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Sunday
Aug192007

Let's Critique a Birth Plan

Since writing this blog piece, the author of the birth plan removed it from public view, so reading the complete plan is no longer possible. Because it was originally published publicly, I've chosen to leave the post as it stands. I will, however, remove the link to the original post. It seems the author might not have been quite ready to have the birth plan shared with the Internet when the search engines picked it up (I received two alerts from two separate search engines), but she left the birth plan up for 4 days before making it private.

I commented on her own blog, thanking her very much for the great learning opportunity she was offering. I continue believing this was a great object lesson for many of us - from childbirth educators, birth book authors, and student midwives to pregnant families, doulas and anyone else who works in the childbirth field I've not mentioned by name.

I thank her for sharing, even if it wasn't intentional.

BIRTH PLAN: WATER BIRTH USING HYPNOBIRTHING

So, I encourage you to go read the whole birth plan first and then I will take parts of it and critique it here. Why are we going to do this exercise? We've talked about this before... remember? Birth plans shouldn't be longer than a 3x5 card long. That's a start. This birth plan, which came across my email as a Google Alert ("Natural Birth") is ripe for using as an educational tool for childbirth educators, doulas and student midwives.

Shall we? (I'll put the birth plan's words in green.)

In advance we thank all our healthcare providers for their skilled care and kind support. We have tremendous gratitude for your assistance and know that during our labor and birth we may not be able to verbalize or show our appreciation. We have tremendous respect for our care providers and want you to know that while we have very specific requests for our birthing experience, that if need be we will always listen to and consider medical advise if a medically emergent situation should arise for mom or baby. Thank you for helping this to be a truly beautiful, natural, once in a life time experience for our family.

Too wordy! Instead of my saying this 8000 times, suffice it to say this birth plan is far, far, FAR too wordy. It behooves the hospital client to remember their nurse almost always has at least 2 and usually 3 patients to attend to at the same time. Reading something this long would be nearly impossible to do.

"It is not only that we want to bring about an easy labor without risking injury to the mother or the child; we must go further. We must understand that childbirth is fundamentally a spiritual, as well as a physical achievement...The birth of a child is the ultimate perfection of human love" - Grantley Dick Read

A quote? Egads. Do not waste space on a birth plan with a quote.

All natural birth has a purpose and a plan; who would think of tearing open the chrysalis as the butterfly is emerging? Who would break the shell to pull the chick out?

This could almost be seen as insulting to the hospital staff. Of course, we natural birthing people see it as right and beautiful, but (many of us feel) the majority of hospital maternity workers tear open the chrysalis long before the butterfly is even ready to emerge... and anesthetizes her during the experience as well. I'd just as soon see this quaint quote left out. They will just roll their eyes at the person who puts it in their birth plan.

The patience and understanding of medical caregivers to refrain from any practice or procedure that could unnecessarily stand in the way of our having the most natural birth possible.

Quiet room, dim lights, our chosen music. We also ask that Dawn not be engaged in conversation and that caregivers converse between each other outside of the room, unless addressing a emergent situation. If permission is needed for a emergent medical procedure please keep discussion brief, with a respectful quiet tone, addressing both mom and dad.

Please open and close door to labor room quietly, with respect for mothers privacy and concentration.

Bullet points should be used. Throughout the entire birth plan, there are typos... two being found in the last line above. It should read: Please open and close door to labor room quietly with respect for mother's privacy and concentraction. Actually, if I were their doula, I would encourage their making a sign to put on the door that said, "OPEN DOOR SOFTLY!" and that would be the end of that bullet point right there.

Please refrain from using terms such as "pain", "hurt", "intense", "hard labor" or making any suggestion of pain being experienced. Please do not offer pain medication at any time. Please do not ask the strength or scale of contractions.

I would bet that in 95% of circumstances, they will say, "I know you don't want me to say anything about pain, but I have to ask just once. Where on a scale of 1 to 10 is your pain right now?" Nurses hardly talk to patients who have support people except during admission... at least until they are pushing, so it isn't that big of a deal, this asking them not to mention words of pain. I also believe that just your saying these words on a birth plan... your telling them not say these things is asking for them to say them over and over again. To think is to create.

Many of this birth plan's requirements are negative for the care providers - against what they normally do - and when they are shoved out of their comfort zone (when any of us is), they can make it miserable for the patient demanding these changes. And, in my experience, they go out of their way to make things miserable for the birthing family... purposefully annoying them with small or large things they specifically asked the nursing staff not to do.

Minimal vaginal exams and only with permission. My preference is to have one cervical check upon a completed admission EFM that supports evidence of strong, active labor to establish dilation and a second cervical check at suspect of reaching full dilation, if needed to advise Dr. Rollins.

This is a strange request altogether... more like a couple of them rolled together into one bullet point. Minimal vaginal exams in and of itself, of course is a terrific request. But, instead of putting it on a piece of paper, when they come at you with a gloved hand, just keep your legs closed and say, "No."

I request my bag of water to stay intact and for it to rupture spontaneously with no assist.

Wellllllll... ya gotta keep people's hands outta your vagina if you don't want your membranes to "accidentally" break.

Minimal EFM after initial admission strip, unless medically emergent. No saline lock or IV unless medically necessary. Blood pressure and doppler tones to be taken minimally without breaking mothers concentration with conversation or brisk activity. No blood draws unless medically emergent and with permission only.

Interesting choice of words... saying "unless medically emergent." It isn't uncommon for the hospital staff to say things are medically necessary (I don't think I've ever heard the term "emergent" used) and to find a way to convince a laboring couple within a few moments why something should be done when initially they thought they would never ever ever think they would consider having it done. BE CAREFUL SAYING "NO" to something.

And this birth plan is rife with "with permission only." Well, permission is granted already upon admission when the papers are signed. Someone needs to educate this couple of that because they look foolish otherwise. It's birth plans like this that make (many) nurses snicker behind those attempting natural childbirths' back - mostly because the person writing the plan is simply ignorant, not stupid.

I request to eat light snacks and drink tea, juices, water and 7-up during labor.

You can request it all you want, but if your doctor or hospital refuse it, you are screwed. Some people are finding it is best to just eat quietly (when no [medical] one is in the room). Instead of you requesting it and putting it on your birth plan, discuss it with your physician and have him/her put it on your standing orders at the hospital! That's the best of all ideas.

To allow labor to take its natural course without reference to "moving things along".

Why are you having a hospital birth? Please read my When You Buy the Hospital Ticket You Go for the Hospital Ride blog piece. The deeper this birth plan goes, the more controlling it gets. How does this person really expect a hospital to not utilize the standard tools to click a labor along? Do they really believe they will let someone labor for 3 days without concern that the hospital administrators and lawyers wouldn't have met to ask the doctor what his game plan is and why he hasn't done a cesarean already? Push for 6 hours without having the doctor's head spin off its spindle as he worries about what he'll say up on the witness stand because the presumption will be the baby will have some serious postpartum recovery issues? While the healthy and alive mother and baby are utmost, EVERYTHING IS DONE WITH THE COURTROOM LOOMING AS THE BACKDROP OF THE LABOR & DELIVERY SUITE! To expect your wishes of an unhindered birth to occur in a hospital is absurd.

I repeat:

To expect your wishes of an unhindered birth to occur in a hospital is absurd.

(I almost just want to stop here.)

No augmentation of labor via Pitocin or stripping of membranes.

Don't say "No." laughing How's that for negative talking? Saying "no" to something gives it an enormous amount of energy. Stripping of membranes in a labor and delivery suite? That isn't even something that is done and makes the author sound ignorant.

I'm sitting here thinking, "You could say, 'Use of pitocin after discussion' or 'Use of pitocin only when warranted," but they believe that's the only time they use pitocin! They don't feel they use pit randomly; so it's just silly to try and say to them to only use it when it's necessary.

The use of a birthing ball if one is available and the freedom of choice to walk and change positions as needed. The freedom to use the floor to find comfortable laboring positions.

Do you KNOW what's on a hospital floor?!? BLECH!!!!!!!!!! (Apparently, according to a commenter, some women do get on the floor with covers and sterile drapes. That seems more appropriate - covered sounds great.)

To allow natural bithing instincts to facilitate the descent of the baby, with mother directed breathing down until baby crowns. Use of hypnobirthing breathing techniques during birth of baby...no Lamaze promts please. Perineal counter pressure if needed to slow the birth of babies head.

Typos in Red. This is all in one bullet point! Please proof and correct typos before giving your birth plan to anyone. Or putting it on the Internet.

Or putting your comments on someone's blog. (Sorry, I couldn't resist.)

It should read:

To allow natural birthing instincts to facilitate the descent of the baby with mother-directed "breathing down" (I would add "of the baby") until the baby crowns. Use of Hypnobirthing (technically, that should be capitalized, but I didn't want to get out the red pen again) breathing techniques during the birth of the baby... no Lamaze prompts, please. Perineal counterpressure if needed to slow the birth of baby's head.

Please do not shine bright lights toward baby during birth, keep lights as dim as possible during labor and birth.

? ? ? ? ?

Even if lights are kept dim, lights will be shined onto your perineum and that is where the baby comes out, so the baby will have lights shined on him/her during the birth. (Unless your care provider doesn't use lights during the birth as a few care providers do not use, including Dr. Wonderful and a commenter.)

I ask once again. Why is this person birthing in the hospital?

Please allow 30-45 minutes for natural delivery of placenta with No pitocin administered, No manual removal, No cord traction.

You can't see my eyes bugging out, can you? Now, I've learned from all the smacks upside my head not to say "You will NEVER see..." but I would LOVE to hear from someone who has seen a placenta be allowed/permitted to be naturally born taking 30-45 minutes in a hospital while the care providers waited and watched with their hands in their laps. I'm trying hard not to laugh at how absurd that even sounds coming out my fingers! As if that could ever, ever happen. Anyone?

(Well, a commenter, Dr. Jen, a great Family Doc came foward and said she has waited 30 minutes for placentas before, so there you have it. I am speechless - and delightedly so! Good for you, Dr. Jen! If she is one, she can't be alone. Thank goodness! So, perhaps the birth plan writer isn't so odd after all? But, I would suspect - in the majority of cases - this request is unrealistic. I would suspect Dr. Jen would agree. Yes?)

Did this person who wrote this birth plan discuss this with their care provider and the doctor say, "Sure! Put that in your birth plan!" Or was it just a wish plan they just decided to write and believe the hospital would follow. I believe it was the latter (but am not 100% sure).

(I am really glad that Dr. Jen uses a birth plan as a spring board and I would love to see more care providers do so - and listen to clients do that!)

Oral vitamin K to be used. No injections for baby. If boy - no circumcision.

Unless you have prepared for it, hospitals don't typically have oral vitamin K... do they? Is that something new they are doing? Or would they look at someone asking for that as if they were also asking for the pharmacy to make their placenta into capsules.

No injections for the baby. At all? Under no circumstances? What if the baby is sick? Has hypoglycemia? There are caveats all through the birth plan. This is one place a caveat might be a good idea. And putting circumcision in a birth plan is bordering on bizarre. Circumcision does not occur in birth anymore - and hasn't for a LONG, LONG time. If you want the nursing staff to roll their eyes at you but good, putting a note about circumcision in your birth plan is certainly the way to do it.

No PKU testing, heel prick, or blood draw for baby.

Again, if the baby is ill, then the baby is going to be poked. That's just the way it goes. And PKU (officially called Newborn Screening) testing is done on the second day or so postpartum... this is also not a birth plan point.

No use of Erythromycin or any eye salve to allow optimal sight for bonding.

Eye salve? What is eye salve? Where did that come from? Choose your words very carefully when writing something like a birth plan. The last thing you want is the staff laughing or rolling their eyes at your choices or your hard work.

Please place a blanket or chux on scale prior to weighing.

Does anyone not?

I've just learned so much from listening to nurses discuss Birth Plans over all these years and it is so much better to set your stage before you ever set foot into the hospital than to expect the birth plan to make your whole experience Nirvana.

And haven't we heard women speak about their birth plans being ignored (or sabotaged) enough to know that long involved speeches get us nowhere? And might even get us sent to Hospital Hell?

I vote for families who want convoluted birth plans to:

1. Have a home birth

OR

2. Have a birth center birth

OR

3. Have a CNM in the hospital

OR

4. Find a Dr. Wonderful

OR

5. Get your ducks in a row BEFORE labor begins so you don't have to fight once you are in labor.

AND

6. Hire a doula to help you with your support and care, but NOT to speak for you.

Comments?

Reader Comments (42)

I very much enjoyed reading that birth plan. I always enjoy a good laugh in the morning.

Is the woman a primip? Sounds like it--the woman has never actually experienced labor, I'm sure.

Most of your criticisms are right on. BTW, I don't think vitamin K CAN be given orally; it is destroyed in the stomach. And I hope someone tells her that if the placenta doesn't separate in half an hour, she is at great risk of hemorrhage. She certainly will have a "spiritual" experience" if she exsanguinates.

August 19, 2007 | Unregistered CommenterAntigonos

I'd like to place my bets for a post dates... inducuction led to inevitable cesarean section for this amazing little birth plan! UNLESS, it is a joke? Nah, Barb wouldn't give us a pop quiz without some reality check right? =)
Holy High Hopes. My birth plan, the one and only I ever made with actual hope in it! Was on a cue card. And it got tossed in the garbage when he turned breech on us.
I never bothered with the last two hbacs! When one of the back ups begged me to. I just wrote "I will not transfer to hospital for anything less than death".
She was not impressed. I was somewhat joking.
Thanks for the early morning pop quiz! =)

August 19, 2007 | Unregistered Commentermm

This is a real birth plan! I get Google Alerts and this came as a "Natural Birth" one and when I went and read it, I just knew we had to play with it altogether.

I don't mean disrespect to the original author/s, either. What I hope is s/he/they are able to take the criticism and re-think what they are asking.

Antigonos: It isn't uncommon for homebirth clients to ask for oral Vitamin K. It isn't something I have ever given to a baby, however. I give IM injections to baby's in need of Vitamin K, but do not routinely give it. Babies with bruising, who've had a rough go of it through the birth canal (shoulder dystocias, posterior babies, extensive molding) or, if we are in the hospital, assisted deliveries (forceps or vacuum) all qualify as babies in need. I obtain the parent's permission, and always do, and then give the injection.

As far as the placenta goes, homebirth midwives in this state are permitted to wait for one hour before transporting as long as there is no bleeding and vitals are stable. I've had no problems waiting that long (and a few minutes more in other locations) with mom ambulating, eating, nursing, voiding and eventually letting go of her placenta. The longest for me has been about 70 minutes, but I have heard of much longer. I personally wouldn't be comfortable with much longer than that.

There is a balance in placenta waiting. How does one know if it is a placenta that is stuck versus a placenta that is just taking its time? You don't until it comes out. Or it doesn't.

Blessedly, I learned to get placentas out if there is bleeding. I also don't hesitate to use pit if the bleeding is getting to be too much right after the placenta was born.

The point about timing wasn't so much *timing*... was really the HOSPITAL allowing the placenta to take its time. There is no way in HELL any practitioner, in this day and age of active management of third stage is going to wait more than 5 minutes, much less 30-45 minutes, for a placenta.

August 19, 2007 | Unregistered CommenterNavelgazing Midwife

I loved your comments although I do have to say that I am guilty of asking for some of those items in a hospital birth myself.. It looks to me like the author of the birth plan has adapted the birth plan that is in the back the HypnoBirthing book! I think that a lot of women in this country would love to have a "natural" birth but are very apprehensive about considering home birth or dont have the right insurance or are concerned about funds to have a birthing center birth. I personally would have loved to have a home birth for my last lil one (now 4 months) and well it just didn’t work out and I made a birth plan with some points that were a lot like those listed in this birth plan including the HypnoBirthing.... I place some of the blame on the online "birth plan" makers as they give certain outlines that are unrealistic..

but hey we can all dream right ??

Until this country embraces midwives more readily and stops seeing pregnant women as NEEDING hospitalization (although I do realize that some really do) for birth this kind of birth plan will live on :)

August 19, 2007 | Unregistered CommenterPartylsbabe

Oy!

It's been my experience that birth plans are a guarantee that you'll get everything you don't want, with the hospital staff treating you like a lunatic or a simpleton. They have the opinion that if you don't want their wonderful toys and interventions, what are you doing here? (and I sort of agree with them, what the hell are you doing in a hospital if you don't want a hospital birth?)I've heard one doctor tell the woman she needed to go squat in a rice paddy if that's the kind of birth she wants. {rolling my eyes}

I have to wonder if all these online "Birth Plan Guideline" authors ever follow through with the end results of their advice....how many women actually have the OB and nurses say, "Of COURSE we'll honour your birth plan! No IV? No monitoring? More work for us? Peachy!" and how many are met with hostility and get just about every intervention in the book thrown at them.
(Please, ladies, bear in mind that your Dr. Friendly has actually taken lectures and courses on how to scare the living daylights out of you so you will be more compliant! They have articles published in their professional journals about the very same subject. S/he has a lot more experience with coercment than you do)

It's their game plan, on their playing field, and here you come with your own set of written rules. I can guarantee you will be looked upon as a non-compliant patient and a potential law suit.

Instead of a huge birth plan filled with flowery sentiments, educate yourself beforehand about hospital procedure, and make sure your partner/companion knows to ask the right questions.
Hospitals are convinced that their way is the safest, so philosophical prose won't impress them and may even make them angry. They have had 8 years of very expensive education, and here you come with stuff you pulled off the internet, how dare you question their authority, skill, and experience?

Write a birth plan if you must, leave the negatives out of it, and then burn it.

August 19, 2007 | Unregistered Commentermamarose

If the writer of this birth plan feels the need to exert this much control over her hospital birth, then she should consider a homebirth or birth center.

And I agree with you Barb - keep the birth plan/preferences to a 3x5 card!

BTW - I review each item listed in a birth plan when I have a woman come in with one. Then I tell them realistically what they can expect or not expect from their doctor/nurses regarding each item.

August 19, 2007 | Unregistered CommenterAtYourCervix

Antigonos said: "And I hope someone tells her that if the placenta doesn't separate in half an hour, she is at great risk of hemorrhage."

Where did this come from? I had a homebirth and my placenta didn't come out until TWO hours after the birth. After 90 minutes my midwife gave me homeopathics to assist the placenta with separating and coming out. I had almost no bleeding this entire time and no side effects.

Our bodies are amazing -- so many shades of normal.

I enjoyed this birth plan post. Parts of it made me laugh. The couple who wrote it is in for a big shock, unfortunately.

August 19, 2007 | Unregistered CommenterLee

You know what? I don't think this birth plan is all that unreasonable. Speaking from the perspective of a hospital birth attendant I expect I would be seeing this plan at around 36 weeks when I ask the client to come prepared to discuss their birthing wishes. I don't always get to know my clients in detail the way a homebirth provider does, and for me, this plan would tell me a lot about the client's personality and wishes. I might help her phrase things a little differently to help with the way the labor nurses might feel, but all in all, I get what she's saying and what she is wanting. It would also give me the opportunity to point out times where we might need to go against her wishes, and what signs she could expect to see, and what I'd be saying. This birth plan would give me a good stepping off point for the discussion of how we are doing this.
Please quit saying this or that would never happen in a hospital. ("No way in HELL" I think were the exact words.) I know I'm rare among hospital providers, but I don't turn on lights when baby is being born (I joke that I can certainly catch a baby by the Braille method, if mama isn't catching herself) I wait at least 30 minutes before yanking on any placenta, and I know I'm not the only one from talking to many other family doctors. I have no issue whatsoever with delaying or forgoing any injections for baby, and I do expect to get permission from my client before I do any intervention, from as major as an instrumented delivery, to as minor as moving her pillow if it looks like it might make her more comfortable.
Women in my practie birth in any position they want, and I've attended many a floor birth and don't bat an eye if mom can't get comfy in the bed and wants to get on the floor instead. We cover the floor with the sterile drape used to cover the instrument table and through down cloth bed pads and pillows as needed.
That birth in your previously post? That looks like about 50% of the births I attend in hospital, with mama pushing as she chooses, and provider waiting to merely prevent baby from hitting the floor if needed.
I know you only write your experience, but you will get less negative feedback if you stop saying "never" and "always" and stick to "unusual" or "rarely." I struggle everyday to provide the most unhindered, uninterfered with births I can for my clients who have such limited options in my state - or who would never know there were options if I didn't tell them.
The other advantage to writing such a plan as this one, is that if you presented this to your provider and they laughed in your face and started ticking off all the reasons why this or that isn't possible you may well realize that this isn't who you want to birth with, and the hospital isn't where you want to be. Nothing wrong with being idealistic; sometimes that idealism is what drives systemic change over time.

August 19, 2007 | Unregistered Commenterdoctorjen

Definately a primip. Anyone who's been through a hospital birth would know better. I think a large part of the "fault" for these ridiculous birth plans is unrealistic expectations that are fostered by folks who write about "alternative" birthing practices...hypnobirth, Bradley, and the like.

Why can't the educators spend some time on the hospital birth process and be realistic about it? Instead they outline birthplans that just get torn to shreads....

August 19, 2007 | Unregistered CommenterOpening Pandora

I love what you have to say, Dr. Jen... and so wish you also had pics and your patients writing about your births! Then they wouldn't seem so rare. Where are the patients of those docs you know? Why don't we hear about them more? Why do we see and hear about the birthrape, birth trauma, 98% epidural, scheduled cesarean, non-VBAC allowing, disrespecting docs out there? Why is it when I go to births, I have to listen to nurses push epidurals as if they receive bonuses for every one they get a woman to take?

I hear you on the "always," "never" issue and am trying to stop that. I apologize. I will go through the piece and edit now if I did that. I thought I was consciously aware when writing it not to do that. I am trying very hard to write about my own experiences, but there are also THOUSANDS upon THOUSANDS of experiences of women who have shared their birth stories with me and whose stories I have read. It seeps in sometimes.

Thanks again for your input and I am so glad you are out there, changing birth, too... one birth at a time.

August 19, 2007 | Unregistered CommenterNavelgazing Midwife

As I read through your comments (and agreed with you!) it brings to mind the journey I've taken as a doula with regard to the power (or lack of) in a birth plan. When I started doula work I thought it was a 'legal' document that would state my wishes in a written manner and BIND the providers to "obeying" me. (snort!!!!!)

Then I went to having it as a shield to protect the client from having to repeatedly come out of labor and state her wishes- she could just point at her chart and every one would know what she wanted.

Then I started teaching clients about using the birth plan as a tool and not a shield, or worse, a weapon. How to write birth plans that were friendly to the nursing staff and didn't make you sound like you printed it off of a website with no understanding of what your hospital does. It was definitely enlightening when clients would ask, "Do I need to put this in?" and I would say, "Do you?....??? How would you find out?" And they call the hospital or take the tour or talk to their doctors, rather than leaving in "Please no enemas or shaving."

Here I sit on the cusp of giving birth myself, just weeks away- and I have been crafting my birth plan since I was about 20 weeks. I have discussed it with my doctor (as I've shared in my own blog) and sought his opinions about whether it was 'nurse friendly' or redundant.

Because I have other issues I'm dealing with I have more need of space than just a 3 x 5" card, but I still tried to write a plan that would not express things that I couldn't express in the moment, or that weren't typical in this hospital anyway. I'd love to share it with you and see what you have to say, if you're at all interested. ;)

I am completely surrendered to the hospital birth I'm going to have, I know where I can push and when I must let go, and it actually brings me comfort that I have attended many births in this hospital and know exactly what to expect.

This couple who wrote this plan is doing their best with the information they have, but they haven't thought past the "It's a shield" process of the plan. It's not a communication tool, it's a defensive document.

August 19, 2007 | Unregistered Commenter.....

Dr. Jen: I don't think I did too bad in the "always" and "never" category. I added comments regarding your comments, but other than that, I didn't have to change anything, so I *am* doing better. :)

I'm trying to listen to y'all!

August 19, 2007 | Unregistered CommenterNavelgazing Midwife

... Do you want to share your birth plan publicly? or privately?

I would be gentle if we went over it publicly. :)

August 19, 2007 | Unregistered CommenterNavelgazing Midwife

Unfortunately, births like I attend are rare - and though the stories are out there (see mdc and threads that say something like "tell me about your natural hospital birth") they are overwhelmed by the many, many more stories that come out of the standard US birthing environment.
My own third birth, with a family doc, in a tertiary care teaching hospital no less, was beautiful and unhindered. I walked, rocked, showered, knelt on the floor throughout labor. The nurse listended to the baby every so often, while I stood next to the monitor so she could hold the fetal monitor on for a few minutes. Her only other input was to keep bringing me raspberry sherbet which was tasting so good I kept sucking it down. Eventually, my water broke and I said I need to push, and they helped me make a nest of bean bags on the queen size bed. My doc knelt on the floor and passed me the baby as I pushed him out. He waited 45 minutes for the placenta (mine always hang on for some reason) and didn't cut the cord that whole time, telling me it was a trick he'd learned to keep the nurses from taking the baby. I needed a couple stitches, and since I was comfortable, the doc continued to kneel on the floor to do them. The baby had a quick exam in my arms, was weighed next to me, and then the baby, my husband and I were all tucked in the queen size bed together, where we stayed until discharge.
Not a usual hospital birth, even for that setting, though, as everyone including the cleaning ladies had to peak in to see us and tell us how amazed they were that we had a birth like that!
In my community I have some loyal following, and my labor nurses are some of them who try their hardest to follow the wishes of our clients. Outside of my loyal following and the teen moms who come to me because I'm the only woman taking medicaid, though, I'm seen as kind of a nut case. A lot of the "normal" patients choose another provider because I'm that nut who doesn't push epidurals, and "won't even cut an episiotomy, but just let's you tear!" Women ask me at their first prenatal visit if they can have an epidural fairly commonly, while only rarely do they show up with a birth plan that states any kind of wishes.
I am well aware that modern medicine and the medical-legal pressures on practice carry the brunt of the blame for what has become of birth. I wonder every day if I should just quit rather than continue to practice in a system so broken. I don't know how to fix the mess that's become of birth care in the US.
I tell you honestly, though, that I personally live for the clients who come in the door waving one of those birth plans! These women may be naive and unsuspecting for what birth in a hospital is truly like, but isn't pretty much every woman who births her first baby? At least these women have made some effort, some small steps at preparation, put some thought into how they wish their baby to enter the world. Many of my clients haven't thought about it at all, and are merely putting all their faith in me to produce a baby for them, preferrably without any pain or work on their part. Maybe if everyone showed up with a birth plan they wouldn't be such a red flag to providers and provides would be forced into starting to take clients' wishes into consideration.
As for blogging myself, with pictures, if I could find my way around HIPAA, I'd consider it!

August 19, 2007 | Unregistered Commenterdoctorjen

The never type comment was in your comments, not in the original post - but the "I would LOVE to hear from" comment sports a significant amount of sarcasm, don't you think? So now you've heard from one :) In the comments you said "There is no way in HELL any practitioner, in this day and age of active management of third stage is going to wait more than 5 minutes, much less 30-45 minutes, for a placenta." And maybe there is no way in HELL, I don't know, but on earth, there are still folks doing that!

Stupid active management of the 3rd stage studies. Prior to them, I would bet the majority of family docs at least were waiting on placentas routinely. When I go to my national meeting and chat with other docs, though, there are many who continue to wait and haven't embraced active management yet. My youngest dd is 4, and her birth was attended by an intervention happy OB (another long story) but she literally sat on a stool with her arms folded for the 28 minutes it took me to want to push the placenta out. Maybe she was going to jump up and yank it out in 2 more minutes - I never found out.
The nurses I work with hate manual removals, or the doc pulling on the placenta. Our one OB who does it routintely now has to put up with the nurses watching him like a hawk and repeatedly telling him to put his hands down - it's a stitch to see it happening. He's an older doc whose been practicing a very long time and is used to a different style of practice, but he's a big teddy bear and listens to the nurses.

I am not easily offended, and do not get bothered by hospital births, hospitals, or hospital birth providers being criticized - I can easily find plenty to criticize myself. I just want to point out that some of us are trying.

August 19, 2007 | Unregistered Commenterdoctorjen

I'm sorry...just had to comment. You are hilarious! This post is all the more reason I need to have a home birth next time! Loved the 'red pen'. I so often want to get out my red pen when I'm reading. Honestly, why don't people take pride in their writing and take the time to proofread?

August 19, 2007 | Unregistered CommenterLynnSofia

I'd be glad to share it. I can make the choice not to come back and look (yeah RIGHT!! lol) if I'm nervous about what you have to say. :)

I gotta change my name from ... back to redspiral, jeez. LOL Didn't realize that happened!

August 19, 2007 | Unregistered Commenter.....

I didn't even read the whole thing. I've read them a million times before and have exactly the same responses you do.
I almost PROMISE you this couple will have a high needs baby. Not saying all high needs babies are 'created'-God sends 'em to everyone but when I taught parenting I could pick in class who would come back with the 'high needs' baby at the reunion almost every time and it was the high strung, controlling types that write these birth plans. The only time it wasn't, was the pediatricians baby. LOL!!

IMO, it's all about COMMUNICATION. If one communicates well and clearly with their care provider beforehand and nurses during labor and birth, most issues are easily dealt with. Also controlling the things you CAN control, like picking he most baby friendly hospital and like-minded care provider you can instead of imagining that you will control your baby and your birth.

It makes me want to shake people.

My birth plan boils down to:
Leave me alone unless I am in a medical crisis. Leave my baby alone unless she is in a medical crisis.
Talk TO me, not at me.
Don't yell at me to push.

And it works. The nurses are not morons. When you decline the gown and bring your own birth ball they know which way the wind is blowing. Without some umpteen page birthplan. If your husband is on board AND you hired a doula? PUHLEEZE. First you can advocate for yourself, then if you are unable you have at least two more people to help.

Almost everything they do to the baby they need your consent to do ANYWAY. And what fool would decline a heel prick that could save their child's life/quality of life with a simple change of diet or medication? No one will ever convince me that the cons of metabolic testing outweigh the pros.

August 19, 2007 | Unregistered CommenterAnonymous

I would be interested to know the relationship this couple has with their care provider. To me, birth plans like this scream of mistrust of the health care provider, and as Barb has said, ignorance. No amount of birth planning can overcome that.

After my first pregnancy was complicated by an overly cautious practitioner, I went in search of a new one. With my first pregnancy and birth, you name the intervention and I had it with the exception of an epidural.

When I became pregnant again, I found my own "Dr. Wonderful". He was known for his low intervention manner. I didn't have a birth plan in the normal sense. What I had was a list of concerns. We went over it together...at the first prenatal visit. He made notes on it, I made notes on it, he signed it, I signed it and it became part of my records.

With him as my care provider, I had two natural hospital births. Natural meaning no IV, no EFM (beyond the nurse holding the doppler intermittently), no directed, purple pushing (well, the nurse tried, I just ignored her, so did dh), no episiotomy, baby nursing within minutes after birth, all baby care deferred for at least an hour (almost three hours with last baby). I did get IM pitocin within an hour of both births because my uterus remained boggy even with vigorous babies at breast.

Funny enough, the most grief I received was from the nurses because I refused to allow them to give the baby a bath. Oh, and they had to get the nursing supervisor's permission for me to WALK from the LDR room to the post-partum room (about 20 feet down the hall)

As a doula, I encourage my clients to envision their births not to plan them. I encourage them to list their concerns/requests and discuss them with their providers. Some do it some don't.
I have had one client switch hospitals because they realized there would be too much fighting to avoid interventions even with their provider's support.

August 19, 2007 | Unregistered CommenterCol

Hmmmm....I just gave birth almost 5 weeks ago, to my fourth child,so this topic is fresh im my mind. You say why is she having a hospital birth?....many women are not able to choose a homebirth although they would love to! I got the midwife to agree to a homebirth since I lived very close to her, but there's no way I could afford the cost-$3000.00 in one payment! I tried calling all three health programs available for medicaid, since Gateway would cover NOTHING if I had a homebirth, figuring I would switch if one of the other programs would cover it. No luck. I'm sure there are lots of women who educate themselves enough to know they don't want the typical hospital birth but just don't feel they can safely birth at home. A birth plan lets them feel like maybe they will have some control. At least in my experience, there's a lot of pressure from other women not to homebirth-people suggest you are crazy for wanting to and that you are jepardizing your baby's safety. So a lot of people probably just go with what's considered normal-the hospital birth-and try to make the best of it. A post like this one would be a better tool than all the generic birth plans you can find online or in books....I didn't bother with one because most of the stuff that would have been in it was standard practice for the midwife anyway. I always wondered-do they actually re-read that thing before you give birth anyway? Probably not.
What do you mean by "Circumcision does not occur in birth anymore?"
? I've had three boys now and the hospital always asks right after birth if I wanted them circumsized? So I can understand someone wanting that in writing to make sure they didn't get an unwanted circumcision!! Can't undo that one!

August 19, 2007 | Unregistered Commentersajmom

I can't determine whose language is more hostile: yours or the author of the birth plan.
This was not the kind of feedback I would expect from a doula.
Perhaps I need to read other entires to your blog and should not respond to one mere posting, but as a "birth-plan-writing-pregnant-lady-who-is-looking-for-a-doula", I tend to look for more positive energy.
I think this post and many of the responses were mean spirited.

August 19, 2007 | Unregistered CommenterAnonymous

I agree with the critique, although I do think that a woman has a right to go to the hospital to birth for reasons of emergency back-up as opposed to a medically managed birth, especially in states that have few home birth midwives and no birth centers - like here in Minnesota.
Please help me spread the word that there are NO LAMAZE BREATHING TECHNIQUES anymore, nor have there been for a long time. I am a Lamaze educator, and although Lamaze was the first education curriculum, it has kept up with the times. Here are the six evidence based care practices taught in Lamaze:
*Labor begins on its own
*No routine interventions
*Freedom of movement throughout labor
*Continuous labor support
*Birth in non-supine positions
*No separation of mother and baby

Lamaze educators are required to teach these six principles because they are evidence-based. I teach breating techniques based on Nancy Li's book, basically just good deep breathing and exercises to increase oxygen intake and CO2 return. That is my option as a Lamaze educator, as long as the core curriculum includes the six care practices above and is consistent with the Lamaze philosophy. Check out the website. After eight years as a DONA certified doula, I chose Lamaze as my certification for childbirth education. It's not your mother's childbirth ed, believe me.
We do provide a lot more information than just the six principles and the way they play out in hospital birth, but those are the core principles for a healthy mom and baby. Obviously, we also provide information about the unforeseen and decision-making in birth.
Lamaze offers a lot of teaching tools to make sure that leaders accomodate all kinds of adult learners. This is important to me since I have an adult child, he's a father, with a learning disability. In my classes, I use a lot of exercises from Pam Englund's book among other resources.
When we get to birth plans, I say that "preferences" is a better word. I DO encourage birth preference forms to be written, because in Minnesota they do have some legal weight, and the general consent forms signed do not override a woman's right to reject any treatment and still receive other appropriate treatments. But the preferences sheet (yes - a single page in 14 point double spaced is best) should take into account the policies of the hospital that mom has chosen, so she should know those policies, and both the philosophy and the relevant birth record of her caregiver (how manyVBACs even if they are a primip, because it reveals philosophy, and c/s rate, and is delivery on a birthing stool cool with them because they have to be on the floor to do it) and have they delivered many women on hands and knees? These questions need to be asked before the preferences are written.
It is in the process of discussing birth preferences that many members of my classes decide to change caregivers.
So the PROCESS of writing the birth preferences is very useful as an educational tool.
I am also a doula of ten years, and I have attended births that involved more than fifteen caregivers (natural moms can take a bit longer) and the written form was a great way to let nurses and midwives changing shifts get a quick overview of my clients values. In general, the nurses and midwives responded very well. So have some docs.
So I am a fan of birth preferences, but please help spread the word that Lamaze is not your mother's childbirth education class!!!
One last word. I recently had a mom in my Lamaze class who was giving birth for the second time but had not taken a CE class the first time. She had had a normal - no meds - first birth but wanted more and so was having a home birth. When we got to the point of discussing birth plans, I asked her to write one even though I know her wonderful midwife and am sure that the care will be sensitive and safe. What I asked was that she write a plan that simply addressed each person who would be present at this birth, and let them know what she was hoping they could do if all went well - why she wanted them at the birth, in essence.
This very young second time mom wrote the most beautiful paragraph to each of the six people who will be in her home at the birth! Everyone in class had tears in their eyes when she read it to us.

A birth preferences form should reflect a mom's personal values and say how she hopes those values will be reflected in the care she is given. It then becomes a sacred as well as useful legal document. I believe nurses and midwives respond to these "preferences" written from a mother's heart in their own hearts, and I think the documents are a good communication tool in hospitals and a preparation exercise for moms.
Thanks to all who responded and care about birth......thanks to Navelgazing Midwife for this very wise perspective on birth "plans" and for opening this discussion.

August 19, 2007 | Unregistered Commenterabdallah

Anonymous,

I'm sorry you felt these comments were mean-spirited and I can see how you would feel that. Most of us here are birth workers - not pregnant women, so the tone is MUCH different than when used towards clients, but you definitely give me/us pause to remember that others read besides us.

I've written before about birth plans with the emphasis towards the birthing woman, but the opportunity came up to write with the student midwife, the doula and the childbirth educator in mind - so I did.

I do write snarky sometimes, it's true. It's very, Very, VERY frustrating as a birth worker (not just as a midwife) to have to say the same things over and over again with regards to birth plans. (Many) Books, (the majority of) on-line birth plans and (quite a few) childbirth educators perpetuate the difficulties with which hospitals, doctors, nurses, CNMs and even midwives contend with. If we didn't have a chuckle about it now and then, we might cry.

Is there something specific you are looking for that we (collectively) can answer for you without sarcasm and snarkyness? We are all really great folks and REALLY wonderful care providers. I'm glad you are game for reading more than one blog piece before judging. That speaks very highly of you. Thank you.

August 19, 2007 | Unregistered CommenterNavelgazing Midwife

I can't believe how negative this blog post is. I don't find it helpful or educational.

August 19, 2007 | Unregistered CommenterAnonymous

Then ignore it.

August 20, 2007 | Unregistered CommenterNavelgazing Midwife

This is obviously a venting post. and the comments have been added by other venting professionals.
Check blogs by doctors, nurses, ANY service profession and you will find heart touching, heart wrenching posts, funny posts and sad and angry posts and frustrated posts. NGM is no different. I don't agree with what she writes or believes some of the time, but this is her blog, her diary, if I don't want to read it, I don't have to.
This is not an informational site for pregnant women, this is a personal blog. If someone can't understand the purpose of blogs, then they shouldn't be reading them.

August 20, 2007 | Unregistered CommenterAnonymous

That looks like my birthplan from my first birth (which turned out to be a c/s!). My second birth was a vbac attended by a cnm in a hospital, and I had a very straightforward bullet-pointed birthplan. In my doula training, I was advised to work with my clients to go over ALL the options and have them pick three things that really mattered.

August 20, 2007 | Unregistered CommenterKaren

It's so interesting, because I didn't/don't see it as a venting post at all. I've re-read it several times and I see it, REALLY, as an educational essay - albeit extremely blunt and informal - about birth plans. I can see why people might be offended, especially if you espouse birth plans, are married to their idea, if they'd worked for you in the past or believe they are going to work for you in the future, but for those of us who have been in birth work for so long and have watch birth plans be flushed down the toilet more times than not, I really think this piece is a wake-up call more than a vent. But you all are surely welcome to read it as you want to. :)

August 20, 2007 | Unregistered CommenterNavelgazing Midwife

I'm a doula. And I've recently started telling clients that a birth plan is a great way to have a conversation with your care provider ahead of time, but not to worry about bringing it with you into labor. You are your own birth plan - just say "no" when something you don't approve of is presented. Instead of spending a long time on the details of a birth plan, I try to instill in these women a mama-lion spirit - knowing their rights and listening to their bodies. And growling only if they have to.

Who can labor when they're scared? And a birth plan is a giant red flag that you're scared.

August 20, 2007 | Unregistered CommenterHolly

It seems like many here are saying that if you choose the right people, and go to the right facility, and then simply tell those people that you chose so well what you want in the moment, then you will be fine and you don't need a birth plan.

But I wonder how that is possible? (Or any more possible than being your own midwife in a UC?) I did not have a birth plan, I chose a group practice of CNM's, a hospital birth center, and a doula (in MN we have no freestanding birth centers, and CNM's practice in groups), yet I had a birth experience that I would now classify as a rape. And as far as making your wishes known while you are in labor? I don't know what kind of mild, relaxing, lengthy labors you all have where you are coherent and "with it" enough to make decisions and make your wishes known in the moment, but there was no way that I would have been able to do that for myself. I was off in "labor land" the entire time and it was not a state of mind that I could think in words and sentences and then express them. Despite that I did come out of labor land a few times to scream "no", or say "I don't want it" or "stop it" or some other thing, but I was not listened to in those instances. Since I thought I had chosen everything well, I did spent very little time with my husband or doula talking about what I wanted. I just thought I would make a decision in the moment based on the circumstances, but that turned out to be totally impossible. I hate reading these types of comments that give women the impression that they too will be "with it" enough to make decisions that they will be happy with, and to verbalize those decisions in a way that they will be taken seriously and not thought of as the crazy rantings of a laboring lunatic.

I wish I would have had a birth plan because then maybe I would have gotten one or two things that I wanted instead of nothing. Maybe they would have handed my son to me instead of taking him away, or maybe they would have helped me breastfeed in the first hour instead of waiting three hours before helping me. Maybe I could have just said to my husband, "go get the birth plan" in order to remind him of our wishes.

You'll probably all read this and say "well, you should have... 'hired a better doula' 'taken bradley' 'taken hypnobirthing' 'taken fill in the blank childbirth preparation class' 'told your husband to stick up for you' 'fired the midwife' 'stayed home' 'written a short birth plan' 'have been more prepared' 'educated yourself more' etc." But you know what, I thought I was doing good by doing what I did do. It was more than any of my friends ever did, and at the time I gave birth, I knew more about childbirth than I had ever known before. How was I to know that there was so much more to learn? How was I to know that the challenge would not be having a natural labor like everyone and every book implied, but dealing with the hospital staff?

And for the previous commentor, no, my baby was not high needs.

P.S. I asked for oral vitamin k in the hospital without ever having discussed it previously and they did have it.

August 20, 2007 | Unregistered CommenterJennifer

Jennifer,

Actually, I can't imagine many of us thinking any of those not very nice thoughts about "If you'd only..." but I can imagine you have played out every scenario a million times and would like to have tried everything to have changed the outcome and if a birthplan might have been it, then it would have been worth it to have had one... I can understand your wishing to have had one.

But, I think you also know that while I don't sit here thinking "if you'd only..." I am sitting here thinking there is a slim chance that a birth plan could have changed much in the outcome of your very difficult experience (I am not sure what words to use... Horrid? Painful? Insert the words you would use). But I see that you wonder if it might not have changed at least *something*... maybe not the entire thing, but *something*. I do understand hope. And regret.

I am sorry for your experience and I hear what you are saying to moms... to do everything they can do find a way to speak for themselves when they might not be able to with their own voices.

In that case, as I said in the piece: Make a 3x5 card, bullet point you MOST IMPORTANT ITEMS because coming in with a birth plan already says what kind of birth you want. It is a given you want a natural birth. Do birth plans ever say, "I want an epidural for my labor and people to yell at me to push during second stage?" No, because that is the norm. It's the unusual that writes birth plans.

So, write what is unusual about YOUR birth plan. What are the "non-negotiable" (barring emergencies) items that are vital to your utmost happiness - and write those things down. Whittle them down to the absolute minimum so the nurse can read them in 20 seconds.

Again, Jennifer, I am sorry. And I really appreciate your writing and know others CAN learn from your experience. Your pain, I hope, will soften as others grow from your lessons.

August 20, 2007 | Unregistered CommenterNavelgazing Midwife

I'm just a nurse at but I have seen doctors at hospitals wait 30 mins for a placenta before. It does happen. Maybe my hospital is not as evil as the ones near you, we have women who give birth in different positions, not just on their backs, our nurses don't yell at them to "push, push" (at least not if things are going well, shoulder dystocia is a little different!). Honestly, as the nursery nurse, my thoughts are to
"get in and get out" and give mom and dad as much time with baby as possible. So, if mom wants, baby goes right to her chest, stays there for a while (I think the longest I've personally let baby and mom chill is 20mins, but usually at least 5), I "borrow" the baby for weights, measurements, a quick set of vitals and "eyes and thighs" and get baby back to mom, hopefully within 10-15 mins. During the hospital stay (at least at my hospital) we are more than happy to keep the babies and moms together, assuming baby is doing well. But we do have to take the baby to the nursery once a day for a weight at least...only one scale. I'm sorry so many people have such bad experiences at hospitals...it makes me sad, when I know we work hard at my hospital to give great care and try to give everyone such a great hospital stay.

And the whole asking patients their pain level so frequently? That is 100% a joint commission issue...we have to do it. And we have to document the pain level, what the patient's comfort pain level is, what steps/interventions we have taken to address the current pain level, then reasses the pain and start over. Trust me, the nurses find the whole asking about pain a huge pain themselves!!!

August 20, 2007 | Unregistered CommenterAnonymous

I am a first time reader of your blog. But I LAUGHED so hard at your take on birth plans!!!! I agree, if you want all of that, then BIRTH AT HOME!

I will be back to read more.... keep 'em coming!!!!!

August 20, 2007 | Unregistered Commenterkalico24

I'm not a midwife, or a doula. I have 1 11 month old son, born naturally (well, except for I let them break my water) in a hospital. I hope you folks don't mind if I put in my .02 here.

There is No. Way. Ever. I will be able to convince my sweet husband that a homebirth is a good idea. His aunt had severe complications & nearly died giving birth. I told him the statistics. I told him stories. I begged him to reconsider. His fear of losing me at home - of being *Responsible* for an unhappy outcome, was not something that I was willing to ignore, and not something I was able to ease, regardless of the effort I put in. And how could I force the man I love, who I respect enormously, who nearly never says "no" to my least whim, to go through with something that scared the snot right out of him?

I had an unmedicated hospital birth, using Hypnobirthing.

My Hypnobirthing instructor was an L&D nurse at one of the other local hospitals & strongly urged us to do a birth plan. My dr's nurse handed me thir 3 page form the day I brought my own (1 page, bulleted, with a short cover letter, as advised by my instructor).

I got everything I asked for - including lunch. The dr put it in my orders/chart/somehow told the nurses "it's OK," and that was quite possibly the best grilled cheese sandwich ever (came back a few hours later, but I'd do it the same in a heart beat).

While I agree that this birth plan needs work, and lots of it, and I have only my one experience to draw from, I have a hard time seeing the "Evil Hospital" that's painted here. Sure, those places are out there, but I doubt it's all of the hospitals (anymore).

And there are valid reasons to do natural birth in a hospital setting. My husband's concerns being one example.

If less intervention is to be the norm in the US at any point, then there has to be people willing to ask for it, not just from midwives, but from OBs too. I don't know any way to ask other than to say it. Verbally and in writing, as often as necessary.

It was a great birth!

August 20, 2007 | Unregistered CommenterRitsumei

Unless something has changed very recently, the US FDA has not approved any oral vitamin K. It exists in other countries, but isn't approved here.

Fortunately, the first family who requested no IM Vitamin K had let their midwife know well ahead of time so our neonatologists could plan for the event. What they did was to write a consent form which stated that oral administration is an off-label use of the IM Vitamin K preparation we use and have them sign it. The baby was given the IM preparation orally and did fine.

It's what they've done since. Can't say it won't get them in trouble some day, because the incidence of bleeding disorders is higher (but still uncommon) when Vitamin K is given orally.

August 20, 2007 | Unregistered CommenterJudy

I am assuming it must be very difficult as a birth worker to see these same things over and over. But this was these people's one birth of their one child. Yes, it sounded very primip in nature. Yes, I rolled my eyes at the preposterously flowery verbage. I really do get what you are saying...yet I worry.

Pasting this whole thing onto MY life's experiences, it seemed a bit flippant as if you were mostly saying "You shoulda got a midwife then!"

Some people just do NOT have $4000.
Some people have %100 unsupportive partners. Some people have traumas, fears, issues that keep them from going outside the institutions, etc.

I know, I know, don't get pregnant, do your research, etc. But for me, the whole tone of this post seemed so MEAN, rather than just frustrated.

I feel sorry for them, and what will probably be their c-section.

Also, asking this one from the heart, what should mamas do when they simply cannot obtain a midwife, and you feel that UC is unsafe? In my last pregnancy my husband lost his job early in the second trimester, and not only was our $750 that we had already paid our midwives non refundable, but we had a failed UC that got me a 2nd #$@# section.

Again, I can't even imagine how many of these outrageous birth plans you see, as you said, hundreds and hundreds of them, each family thinking they wrote something big and important, each nurse and OB rolling the thing up and smoking it...

But what about it?
I want to know what to do when my friends and family think they are all enlightened writing things like "no episiotomy", and "soft lighting" on their special-est stationary.

Is it really homebirth or give up? When will insurance cover SAFE BIRTH?

U always make me think--
much love--

a typo queen nursing 2 kidlets as I type
:P- - - -

August 21, 2007 | Unregistered CommenterHousefairy

I wonder exactly where in the world this woman was. I am a student midwife on a labour ward placement at the moment, which is in an obstetrician led unit rather than a midwifery led unit/birth centre, but I still discuss choices for the management of the third stage with women, and it would be fine if they didn't want to have an oxytocic to speed up the delivery of the placenta. It would be ok if someone refused the vitamin K, or chose to have it given orally, and it's perfectly normal for women having normal labours to eat and drink whatever they want during labour.

We don't normally ask about the level of pain, or the strength of contractions, we might ask permission to lay a hand on the woman's abdomen to feel the strength of the contractions, or ask how she is feeling, but I don't think it would be a huge problem to avoid using the word pain. We often refer to contractions as 'tightenings' anyway.

Women only have IV access sited if it is medically indicated, and we don't do EFM routinely either. We would want to use the doppler or a pinard stethoscope to listen to the fetal heart fairly frequently.

I don't get why you would shine a bright light at someone's perineum while they were birthing? We frequently have the lights dimmed, and the only time bright light is shined at the perineum is if suturing, or an operative delivery is required.

There might be a problem with the water birth part, because currently we are not supposed to allow women to birth in water, it's supposed to only be used during labour, with women getting out for the actual birth, but most of the midwives would not have a problem with advising a woman that this was the policy, and letting the woman make up her own mind- we would normally just tell them that whilst we have this policy, if they decline to leave the pool then there's nothing we can do about it.

In fact, for a woman having a normal labour none of what you have quoted from this birth plan would be a massive problem at my hospital. The only problem would be if things occurred that required us to let the doctors know, as they are more likely to put pressure on women to accept intervention.


I know that there are many hospitals across the world in which this woman's birth plan would be a joke, but at least in my hospital, we might have a joke about the typos, or the wordiness, or the silly requests for things we would do anyway, but none of the choices the woman has expressed in her birth plan are ones that we would think were ridiculous or impossible to 'allow'.

August 26, 2007 | Unregistered CommenterAnonymous

Your writing of the word labor as "labour" and speaking of the use of a Pinard Horn lets us Americans know you are in Europe, probably in the UK... yes? So, we can surely imagine that birth plan might seem absurdly normal to you. How great!

But, as you can see by at least TWO of the responses, it isn't all that uncommon (in my experience either) for a L&D nurse to see a birth plan - ANY birth plan - and not only roll her eyes, but ASSUME that woman will be having a cesarean and then, I believe, consciously or unconsciously, set her up for that end result so she will be right.

I know DOZENS of us have heard L&D nurses say this exact birth plan statement.

August 26, 2007 | Unregistered CommenterNavelgazing Midwife

Oh, I wish I had read this before my first birth ... fortunately I'd caught on by birth #2.

September 1, 2007 | Unregistered CommenterScraps

Okay this post pisses me off to a degree. Not for the truth spoken in it, but that its so condescending and disrespectful of a couple/woman who is making the best attempt at getting the type of care they want and value. There's nothing wrong with that. While the critiques may be valid. Its just rude to be so patronizing to all those couples who haven't learned what the hospital system is all about. How about some kind, encouraging, informative words that will assist women in learning that hospitals aren't the place to be birthing babies normally? I'll admit my birth plan was alot like that one, only to find out later that hospitals are not in the business of being respectful, kind and caring towards mothers. And obviously with posts like this, some midwives don't go out of their way to do that either.

May 11, 2008 | Unregistered CommenterJenne

NGM, Anonymous could also be in Australia, we use that spelling of labour as well. It does confuse me though that she says fetal, we don't use that spelling and i didn't think they did in the UK either (although i suppose it is becoming more common to spell things the americanized way)

May 15, 2010 | Unregistered CommenterJade

2 years later... but Anonymous could be in Canada. We use all the "-our" endings and don't spell fetal with an "o"

April 9, 2012 | Unregistered CommenterCanadian

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