Sharing this beautiful post from my friend Catherine at Bellabirth.
Recently in a facebook group that I admin someone advised that they feel that doulas are “airy fairy and wanky”. Wow. As insults go that’s a new one for me (and I’ve been called a lot of names!) and I went through a range of emotions before responding. My first emotion was anger – mostly because I thought my group was a bit above insulting people like that. Then I felt frustrated and sad that there are people out there who may be missing out on the benefits of doula because of this misconception. I also developed a bit of a complex – do people really think *I’m* “airy fairy and wanky”? I ended up taking this as meaning the commenter doesn’t know what a doula does but feels they may be “new age, hippy nonsense” and if one person feels like that then there are bound to be others.
I always seem to be getting asked “what do you do?” (as if raising 2 children isn’t enough…) and I respond by saying that I’m studying to be a doula. The response to that is mostly “huh? What’s a doo-la?” I explain succinctly that a doula is a professional pregnancy and birth support person. “Oh”, people say “Really? That’s a thing?” My GP asked “do people really pay you for that?!” (well…they don’t yet…but they will!). Some people want to know if that means that I think all women should homebirth (nope), or if I judge women who have epidurals (nope – had 2 myself so that would be a tad hypocritical!), or if I can do VE’s and monitor the baby’s heartrate (nope again). So just what does a doula do?
“According to DONA International, a doula is a professional who is trained in childbirth and provides continuous support to a mother before, during, and just after birth. Doula comes from a Greek word that means “a woman who serves” or “handmaiden.” (referenced from Evidence Based Birth: http://evidencebasedbirth.com/the-evidence-for-doulas/)
Doulas “mother the mother”. She is our focus. And what we do for her will vary depending on what she wants and needs at the time. Some women want a doula to help with comfort measures such as relaxation, massage and positioning; some want a doula to help them source evidence based information; some want a “sounding board”, someone to talk through their goals, hopes and fears for their birth; some want help establishing what their choices are and writing their birth plan; some want someone who will remind them of their goals and encourage them to keep striving for them; some want someone who will remember to put up the inspirational posters, turn on the music and get the oil burner going. Most women want a combination of some or all of these things. The key here is that the mother decides what she wants from her doula and the doula provides that service (or refers to someone who can). Childbirth International’s (doula training provider) philosophy is that “You are unable to be specific about your role, since you are not the one who defines it”.
And just what does all this accomplish? Do any of these things provide concrete benefits to mums and babies? Well, yes. You can find the references in the linked article from Evidence Based Birth but it was found that:
“When continuous labor support was provided, women experienced a:
• 31% decrease in the use of Pitocin*
• 28% decrease in the risk of C-section*
• 12% increase in the likelihood of a spontaneous vaginal birth*
• 9% decrease in the use of any medications for pain relief
• 14% decrease in the risk of newborns being admitted to a special care nursery
• 34% decrease in the risk of being dissatisfied with the birth experience”
So having continuous support from a doula has been shown to increase good outcomes for mums and bubs. Airy fairy and wanky? Or a sensible investment in your birth?
On a personal note, what will *I* do as your doula? I had someone ask me if I would be trying to convince them not to have an epidural and my response is this: “My role is not to “convince” you of anything other than the fact that you are a strong, powerful and amazing mumma who is more than capable of making well informed decisions about what is best for you and your baby”. If someone is trying to convince you of something it means that they are not supporting the choice you have made. And my role is to 100% support the choices of my clients. At the end of the day I can’t very well criticize OBs, midwives and mothers in law who try to convince you to birth a certain way and then do the same myself. I will always encourage you to use the BRAIN decision making tool (benefits, risks, alternatives, intuition, nothing) and once you feel that you have explored all your options and made your decision I will do everything I can to support that decision and help you to make your plans a reality. It’s important to me that women enter motherhood feeling strong and capable, so I will continue to reassure them that they are.
Realistically doulas are going to be viewed as new age and hippy because, as a society, we don’t place value on birth and the birth experience. Birth is simply seen as a way to get a baby out rather than a huge transformational process that can have a far reaching impact on mums and bubs and women who want a positive and empowering experience are seen as “selfish” (see my previous post “Mums matter too” for more about birth trauma). If you insist that birth is spiritual then that is “new age hippy nonsense”. And doulas have no distinct job description, no governing body, no registering organization. A lot of women couldn’t necessarily put into words what precisely their doula did that made their birth a positive experience.
So, “airy fairy and wanky” – does it still bother me? After having a few days to think about this I’ve decided that it doesn’t. In future I’ll simply use such comments to fuel a conversation about just how having a doula can benefit mums and bubs.
Do you feel that doulas are “airy fairy and wanky” or “new age hippy nonsense”? Did you have a doula? Did it benefit you?
This is the article that the two quotes came from. http://evidencebasedbirth.com/the-evidence-for-doulas/
Disclaimer: I am a student doula. I am also a student hypnobirthing practitioner. And I also planned to hypnobirth my second bub – with a doula providing plenty of additional support.
What brought me to this belief in doulas and hypnobirthing? My first birth was a very traumatic experience. I had no support other than my partner – and there was no-one there to support him at all! We did an independent childbirth education class, the only one running in our area. It didn’t really prepare us at all and dare I say it was probably quite similar to a “standard” hospital class: ie: not really big on practical tips about how to handle labour, how to support someone through labour or techniques to use for pain coping. We had one – to – one midwifery care throughout labour but the midwife spent more time looking at and playing with the ctg monitor and pushing drugs than providing any support. She made no suggestions about how I might achieve the birth I wanted or how my partner might support me. I didn’t even have a birth plan I could refer her to as this same midwife had told me that there was no point doing one. I spent my labour feeling alone, isolated, terrified and panicky.
So for my next birth, realising that I couldn’t rely on the hospital to provide the support I needed and realising that my partner really needed some extra support as well, I looked into options. After talking to several mums I decided that hiring a doula was an important first step. And then I decided that a hypnobirthing course would be a great way to ensure that I had covered all my bases in helping to ensure I had a positive experience second time around.
What is hypnobirthing? Hypnobirthing Australia is a childbirth education course which explores and promotes deep relaxation techniques for pain coping and relief. You go to the course at a venue with several other couples where you are taught the different techniques and tools to help you through pregnancy, labour and birth. It is really in depth with a great mix of theory and practise. Then you go home and practise the techniques you have learned. After most classes you will receive some additional support such as phone support and fear releases but generally speaking your course facilitator will not be with you at the birth. They won’t be there to remind you of the techniques you’ve learned. They won’t be there to remind you to ask questions. They won’t be rubbing your back or suggesting you hop in the shower. In the flurry of activity and the intimidation of a hospital you and your birthing partner will need to remember all that you learned.
What is a doula? A childbirth doula is an independent support person, hired by the parents, for the purpose of providing emotional support and physical comfort measures during labour. Most doulas also assist in areas such as: exploring birth goals and fears, birth planning, helping you to source information in regards to your choices and options as well as assisting with breastfeeding and the early post partum period. For me the most important aspect of a doula was that she is independent. She is not paid by the hospital and therefore her complete and total “loyalty” is to you – the birthing couple. I knew that she would support me and stand by all my decisions. Usually a doula will do a little general antenatal education with a couple, but you will generally only have anywhere from 3 – 10hours total with your doula before labour.
If I do the hypnobirthing course can’t my partner be my doula? No. A doula has many many hours of training in childbirth. Far more than the 12hours training provided in the Hypnobirthing Australia antenatal course. Good doulas have a solid understanding of what is normal, what is hospital policy and what natural things can be done to assist many minor complications (such as a stalled labour). A doula will generally know what the hospital is likely to recommend if a bump in the birthing road is encountered and this means that she will be able to have a conversation with you ahead of time. This ensures that when the OB or midwife announces the complication and their proposed treatment a) you don’t need to make a decision on the spot or find the courage to ask your care provider to leave so that you can talk it over with your birthing partner and b) the decision can be more considered and less emotional. Leading us to the second reason a birthing partner generally can’t be your doula. A doula is not only independent of the hospital, she is also independent of the family unit. This means that she is far less likely to be swayed by emotional argument and more able to support women to make considered decisions in the face of obstetric intervention.
Take home message? Having a doula can really enhance your hypnobirthing experience by ensuring that you have someone independent of your hospital and your family supporting you at the time you need it. And completing a Hypnobirthing Australia course can really enhance your doula experience by ensuring that you and your birthing partner have an understanding of normal birth and a really comprehensive collection of tools to use throughout your pregnancy and birthing journey. And both can really help your birthing partner to shine at the critical moment.
Now it’s time to get to the nitty gritty – how do I write a birth plan that is realistic, will be well received and leaves me looking forward to my birth experience? As with everything to do with your birth it all boils down to your care provider. Whether you have chosen a care provider who cares about and supports your birthing goals will help you to decide how you will word your plan. If you have chosen a care provider who believes in your ability to make great decisions for your birth then you plan will likely only need to be very brief and cover “in case of” scenarios. If you have chosen a care provider who actively does not support your birthing goals then you need a new care provider before you need a birth plan! The information I am providing is on the assumption that you are birthing through an Australian public hospital and are receiving “standard care”. So I am assuming that you will be seeing different midwives and OBs over the course of your pregnancy and that you won’t necessarily know the care providers that you will have in labour and birth and also that you will be “encouraged” to follow hospital policy in regards to testing and procedures.
As a doula I would greatly encourage women to think about their pregnancy plan as a first step. Write down all the tests and procedures you will likely be offered and then do a little reading on each one and decide whether you would like to consent or decline. Low risk women in the Australian public system will generally (but not always, so check with your provider!) be offered: An early pregnancy dating scan as well as various blood tests to check for vitamin and mineral levels, STDs and general wellbeing; the Nuchal Translucency scan at 11 -13 weeks; The Morphology scan at 20 weeks; the glucose tolerance test (GTT) at 28 weeks, If you are rhesus negative you will be offered Anti-D at 28 and 32 weeks, GBS swab at 36 weeks, you may be offered a late pregnancy growth scan and you may also be offered a stretch and sweep induction starting from 38 weeks. There is various evidence both for and against each of these and it is well worth doing some research into each of these and forming your own opinion on whether it is necessary for you.
When preparing a Birth Plan I like to include a short introductory paragraph which introduces you and broadly states your birthing goals. For example: “I had a previous traumatic caesarean and am planning a peaceful, hypnobirth VBAC this time” or “I have been diagnosed with full placenta praevia and am planning a family centred caesarean to welcome our baby into the world”. It’s also a good idea to acknowledge your care providers with a simple “Thank you for helping us to achieve our birthing goals”
Most birthing plans are divided into sections according to the stages of labour. This can be useful as it means your carer can simply flick her eyes to the appropriate section straight away.
Early first stage:
If you are planning to labour at home as long as possible (which most care providers would recommend) then do not include early first stage information in your birth plan. Discuss this with your doula and birthing partner. Think about how you will keep up your hydration and nutrition, as well as ensuring that you get plenty of rest. Include what will happen with your other children or who needs to be called to come to you. Perhaps include some information regarding when you would like to head to hospital and what pain coping techniques you would like to use while at home.
Active first stage:
What would you or wouldn’t you like for pain coping / pain relief; include if you plan to use the bath / shower.
What would you like to consent to in terms of foetal monitoring?
Do you wish to have “routine” vaginal exams or would you prefer to only have them if you ask or none at all? – Note: Don’t use the phrase “minimal VE’s only”. Minimal is a very subjective term and what you consider minimal could be very different to your care provider. Most hospitals would say that they only do minimal VE’s as a matter of routine anyway.
Will you consent to or decline augmentation if labour is lengthy? It is worth doing some reading and deciding what YOU consider to be a “lengthy” labour – like the word minimal, lengthy is very subjective. Would you only consider augmentation after 12, 24, 36 hours of active labour? Would you prefer to simply put no augmentation?
Do you want to be coached in your pushing or would you prefer to push instinctively?
Who will catch the baby?
Do you consent to an episiotomy or would you prefer to tear naturally or have the perineum supported to help lower the risk of tearing?
Would you like a mirror so you can view your progress or would you like to be reminded to touch the baby’s head as it comes down?
Do you wish to have a physiological third stage and / or delayed cord clamping?
Baby to be placed immediately onto mum’s chest for breastfeeding?
Who will cut the cord and when? Or are you planning a lotus birth?
Do you wish for your baby to receive the Hep B vaccine or the Vitamin K injection?
At what point would you like weighing and measuring to be done?
Do you wish to be discharged straight from birth suite?
We all know that sometimes birth doesn’t go according to plan and it is well worth having a think about and discussing with your doula and birthing partner what you would like to do if things deviate from normal. Think up or ask your doula to provide you with some different scenarios and then talk through what you would like in those instances. I also highly recommend writing up a caesarean birth plan and will cover caesarean birth plans and family centred caesareans in a future post.
NOTE: Do not use the words “unless medically necessary” anywhere in your plan. This implies that you believe that your care provider performs unnecessary interventions which could be considered very insulting.
I would also consider including a paragraph at the end stating that you are aware that sometimes special circumstances or complications can arise and that if this happens you would like to be provided with all the Benefits, Risks and Alternatives of the proposed course of action (Refer to the BRAN or BRAIN decision making tool) as well as privacy to discuss this with your birthing partner and doula before making a decision.
So the take home message from this three part Birth Plan series is:
Birth plans should be well researched and suited to your specific, individual circumstances. It should reflect YOUR goals for your birth and be based on your own cultural beliefs, values, experience and health. A birth plan should be prepared in close conjunction with your care provider as well as your support team. And it is always worth having a plan B – because you just can’t predict the weather!
This is just one of many ways you may wish to consider writing your plan so please feel free to comment below with your thoughts on what you consider essential to include in a birth plan or your own favourite links and templates.
Here are some links to further information on birth planning and template plans you may be interested in:
Mother’s Day is the perfect opportunity to start spreading the word that, in childbirth, “Mums matter, too!” Those who have known me for a while would be aware that this is a fairly common mantra for me; but I would like to explain how this has come to mean so much to me, and why I think mums matter. In answering these questions, I am going to share some of my personal experiences of birth and birth trauma.
So many women are entering motherhood amidst a range of negative comments: “You can’t make good decisions for your baby! Your body can’t birth your baby! We don’t care what you want! Just do what the doctor / midwife says! All that matters to us is the baby – you don’t matter anymore.”
As someone who has been a new mother on the receiving end of many such comments, I would like to share a small part of my journey through birth trauma and the impact that it had on me.
When I found out I was pregnant with my first baby, I desperately hoped for a natural vaginal birth. Not because I necessarily thought that experience would be better or safer, but because I was terrified. However, my fear was not of birth – I was excited about the prospect of labouring and birthing my baby. The idea of pushing or even tearing never bothered me at all. I was actually terrified of the hospital, of interventions and of the staff. A previous experience in hospital had left me with the feeling that hospitals are a place where doctors and nurses frighten you into accepting tests and procedures that are risky, painful and maybe not even necessary.
My birth plan was to labour at home until I was pushing, go to the hospital birth centre to push the baby out (because my partner was opposed to homebirth), and then be home four hours later. I ensured that every midwife I spoke to was made aware that I was terrified of hospital… and yet not a single person offered a kind word or support of any kind.
The birth that I got was a very traumatic experience – I was bullied into a lengthy induction process culminating in a caesarean surgery followed by separation from my baby and a six day hospital stay. The first thing my midwife said to me when she came to see me (she hadn’t been present at the surgery due to shift change) was: “At least you have a healthy baby.” Here I was lying in a hospital bed, exhausted and in pain, in shock, feeling incredibly disconnected and drugged, unable to even pick up and take care of my baby and that was all she could say. There was no: “Sorry that you needed surgery”, or even a simple: “Hope you have a speedy recovery.” There was no question about how I was feeling or even any acknowledgement that I might possibly have feelings about what had happened. In fact, nothing she said acknowledged what *I* had just been through or even that I had been involved in the birth of this baby at all.
While that was the last time I ever saw that particular midwife, I encountered this sentiment everywhere. The child health nurse who came to see me at home cut me off as I started to talk about being upset by my experience by saying, “Well…at least your baby is alive.” In amongst all the congratulations from family and friends, there were many comments about the baby – how beautiful she was, how tiny she was, how blessed we were to have her and a few comments for me to remember that, “All that matters is a healthy baby.” I don’t remember any of my friends or family asking how I was feeling after unexpectedly having major surgery. There were no questions about whether baby and I were alright after “needing” an emergency caesarean. I’d had a hole cut in my abdomen big enough to get a baby through and no-one even thought to ask if I was feeling well.
I learned pretty quickly that, in becoming a mother, people had ceased to be interested in my wellbeing. And, I learned not to bother sharing my story or experiences. Women who had been through it thought I was nuts: “My induction was great! I loved my epidural! I’d much prefer a caesarean over a vaginal delivery! Really? That’s not so bad I laboured for 50 hours!” Alternatively, I didn’t want to scare women who were yet to experience the joys of pregnancy and birth in the medical system. So, I kept as quiet as I could, wondering what was wrong with me. Why did *I* want more from my birth than other women wanted from theirs?
As I started researching my options for my next birth I discovered something phenomenal. Guess what? There was nothing wrong with me!! I wasn’t crazy, or ungrateful or a “bad mum”. Turns out I was in good company – I joined groups of women online who were embarking on journeys to overcome birth trauma and plan positive experiences for their next births. While it was sad to see so many other women feeling as I did, the support I found and friendships I have made have been invaluable. I also attended a few Birthtalk “Healing from Birth” meetings. And, oh my, were they powerful! Gradually I started to realise that I had nothing to be ashamed of. The ones who should be ashamed were those who bullied me, coerced me, manipulated me, abandoned me and dishonoured me (and so many others like me) during the birth of my child.
I don’t know anyone who has gotten pregnant just so they can have a positive, beautiful, vaginal birth. We do get pregnant because we want a baby in our lives. But, we also want to connect with, love and care for our babies, and that is hard to do when your birth experience leaves you:
– Suffering flashbacks every day that leave you crying and shaking
– Crying yourself to sleep at night, reliving the trauma of fear and isolation.
– Hurrying back to work before you are ready in the hopes of “escaping” from the experience.
– Pouring all your spare time and energy into researching and learning, so that you can have a positive experience next time.
Add to these consequences the usual sleep deprivation and challenges of motherhood, and a new mum who is suffering from birth trauma is not left with much time or emotional space to connect with her baby, learn who they are and just enjoy being a mum.
Women are aware that we will need to make sacrifices for the wellbeing of our children. We know that we will have to forego sleeping in, lazy Sunday breakfasts, reading a book all the way through on a rainy afternoon, partying until 3am and we know that we may never again pee in peace. However, we don’t expect that in becoming mothers, we will need to give up our human rights, such as our right to bodily autonomy. We don’t realise that, from the moment we see those two little lines on the stick, we are no longer entitled to think about ourselves – at all.
Every step of the way we are told: “Think of the baby!” You can’t complain about morning sickness because you should “Think of the baby!” If you don’t really want to do the GTT, you have to because, “Think of the baby!” If you don’t want a vaginal exam at 38 weeks, you again have to “Think of the baby!” What this standard practice really says is: Your baby is more important than you and we don’t think that you are able to make competent decisions regarding his/her wellbeing. Sure you have a universal human right to decline medical procedures – but if you do that during pregnancy or birth it can only mean one thing: you don’t love your baby.
So, this Mother’s Day, how can we honour the mothers in our lives in a meaningful way? How do we show mothers that they really matter? Does a cooked breakfast one Sunday a year really acknowledge all that mothers go through?
How about this – the next time a friend or relative makes a birth announcement, instead of simply sending your congratulations and your love, also ASK HER HOW SHE IS FEELING. Don’t tell her how she should feel (Just be grateful you have a healthy baby!) or assume that you know (Golly – 50 hours of labour? That must have been horrifying!). Just ask her how she is doing. Listen to her story. Witness her tears and triumphs. Acknowledge that her feelings are valid rather than fobbing any sense of disappointment off as simply being a case of the “baby blues”. Reassure her that negative feelings don’t mean she is a bad mum. And don’t assume that she will feel the same every day. And, the next time you see her, ask her again: How are you doing today? Acknowledge that her feelings about the birth may change over time. Some days she may feel awesome, and some days she may feel like crap. But, whatever you do, just keep asking because suffering from birth trauma can be so very isolating.
So, the next time someone tells you that “All that matters is a healthy baby” feel free to remind them that “mums matter, too!” Or, if you hear of a friend’s birth resulting in unexpected outcomes, remind her that she’s important and that her feelings matter. Ask her how she’s feeling or if she needs anything. Wish her a speedy and safe recovery. Acknowledge that she didn’t “just give birth” – she underwent a major transformation from woman to mother… and that is actually a big deal.
Here are some links to additional information, resources and support for women suffering from birth trauma and their loved ones.
Please feel free to comment with your experiences or advice for mums suffering from birth trauma and their loved ones.
In the previous post I examined some of the misconceptions about birth plans. In this post I’d like to examine the benefits of a birth plan and also talk about how to write a good one.
Benefits of a birth plan:
It means asking some tricky questions: of yourself, your support team and your care provider/s
When you sit down to start writing a birth plan you need to ask yourself some questions you may not have thought about before. Like: What does birth mean to me? What type of experience do I want? What support do I need? What risks am I comfortable with or not? It also means that you need to ask these questions of your support team and your care provider/s. Does your partner expect that you will just get an epidural? If you don’t plan to have an elective epidural this could cause problems when he finds out that you expect him to rub your back, walk around with you or support you in other ways. Same with your care provider: If you don’t want to allow an induction for being post dates then you don’t want to find out at 41 weeks that your care provider expects you to be induced at 41+3.
Your care provider and support team will have an excellent idea of how you would like to welcome your baby into the world.
I’ve had 2 births – the first I didn’t really write down a plan. The midwife I saw for the birth plan appointment told me that she doesn’t believe in plans, that I should call them birth wishes and that, because I was planning on birthing in the birth centre then I obviously wanted a certain type of birth which they provide. Fast forward 5 weeks and this midwife was my “support” during a very traumatic induction process in birth suite. I had no birth plan and she had no idea that I wanted an active birth; that I had a phobia of hospitals or that every time she suggested an epidural my panic level increased. She had no idea that I was excited about the idea of labouring and giving birth but was TERRIFIED of the hospital, interventions and possibility of surgery. She spent a lot of time pushing interventions on me and seemed to get more and more frustrated every time I shook my head and said “no way!!!” I wasn’t in a position to be having a lengthy discussion about my fears and my hopes and I had no plan to direct her to. For my second birth I wrote a kick ass birth plan. I spent a huge amount of my pregnancy researching my options and deciding what I would and wouldn’t consent to. I researched my hospital’s policies and made sure my plan included reference to them and whether I planned to follow them. I thought about what I would do in the event that I went post dates. And I also wrote down a caesarean birth plan. Then I discussed all this with my birth partner, my doula and my care providers so that they were aware, ahead of time, what my hopes and goals were for my birth. My second birth did not go according to plan. I don’t think that anything on my plan came to pass! But I knew that the reason it didn’t go according to plan wasn’t simply because no-one understood my needs. Or because someone else made decisions for me. It was simply because sometimes birth just doesn’t go according to plan. However – When we decided to go for another caesarean I was able to direct my care providers to my caesarean birth plan and this ensured they knew what I wanted. Therefore my partner never left my side, I had immediate skin to skin, my baby never left my sight. My first birth, with no birth plan resulted in far more trauma than my second.
Writing a birth plan supports informed decision making.
Regardless of whether you write out a birth plan or not you will still be required to make a variety of big decisions in regards to your pregnancy, labour, birth and post partum. Many women suggest that you “just do what the doctor / midwife says”. As I discussed in an earlier post – YOU bear the responsibility for decision making during your pregnancy and birth. Following the advice of others doesn’t take away your responsibility for the decision making. You still have to consent or not. You and your baby are the ones who bear the physical risk of the decisions that are made during your birth and every single test, procedure or intervention holds some risk. By researching and writing a birth plan you will know ahead of time what interventions may be offered to you, which ones the hospital will “insist” on and what your other options are (because there are ALWAYS options). By writing out your plan you can feel confident that you have made fully informed and considered decisions rather than making an off the cuff decision while in the throes of labour, without all the information. You can also feel confident that the decisions made have been YOUR choices, based on your own beliefs, values and health circumstances rather than decisions made by the hospital because “it’s policy” or “it’s just how we do things here”.
Having a birth plan isn’t just an outcome – it is a process. It starts with asking questions, thinking about scenarios, researching options, writing the plan and then sometimes something will come up during your pregnancy which will send you back to more questions, more research and amendments being made to your plan. It’s vital to remember that your plan may need to be amended several times over the course of your pregnancy and this is okay. By the time you go into labour you should have a very relevant, well researched plan which your birth partner, doula and care provider/s are well versed in.
Please feel free to comment below with any of your own ideas about birth plans. Did you have one? How did you feel it benefited you and your baby? If you are a care provider please tell us what you think are the benefits of a well thought out birth plan.
In Birth Plans Part 3 we will look at how to write an awesome and relevant plan and I’ll provide some templates you might like to use to kick start your thinking.
Birth plans – love them or hate them, pretty much every woman and care provider has an opinion on them. Some feel that they simply set a birthing woman up for disappointment while others feel that they are a vital tool in achieving an empowered birthing experience. So let’s have a look at birth plans – what they are and what they aren’t and how they can help a birthing woman, her care providers and her support team.
In part one of this article, I’d like to look at some common misconceptions about birth plans.
“Writing down a birth plan sets a woman up to be disappointed if things don’t go according to plan.”
Regardless of whether you write down a birth plan or not we all have ideas about how we want our births to go. These ideas may be as simple as “I’d like a vaginal birth” or “I really want Doctor Jo Bloggs to deliver my baby” or “I’d like baby’s dad to cut the cord” or your ideas may be more complex, running up a list of tests, procedures and interventions that you do or do not wish to have. Not writing these down doesn’t make these desires go away – all it means is that it’s highly possible that your care providers during labour won’t know about them! I had 2 births that didn’t go according to plan. The first, with no birth plan, was very traumatic for me. The second, where I had spent hours working on my birth plan and discussing it with my doula and midwife I found to be far less traumatic. The fact is that a birth plan has very little to do with whether a woman will be disappointed by her birth experience.
“We should call them “birth wishes” or “birth preferences”.
Okay – firstly I understand why people may prefer to use these terms. They sound “nicer” and a lot less confrontational. Like you are going in and asking if this is okay instead of telling your care provider that “This is what I plan”. And that is exactly why I don’t like these terms. They suggest that you’re not terribly committed to the ideas you’ve written down. You know – I wish for world peace and I wish I’d win lotto, doesn’t make it even remotely likely to happen! As for preferences – what happens when what you’d prefer is different to what your care provider prefers? A care provider has no legal obligation to respect a preference. They do have a legal obligation to respect what you do and don’t consent to.
“But you can’t *plan* birth!”
No you can’t. But I also can’t plan the weather – doesn’t mean I won’t schedule in a trip to the beach next weekend and then just change my plan if it rains. You really just never know what is going to happen in a birth and I see this as an excellent reason to make sure you have a great birth plan. Because the process of writing out your birth plan should include talking to your doula, your birth partner and your care provider/s about different scenarios. For example: If you put in your plan that you really don’t want an epidural this should open up conversation about what you DO want to use for pain coping and/or relief, under what circumstances you might feel that an epidural is the best option for you and what you would like to have happen in that circumstance. These can then be written, briefly, into your plan. Writing a plan and discussing it with your doula and care provider ensures that you are able to think about different decisions, assess different options and do some research prior to being in labour. It saves you from having to engage your neo-cortex at that vital moment!
“My only plan is to have a healthy baby – I don’t care how it happens!”
Firstly let me put it out there that having a birth plan and / or wanting a positive and empowering experience does not mean that you don’t consider the health of your baby to be most important. As a student doula I always make the assumption that a mother’s number 1 goal for her birth is to have a healthy and safe baby. Wanting a positive experience does not make you selfish. Now that we’ve got that cleared up, going through the process of birth planning can also help to ensure that you do, in fact, have a healthy baby and a healthy birth. Every single test, procedure or intervention that will be offered to you by your care provider holds varying degrees of risk to both you and your baby. By going through the process of researching and writing a birth plan you can make decisions about which risks are acceptable to you and which are not and can ensure that you are aware of alternative options. For example you probably don’t want to find out after you’ve had pethidine that it can cause breathing problems for bub if given close to birth or find out after you’ve had a c/s for foetal distress that the induction you had actually holds a high risk of causing foetal distress. It also enables you to ensure that your care provider is aware of your goals for a healthy birth and understands which risks and options are more acceptable for your family.
“Will anyone even read my birth plan?”
If your primary care provider is not interested in your goals, wishes and preferences for your birth then I would consider it a good idea to find a new care provider! A birth plan should open up plenty of conversation with your care provider, who should be sharing with you plenty of evidence based information regarding your options as well as your hospital’s policies. Remind your care provider that you chose them to be your care provider and obviously you wish for them to give their opinion of your birth plan. Remind them how important it is to you that you have their support for a beautiful, positive and safe birth. Bring them into it! Once in labour it is not unusual for many women to attach a sign to their birthing room door advising that they have a birth plan and, unless there is an emergency, staff are to familiarise themselves with it before entering. If it becomes clear to you that a person who is caring for you has not read your plan or is not interested about your birthing plan then it would certainly be considered reasonable to ask for a new care giver – even if you are in labour at the time!!
These are just some of the misconceptions I hear a lot. If you have any you’d like to add please comment – I’d love to hear your own thoughts about birth plans! In the second part of this article I will look at some specific benefits of researching and writing a birth plan as well as how to do this effectively.