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Do Birth Plans Help or Hurt Women?

by Katherine Stone (Subscribe to Katherine Stone's posts)
Dec 15th 2010 11:00AM

12Comments

Filed under: Breast-Feeding, Delivery


Paint the nursery. Buy the onesies. Write the birth plan. These days, women are encouraged to create birth plans as part of their preparation for having a baby. In them, the mom-to-be describes what she does or does not want to have happen during childbirth and in the hospital afterward. Birth plans are meant to empower women, but are they a good idea for every mother-to-be?

Jenny Lawson, also known as The Bloggess, wrote about birth plans last week in a tongue-in-cheek post on Cafe Mom's The Stir. In her piece, entitled "Your Birth Plan. Good Luck With That," she humorously described birth plans as decisions on such details as "... how you want to deal with the pain, where to have your baby, what part of your body you want your baby to come out of, and a host of other things that all basically sound like various degrees of unpleasantness and horror." She went on to share all the ways in which birth plans can fall apart when childbirth doesn't go exactly as planned, which seems to be more often than not. Her conclusion? "If you're lucky enough to end up with a baby, you win. "

Lawson's post engendered a surprising debate. Some thought the piece was hilarious. Others felt she was "belittling" women who want more involvement in the decision-making process while having a baby. Gina, from the blog The Feminist Breeder, commented, "There is NOTHING funny about keeping women uneducated. A birth plan isn't designed to script out your birth. It's designed to let you know what kind of birth experience you're hoping to achieve, and whether or not you're with the provider who's going to respect that. If you want an unmedicated birth, you MUST train for that, and you MUST have a provider that doesn't have a 98% epidural rate. THEIR practices determine your birth far more than chance. If you don't know your options, then you frankly don't have any, and THAT will determine your birth... not circumstance."

I see Gina's point. I agree with those who believe birth plans are a good tool. Women should have more say in what happens to them. They should be prepared ahead of time for the kinds of decisions they will be asked to make, so that they aren't forced to make one in the heat of battle, so to speak. At the same time, I fully agree with Jenny. I thought she took a funny look at the amount of uncertainty involved in birth. So much can happen that is outside of your control. Some women never make it to the hospital in time. Some women need emergency C-sections. Some babies have prolapsed cords. I don't want those new moms to be more traumatized than they already are because nothing in their birth plan came to fruition.

One comment in particular stood out to me, from someone identifying herself as "swistle." She wrote, " I don't think ANYTHING contributes more to post-birth Dissatisfaction With Life than a birth plan. It gives the absolutely false illusion that if you PLAN it, you can HAVE it." Depending on the person, I believe there is a lot of truth to that.

I had a plan. My birth plan, which was duly delivered to every official hospital-staff-looking person I came across, covered everything from whether I wanted an epidural (abso-farking-lutely!) to whether I wanted to breast-feed (I would give it the old college try) to how I felt about induction (no thanks).

I didn't mention in my plan what I wanted to have happen if my water broke, which it did, thus requiring induction. I got the epidural I wanted, but wasn't prepared for it only to work on one side of my body. I didn't plan to be asked to push for four hours to try and get out my beautiful but watermelon-headed baby, and then have to deliver via forceps because I just couldn't push out said watermelon head on my own. I didn't plan for my son to have jaundice and for nurses to give him bottles in the nursery without telling me because they were worried he wasn't getting enough fluids. He later refused the breast because he just loved those bottles. There went breast-feeding.

I did excellent research and had a well-written but not over-the-top birth plan, yet pretty much none of it panned out. Why does this matter? For me, it was the beginning of feeling out of control, out of sorts and full of anxiety. It was a contributing factor to my postpartum OCD. Not the key factor, mind you, or perhaps even among the most important -- my perfectionist personality, my family history of mental illness and my until then undiagnosed OCD played major roles. I do think, for some women, not being able to fulfill a birth plan can feel like the first failure of motherhood. I'm not saying we should feel that way, but some of us do.

As "swistle" was saying, a birth plan can lull some women into the false belief that they have more control than they really do. If those are people already at risk for postpartum depression or anxiety, that could be a problem.

I loved this post on BlogHer from Joella Critter of the blog Fine and Fair, who ended up having a C-section and being unable to experience many of the things she had asked for in her birth plan. She wrote a beautiful letter to her daughter about that birth:
"Throughout that experience, I learned one of the most important lessons there is to learn about parenthood. There is no 'What to Expect'. There is no perfect plan. We must expect the unexpected, and plan for the un-planned. It's good to know what our preferences are, it's good to have goals, it's good to have a vision of how we want life to go. However, the more we cling to those things, the more we expect them, the harder it is when things don't go according to plan. Life is full of curve balls, and you, my dear, have proven to be the sharpest curve ball of them yet!"
If creating a birth plan is about thinking through options and stating preferences, that's great. If it's about getting to know whether your obstetrician is the right person for you, that's even better. But if the woman creating the birth plan is fixated on the ideal birth, or striving for perfection, or trying to control what is sometimes uncontrollable? Not so much. While birth plans can be empowering for many, for others they may be painfully misleading.

What do you think?

Tags: birth plan, birth plans, BirthPlan, Jenny Lawson, postpartum anxiety, pregnancy, pregnant

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