Birth plans: Helpful or unrealistic?

I think having a birth plan is kinda silly. Noone can fully plan what is going to happen naturally. I feel you can have an idea of what you would like to have happen, but that is about as far as it goes. The only plan I had was to get the baby out! lol
(I did ask for no epidural though, and my wishes were granted. thank you Nubaine!!)

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I think birth plans will continue to be ignored and worthless in a hospital setting because:

a. Doctors and midwives have a financial incentive to perform interventions. It is an inherent conflict of interest and why natural childbirth in a hospital setting is virtually impossible.

b. Doctors and midwives are in a rush. They are pressured by the hospitals, arbitrary birth timelines and their own schedules (they want to go home too). Its another inherent conflict of interest preventing natural childbirth in a hospital setting.

c. The threat of lawsuits forces doctors and midwives to "get things moving" and "get that baby out". Without lawsuits, some doctors and midwives might be able to get past the financial and time incentives to use interventions.

The only way to have a remote chance of having your birth plan respected and honored is to have a home birth. If you must give birth in a hospital then make sure your caregiver signs the birth plan in the presence of witnesses.

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I think the point of a birth plan of for the parents to talk about their options, do some research, and realize that they do have choices. Yes, birth is unpredictable, but women have the responsibility to be active in their health, and a birth plan is one way for them to express their wishes to a staff of people they will likely have never met (beyond their OB) before.

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To assume that you can imagine your ideal birth, write down what that is and assume it'll go that way is wildly myopic.

However, to imagine your ideal birth, write down how you are going to work to achieve it and then tell the medical staff (verbally only, from your - the mother's - very own lips) will help to empower you to have a better birth.

And by better birth, I don't mean that you will have an easy birth or that you will achieve your ideal, but that you will feel more in control over how you deal with your labour and your own health care. And that is what the focus should be when talking about birth plans/birth preferences: how you will deal with labor when it goes well and when it presents challenges.

Much like a road trip, deciding to run a marathon, undertaking a remodeling project, painting a picture or any other significant experience, birth is better when you have a map of how you want to get to your destination and the flexibility to be able to detour when the situation calls for it.

THe birth plans I help my clients write are often a very short list (about 3 items) of the most important things they want from their labour. And it is stated as a strategy: "Unless medically indicated, we would like to labour without any pain medication. We will be using movement, positioning, meditation, vocalization and massage for pain management. If we desire pain medication, we will ask the staff for it." This lets the nurses know you have an idea of what you want to do in your labour, that you've likely thought about pain management, that you will ask about it if you want it and that you acknowledge that there may be circumstances where an epidural is a best/required.

You are more likely to get respect from your nurse if you can say this to her. And, if she brings up pain meds, you can and should tell her that you will tell her when and if you need it.

I don't think birth plans should be dismissed outright, but I think they're definitely being applied incorrectly in many cases. I also think that many women are just too compliant when they enter a hospital and forget that they own their bodies and have a say in how they have their babies.

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Writing up a birth plan was part of our antenatal course. I enjoyed the process because it allowed my husband and I to discuss what we wanted for the birth of our child, to prepare and imagine, to write down what was important to us so that in the heat of the moment, it was all there clearly stated for the midwives to see. It took away a lot of the worry for us.

On the flip side, I ended up having to be induced (rather than the water birth as planned) and because I had firmly stated in no uncertain terms that I WAS NOT to have drugs or any sort, NO MATTER WHAT, the midwives fought me to the bitter end when, at 24 hour in to a horribly painful labour (I suppose that they all are), I was begging and pleading for an epidural. They kept shoving the freaking birth plan back in my face. I never regretted my delusions of perfection more than in those hours of being denied my epidural!

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I wrote a birth plan during my second pregnancy, then I didn't use it because I was embarrased and had heard too many stories of nurses laughing at you for bringing one in all typed up. So I just drilled to my husband repeatedly what I wanted, and luckily he managed to remember! I think my second delivery was much more "ideal" than the first, neither was awful or too far outside my expectations.

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I'm genuinely puzzled about this birth plan nonsense. Ideal labor process? Labor is a means to an end, and for every woman that end is a healthy baby. Very rarely is the birth plan targeted toward this end; usually it is an attempt to spew high-minded, hippy-dippy notions about "ideal birthing." Birth is by definition one-size-fits-all; any attempt to personalize it is silly and frivolous.

You know, people don't walk into the OR for their triple-bypass with a "surgery plan." And while I agree that normal births aren't medical in nature, one must completely defer to the medical staff if one chooses to deliver in a hospital. Otherwise, you're better off delivering at home if you're not interested in the doctor's advice anyway. Of course some nurses laugh when they see a "birth plan." These nurses have seen enough deliveries to know that the phrase itself is an oxymoron. Hospitals are not paid to cater to your every whim and desire; they do not care what you want; their sole function is to deliver a healthy baby while maintaining a healthy mother.

Do you all do this type of thing to your accountants? Have you drawn up a summary of your feelings toward lawn care for your landscaper? Have you catalogued your philosophical perspective on education to your kids' teachers? Have you told your dentist that it your mouth goshdarnit, and you're not going to be forced in flossing?

Ridiculous.

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Mel, as a nurse, I can tell you that people do often come in with "plans" for their medical procedures. For the most part, I think they are very helpful. Discussing expectations is beneficial for everyone involved.

As for the birth plans, I think you have missed the point. They are not meant to be used as a discussion of birthing philosophies, but rather as a tool to help medical professionals make the correct decisions when the client may not be at her most articulate or clear-headed. A nurse would not put a mother in danger in order to follow her birth plan, but there are often several "right" choices and it's nice when the mother (and her partner) has considered them beforehand.

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I had a birth plan that was very detailed. None of it went as intended b/c, apparently, I have an "incompetent uterus". BUT, I have a healthy, beautiful child now, so I'm all good :)

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I think ivory and ikate have explained the point of a birth plan correctly. If you expect the birth of your child to go exactly as 'planned', then of course the nurse/midwife/doctor are going have a little chuckle and then hopefully try to explain that that isn't the way it works. My girlfriend expected the birth of her baby boy in January to go a certain way and when it didn't, the doctor was frustrated because she hadn't researched pain medication/epidurals at all and didn't want any pain medication. They were faced with having to have a c-section and weren't prepared for that. I wouldn't trust my careprovider blindly, because they are human and can make mistakes or miss something.
A good hospital/practitioner is going to want to know your preferences and will appreciate a clear, concise birth plan that states preferences, not demands.
Also, Mel & Sheryl, I don't know if you know this or not, they don't put you out and rip the baby out anymore... they stopped doing that a few years ago...
Not that there aren't hospitals/practitioners that have their own agendas, but that doesn't mean that they are all like that.

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