In my very limited exposure to the world of obstetrics, I have come to realize that birth plans are more popular than I actually thought. Having the medical background that I have, having had two children myself, and now being on the other end of the delivery table, I am beginning to feel that women who make birth plans are really not as informed as they think they are. In fact, sometimes I feel (and I’m not alone in this) that having an uninformed and unrealistic birth plan is doing more harm to the baby than good… Not to mention that they can often be insulting to the very people who are bringing babies into the world.
Don’t get me wrong, some people have reasonable, respectful plans, and they usually have the birth experience that they want. These birth plans include such requests as: “I’d like the lighting to be dimmed whenever possible, I don’t want to be offered medications for pain, I would like to listen to my own music, I would like to be able to walk around as much as possible, I would like to limit fetal monitoring unless the baby is in distress, I do not want an IV unless it is medically necessary, If interventions are required in my labour, I would like to remain informed about my needs and my options, I would like to have skin-to-skin contact as soon as the baby is born…
These kinds of requests on a birth plan are wonderful for a few reasons: (1) they are easily attainable, (2) they fall into the realm of what “medical professionals”do anyway, (3) they inform us of your preferences for you baby’s birth, and mot importantly (4) they do not jeopardize the well-being of the baby.
Before I talk about the things I seriously dislike about birth plans, I’ll outline a few facts:
- As much as possible, physicians follow “evidence based practices.” In other words, if we do something, it’s because there is evidence (research) to support it. In most cases, if there is no evidence to support an intervention, it usually falls out of practice.
- Obstetricians (at least in Canada) do not want to do C-sections. Yes, they get paid more for doing them, but not THAT much more. More importantly, though, there is more risk to mom, more risk to baby, more work, and no evidence to support that c-sections are better than vaginal births unless there is a clear indication for it.
- Medical students and other “trainees” will not hurt you. In fact, you will probably get better care when students are involved because they are studying like crazy and the physicians who are teaching them are always current and up to date on their information and their skills. Medical students and Residents also have much more time available to dedicate to your care than the attending physicians. Having them involved in your care will actually ensure that you are being followed more closely. Furthermore, students are usually too scared to do something that they are not comfortable doing. Refusing to let students be involved in your care only hinders education of future doctors. How do you think current doctors ever learned their practice?
- Maternal, infant, and perinatal mortality rates are lowest in developed countries where medical care and interventions exist. To get a reasonable idea of what happens when modern medical interventions are not used, look up the maternal, infant, and perinatal mortality rates in 3rd world countries. By refusing modern medical interventions, you are increasing your risk of complications immensely.
So, in my very limited experience, most birth plans seem to be based on nothing but a template. I say this because every birth plan I see have almost the exact same wording in their sentences. These templates are likely downloaded from the internet or else provide by a doula. I have nothing against using the internet for information or using a doula, but I do have a problem with people remaining un-informed about the decisions they make. To support this litte assertion of mine, I have heard many physicians say that when they ask patient to bring in their birth plan ahead of time and discuss some of the items on the plan, most patients will change their minds about the choices they make because they finally understand why the interventions are offered. (I should also mention that where I live, a doula only needs to take a weekend course on how to coach a women through labour. Compare that to the 9+ years of training that an obstetrician receives… Always consider your sources)
Just to give a little perspetive:
In my last 2 call shifts, we had five women present with detailed birth plans. All five plans refused both pain medications and interventions to augment labour. Two of the five women ended up receiving an epidural for pain but still refused to augment their labours. Three of the five women ended up having emergent c-sections. One woman delivered her baby in the toilet without telling anyone that she was pushing. The one lady who had a vaginal birth progressed through her labour well, but she was one of the women who received an epidural.
In those same two call shifts, we delivered over thirty babies. We only did five emergent c-sections TOTAL. As I mentioned previously, three of them were women who refused medical interventions to progress their labours. That means that out of the other 25+ women who came in with a simple birth plan of “get the baby out safely,” 23+ delivered their babies vaginally without complications.
So 3/5 women (60%) with complicated, restrictive birth plans ended up having a delivery that put them and their baby at serious risk (and that doesn’t include the baby delivered in the toilet). Of the 25+ women who came in without a birth plan, over 90% of them had safe and timely vaginal deliveries.
Think well and always be informed.