birth. They have birthing tubs in all of the rooms and everyone in the natural birthing community raves about how wonderful the staff is. At the same time, I know women who give birth there who just want their epidural as soon as possible.

With my first birth, I did not have a written birth plan because I assumed I had chosen my environment and providers so that I could have what I want. But when I got discouraged and said that either I needed a really good pep talk or an epidural, I got the epidural which led to about every intervention they had except for a c-section. In retrospect, I wish I had made it clearer to those supporting me how important it was to me to give birth naturally. I may have ended up on the same alternate path, but at least I could look back and feel like we tried everything we could. As it stands, I now can give you a long list of the things we could have tried but didn't.

Even in an environment that is very supportive of natural birth, I think a patient owes it to her providers to let them know whether she's in the "give me drugs" or "natural please" camp and how important it is to her to take that path. Someone who wants drugs doesn't want encouragement to do it naturally any more than someone who really wants to go natural wants to be offered drugs. So I think there is a place for birth plans, and this would be where they come in.

August 22, 2006 | Unregistered CommenterAnonymous

Awesome!
I am sure that I have lost prospective doulas clients in interviews because I am so blunt about the reality of not being able to have a "homelike" birth at a hospital. It's all about choosing your battles and going with the flow in order to create a positive birth wherever you end up.

At the end of the day, we don't choose where our clients give birth. All we can do is help them navigate the situation gracefully.

August 30, 2006 | Unregistered CommenterCat

"Why... why oh why... if you want a "home-like birth inside the hospital" aren't you considering a home or birth center birth? If you want control, why go where egotistical birth is the norm? If you want autonomy, why go where lawsuits and defensive medicine are the rule?"


Because I live in Missouri, where midwives are, for all practical purposes, illegal. Because there are no birth centers here, certainly no free-standing birth centers. Because Barnes St Louis Hospital used to have doulas on-site and on-staff until two years ago. Because I have no other options, short of driving 6 hours to Ina May's farm, which is my goal. Because I would LOVE to have a homebirth but I still want a professional, ie, a midwife, to attend me. Because I may have no other choice.

June 27, 2009 | Unregistered CommenterErica Douglas

Erica, it must be so hard. I can't imagine not having any choice, but do acknowledge that your situation is not isolated. I know that there women who choose to UC because they also have no choice but to go to a hospital. I wish I had an answer.

Not that you need to or can, but maybe this can be an option with a midwife close to your location... a woman in New Orleans hired me to go to her (this was after Hurricane Katrina and she couldn't find any midwife to attend an HBAC) 2 weeks before her "due date" and I stayed until several days postpartum. She had a trailer I stayed in, equipped with WiFi and cable and air conditioning, but shared meals with them and rented a car to see the sad sites around New Orleans. It was one of the most wonderful midwifery experiences I ever had.

I wish resolution for you, even if it is having a successful, beautiful hospital birth.

June 29, 2009 | Registered CommenterNavelgazing Midwife

I too would say I have very few options. I had a hospital birth with my first, attended by my family doctor. No real complaints, but they didn't even look at my birth plan. I ended up trying nitrous gas and asking for an epidural in transition even though a natural birth was my plan. Thankfully I was fully dilated and was able to decide not to have the epidural. The next two babies were midwife attended home births without complications.

Recently I went from living in a city to a town of 5,500 with 5 General Practitioners (Family Docs) who deliver babies in the small local hospital 5 minutes away. I am due right before Christmas and now live at least 1.5 hours from a midwife attended hospital birth. While we did seriously consider having the birth with a midwife in the city (one even suggested a hotel for the birth), it would mean driving, while in labour in the middle of winter in a northern climate I'm not familiar with. I've never been in a car in active labour and my second child literally fell out without a single voluntary push - I would be a little nervous to have this one in the car!

I should mention that here (in Alberta, Canada) and where I am from (Ontario, Canada) midwives are regulated and covered by our free health care. Midwives have hospital privileges as well as attend home births or birthing centres. So a hospital birth with a midwife would be a happy medium for some I imagine.

I guess I will have to go over common procedures here at my next prenatal appointment, but there isn't much I can do if I don't like the answers I guess.

September 18, 2011 | Unregistered CommenterNot A Lot of Options

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