I don’t appreciate the author’s mocking tone of birth plans. I had birth plans for all of my births and am glad I did.
The point of having a birth plan is that it gives you the opportunity to think through different options in advance—so you aren’t thinking about them for the first time in the throes of childbirth. It gives you a chance to have a conversation of your preferences with your provider prior to labor, or in early labor, so you aren’t trying to advocate for yourself in the midst of giving birth. It also helps women understand that they actually DO have options, and are allowed to speak up about them.
Problems arise not from birth plans, but when people push a birth ideal too hard. Any midwife or doula worth their salt will tell you that you need to be flexible.
My first and my 3rd kid were born 6 yrs apart, and it was interesting to see how much shorter my birth plan was the 3rd time around. This is because things I had to specifically ask for with the first baby—like delayed cord clamping, no routine episiotomy—became standard practice at my hospital by my third. It’s a reminder that birth plans emerged because women HAD to advocate for themselves.
18
The longing felt to bear children is sweet and the rewards of parenthood despite all of the self sacrifice that is demanded is one of the best things about which humans experience in life. We live in a society that is so well adapted to human needs and challenges that we mostly expect child birth to have great outcomes. There are stories about babies delivered by parents and first responders that prove to be happy events. But we should remember that not so many generations ago deaths and permanent damage to mothers and their children was very high risk. The instincts humans have hardwired serve the species rather than the individuals.
We need to remember that history tells us of numerous human societies that collapsed due to human folly as well as natural calamities and the risks to individuals of harm and neglect well addressed by these societies suddenly becomes high.
2
Knowing what to anticipate and being informed is important when planning for your birth, however as Ms.Counter described birth plans are rarely fulfilled due to the uncertainties of each labor. I provided OB anesthesia for most of my 40 years of practice and have a two suggestions:
1) There is no advantage to an early labor epidural in most cases. Epidurals are wonderful for most people but not without risk and I found those receiving an epidural before induction of labor or in very early labor were often frustrated when “hard” labor begins because they “feel something” or they’re frustrated because they feel nothing and are unable to push effectively when fully dilated.
2) Walking in early labor physically and psychologically is helpful. If you decide to get an epidural, walking may be discouraged because your leg muscles may be affected and walking with an epidural in place can displace the epidural catheter and require replacement once displaced.
Finally respect but don’t fear labor, you may be surprised at how well you and your supportive partner handle it. It is always an amazing experience.
6
Oh this makes me sad. I feel bad that this person experienced such birth trauma. But I think a “you can still have a realistic birth plan with fully informed consent” is more productive to the reader.
Who knows why she was induced, at how many weeks, the indication, the medical interventions she agreed to, the amount of lack of information she was given before agreeing to these things.
Birth scenarios vary tremendously. But advocating for better risks vs benefits disclosure from providers and true informed consent can minimize these unforeseen traumas to the new woman navigating her choices about birth.
6
Thank you. As an anesthesiologist, I have seen it all, and I can tell you that the idea of having a “plan” for an inherently un-plannable event is a fool’s errand. My fellow women, I implore you, please stop seeing childbirth as an experience or, worse, something by which you measure yourself against your friends (and fake “friends” on-line). Start seeing it as a means to having a healthy baby.
10
Better yet don’t have children at all.
3
A tale of two doctors—
I wanted a natural birth with my first child but that so did not happen. Because I was past my due date, my daughter’s arrival followed 12 hours of hard, Pitocin-induced labor supervised by a complete jerk of an obstetrician. This fellow was rude to my husband, cursed at equipment and personnel, and threw things during the delivery. In spite of his ministrations, my daughter was born healthy but my husband and I were both traumatized by the experience.
Needless to say, we chose a different (female) doctor for our second time around. That birth experience was so natural that I went through transition in rush hour traffic. In the delivery room, the doctor told me my daughter had passed a bowel movement in utero and that if she aspirated it, she could die. She instructed me to push the head out and then STOP pushing so she could suction my daughter’s nose and mouth out before she took her first breath. Can you even begin to imagine how hard that is to do? On top of that, the suctioning equipment at this supposedly nice, middle class hospital was broken and the doctor had to suction her by hand using a bulb syringe! It all worked out OK and daughter #2 is healthy today. I left the hospital filled with gratitude for that doctor’s skill and also the new understanding that childbirth really is a life-and-death affair.
4
Yiddish saying: Man plans and God laughs.
13
Thank you for a reality check for all expectant moms. Now please write another article encouraging everybody to let go of all the other fantasies new moms have about perfect parenting. Between postpartum depression, going to work with a new baby at home, and the isolation of motherhood if you are lucky to stay at home, new moms are under enormous needless pressure. I was lucky in that I had twins. The pregnancy and birth were a total disaster and I tried for about 24 hours after I finally got them home to keep the now required journal of when the babies had eaten and pooped. But I soon lost track of who of all three of us had eaten and pooped when and gave up. About a month later, I threw out all of the parenting books I had so scrupulously read while pregnant. I attempted nursing for about 6 weeks before my very wise immigrant doctor who knew how things were done in less privileged parts of the world, advised me to give it up as I simply wasn't able to feed them both sufficiently and heal my own body's trauma. My only parenting rules were to make my kids do as much as they could for themselves, never lie to them, and love them with all of my heart. Everything else worked itself out.
5
TL/DR: “My birth plan didn’t work out. Therefore, birth plans are pointless.” Drivel.
7
Everyone has a plan, until they get punched in the mouth. - Mike Tyson
3
Go in with a plan, especially if will help you feel less stressed. But also go in prepared to let it change.
Some other thoughts:
1) Try it without drugs; you are tougher than you think. But don't feel bad if you do need them, or you have to take them.
2) Listen to your body! I really wanted that warm bath, but the minute I got in it felt wrong. Turns out I'd dilated about 6 cm between the time I asked for one and when it was ready.
3) Things my midwives have said to me: "Well, at least you don't have to worry about finding yourself in a porno film." (as she wielded thread and needle) and "Oh, I'm just pushing your uterus back in..."
4) I have found that each birth reflects fairly accurately the personality of each child.
Good luck!
2
"People" don't get pregnant, WOMEN do. It's revolting to pervert our language to erase women. A woman is an adult human female. The New York times should not allow this sexist linguistic practice in print.
5
Hi Rosemary, Did you have a midwife attend your birth?
1
My daughter died giving birth to my granddaughter from a little known and little understood condition called amniotic fluid embolism (AFE). To learn about this fatal complication of child birth check out https://www.afesupport.org/.
There is no way to plan or predict this horrific, heart-breaking event.
6
@Mark Cohn, so sorry that your family had to lose your daughter this way.
Kind of you to take the time to inform others in light of your loss.
5
This was a very needed piece, spot-on and managing to avoid being melodramatic. Recently, my daughter asked me questions about her birth for her health class and I just couldn't. I have told her before that it was difficult and that I hemorrhaged, but there was no way I was going to share the details with her teacher. I also just couldn't tell her that she wore ugly blue clothes donated to the hospital rather than the pretty ones I had brought for her, because in the panic they were not found, or that I couldn't carry her for months. For those of us who can't have wonderful pregnancies -on the plus side, months of bedrest make you wonder at the NYT publishing quarantine stories, I mean those people can go pee whenever- and fairy-tale deliveries, it doesn't help to have that societal pressure.
1
“Let go of your fantasy ‘birth story’.”
Just wow.
I like the 1950s version better:
“Don’t worry your pretty little head about how this labor and birth will take place. The doctor is here to make every decision for you.”
6
'Crazy Americans, they think death is optional.'
1
In the middle of a long, exhausting labor my husband said "You need to be quiet. You're embarrassing me." Make sure your birth plan leaves room for homicide.
23
When my grandmother delivered my mother in 1924, she went to a modern Minneapolis hospital.
She was born into a wealthy Arkansas family where the norm was to deliver at home assisted by your Mom and sisters and the local doctor or midwife. They were aghast when she married a Northerner and wanted to deliver in the hospital. Unfortunately her “damn Yankee” doctor didn’t use good hand washing technique and she developed childbirth fever. She died of sepsis six weeks after my Mom’s birth since antibiotics weren’t available. She probably would have lived if she had delivered at home with her family.
Aseptic technique has improved dramatically since then. As a NICU nurse, I opted to deliver my babies in a hospital stetting with a birthing room so I got the best of both settings.
4
My children are now 31 and 33. I am a physician. My birth plan was to have a healthy baby and a healthy mom. Nothing else mattered.
First delivery was 3 weeks early and fairly routine. Second one was hell. She was nearly 11 lbs. no anesthesia no drugs. I hemorrhaged at the delivery. Had to have manual extraction of clots with no pain meds. 10 days later I hemorrhaged again and had a D&C in the ER with again no anesthesia because my blood count was too low to go to the OR. This was 1988 early in the HIV epidemic. The blood supply was not safe. I thankfully was not transfused. I developed c difficle colitis from amoxicillin that was given for a UTI that I had right before delivery . I was in the hospital for 3 weeks barely saw my daughter until she was 3 weeks old. In the end I was ok and she was ok. Nothing else mattered. So I got to follow my birth plan.
And the hogwash stuff mothers were told at the that time was if your didn’t breastfeed in the delivery room you wouldn't bond well with your baby. I have always been close with her
There is too much pressure on new mothers. All you need is to end up with a healthy mom and a healthy baby. How you get there does matter. And thanks to modern medicine my children did not grow up without their mother.
9
@Martha second to last sentence should read “ does not matter”. iPad typing is challenging
1
I’m not religious but don’t those folks say “ (wo) man plans, God laughs” ? Birth plans are narcissistic. The PLAN is to have a healthy baby and a mom who is alive Stop thinking about your “ experience “. Think about the best outcome for your baby My son was born in high tech hospital heaven - it was great At the last moment, all hell can break loose . This is like anti-vaxxers They don’t know the horror of the past and so cannot learn from it
3
My plan was to keep a photo I loved of a house on a bay nearby to keep me calm;My daughter was due Dec. 12, but my water broke Nov. 24;I called my doc & said I either had the longest pee in history or my water broke;He said, calmly get yourself together & come to the hospital;I called my husband who was working downtown who said to bring a clean sheet & he'd meet me at the Hosp;I didn't ask about why a clean sheet, instinct from too many moves?I arrived at hosp.& a slow chaos was building;it was a full moon;there was only one anesthesiologist on duty;some women were in beds in the hall;I got there, changed, put up my photo,left the sheet in the car;replaying in my mind my doctor's advise that there are no extra points for taking pain medication& remember if it feels like you're pooping a watermelon, you need it; Nah, my trusty photo would do;my husband arrived & it began, centimeters discussed,what to do; I started feeling some pain but it was too early in the centimeter game;I thought of the house, &sound of the bay, & where the anesthesiologist might be;an exhausted looking one came in & asked, did I give you an epidural yet;I quickly answered not yet, but stick around;my doctor's staff came in & did THE WAVE hoping to help me relax;it was cute, but no dice;the urgency & pressure began&so did my mantra,Get The Epidural;finally I did & somethings came back into focus;ten minutes later he came back & asked,did I get you the epidural;NO I shouted, but my husband waved him off.
1
Well, both of my labors, in 1979 and 1981, were sheer hell. My daughter had two midwife facilitated water births at home and all went great. It still, even today, is what it is. More money is spent on drugs for men to have erections than is spent on scientific research concerning the vagaries of childbirth. My own simplistic analysis has shown me that there are birthing hips and hips that are not so much. Instead of buying second, third and fourth homes, perhaps physicians could spend some time on lower paid research! Motherhood is an underfunded area of study because women and children are expendable . Research doesn’t pay as well as emergency interventions.
6
https://www.yiddishwit.com/pics/laugh.jpg
Man plans, God laughs.
2
When I had my first child in 1992, we were swayed by all of the marketing literature from our nearby hospital...pictures of laboring women in spa bathtubs, etc. However, my child lingered in utero and I was schedule for an induction. There was no warm, water-based bathtub. I labored in a bed with heavy doses of Pitocin, and the attached a screw-like device to my baby's head, while he was still in the uterus...to monitor him. The epidural was painful and took half an hour to place. After nearly 12 hours of labor, the baby was ready to be born at about 8 pm, but the doctor was late. I was told not to push or laugh until the doctor arrived....an hour later. She was on another delivery and it was all about HER convenience (and need for fees) and not my baby's health. My baby suffered subdural hematomas from lying in the birth canal, being constricted by severe, Pitocin-induced contractions. He spent 10 days in the NICU. On the delivery of my second child, we went to the same hospital and I screamed at every nurse, attendant or bystander who was near, "When this baby is ready to be born, I'm pushing him out!"
3
Thank God my wife and I chose Lemaze for the birth of our
three children. The classes and the experiences prepared me for that afternoon, alone, many miles away from medicals, in the foothills of the Sierra Perija.
Jose came pleading, in panic, that his wife was giving birth,
and needed a ride to the hospital in la Villa de Rosario.
After hurrying to pick her up, it was clear that she had been fighting the process while her husband dallied.
We had only gone a few miles and after asking her to help me time her contractions, it became horrifyingly obvious that she would never make it to town.
I stopped at the next finca, explained what was happening to the family there, covered their sagging old bed with newspapers, sent somebody back to my place to get iodine solution and thread. It was time. The baby was already crowning as soon as we had the mother propped up on that old bed.
I assured her not to worry, that I had been there before,
and it was already time to push.
I literally had to catch the baby girl that spurted from her mother's vagina.
Those seconds seemed like years, as I held the baby aloft by her ankles, letting the fluid drain and carefully slapping her on the back and shaking her and praying.
She finally breathed, screamed and changed colors.
We cleaned everything with a weak iodine solution, tied-off and cut the cord, and as soon as the mother regained consciousness and dropped the afterbirth, we loaded her in the back of my old pickup and headed to town.
1
Though hardly a perfect analogy, birth plans sound awfully like war plans which "do not survive the first contact with the enemy". Perhaps Robert Burns is more apropos when he wrote in his 1785 poem ""To a Mouse, on Turning Her Up in Her Nest With the Plough": "The best-laid schemes o' mice an' men
Gang aft agley" which translates from the Scots: "The best laid schemes of mice and men go often askew"
2
Its shame no one is studying when and how to conceive a child. World need to study hindus system and see how effective , karma and reincarnations is true and effective . How ,when you want a child how you pray and invite good souls .
Birth plan: Healthy baby. Healthy mother.
3
Natural birth planned, lamaze classes, all that. 10 days late, baby face up, all efforts to get her to turn were pointless, she rolled right back, her heartrate dropped, didnt recover, emergency c-section, in which I did argue with the surgical nurse who wanted to prep me for a vertical incision. Doctor agreed with me, horizontal it would be. The big burly former football player nurse anesthestatist gently curled me up in his arms for the spinal and jollied me, and my husband at my side through the rest of the procedure. Beautiful healthy baby girl. Later my BP crashed and I spent a few hours head down, feet up in my hospital bed till the anesthesia cleared my system.
Oh, did I mention the freak early May hail storm that broke almost every window of our car in the hospital parking lot that night?
It took us five years to have a second child, my DH was afraid he'd lose me. Second child another face up c-sec, 14 days late, but with much less drama, and just a typical January blizzard.
1
This is almost identical to my child’s birth story. At the time, I felt like a failure. My body didn’t do what it was supposed to do. Medical intervention saved my life and my child’s life. Now, I’m just happy we are both alive! Now, when women tell me they are pregnant, I suggest they don’t have a fantasy birth scenario in mind. You never know what will happen and it’s best to proceed with an open mind rather than trying to go for some sort of birthing prize! I get super upset at women who think anything but a natural birth is a failure. It’s just not a choice for some of us
3
My fantasy birth story is not having a birth at all. So far, so good!
3
Ha ha ha. I spent so much time on the birth plan, I forgot to read thoroughly on the creature I was bringing home!
Birthed her over two days and will be raising her for a lifetime.
5
Event planning - Life Event Planning - seems to be a very First World fairly wealthy White woman thing to obsess over.
How many women of color are in these Birth Plan groups?
First World white women, are obsessed with planning the life-events and their celebrations of everyone important to them. If they had their way, they'd be documenting and providing specially made baked goods - gluten and lactose free - for their child tying their first shoe laces. If they actually use laces, and have not been eliminated for safety reasons. Every mundane thing in life is obsessed over by First World wealthier white women.
Its gross.
3
What is this birth plan of which you speak? And why plan when this is a situation that is pretty much being controlled by your body. When I pregnant with my first, 24 years ago beyond a single book on birthing, I didn't read anything else, nor did I go to any classes. I figured this was something women have been doing forever, I could do it as well. And I did. And besides telling my husband to go and smack that woman down the hall because her screaming was scaring me (I was feeling a bit cranky at this point), and then telling him to go sit down because he was bothering me and I was busy, it was just the normal messy, painful business of birthing another human.
1
Finally, a woman fighting back against birthzillas. How you give birth does not determine your worth as a mother or a woman.
5
40, c-section by choice, in it for product not process....delighted
3
I don't expect my children to ever ask for a story of the day they were born.
In childbirth and boxing, everybody's got a plan until they get punched in the face.
Don't let peer pressure or birth positive propaganda delude you into believing you can control what happens on the day of your birth beyond expressing some precatory wishes. Your health care provider will put your health and the survival of your child ahead of satisfying your need to feel in charge. And if you attempt to bypass that reality by avoiding doctors in favor of an environment where doctors will be too far if needed, well, some very sad women lucky enough to survive that decision have shared their Darwin Award stories about how that choice brought them into contact with reality, and how much they wish their children had survived.
Birth plans should be that the mom and baby will survive. Then they are (usually) successful.
2
Birth plan:
1. Get the baby out safely
2. Get mother through safely
The only birth plan necessary.
2
Just another way for women to criticize each other.
From a woman who has been called selfish, unnatural, and out of touch for being childless.
1
Why do some women feel the need to share their birthing stories, particularly when there is nothing, zero, nada special about their experience except, of course to themselves? Ugh...
1
Oh, let people have their fun. What does it hurt?
1st world conceits.
TL/DR: “My birth did not go as planned, therefore birth plans are pointless.” Balderdash.
3
An undercurrent of birth plans and the culture of birthing in the U.S. is that you can’t trust your OB. This is silly and dangerous. Your OB has your back way more than the random writers and bloggers trying to make a buck off you with their nonsense.
I felt bad my OBs had to waste time asking me about my birth plan. As an expert in another (non-medical) field, I know enough to know I’m extremely ignorant when it comes to child birth. No amount of reading the internet for a few months before my births was going to change that.
Ask questions absolutely but trust the actual experts. Thanks for this piece!!
2
You nailed it, Ms. Counter. Drop your mic and take a well-deserved bow. I am a board-certified OBGYN physician of over 30 years and couldn't agree more. The sacred act of birth is not a theatrical production. It's a miracle.
20
It's a very individual thing, and the balance between understanding what you can control and what you can't comes into play heavily in a situation like childbirth.
When things went south with my firstborn, it happened fast - she was a forceps baby and and it took three hours for the doctor to repair the damage to my nether regions. Both subsequent pregnancies were much less harrowing, due, in part, to switching from the OB/GYN who had minimized my concerns while pregnant to a practice run by certified nurse midwives (who worked under doctor supervision in hospital settings). As Ms. Counter so eloquently states, the only thing that really matters is for both parties to be alive post-delivery.
5
If you haven’t already seen the Amy Schumer SNL sketch on this topic — I believe it’s called The Perfect Mother? — you simply must. It encapsulates the birth fantasy/realty chasm with great humor (and accuracy, for many!).
7
Like anyone, I did not want to be cut open, but after 12 hrs of labor going nowhere, I had a feeling something was wrong. I told my doula and doctor that no, I did not want to take a scalp sample (to test the baby’s oxygen). I wanted them to get him out. They did, and he was in much distress. I threw my plan out the window and possibly averted a tragedy.
10
As a Dad, I can say that the only things that I think should be in a 'birth plan' is to: 1) Always plan to give birth in a hospital - when things go wrong in childbirth, they can go wrong quickly and catastrophically; 2) Get to the hospital as soon as you can; and 3) All men should plan to come away humbly from the experience realizing that we as men are physically inferior in almost every way to women.
2
My grandmother had 7 children (6 of them lived to grow up). For the last birth, she decided to "try" a hospital birth. She was admitted and became so distressed by the crying babies she could hear and other sounds, that she left, went home and delivered her last child there.
I worked as a Labor and Delivery RN for many years, in two different, large, major medical centers. When I began, some doctors still used "twilight" ( a drug mixture of demerol, scopolomine and ativan or phenergan )....it did NOT knock the women out (which would have been far too dangerous)....but put them in a light-moderate type of drugged sleep in which they screamed, fought, vomited, voided themselves......usually in the delivery room they were given gas or IV anesthetic to be "knocked out" for the actual delivery. These women REQUESTED the twilight sleep? They visualized a pretty, sleeping princess of some sort....but it was nothing like that.
Prepared childbirth classes, whether "Lamaze" or other, came along and became more and more popular. One young woman I spoke to went to the classes but STILL demanded "twilight".....I did try to talk her out of it, stupid on my part, but could not. Eventually the few doctors that still allowed "twilight" aged out and it died off. Thankfully.
Epidurals CAN slow down labor if given too soon. The rule of thumb was a woman had to be dilated to 4cm or more to be given one. (10 cm is fully dilated and the baby is then born).
2
I had a baby at home, no phone, no running water, no electricity., no midwife, no doctor... lots of hippies did back then. No gory details.
In fact, I had 3 at home, but only one under these conditions. All easy, no problems. No plans either.
Birth plans are in part a symptom of a lack of trust for the hospital birth system, which hospitals need to work to regain.
3
Started in early 90s, I think. Does the medical community think this is stupid? I know unnecessary C-sections to increase hospital efficiency were the impetus, but it has gotten out of control. If you want the custom birth experience, arrange for it at home or in specialized facility. I hope the average hospital with a high volume doesn't have to deal with this.
This was really funny and kind of sad. Funny that of course things didn’t go as planned and sad that your generation feels it necessary to so compulsively and obsessively “plan” a birth. I’m 61 and before the birth of my first child I bought a popular “What to Expect When you’re Expecting” book and read it. I had regular prenatal care but never thought twice about a birthing “plan”. When the baby was ready, I figured I’d know. When he was, I did. Same with my daughter four years later. You should have been enjoying your last relatively sorry-free days of your life. Good luck, sweety. Nothing is going to go like you plan.
1
“the year was 1927...so birthing in hospital made little difference.”
From what I read, giving birth came to hospitals back in the late 19th century because hospitals offered morphine for pain relief.
Aged 39, first baby. Planned to give birth at home with a doula and midwives in a birthing pool under our Christmas tree, using TENS and breathing to manage pain, after starting contractions with reflexology.
Christmas tree fell down causing a 5 hour hiatus and stopping of labor.
Midwife turned up and said I was only 3cm after 24 hours of contractions. I was so tired.
I went for a walk whilst my husband out the tree up again. My doula went home to feed her own baby, told me to rest and she’d come back in a few hours.
The contractions started hard and fast again after a few hours doze. Doula returned and cheered me on. Midwives arrived and left us to it whilst they snacked. Contractions and then involuntary pushing took me over. I gave birth to a 9lb baby boy with a head on the 99th centile. At home, under the Christmas tree, with a cry of I love you. My waters burst as the final spasm crashed over me. I reached down and felt his head, his hair. He swam into my arms, my husband and I gazed into his dark eyes, he looked at us with total calm. My husband cut the cord after it stopped pulsing. The midwives sutured my labial tear. I got into bed, my son suckled and dozed. He never cried. But I did, and my husband did with happiness
Dreams can come true
2
It was 1985, easy pregnancy, small weight gain, great OB, dedicated maternity hospital - it would be perfect. Well 26 hours of labor - all on a fetal monitor - 3 shifts of nurses, pushing and then ...nothing. A c- section and lo and behold - not 1 but 2 healthy big baby boys, actually 35 years ago today. Plan? hah!
1
@lastcard jb did I mention no one had a clue until 1 was born? No one, Zero. 3 doctors, monitors, 3 shifts of nurses- zip.
1
I am a labor lawyer, and when I pregnant with my first and only child I was in private practice with a big, multi-office law firm. My birth plan was to work through the Friday preceding my due date and then to take off. Things did not go according to plan.
The week before, I was in the throes of handing off my cases to another lawyer and stopped for a labor group meeting with the chair of the department who was visiting from the main office. When the other lawyer and I resumed our review of my files right after that, I asked that we move to the break room where I—very great with child—could put my legs up on another chair. But no sooner had I settled in than my water broke, leaving me sitting, dripping, in a puddle. My secretary happened to walk in at that moment so I asked her to call my doctor and to please fetch my trench coat, so I could slip out without clients thinking I had wet my pants. She returned shortly with my coat and my doc’s instructions—along with what appeared to be everyone else in the office AND someone from building security. The crowd watched grinning, while I, still dripping, slipped ignominiously into my coat and was escorted out of the building to a waiting car.
My precious daughter arrived several hours later, and the next day I received visitors from the firm—as well as a copy of the minutes, circulated firm-wide, of the previous day’s meeting. The minutes described “the most productive labor department meeting in firm history.”
1
My home births worked out great, three times! No interference may have helped.
1
There are many things wrong for the feminine half in today's world. Many things in need of change. We all know them so I won't dwell on this here.
But the process of giving birth is not one of them. It's a process unchanged since....well....forever. It's basic biology.
Intercourse, pregnancy, 9 months (give or take), and then a gauntlet of pain and agony to a new life. Or not. Regardless the consequences are that for the person (s) enduring it your relationship to your life (and others) is forever changed.
This gauntlet Nature required be run is what insured men outlived women overall. Until the modern era that is. So though the process can still be long, arduous and painful can we say Hallelujah for modern medicine? The gauntlet is now within a velvet glove. Ummm....so to speak.
And life; it goes on.
John~
American Net'Zen
I had a birth concept. I was going to have a no-meds, non-induced, VBAC with twins. I followed of Inga May Gaskin and others. My own birth was horrible. I actually feel like I had PTSD after it was so bad. It was long, fragmented, and unproductive -- 35+ hours of labor and only ever dilated to a 3. It started at 11 pm on night, steady contractions about 6 to 8 minutes apart and stalled at about 6 am. Having had no sleep, I spent the day caring for my 2 YO twins. Rinse and repeat the next night - 7 hrs, then stalled. Water broke at 11 pm the third night. Contraction 90 sec apart/90 sec each. Vomiting or having diarrhea (sometimes both at once) between each one. Spent all night in the bathroom at the hospital, laboring on the toilet with a bucket in my hand. 3 nights - zero sleep. Twins flipped over and over again - cephalic, breech, transverse to breech again. Pain was unbearable. Tailbone fractured. 1 pm next day - begged for pain relief. Demerol took the edge off for ~ 2 hours. Wore off. Moved to epidural. Labor stalled. More flipping; more agony, even with the epidural. Breast pump restarted contractions. Doctor discovered twin A was now a footling breach with a prolapsed cord. After 35 hours of labor, I had only dilated to 3 cm and ended up with an emergency c-section anyway. Never again. I'd schedule a c-section rather than put myself through that agony again. Still angry at Ms. Gaskin, 9 years later. She lied about how awful birth can be.
2
My first pregnancy was fraught with risks and I handed all decisions to my doctor, a woman. And so I had the induction, the painkillers ("do you want a six-pack?"). I'm still not sure how I avoided a ceasarean -- just good luck. I was certainly not bitter about any of this. I felt incredibly lucky to have a healthy baby and deeply grateful to my doctor and nurses.
With the second baby, though, I was in a much better place and able to make my own decisions.When my baby was a week past his due date, I took some castor oil and went into labor. We took our time getting to the hospital and my water broke en route, so I was fully dilated and ready to push. Because I had done my homework, I knew an epidural wouldn't be useful. I also refused and internal fetal monitor. It was a glorious experience and I felt fantastic, on top of the world holding my bouncy baby. It had been the labor of my dreams.
Imagine my shock when I learnt that my baby's cord actually had a true knot, which could have killed him. With a monitor, my doctors would have discovered this problem and probably given me a ceasarean. I fully understand why women try to have a birth plan: the American way of birth is so awfully unnatural and dehumanizing, and our ceasarean rates are so terribly high. But I was very, very lucky that my chutzpah didn't kill my baby and shudder to think of the risks I took.
2
My mother used to say “man (or woman) plans and God laughs.” I had two kids I n the fifties. I worked for an ob/g who was also my ob. No plans, worked until I went into labor. Had a spinal for delivery, low forceps & episiotomy—almost 10 lb baby. Probably could have done it myself—big pelvis, but why wait? And in those days, docs knew how to use forceps. Home in 3 days, no hospital insurance. Second time, worked until membranes ruptured when I got home from work. Boss said call when I went into labor. that was Monday nite. Nothing doing on Tuesday, and he wanted me to go in for induction. However, my husband was in college on the Gi bill, and coming out of the hospital would be in the midst of his exams, so told the doc hold off till the weekend, if I didn’t start spontaneously. So we held off till Saturday. (Would never do that today!) Had to hold off after I got to the hospital, all the labor beds were full—baby boom, you know. Visited with some of my patients who were in labor till a bed emptied. Doc started the pit infusion, told me to time my contractions, went back for office hours, and two hours later came back to deliver me. Low forceps, episiotomy . Small baby—only 8lb1 oz —lol! and my husband was in the delivery room with me.
The Point of all this is that all the plans in the world aren’t necessary and it wasn’t all terrible in the past, but people love to tell the scary stories and forget about the ones where it all went like clockwork.
Nope. Chuck the cutsie plan. Nature rules.
I was born 2 months premature, weighed barely 2# and this was before modern NICU units.
Having babies isn't fantasy. Neither is marriage/partnership. Chuck the cutsie plan for that, too.
1
Probably the most important difference between her great grandmother's "Birth Plan" if she had written one, and this author's, is that her great grandmother would have mentioned the necessary support and care she would receive from her husband and father of her child. The author totally deletes him in her "Birth Plan". So who's better off now, the great grandmother 100 yrs ago, or the author? Which child will be better off, her grandmother or her daughter? Modernity has been great for tech, not so great for families it appears.
2
In the military they say "no plan survives contact with the enemy".
Women should not shame or stress out expectant mothers. If they have a pipe dream of a birth plan, they will probably learn soon enough! I just smile when women without children have all the answers. Why burst their bubble? If childbirth doesn’t, teenagers just might!
1
Learning how to cede control and roll with the punches is the very first lesson a new mom should learn...IMHO. And it should start when she learns she's pregnant. Just as a newborn is not going to adhere to your carefully planned sleeping/feeding schedule, there is no guarantee you'll have a problem-free pregnancy, either.
Stay calm and laugh. A lot.
Amen! You plan and God laughs. Never more true than in L & D. Sadly some women are disappointed when the experience doesn't live up to Instagram expectations.
To each her own, which I think is the main point here. Personally, I liken natural childbirth to natural tooth extraction.
While I respect and am amazed at my friends who opted for a drug-free delivery, epidurals worked perfectly for me and I am grateful. God gave us brains to make our lives better.
4
Wonderful enlightening story.
Reminds me of a labor and delivery nurse's birthplan I just read: https://www.babymed.com/labor-delivery/a-labor-and-delivery-nurse-birthplan-birthing-plan
The best of it was: Obviously, c/section is bottom of the barrel. Of course, if the baby is breech, in distress, if I fail to progress or descend, I understand c/section is the only way to go.
1
Childbirth planning isn't about fantasy -- it's about planning. My husband and I spend time talking through our ideal plan for the birth of our son and through that process made a lot of decisions about "what if's" -- and when the birth of our son got rough, we were both so happy we did. Because through our discussions, we'd agreed that my husband should stay with the baby no matter what. And when both me and my son needed emergency intervention and intensive care, my husband knew what to do and I didn't have to worry. (Of course, my husband was freaking out -- but in the midst of the freak out -- he didn't have to make a deeply emotional decision.) BTW, 23 years later all three of us are swell.
happiness is overreach
peace is sufficient
— should be
1
In war, "plans are useless, but planning is everything."
-Eisenhower
1
I just wonder,Why did we evolve so badly?
I’m annoyed by this never-ending “natural” birth movement. Women judging women about pain control, really, how empowering. Childbirth is painful and traumatic, get the epidural!
3
That was a good account. Sounds as if not that much has changed, beyond more elaborate birth plans/fantasies, since I had my kids in the 90s. Stand out memories “Are you sure you are ready for the epidural? We could wait a few minutes.” “Yes I am ready for the epidural.” “You should have told us you had hemorrhaging with your first child.” “I did tell you.”
All worth it, but enjoying the experience should be viewed as a rare bonus if you ask me.
You should still try to complete a birth plan in advance. Sometimes, it's the only way your voice will be heard once the process all begins.
1
Don't need to travel back in time. More than half the work don't have birth plans now. they just have the baby when it comes wherever they are.
I was a Peace Corps volunteer in West Africa. I know how the other half lives. We are so privileged here to have clean, well staffed hospitals and reliable transportation (and good roads) to them. Never forget this.
Go ahead and make a birth plan if it helps you feel more informed, but be prepared to throw it out the window come birthing time. Doctors and midwives want you & baby both alive and healthy at the end of the day. Let them do their jobs.
16
I am a male and 85 years old and I wonder what today's dad do during childbirth? When I was a becoming a Dad - I now realize I was in a black out! No nothing and when my wife said her water broke? Not amazed but I wondered waht to do. As I stood in the bathroom doorway - there war question to answer that I had no clue about.
I hope today when a expectant mother goes to the doctor for the first time she is given a booklet for her partner as well as information about the forthcoming birth.
The memories are as terrifying today as they were years ago,
as I stood in the doorway not knowing what to do
37
@Everett Charters So sorry that that was youor experience! I was born in Brooke General (San Antonio) just at the end of the WW2. My dad was in the military and based there, and he did his time pacing in the waiting room.....having to rely on his personal experience of his mother giving birth in the front bedroom upstairs eight times, not on what the mil MD said to him.
These days, many men do get an education during Lamaze training. I don't suppose it's possible that they can ever be as learned on the subject as women who have been through it.
2
@Everett Charters Men It depends. I held my wife's leg and encouraged her for both of my children. I think men are generally in the room these days, even for a C-section.
1
You sound like a good husband!
1
The OBs I know joke that the length of the birth plan is highly correlated with the length of the c-section scar.
47
@Chuck This joke is sexist and lacking in the compassion any OB should have for laboring patients. I'm glad the OB who performed my c-section understood the need for women to maintain agency throughout the process (though I had many other providers who treated me as a brainless baby factory). If you hear such jokes again, please ask the OBs what their c-section rates are. I'd bet they're higher than average.
78
@Chuck And that's why many women distrust the medical system.
4
@Sally
How is it sexist? Seriously, how?
I think the implied correlation might be as follows: the longer the birth plan, the longer the delay to c-section, the more critical the situation, the faster the baby needs to come out and, therefore, the longer the incision.
I’m a vet. While I prefer my patients birth on their own, when they can’t, or when it appears that the risk to mother and/or babies exceeds the benefits of continued labour, I perform a c-section. You can do that a heck of a lot more elegantly if everyone is stable. But when the HRs are too low or I have other reasons to be concerned about survival, I am getting them out as fast as possible, which usually means a larger incision so that I can exteriorize the uterus as fast as possible.
Also, have you considered that the higher c-section rates of some doctors might be because they care for a population of higher risk pregnancies? Or that they might be fulfilling the birth plans of women who *want* c-sections (ie maternal request)?
I’m not sure it’s very helpful to advise women to be unprepared for giving birth. And I think perhaps our problem is with the word “plan”. I suppose the problem stems from the assumption that all plans made then come to pass exactly as conceived?
That’s hasn’t been my experience in life. And I didn’t expect it when I made my birth plan. But what I learned through the process of making one (mostly by listening to other women’s birth stories) is that every birth story is different because there are innumerable possibilities for how we go into labor that no one can predict. But we can be prepared for. The process also made birth less scary for me, which is also really important.
My birth didn’t go the way I had planned or dared to idealize, but I did come away with a healthy baby boy, (which is everyone’s first priority, by the way) and I felt like at every point I had choice and agency to make decisions because I was informed, as all women should be.
Last and most importantly, no matter how your baby comes into the world, if it wasn’t exactly how you planned it, it isn’t your failing or your weakness as a woman that caused it, as we are somehow still conditioned to believe. But please try to inform yourself of the possibilities. And give yourself the opportunity to think ahead what you would like should you meet an unwanted scenario.
4
My daughter's high school friend died in childbirth about 10 years ago. She was in her mid-twenties. She had prenatal care. She gave birth in a well run hospital. She died due from blood loss. Childbirth still kills way too many women in the US. It's just not publicized.
2
This story follows one from a couple of days ago in the NYT about the vast amount of unpaid work women do around the world. My birth plan was not to give birth. Unpaid labor begins right at the beginning.
1
My grandfather delivered my mom and her 7 siblings on the farm in rural Manitoba just as he did with the farm animals. But my grandma worked physically way more then we do today. We are wimps comparatively. Labor is called that because it is hard and painful. My kids are in their late 20’s. Our only plans were how to get to the hospital, but even that is foolish, one of my daughters friends mom said she wanted a home birth despite her first being a c-section nearly bled to death attempting home birth, luckily the ambulance got her to the hospital where she and her baby were saved by a c-section. Just be healthy and listen to health care professionals, they are the experts and birth is anything BUT predictable.
3
I had a birth plan, and told everyone EXCEPT my baby. He decided that 5 weeks early, in the middle of the night with my husband out of town, was the time to come on out. My husband made it back in time to run into the delivery room and watch his son be born. And my son is a healthy kid. So I guess it did go according to plan... just not the one I dreamed up!
1
Brith plan. Have a healthy baby. I did. Everything else did not matter.
2
A planned and successful C-section was uneventful, with a beautiful healthy boy.
The story of his birth was from then on taken over by my mother in law who was always nasty to me and we were never ever close. Yet she turned up at the hospital despite being told not to come, and rarely left my room for days, inserting herself into the proceedings and ruining my precious early days with my son. She was present for intimate medical discussions, exhausting me and wearing my relationship with my husband. I wanted to kill her. I remain very angry 22 years later.
I had only one child and have not a single pleasant memory other than the impact her selfishness and insensitivity had on my only live birth.
It’s not always the medicine.
I didn’t plan for it.
I didn’t have a remedy.
1
My babies were born in 1976 and 1980 My oldest now delivers babies. She was honored for the most deliveries in a rotation -- 98% without an episiotomy. For her birth, I interviewed three docs in Northern NY state in 1976, but even then I was sure of what I didn't want -- my baby removed from the labor room, drops in her eyes, any medication. I did want to nurse right on the table. I almost got it all too. I will never forget her crowning at the crack of dawn back in the day when delivery rooms had windows. I nursed that little girl for four years and now she subs as lactation specialist. Won't go into the second birth which was a bit too precipitous where I suffered through five surgeries over thirty years to correct the damage. However, given the jerky doc left his post at the peak time, I probably would have been better off squatting in the field. At least back in the old days my bill for poor services wasn't in the six figures. Still feisty I checked out AMA because they wouldn't bring baby to me to nurse. Now I'm 70 and all is pretty well.
2
My birth wish was: everyone survives without lasting physical or mental trauma, and I get to have a baby to bond with. I had absolutely no expectations of having a lovely, or even good, experience apart from that, as I have noted that women I know with inflated expectations (often cheered on by midwives and Instagram) who had reasonably good experiences went home sad and disappointed.
1
I had a birth plan, though i never considered it a checklist or something that i could order up a-la-carte. I took it as knowing my options and knowing what i wanted and wanted to feel in a birth experience. I get that having that is a form of privilege. I also wanted to be in say of what happened to my body, knowing the stats for trauma in birth and knowing that a large part of said trauma is something thay can be reduced through empowerment. My plan was not a checklist though, it was more like helping to format multiple options or considerations and picturing how i can work within them to mentally feel good about the situation, including unexpected ones. It was an exercise to help me work towards what I wanted...especially in our culture that fears birth and often frames it in terms of risk, trauma, saving, and death rather than power, experience, peace. Society will write a birth plan and what to expect from the experience for us more often than not. For those that like the message, prefer interventions, and want the epidural...it can work for them. For those who don’t like the current narrative, it can be extremely restrictive
24
My oldest daughter is in pre k, and at her (wonderful) school the parents are invited to come in and tell the class their child's birth story on their child's birth day. I sort of know what I'll say: that I couldn't quite push my daughter out and the doctor brought in a kind of vacuum cleaner and tugged her out. I actually think the kids will like that story and though for a while I was a little embarrassed that I didn't have the physical strength to push her out, I don't really care any more. My youngest daughter needed emergency open heart surgery a few hours after she was born to install a pacemaker. She lives with a life threatening heart condition, but recently turned two and is beautiful and happy. I'm glad that I still have two more years to figure out how to tell her class her birth story. Will I say that she was brave and I was too? Or that we both just got through the day with a massive amount of pain killers and spent the rest of our lives reckoning with it all?
19
@lizzie Whatever story you tell will be fine when you tell it and somewhat different every time. It will live and develop alongside your daughter and you. xx
12
I am a perinatal professional who specializes in helping mothers process their birth stories. Your dilemma— how to talk about your child’s birthday when the birth was traumatic for the mother— is a common and painful one! (Side Note: the school/teacher who sets this up is clearly NOT trauma-informed, and I think this is harmful practice unless is it skillfully and mindfully guided.)
16
@lizzie
Sorry, but I believe the kids in pre-K are too young (and do not need) to hear the “birth story” of their peers. It could be quite traumatic, and whatever happened to privacy?
23
When I found out I was pregnant, my partner and I chose a birthing center for my prenatal care and hoped that I would be able to give birth there. (They told me that I would have to remain “low risk” in order to do so). We hired a doula. We learned about the stages of labor and a few techniques for natural pain relief. I imagined doing most of the labor at home with my partner. I worried about making so much noise that it might disturb the neighbors.
In the end, giving birth wasn’t the romantic experience I imagined but I was able to stick with our “plan” (secretly laboring by myself in the dark shower as my partner slept unaware; showing up at the birthing center pretty dilatad; choosing the position that worked for me, catching my own baby in the tub). I do think that the information I consumed and the specific kind of support I chose helped me to birth my baby in my way, and I feel lucky for that.
I also feel lucky that the midwife who checked on us at home the next day noticed that I was unusually ill and sent us to the hospital. I was admitted to the ICU and spent the next two weeks there, separated from my daughter and very very sick. I’m proud that I made choices about my birth, and when the plan changed, I’m greatful for the medical establishment that saved my life.
42
As the chairman of a large academic Obgyn department, I can tell you that “man plans, god laughs”
Get good prenatal care. Have a good midwife or obstetrician. Place your baby’s well-being above your expectations
Birth is a natural event, but before modern interventions, nature didn’t always give the desired outcome.
Listen to the doctors and nurses. When they tell you that sitting in tub water (which is far from sterile) after you rupture the placental membrane (“my water broke”) will increase the risk of infection to the baby and to your uterus, don’t think you know better.
The reason modern medical care has interventions is to make labor safe. In NY the average malpractice premium is $180k. Not getting sued is plenty incentive to provide high quality care to you and your baby. The medical establishment is not the enemy.
Enjoy your pregnancy and trust your providers. Your plan might be great but be open to what god (imaginary or real) gives you.
Btw, nice column.
116
Of course, the medical establishment is often the enemy. Decisions are made in fear of malpractice, and the induction/epidural/Caesarian trio is one scenario that seems to be all too common in American hospitals.
10
@Dr Obgyn
I had five kids between 1975 and 1988, and I agree
totally with what you say. All were natural births,
some with epidurals and none with complications. But,
the lying down position is very good for the doctor, and terrible for the mother. Please consider. Thanks!
7
@Dr Obgyn For the life of me, I don't understand the water birth. Who in their right mind, after reading so many articles about city water and the failings of water treatment plants, would even think of sitting for possibly hours in that bacteria breeding ground?!?
My three children were hospital deliveries: #1 with complication of preeclampsia, ambulance ride to NICU hospital & 1 week of post delivery hospitalization for myself and child; #2 was breech; only #3 was a relatively "easy" delivery.
Perhaps because the first was the most challenging I had a more realistic idea about the benefits of being in a setting that could immediately react to emergencies.
3
I opted to deliver my first child through a drug-free, all natural water birth and dutifully attended all the Hypnobirthing classes while crafting my five page birth plan, guided by a doula with many years of experience.
I ended up, after 26 hours of labor and 5 hours of pushing, with an emergency C-section after my son went into fetal distress. The doctor was straightforward- there was a chance that one of us wouldn’t make it through. We did, thank goodness for modern medicine, but I was left with a near death experience and postpartum PTSD.
Why don’t we talk more openly about the realities of birth? Why has the author chosen not to tell her daughter the truth? What is it about our culture that insists we uphold childbirth as a mysterious and beautiful passage- a fairytale- when in reality, so many women and babies suffer severely, particularly if they aren’t white, upper-middle class and well-insured?
Thanks for such a valuable and necessary read.
106
I can only speak for myself, but I chose (or choose, for the time being) to withhold the full reality of my daughter‘s birth story from her, because the way that they come into the world is so important to little kids and their sense of self worth. Imagine being told that you caused your mother unimaginable pain and suffering, and possibly caused PTSD while entering the world. My daughter‘s birth took 4 whole days and included being stuck in Monday morning traffic for an hour while 10 cm dilated and pushing, with a baby whose head wouldn’t engage. It ended with me losing all of my agency and being reprimanded for the better part of an hour by the hospital chief of obstetrics. My son‘s birth on the other hand was a life-affirming experience and I’ve never felt stronger in my life. I don’t want my daughter to feel guilty or less-than, because I needed years of therapy after her birth before I even considered having another baby.
12
@Aimee Pestano Certainly you understand that we don't talk about the realities of birth because if we did no one would have a baby. Except for passing a stone or having your arm cut off without drugs, it's extremely painful. Worth it, but painful. Only the most socially inept or clueless dwell on this at a cocktail party.
My recommendation is eat a healthy diet, stay in shape, prepare yourself mentally and physically. Find a great doctor and hospital (like my daughter LOL) Be flexible enough to accept changes to the plan. If a home birth, be very very careful. You could be that small percentage that have issues, and you want to come home with a healthy baby. It's all about the baby, not you. Go to LaMaze classes because now at 70, that breathing has taken me through so many painful situations. Doctors are always surprised at how much pain I can now ignore.
4
I think it’s important to think through preferences while remembering that a plan is just that—a plan. If the realities of your delivery end up matching your plan, that’s terrific.
Having said that, I’ve heard numerous moms say how unprepared they felt for their emergency c-sections. Obviously it’s not “the plan,” but it’s not a rare outcome either and I really feel for women who went though that experience with little idea of what to expect. My birth class barely covered it and I wish it occurred to me to press for more information about basics of the procedure.
In my personal experience, the most important part of my “plan” was making sure everyone knew NSAIDS and aspirin can cause me to have an anaphylactic reaction. I talked to my OBGYN about it from day one. I brought materials to appointments and to the hospital. I wore an allergy bracelet. Yet when I finally entered my room “Motrin” was still written on the white board as the preferred pain reliever. Thank goodness my *brother* noticed before anything could go wrong.
36
I wish that I had hired a doula. My OB practice sent me their youngest and least experienced doctor. She didn't want to be there (her second delivery at 2am) and left me to take a nap for almost two hours in the middle of the night. She was horrible. The delivery nurse was sweet but she had very little experience. I wish that I had someone there to advocate for me.
Make sure you know the doctor who is going to be delivering your child and make sure you trust them.
23
@Kara You may not know the doctor who will be on call when the baby comes. My clinic made sure to have multiple doctors care for me during my pregnancy so I would at least know who might be delivering my child. Ended up being an unplanned C-section.
10
When I gave birth to my two daughters, one in 1975 and one in 1984, I followed the trend of the times to go for "natural childbirth." The experiences, in particular the second one, were excruciatingly, unbelievably painful and damaged my bladder permanently. The breathing didn't help. Even though I begged for pain relief, I was told it was too late. Daughter number two was facing backwards: my labour went on for twelve hours, with one hour in transition and half an hour pushing. I got nothing, not even a Tylenol. I felt so betrayed by the empty, seemingly baseless promises of "natural" and even "painless" childbirths. My younger sister and her daughter both were given epidurals when they gave birth and experienced close to painless childbirths. My son-in-law's sisters all opted for caesareans. Looking back, I'd have to say epidurals or caesareans were the smart way to go. I can't fathom why doctors and natural childbirth advocates acted as they did back then and ignored women's suffering.
45
@Karla Decker
I had a great birth experience back in 76, but the second one not so much. I too ended up with traumatized tissues and a bladder that took five surgeries to get right. Your doctor and hospital choices are very, very important. If you start smelling a rat, switch.
3
I am very grateful to those who have fought for birth plans. Part of the plan must always be: medical personnel calls all the shots as soon as they think it’s necessary.
3
This should be our "birth plan:"
1. Have a healthy baby.
2. Don't die in the process.
Trust the doctors to ensure both #1 and #2 happen.
My plan was like the author's. It didn't take into account a stalled labor and very big baby who was no way getting out on his own. I thank my doctor and hospital team every day that my son is now 25 and that I am alive to be his mom, which also depended on reliable anesthesia and sterile surgical technique. As a doctor myself, I insist on the use of Science, as should every woman. I would be dead without it, and so would my son.
Have doctors made decisions in their own interests and not in those of the mother and her baby? Certainly. The "birth plan" should maybe include a list of contingencies, "if this, then that," to cover what the mother-to-be WANTS and what she may have to ACCEPT if the course changes along the way.
The illusion of control is dangerous to the lives of women and their babies.
8
Birth plans should be discarded because generations ago we had less optimal medical care? Because Mom was back to work on Monday? (Yay, no paid family leave!) Because women today find it hard to get good information as they rely on social media? (Hopefully they aren’t looking to this article, either.) Because labor can be unpredictable and still dangerous? I see no logic in any of those arguments. How about instead we seek to provide more holistic and inclusive healthcare for women across the lifespan, including education and empowerment in their health choices. And how about instead we look to the plethora of other countries with way better maternal health outcomes and change the way we do things. Spoiler alert: a huge component to those improvements will be putting women right back in charge of their bodies and medical decision making, including if they choose a BIRTH PLAN. This article was so frustrating to read. I am sure many a right wing politician wishes all women would just comply with the system as you suggest.
9
The birth wasn't easy, but compared to the life I've shared with my two boys, the birth was easy. I adore my kids, both of whom had life-changing medical issues. I am still worrying, planning, falling down and getting up for them. I know they will be OK--both are exceptionally smart and good young men. But if ever I'm asked advice, I tell potential parents that you have to be ready to give up everything should that be required. If you are not, don't have kids. We focus too much on birth and not enough on life.
15
@Kathy
Thank you for your rare honesty.
2
This story and many of the comments are almost beyond imagination. And going back in time, probably hundreds or thousands of mothers died giving birth to my ancestors.
I understand that plans and circumstances change, sometimes quickly, but I still feel that every birth should be deeply and carefully understood, to see how we can improve the process for mother and child. Both planning and deference to medical authority seem to cut against learning and taking responsibility. I bet that if we could combine detailed and structured accounts of each birth with longitudinal data about child and mother outcomes, we could avoid tons of suffering.
And the pre-birth planning process is really a way for women to think about and share what they want. The plan itself is not the point, but it is an effective way to focus questions of trade-off's and priorities -- to explore values -- and to communicate those to the people around you, so they can support you.
8
I love this story and how it contrasts reality happening and planning to create reality. The continuation after the plan with the re-imagination of events after the facts, the dissonance of the experiences, and the cognitive resolution. Reality is, in fact, an ever-changing set of perceptions in an always shifting set of conditions. Sometimes, knowing how to use those tools to override good intentions and navigate reality as it unfolds saves lives.
6
Of course you can’t plan for birth, but you can prepare for it. By saying birth plans should be thrown out, that robs women of a potential sense of agency. The problem isn’t with the plans themselves as much as it with the ideals the author writes of - focus on things like music and who cuts the cord, etc. Even meds or no meds shouldn’t be the main focus because sometimes things end up differently than you wanted, like with everything else, and women don’t need that pressure.
But saying birth is unplannable shouldn’t mean going into it without consideration of what you would want under many different circumstances. Picking a hospital and provider that you trust and, importantly, who follow evidence-based recommendations, is key.
Also, something that’s frequently missing in the narrative of women earlier dying in childbirth is the important information that most did not die during the birth itself, but in the days and weeks following the birth, mostly from infections but also from complications like eclampsia. This is still a problem in maternal mortality today as women are discharged with little support and expected to monitor themselves. Luckily the availability of antibiotics and sterile supplies has made a huge difference to the author’s grandmother’s time. But going into birth focused on the risk involved in getting the baby out - while not to be neglected- helps mask the risk of interventions that raise maternal mortality and the risks after birth women still face.
17
I requested no bright lights (muted lightning instead), relative quiet and the services of a midwife. Things did not go like a fantasy birth, but the above preferences, which were followed, meant a lot to me.
10
This is such a refreshing read.
I’m 7 months pregnant, and from my perspective, this “birth plan” pressure is unnecessary. Anyone seeing a medical doctor in a developed country is going to be in great care.
Why don’t we divert efforts from body shaming and over-indexing expectations of women to something more productive? For example, why does health insurance cover Viagra but not doulas? Let’s rally our efforts towards increasing science-based options and look away from the tien-wasting debate of natural vs medication.
20
I did a fantastic job.
Two babies.
No drugs ....
natural births.
Birth plans.
I researched ad nauseum about my rights and responsibilities to give my infants the best possible outcomes with a fall back to the medical model if needed.
First was a midwife assisting
Second a female ob.
1987 /92.
Today the pendulum swings back to medical model intervention.
It’s a conservative paternalistic way of planning and attempting to execute a women’s right to self determination.
I bet staff at units are not as educated in the art of breath and mediation and counting and moving. Stressed out and understaffed. Women are not given the tools to overcome their anxiety and fear of nature.
I say this for those in low risk categories and monitoring that suggests a natural choice is safe.
Most staff make fun of these efforts.
I didn’t care. It was my experience and my baby. And I was a nurse.
17
@nurseJacki I did a fantastic job too!
I had a high tech pregnancy from discovery to delivery because the only "normal" aspect of my pregnancy was conception. From there on out, it was a 100% medicalized pregnancy. I did it! I stayed in bed! I took the labor-stopping medications! I attended every doctor's appointment and followed doctor's orders! I did everything I could to ensure the birth of a healthy baby! I did learn all the delivery stuff, the breathing, etc., but nature had other ideas. My doctor listened to me every step of the way, as much as was safe, and when necessary, he told me what to do. Because I did as I was told, in an ultra-high risk situation, of which I had MANY, I lived to tell the tale and have the baby, who is now a man.
You're right about the low-risk situation, but women need to be assured that they have not failed when their plans don't materialize and have to be changed mid-stream. Not everyone is lucky.
4
@ Ellen Tabor
Yes Ellen you are so right.
Moms are not cookie cutter medical cases.
I was high risk too...
Age 35/40 and pre eclamptic with baby #2......
Baby number 2 had Meconium Aspiration.
I had a better experience as did baby #1with an APRN midwife.
It all turned out ok but we did worry about our little baby aspirating feces in utero which could have caused sepsis for the tiny babe.
I would still recommend a written plan discussed with your caregivers.
A combination of medical / holistic. Models can be flexible . It must be. And the mom should be calm and not in labor when asked to chose options for pain and labor interventions.
Bottom line is a woman is responsible for being an informed participant in this miracle. And healthcare workers should stop ridiculing women for presenting birth plans. Instead support women of childbirth age in all their choices and surprises. Partner with us. Inform us.
Congrats to all commenters for sharing.
It’s fun to remember . Such precious moments mostly.
1
My mom was a Labor and Delivery and NICU nurse and said that the birth of my first child was one of the hardest deliveries she had ever witnessed. My birth plan included no epidural, since that was the way most of the moms in my hippy California community delivered their babies. Eighteen hours and a lot of pain and vomit later they gave me an epidural (I was 9 cm... don’t let them tell you it’s too late). Two hours of pushing later my son finally arrived thanks to a suction... only one push away from being delivered via C-section. When I told a friend about the delivery and the desire to go without drugs she was horrified. She said, “Do it for the pioneer women. They would have given anything for those drugs.” My second child’s birth was a completely different experience with a lot less trauma.
I think it is time we give up on the fantasy of a birth story and focus more on fetal and maternal health, both mental and physical. There is no shame in accessing modern medicine to optimize the birth of a child. A healthy baby and mom should be the overall goal.
24
I am the mother of 3 born in the early 70's. Had epidurals and all went well except I almost didn't make it to the hospital in time with my 2nd. He was 3 1/2 weeks early and couldn't wait to join us apparently. I was dialated 8 1/2 centimeters when we arrived in the ER. One thing I remember thinking with all 3 of them as the contractions got harder and closer together was that I didn't care who was in the delivery room as long as I gave birth in the next 10 seconds! I could have cared less if the National Guard was in attendance! They call it labor for a reason! The hardest, unique labor a woman experiences in her life with the sweetest reward.
14
@LM Remember, it is your body starting the labor, not
the baby wanting to come out.
2
I had my first baby one hour and forty-five minutes after the first and I guess I could say the last, pain. My husband putted all the way to the hospital and when I told him he better hurry up, he said, he said, "Oh honey, you have hours left." When we got to the hospital I was put into the Labor Room for about five minutes and then rushed into Delivery Room #2 and a few minutes later delivered a healthy 7 pound baby girl.
When the time came with the second baby my husband did not putt-putt to the hospital.
12
Brava! You went, girl! My wife had a beautiful pregnancy, no illness,even an improved sense of humor. She never felt better. On super bowl evening something started and from that point on nothing in our extensive reading and planning for a midwife directed natural birth had any recognizable relation to what happened. What to expect? The unexpected. 5 days later I was thanking modern medicine for epidurals, a c section, and a perfectly healthy son who just did not want to come out.
19
Forty-six years ago, my first daughter arrived 10 days early. My water broke in the middle of the night and we came straight to the hospital, where it was quickly discovered that she was a single footling breech! Emergency C-section followed. I felt robbed of the experience of being awake, but was consoled by the fact that my wonderful OB had made a cassette tape of the delivery, where I could hear the nurse announcing her Apgar score and weight, as well as her first cry. He did the same for our second daughter who came along 19 months later. It meant the world to me.
19
Let me just start by saying that I did not carry my son. I have health issues making pregnancy very risky (and at 38-39, my age alone was already on the risk category), so my husband and I chose gestational surrogacy. Our original plan was for the surrogate or her husband to call us as soon as she went into labour and for us be there for the surrogate’s delivery. We’d then stay in her town (about two hours away from us) for few days after birth to be with the baby. Then, due to complications, she told us she’d have a scheduled c-section. The plan changed to arriving in her town the day before the delivery. At the end, however, she had to have an emergency c-section two weeks before the scheduled one and I found out about my son’s arrival via a text from the surrogate’s husband - a picture of my son, who was born at 35 weeks, one day. He’s now a happy and healthy 16 month old who loves cars, blocks and mac and cheese!
23
2 babies. 2 c-sections. First one a surprise because it wasn’t planned. The second one was planned because of a breach position. All’s well that ends well. Modern medicine is a beautiful thing.
25
My birth plan is this - I want all personnel to obtain my clear consent before they perform procedures on me. If I’m not in a position to communicate my wishes, then my partner, holding medical power of attorney, can speak for me.
This shouldn’t be too high a bar.
21
@MH it shouldn’t be, but it may be. I shared your POV but my experience was one intervention after another after another, and even though I undoubtedly said yes to everything, it was certainly not the logical, clearheaded consent I imagined. Even though I took a birthing course that included advice to ask a series of questions to guide the process — something like, benefits? risks? alternatives? what if I do nothing? (I am missing one.) I do t think we ever remembered to ask in that format, and four days of lack of sleep and little food made me less than sharp. It was so much more incremental, but one step after another I lost my agency, even though I was on high alert for that situation. The whole thing lacked good communication, and my nice little icons I worked into the (yes, printed) birth “goals” (class recommendation: “don’t call it a ‘plan,’ and at the very top thank the medical staff for helping care for you, because otherwise they will think you are foolish [and they did anyway]). I felt entirely unprepared and not adequately supported.
13
@EM
I think I missed the punchline. Can I ask if you delivered a healthy baby?
I was terrified just thinking about the birthing process due to endless stories I heard and read, recounting a brutally painful, primal process. But now I was pregnant. So instead of giving in to the horror stories, I educated myself. After all, I reasoned, women have been giving birth for thousands of years. Without drugs. I wanted to see if I could endure "the greatest pain" (In retrospect, I found dental nerve pain to be worse- labor is painful, but it gives breaks from the pain between contractions.) I ate healthy, exercised, and was able to birth two babies without meds (one in a birthing chair left over from the 60's!). Luck/genetics/health issues often determine outcomes, but it doesn't hurt to prepare your body for this life-changing event.
That said, I wouldn't be here if my Grannie's neighbor hadn't stopped by, and found her crawling on the farmhouse floor (1920's) with intractable labor pain from a breech baby. Thankfully, he drove her to a hospital. As others have said, sometimes we need backup.
28
That’s great. I also did these things — healthy eating, exercise, etc, things anyone should do in life in general — and my son’s cord wrapped twice around his neck. Thank G-d for c-sections and shame on anyone who makes a mom with a birth that doesn’t align with her hopes feel somehow at fault for not trying hard enough.
2
I didn’t have time to even come up with a birth plan. I went into labor at 28 weeks and after 10 days holding him in, my water broke and I had an emergency c- section. All I cared about was that he was healthy and thankfully he was. We always told him his story and 11 years later, still loves to hear it.
13
The birth of my first child was at home with a midwife. She told me the birth followed the perfect parabola. It was such an amazing experience.
My second child was a double footling breach. I had planned another home birth. The midwife's arrogant male OBGYN backup told me the midwife was just feeling the hands of the baby....No manual exam. I had a birth dream about being followed by two males in trench coats. This child and I were going to a river. I knew that we could cross the river and be OK. When I told my then husband about it, I went into labor. Within an hour, my child's first foot made an appearance. My husband was slow in calling the midwife. She met us on the road on the way to the hospital. Two pushes and my child was out--the umbilical cord wrapped around her chest twice. That daughter always wanted to hear her birth story and on her birthdays when I went to class and brought a cake, she insisted I tell the story to the class. Just glad she was not the first birth.
11
It’s articles like this that make it clear that women today are deprived of the basic knowledge and experiences of our great grandmothers who would have attended births and known that it’s not a predictable or “manageable” experience. Medical professional management has yielded much higher c-section rates and lots of disappointed moms who had such high expectations of their “birth experience”. Starting with induction this story is typical of the medical birth, filled with fear, trauma and disappointment and raises the expectation that doctors save mothers and babies. The fact is US medicine produces higher mother and baby death rates. Basic knowledge of pregnancy and birth, especially through first hand experience has been replaced by fantasies. What we really need is the equivalent of burial society. A birth society where is expectant mothers can be supports to each other during birth and get experiences firsthand before becoming mothers. This would allow you g women the direct experience to truly take back the process.
22
@Mossflower you are absolutely right- before we give birth we have no idea and zero experience with a very universal life experience! Unless you poke around on the internet, prenatal care only tells you when to come to the hospital, but that’s it, really. And even that is confusing.
1
@Mossflower YES
1
Great article! I recently had my first and only child and I had no birth plan. The only thing I had done was practice the drive to the hospital with my husband, find out where to check in, and see where we needed to leave our car. Well, when the time came, the hospital was going into lockdown due to an active shooter in the building. The check in desk was abandoned, and my husband had to bang on the maternity triage door while I clung to the wall barely able to stand (there was no person with a wheelchair to take me away as I had seen in movies) before a nurse sheepishly cracked open the door to get us into the ward. Everyone had heard about us by the next morning, as in, “oh, you are the couple who had a baby during the lockdown!” So, I found out that you can’t plan for the seemingly simple things either.
33
I am a perinatal professional who specializes in helping mothers process their birth stories. Your dilemma— how to talk about your child’s birthday when the birth was traumatic for the mother— is a common and painful one! (Side Note: the school/teacher who sets this up is clearly NOT trauma-informed, and I think this is harmful practice unless is it skillfully and mindfully guided.)
Reflect on the birth through a child’s eyes: what was the season or weather? What time of day did labor begin or end? Search for the positive moments, funny moments, acts of kindness by others, your own moments of courage and love. They most want to know about all the good feelings and love that their parents had when they first “met”— looked into each other’s eyes, etc.
There will be a time when you can share the more raw “adult” version— the overwhelm, fear etc... perhaps when they are teens or young adults. In the meantime, I encourage you to seek out more support in coming to terms with your difficult birth— you can move toward resolution and healing. Wishing you well.
27
@Virginia B. There will be no raw stories from me. My daughter is terrified of giving birth and if I want to have grandchildren I will definitely keep her birth story to myself.
12
My birth plan the third time round was not to tear. My midwives and I worked as a team before and during the birth to make this a reality and we did it. That’s the role of a good plan - working and communicating together with all the relevant information. And they are different for everybody. My labours were extremely fast - part of why I home birthed as I didn’t want to drive in labour or deliver in the car park. But I tore brutally the second time. My third labour my midwives helped me slow my labour down making it longer but I birthed my 10lb baby at home with no tears. Still thankful to this day!
16
Ain't that the truth. The first time I was shocked by the pain of childbirth (before the anesthesiologist arrived) and, after a long labor, ended up with an emergency C-section anyway. The second time I voted for a SCHEDULED C-section. It went like clockwork. I was fully conscious and felt fine. THAT was a birth plan!
26
That’s an understatement!
I mourned the perfect birth experience for quite a while. I wanted no epidural, no c-section, and no pitosin. I got all three after two days of a rough labor. Thankfully my son was ok.
My second birth experience on the other hand was awesome! A Natural birth only a little mystery drug to take the edge off. The nurse actually said to stop pushing because she needed to fill out her paperwork. :0
As the song says “you never can tell”
9
I didn't have a birth plan beyond wanting to do it naturally (without pain meds). I had been with three other women when they gave birth so I thought I was pretty prepared. NOT! I did not handle the pain well. I became almost hysterical from the pain. My labor was not long and the pushing was not long but I was a basket case. My doctor did prescribe some morphine to help calm me but I didn't get an epidural. Since then I tell everyone "get the epidural".
20
Maternal mortality rates in this country have more than doubled since the late 1980s. Maybe we should take a look at why. All the new and wonderful interventions, like Cytotec? Obstetricians terrified of lawsuits and afraid to let labor progress naturally OR wanting a convenient scheduled birthing event so they can be home before dinner?
Here, lay on your back (where gravity won’t help this process one bit), take some Cytotec (bc it’s cheap/don’t worry about this being an off label use/let’s hope it doesn’t kill you), next pitocin, then epidural bc the contractions will be unbearable, then, oops, you need an episiotomy bc you can’t feel anything and have been pushing forever. And that is a good outcome, not leading to an emergency cesarean. AND women are supposed to not advocate for their own health in these scenarios!?
ALL WOMEN want the best outcome for their babies. No matter if they decide on a drug free labor or go right to the scheduled c-section. Of course, things change. But we shouldn’t be shaming women because they have a preference, or acting like there aren’t benefits to avoiding interventions and having vaginal deliveries in many (not all!) cases.
Women should be allowed to trust their bodies, and make their own informed decisions. They should be empowered and given the resources to care for both themselves and their babies, before, during and after delivery.
29
Pregnant with twin girls. Labor was induced, with medical approval - both girls were in a good position for a vaginal birth, we were told. 16 hours later, I started bleeding heavily. By the time we all realized it was an emergency, one of our twins had lost so much blood that she later died. So instead of a vaginal delivery, I had a true emergency C-section (doctors and nurses yelling, full anesthesia).
So, it can go very wrong, very fast. And even with that, we have told our daughter - who Ian now 4 - a full story of her birth. Not THE full story, because there are many full stories that can be told, and many details I’m sure we’ve forgotten, and because we don’t want to scare her with gore... but it feels right for her to know about her twin, and for this to be a part of her origin story. For her, I think, it’s not sad or distressing - she seems to take it for granted.
10
@Beth Reed 'Full anesthesia' sounds good.
I begged for a C- section upon realizing I couldn't handle how what I thought was going to be 'plain old pain' became 'scarey panic pain that the only way to stop it is more pain until you finally give birth and suddenly your not in pain anymore.
Then he or she (let's not go there) has to deliver the placenta and stitch you up. It's the mans fault in the first place, or vice versa?
Every baby has it's own way of being born. Unfortunately we don't know what it is until the time comes. But thinking about a birth story is a good idea and not be be mocked. Pregnancy won't go on indefinitely. It feels endless but it will end. It's good to have narrative to acknowledge it.
4
Amen, sister!
When asked for my birth plan, it was, “To try to get this baby out without a c-section.” When the nurse would give me a look, I said, “I suspect most of this is out of my control.”
This plan worked well for both babies. No c-sections required. I didn’t expect marathon labor, an epidural in one case (so I could sleep), or not eating for more than a day. Low expectations meant no disappointment!
10
It’s very interesting to read. Giving birth to a child is always life and death to the mother doesn’t matter whether it’s done at home or in a plane or in a maternity hospital. Modern medicine and technology has certainly made things somewhat better.
Planning and giving birth to a child is not that important since millions give birth everyday in this world but taking care of the child in all respects matters most.
Sadly many working couples give priority to their jobs, promotions and whatnot without spending some valuable time with their children. Their earnings and fame mean nothing to the children. Money matters precious little to them. What they want from their parents is some quality time, love and affection, that’s all,which doesn’t cost a single penny.
9
Birth plans are a mystery to me. I have no interest in birth as a spectator sport; my in-laws inquired about attending the birth and were met with quite an Anglo-Saxon response.
My husband was more invested in the pros and cons of an epidural than I was. My opinion was, if I need it, I’ll get it. Well, eventually I decided it might be helpful, but then it was too late, and, eh. We all lived. Literally.
The object of child it is a healthy kid and a surviving mother. That’s it. You can put doilies on it if you want, and dress it up as a mystical experience, but all I want is that sweet feel of that insanely soft head against my cheek. And the infant who grows up to be an adult you’re proud of.
39
I decided, when pregnant with my second child, to give birth at home (on an Air Force Base) with the services of a midwife rather than rely on the judgement of an OB known to decide whether or not to perform a C-section based on his tee time. My beautiful, healthy 8 lb 9 oz daughter was, in fact, born in our on-base quarters after ~8 hours of labor with her father, brother, God-mother and West Highland terrier is attendance. It wasn't exactly as planned, but it was SOOOO much better than her older brother's arrival in a base hospital, with what seemed like dozens of strangers sticking their hands into my privates and procedures and drugs being administered without warning - or over my objections. Both of my children were born healthy and without any complications that endangered their or my life, but the birth experience with my daughter was so much better because the midwife really included me as a participant, instead of a subject.
24
As a childbirth educator for many years, I talked about all of the things that can happen, from induction to placenta previa, to a planned C-section to an emergency C-section. When I would see my clients post-partum, they would tell me, "You didn't tell us about this!" even though I had. I was probably the same way when I had my first child.
15
When medical doctors took control over women’s bodies and labor processes, so much was lost. Women have been birthing without medical intervention for thousands of years. MDs should only be called in for emergencies.
8
Women have also been dying in childbirth for thousands of years. I know people who had easy, quick births; I know people who had harrowing births; mine was somewhere in the middle. So it has likely always been. For every woman who gave birth in the morning and drove a tractor in the afternoon, there’s a woman who gave birth in the morning and was laid out in a coffin in the afternoon. Plus a bunch somewhere in the middle. What drives this need to romanticize childbirth? Women are not magical primal wolf-witches and the ease or “naturalness” of our childbirths has to do with a bunch of random biological factors that are mostly outside of our control. We are fortunate that doctors can now help us ensure that those factors don’t kill us as often as they used to.
119
@Yeah But Well said. Men go to war and fight on battlefields; women give birth. There is an equivalency between men's war stories and women's labor stories. There is nothing romantic about either situation and bragging rights are a bore. You do what you have to do and be grateful for the modern medical help which is available when you need it.
16
It is great that modern medicine has made giving birth safer and led to lower infant and maternal death rates. But modern medicine has a financial incentive to medicalize childbirth and encourage all pregnant women to give birth in hospitals. Whereas the vast majority of births to low risk women don’t NEED to be done in a hospital. I gave birth at home with licensed certified nurse midwives who carried crash carts in their trunks and had arrangements at the closest hospital in case my birth needed intervention. My prenatal care, birth and postnatal care (including help breastfeeding when my baby wouldn’t latch) cost $2000. If I had done all of that in a hospital setting, it would have cost upwards of $15-20,000 or more. Every woman has the right to choose how they want to give birth - whether at home, in a birthing center or in a hospital - and emergencies can’t be planned for. I just don’t buy what the medical establishment is selling that hospital births are the only safe way to give birth - when births pay for a large portion of hospital budgets. They have turned a natural process that should be celebrated into a medical procedure to be feared. In many other countries home birth and birth centers are the norm, with no difference in mortality rates.
7
I promise your birth story will get better with time. The pain is one of the first things to fad. I do not remember how I got to the hospital, but I do remember that we waited until after midnight so we would not get charged for an extra day. I remember being horrified that this MAN in a white coat wanted to check to see how I had progressed. I screamed like I was being murdered. The next thing I remember is feeling like I wanted to sleep and this insistent woman insisted my mother had fallen, broke her hip, and was headed to surgery and was I okay with transferring her to a different hospital. My mother had just left my room mad that things were not progressing. Then everything went black until I heard my mother-in-law scream that THAT CANNOT BE HER GRANDCHILD and a huge crash. I did not regain consciousness for 2 more days. They tell me I almost died. MIL passed out, my husband passed out and both ended up in ER. But 33 years later, I can laugh at the utter disaster of the day my son was born.
By the next week everyone was on the mend, and it was my grandmother-in-law that broke her hip at 92 putting screens on her 2nd story windows. My more progressive friends asked what would I do different with the next birth plan. I said "I planned on never getting pregnant again."
Rumor has it if we live long enough, our kids just appeared in the crib one day.
21
@Sierra Morgan
Every woman’s experience of childbirth is unique but... your tale is extraordinary. I’m so glad you lived to tell it.
This is an amazing story
In a cemetery five miles from where I now live are buried two young women and one baby boy sharing one headstone. They all died in the 1870's, and they are the first and second wives and son of one man, my twice-great-grandfather. The first wife was my twice-great-grandmother, who died having her second child, a boy who lived only a few months. The second wife died five years later, having her only child (who survived). My birth plan boiled down to me and my baby (in my case twins) not ending up there with them. In their era, we probably would have. My two will graduate from college later this year.
52
I gave birth 24 years ago in Japan. No epidurals, so I prepared to deal w/ the pain via shiatsu massage and learning about the stages. My water broke and my husband said, "oh, we have 24 hours." No, we need to go now! The taxi ride to the hospital took one hour. By the time I got onto the gurney, they said I was 10 cm dilated. Through my husband as a translator, my daughter was born an hour later. I do consider myself very lucky! Nice, too, to stay in the hospital for 4 days with the new baby.
12
I think putting together a birth plan is a great idea. You just need to plan ahead for various contingencies. For example, If the baby needs to go to the NICU, does your partner stay with you or go with the baby? If you have to have a C-section, you should know that you can ask for skin to skin time immediately after the baby is born in most cases. I didn’t know this for my first delivery, but made sure it happened for my second. talk to your doctor about various hospital policies and procedures, and what kind of decisions you will need to make. It’s much easier to think about these things in advance been in the moment. Of course, flexibility is key!
11
I’ve heard so many other mothers who had horrible disappointments because they had an expectation that their birth plan would be what it was - then they needed pain meds, had some issue requiring interventions or simply did not go as they imagined it - and they feel traumatized, like a failure, like they should have been able to control it.
I think birth plans give a false idea that you can control it - and I’ve heard that from many women. My own births, I had no plan, no expectations, just expected to do what made sense. Pain was tolerable until very suddenly it was horrendous and I had an epidural. A breech baby was externally rotated, then started having heart rate issues and wouldn’t come out, so there was a c section.
I see a lot of comments about how “of course” mothers know that their birth plan isn’t a guarantee if something happens - but it still gives that idea, that you can plan and get what you want and there is real harm done with that expectation.
19
As a mother of two who had two "natural" births, article bothers me on so many levels.
1. Having an "ideal birth" plan is empowering for many women, because it allows them to think about their needs and preferences in advance of their birth, and to be prepared mentally and logistically for many of the common unfortunate or unwanted scenarios/interventions that unfold in a typical birth, which can often be avoided with the right education, preparation, and support;
2. Being stubbornly attached to a birth plan and having an inflexible, unrealistic attitude toward unknowns is vastly different than planning in advance to make as many autonomous decisions as possible, while realizing that circumstances may dictate deviating from that "plan" or those "preferences"
3. Comparing women's ability and desire to plan for birth in the current day with the horrendous way women have fared in times past in regard to childbirth is useless, unless one is trying to make women somehow feel badly about the fact that women's rights and protections have advanced our overall well-being to the point that.....what? To have birthing "desires" means we are spoiled, selfish, and trivial? What brats are we, who desire to not have our bodies completely overtaken by the medical establishment!
4. I feel for any woman who has had a birth experience that threatened their very life or sense of safety. I was LUCKY--I loved my births. They (mostly) went according to plan. Plan, but know plans may change.
46
This.
M,
Yes, on one thing you are right: you were very lucky.
65 years ago my mother had a normal pregnancy, her second child. She checked into the hospital everything was normal at first then NOT.
There was a problem with the limbs, they would not fold into the canal. If the doctor had not broken the leg to allow the birth both mother and child would have died.
Until the baby is born there is not certainty that the birth will be safe and normal.
The risk of something going wrong and not having the medical resources available is not worth taking.
20
Such politicization of a birth. Such expectations.
Having been involved in thousands of births as an Anesthesiologist, I can tell you that it sometimes goes as you wish. Coming in with a long list of demands ( they are rarely requests) does not really work. Nature will do as Nature wishes.
Accepting that, and accepting the knowledge, guidance and professionalism of the doctors and nurses on call in the middle of the night who can save two lives at once, will go a long way.
28
First off, women and people who support them are warriors. I credit Lamaze with making my birth experience a success. I had a difficult birth because my doctors did not listen to me early on. I tried to discuss my SCI L5S1 injury and reminded them at every appt. An epidural was signed for 6 mos in advance so the the anesthesiologist(s) would be onboard in advance. Of course they were all ‘aware’ except the one that was present that night who viewed the scar while beginning the procedure then refusing and leaving right then and there. All I can say is Lamaze truly worked! My water broke, then my dr did not show up and by the time I was in labor 22 hrs and angry, it was determined my son was in distress and had an emergency C-section. I had been having extensive testing three weeks in advance of this because my doctor informed me that my son was severely brain damaged. I kept saying he’s not. They said ‘denial’. He was born perfectly healthy.... Years later, my father had a procedure and was in severe pain and he was unable to have any pain meds for several hours. I was able to get in his face and talk him through Lamaze for several hours. He later commented on how much it helped him get through it. It really gave he and I a unique shared connection ever after. He had serious med issues and spoke of that time off and on. We would do the Lamaze together on his later procedures. It was a life saver. It’s been my experience, when I’m planning, life is laughing!
6
This article conflates the idea of a “birth plan” for the purpose of picking out your favorite new age music and a birth plan that is about limiting routine medical intervention in childbirth to evidence based necessary procedures under the circumstances. Please don’t trivialize the importance of automony and respect for women.
67
@Sandra a birth plan is about CHOICE. for some women that means a birth plan that requests epidural, or even elective caesarean section.
Please don't conflate the idea of a birth plan with limiting medical intervention. That is perhaps your birth plan and it is many women's aim with a birth plan, but it is not every woman's plan. Please respect autonomy for all women. Thank you.
Regards, SJ. a home-birther who is a practicing registered midwife
2
Never had kids. Never felt the urge, and really can't recall discussing anything about pregnancy or birthing with my Mom, nor her with me.
She & my Dad always just loved all three of us, her children, and took a lot of family photos. Typical Boomer family/kid scenario.
Closer in age, but younger to my most adored and revered
sister-in-law, a woman with a cheerful spirit coupled with fierce independence plus a spine of titanium she (and my brother) had two beautiful girls while in their mid-late 20s.
Pressed for any detail of the birth process or any hint of things challenging or less than' ideal ... she would simply say, 'you look at your baby and forget all the rest,' and 'it's all worth it,' things to that effect.
I alway suspected it was waaaay harder than that (much less the pregnancy itself & next 20+ years of raising a chid).
I am beyond grateful for my two beautiful nieces, and for my brother and sister-in-law who took that life path and responsibility on.
Good luck to all women and babies who take on the world in this bold endeavor of new life.
31
Very glad your daughter is with you and growing up!
Hoping your description of your "birth plan" includes lots of poetic license, as it focuses on your ideal birth rather than your health care needs.
My experience of planning was quite different than the one you describe here. 28 & 25 years ago, I did work on a birth plan. Part of planning was learning as much as possible about the physiology of birth, including emergencies, contingencies, and helpful interventions.
My first birth was easy but the second had some complications. The nurse-midwife followed the birth plan as carefully as she could. It made a difference.
10
Bless you -and bless your daughter, I have a feeling that she has a great Mum from a line of great mothers.
3
not to die. My mon would add not be, become, or get depressed. Depression killed back then, A weakened immune system was dangerous to life. Her version of Christianity was a guidances to never, ever be depressed.
6
It all boils down to the myth of control. We lead such privileged lives, so far removed from the vortex of nature, that we become deluded into thinking everything is under our control. Labor and delivery is just the punch that throws your head back. You're in the ring, now. Child rearing is the ultimate exercise in letting go. You're not in control. You never were.
72
@Denver Doctor
Many many years ago my Doctor and I were discussing my future delivery and I remember him shaking his head and saying "what we want is a healthy baby and mother, that's what's important"
14
I didn’t even attend childbirth classes. Was too busy working 1.5 jobs and was exhausted from being severely anemic. My plan was to have a healthy baby, and that was it. I experienced some complications, but my very robust daughter eventually emerged. As at least one commenter noted, parenting is an exercise in letting go. Without being fully aware of the extent to which I’d soon be doing that, I started letting go a little early.
6
I think the birth plan is more about developing expectations. Mental preparedness helps even if plans go drastically awry. Especially when plans go awry. If you go through a birth "plan," you should be pretty familiar with the birth process by the time your package arrives. Mother and father won't be thinking too clearly in the moment.
One of those small little factoids you learn while learning: If you admit yourself to the hospital too early, they'll send you home. So going early is bad. You're supposed to time your contractions. If you time it wrong though, you're having the kid on the living room floor. You'll need to call an ambulance to cut the umbilical cord.
And no, midwives are not on call 24/7. You'll be lucky if your doctor is even in town.
Not that any of it matters anyway. You mostly need the hospital to stop hemorrhaging if hemorrhaging occurs and provide mom with room service when done. Everything else is somewhat formality. The baby is going to come out one way or another. The rules of gravity still apply.
For those who have never experienced a childbirth, here's the most realistic perspective I can give: Be prepared for you or your spouse to take a giant green dump on the floor in front of a room full of strangers and not care. That basically sums up delivery.
10
My mother frightened me growing up with her birth story of screaming in pain and grabbing the doctor's arm as I was delivered. I was determined that that would not be me. I read as much as I could, watched birth videos and practiced breathing techniques. I had a 36 hour labor with a spinal just before delivery. There was no screaming and no drama. The stories about "You wont remember the pain" are not true. It was painful and I never wanted to repeat the experience. My only child is 46 and thriving. Her two children were scheduled caesarian deliveries without a single labor pain.
11
@maya Just because your daughter never had a labor pain, that does not mean she had no pain. I had a scheduled caesarian (I was having twins). The pain when the anesthesia wore off was excruciating, and the recovery was, to put it mildly, no fun (I'll spare you the TMI). Yes, I would have done it again, but having had in one go the two children I wished for, I was sure glad I didn't have to.
4
@B You're very right about post surgical pain which my daughter did experience. I was focused on the pain of prolonged labor and in no way wished to minimize the pain following surgery.
4
As an Obgyn for almost 20 years, i have reviewed many birth plans with patients. Often it is not about unrealistic expectations but about communication between me and the patient. Especially for first time parents, who have no idea what happens in birth or on labor and delivery, discussing a birth plan allows me to explain some of the things we do in advance of labor and why we do them. And i would much prefer to know who has unrealistic expectations up front-so we can try to manage them in case things do not go as planned. Still-as a pt said to me recently, in the words of Mike Tyson, everyone has a plan until they get punched in the mouth. I always tell pts that my birth plan is a healthy mom and a healthy baby at the end. That’s truly the only plan and flexibility is paramount.
88
The plan for us was a healthy baby. Nothing on paper. No gender reveal or any of that stuff beforehand; we didn't know, and didn't want to know. We did have names in mind for whichever way things went. We read the books, got with an obstetrician early, went to LaMaze classes, and went to the hospital with the understanding that the outcome was not in our control. The first was a frank breech delivery under anaesthesia and the second, a forceps delivery because of fetal distress. Both were breastfed for two years. Both excelled academically and went on to professional positions. The "baby" will be forty later this year and has a baby of her own, induced at late term, born by caesarian, no doulas or water or plans for anything but finally to hold that long-desired baby, who is cute and smart and none the worse for lack of plans on paper.
16
Best advice ever. I attached to a fantasy while I was expecting my first child. Things went sideways in a big way, and it took me years to get over it. I didn’t fantasize about the birth of my second child, and that really made a difference.
23
I’ve scrolled through a lot of comments and most are purely persona. Few acknowledge that women declaring their autonomy through birth plans, doulas, and in many other ways are essential. While birth isn’t simple or made to order, women who demand better are not pie in the sky, and should not be condescended to.
This dismissive “get over it” attitude is exactly how the US got to be so out of sync with most of the world, with our sky high C sections and poor maternal mortality.
One of my great-grandmothers was privileged at the turn of the 20th century. My grandfather remembered her breast feeding his brother and claimed she had one of the first women OB-GYNs in Boston. Who else besides a woman trusting another woman when few do, and behaving contrary to expectations, can change things?
Everyone should feel ok about their births, but please don’t look down on women trying to change things. Even if they are unreasonable. Many people trying to change things are very unreasonable. Thank god.
46
Our poor maternal mortality is a direct result of underlying heart conditions and hemorrhage. I’m all for women having the support they need, but let’s not conflate our wants with the reality. No doula, birth plan, or “fight the man” mentality is going to resolve the real problems of lack of access to real medical care (No, that American home birth midwife is not real medical care. I’m sure she’s lovely and she listens to you, but she’s highly unlikely to be as medically qualified as the people who pass out jell-o in a nursing home, same for the vast majority of doulas.) and poor maternal health.
7
@AS Haley Having one of the first ob-gyns in Boston was how Rose Fitzgerald Kennedy delivered her daughter Rosemary. Rose was delivering easily when the attending nurse, following orders, held her legs together to "halt" the process until the doctor arrived. The oxygen deprivation of that 30-40 minutes is reckoned to have caused Rosemary's developmental difficulties. It would seem that having one of the first ob-gyns in a community is an invitation to hero-worshipping folly!
3
My birth plan was simple - have a safe delivery so my child and I would both live and be well. That is all that matters.
28
In my birth plan, I was all set to resist the episiotomy that the "medical establishment" was foisting on unwitting women.
But at some point in the middle of pushing, my midwife (yup, a midwife) said she needed to do one, and I couldn't say "have at it" fast enough.
Here's the thing about having your birth plan tossed out the window: it's great preparation for parenthood.
60
@Elizabeth A Agreed. I don't think we share enough with our sisters about the damage episiotomies actually do. We should be supporting any and all alternatives to them, because they can destroy your sexual future and make your obstetrical future even more miserable. The worst doesn't happen to everyone.....but it happens to too many.
When my sister was expecting her 2nd child, 11 years after her 1st, I asked her if she wanted her 11 year old daughter in the delivery room. She replied, "Not if I ever want her to have a child of her own."
31
@ca My nine-year-old was with us (in hospital) when her younger brother was born. It was wonderful, and I still believe the experience contributed to their close relationship.
7
@ca I was 12 when my baby sister was born and while I wasn't at the hospital when my baby sister was born, my dad showed me photos afterwards, much to my mother's consternation. Those pictures certainly scared me off of having sex until after 18.
Birth plans help folks know their options. If you don't know your options, you don't have any. Common sense allows us to realize that yes, we can't actually PLAN how a birth is going to go, but we can have preferences
32
Yes, it is wonderful and smart to go into birth with flexibility about your plans and desires...and yes, getting the baby earth side alive and healthy is absolutely a priority, but let’s not completely forget that a birthing person is also allowed to have an ideal In their mind, and a hope to deliver the way they want. I’m reading so many posts about “all that matters in the end is a healthy baby” and I’m really upset by that thinking. Yes, a healthy baby is a priority, but please don’t forget that the human that carried that baby for 9-10 months is a thinking, feeling, person also. Their mental and emotional health matters also. I know many women who had birth experiences that left them traumatized, depressed, and scarred- both physically and mentally, and I’m here to say that they matter. I wish everyone could have a birth doula and a midwife along with whatever medical team they choose. It can be the difference between feeling like nothing more than the vessel that carried the child, and feeling like a valued, important, whole, person.
52
This was wonderfully written, thank you. This is a great perspective to have about birth plans. I was very much in the "whatever happens, happens" camp so I had no plan. In retrospect, the lack of a plan contributed to a lack of communication, and several things happened during my labor and delivery that I now deeply resent. I very much felt like my needs were unimportant through the whole process. In the end, yes, I got the healthy baby and I haven't been forever scarred by my L&D but the experience could have been a whole lot better. Unfortunately I realized too late that we really have to make a point to advocate for ourselves because no one else will.
7
@Carey Thank you. While the birth of my daughter was relatively trauma-free, I remember feeling like I’d been hit by a truck and no one cared. Yes: advocate for yourself. Your health is important, too - especially for that brand new human being who is depending on you. Get the support you need.
5
As a certified nurse-midwife, I always tell my clients who are disappointed that they didn't have a "natural" childbirth: Did the child come out of your body? Then it was natural.
96
First time birth is, plain and simple, traumatic for most. Maybe if we stopped painting it as a beautiful, miraculous, woman-making endeavor you have much say over, we would stop being so surprised when we discover who painful and frightening it can be, even without medical interventions.
25
@Anonymous Actually, having a birth plan and fully understanding the birth process can significantly reduce anxiety, fright and pain. I used the Bradley Method and had two unmedicated childbirths. Did it hurt - of course it did! Child #2 was nearly 10 pounds! But I was prepared for how I was going to handle the contractions and that really helped. You'd train for a marathon, right? I don't think it does anyone a good service to tell them that children birth is traumatic (maybe it is for some and not for others - it was life-changing in terms of my perspective, but I wouldn't call it "traumatic.") I'm a grandmother now, of a granddaughter, and I'm sure if she chooses to become a mother, she will avail herself of whatever processes work best for her, all with the support of her family. I suggest that rather than telling everyone to throw their birth plan out of the window, it is more constructive to be supportive of women, each of whom is different.
17
@Anonymous Hear, hear! The first time was traumatic, throwing up foam ( there was nothing left in my stomach) in-between contractions for hours from pure pain. I was in a kind of nightmare, where I saw a panther jumping up and tear at my innards. Had I shaken it off, I had a few moments respite and then I saw the next panther crouch down for the jump. My husband was crying in a corner I was told. I do not remember seeing him at all. The next birth was wonderful. That time the hugging and puffing actually helped because the pain was simply a lot less to begin with. Stupid thing is: I felt ashamed the first time because I could not handle the pain...
I remember when my wife’s OB asked us our birth plan for our first. My wife: ‘To go to the hospital, tell you we’re having a baby, and you all deliver it. That’s your job. I’m already doing mine.’
As usual, she was spot on.
46
Birth plans are important. As the author said, "women have no doubt been planning for birth as best they can since the beginning of time." Making a birth plan and communicating it to the birth attendant is the best way we know how at this time.
At my first birth, in 2005, no providers (I tried several) would take the idea of a birth plan seriously. The birth went poorly for both me and my daughter. For my three subsequent births, I made sure to be increasingly careful about who I chose for my attendant. There were always surprises -- major ones -- but having communicated clearly with the attendant during pregnancy helped me and my husband manage the complexity to our satisfaction.
I absolutely encourage women not to be shy or embarrassed about communicating their plans. You have your children to consider. Speak up now.
19
When my peers and I were having our kids forty plus years ago, we planned read and became as informed as we could about the whole process. The goal was to have nature take its course as much as possible.
We were all older and opted to use the birthing rooms in our hospitals. None of us were induced and only one friend who had a very long labor had an epidural.
There were very few interventions and we had very healthy babies.
Were we in better shape than moms today? I haven’t heard of anyone whose labor wasn’t induced recently.
10
Absolutely no plan made apart from delivery of a healthy child. Broken water at 4 am, unfortunately, my darling girl needed to do no. 2 which upped the chance of infection. No plan for the car not starting or induction not working or failure to progress, so no plan for an emergency C section. All things considered, it was slightly traumatic for myself and my dearest but she is now a wonderful smart young woman who I am immensely proud of
7
While many of these comments rightly call out the unacceptably high maternal and infant mortality rates in the U.S. (particularly when complications occur, as they frequently do), none mention the far-more-unacceptable racial disparities in maternal mortality during childbirth. Although it may seem callous to point out, 1927 and 2017 homebirth are not the only situations in which the author might have died -- if she had been black, she might very well also have died, even in the "best" of hospitals.
30
On the contrary, there very much is planning and preparedness, including for the remarkable and wondrous spectrum of human parturition.
A physician MD
16
I delivered a baby when I was a third year medical student. The mother was having her third child and was crowning when the resident showed me where to put my hands to catch the baby. It looked like she was in danger of tearing and he took a pair of scissors and WHOMP! did an episiotomy with no anesthesia and no warning, which horrified me. All I could think of after that was that I would not want that to happen to me.
So, seven years later, when I was giving birth to my first child, my birth plan consisted of asking the doctor three months before delivery if I could have an epidural. That was it.
13
@NMY I had an episiotomy like this during an unmedicated birth. It felt like a pinprick. The pressure of the baby's head is numbing.
@NMY I was on the receiving end of just that kind of episiotomy! And from a pregnant woman ob-gyn at Harvard to boot. That was 35 years ago and I do hope it has been significantly rethought since then.
@NMY I would have found a physician who had an episiotomy rate below 5%. Operating without consent is assault, except in the vanishingly rare case in which immediate death would be likely to result from a one minute delay.
Regarding the "she looks like she might tear" excuse: Most spontaneous tears are first degree, a few second degree (involving muscle). An episiotomy involves cutting muscle (so is as equivalent injury, but involves certain muscle disruption, not just a possibility) and increases the risk of devastating third degree tears, https://www.tandfonline.com/doi/abs/10.1586/eog.10.21
Episiotomies are caused by impatient or scared doctors following custom, not empirical evidence. They result in longer, more painful recovery (because the pelvic floor muscles reflexively and involuntarily must contract every time a person goes from sitting to standing or standing to sitting, laughs, or coughs or sneezes, putting strain on the surgical wound). Episiotomies can also result in prolonged dyspareunia, and later life pelvic floor dysfunction. Yet they were pretty much manditory from the 1920's to early 1980's. The excuse usually written was that "a straight cut is easier to repair than a jagged tear", but no one discussed whether it healed better--more about ease for doctor than health of women. Cornell Weil Medical Center still has a 40% episiotomy rate -- done "only when necessary"--this is not just about ancient history.
2
44 years ago I planned a drug free natural birth. I waited for 6 hours (of hard labor) while my doc finished his office hours and came over to do the medically necessary c-section that was decided upon (but not communicated to me) right after I got to the hospital. They didn't seem to think it was necessary to keep me or my husband informed. I changed doctors and hospitals for the next delivery. Make your plans. Be aware of all the stuff that can happen. Don't beat yourself up when the plan changes.
16
@Elaine V Things have progressed to the point where a woman gets a say in the choices available...up until the safety of mother or child are threatened...and that is a very good thing.
Please don't give away the hard-won rights of women so cavalierly.
My first child was an emergency C-section at 28 weeks. My water broke the day before, and I quickly developed an infection. My baby spent 88 days in the NICU, survived a cerebral hemorrhage, heart surgery, and neurosurgery. He is 39 now, and severely multiply handicapped. I learned early and hard that I wasn’t in control. My child didn’t follow any path I ever imagined (let alone “planned”), but he’s happy.
43
@lauried-laurie, i am so sorry for your difficult birthing path, and your son's. with my last child, i had my most "ideal" birth, at home, no interventions and no medical problems. that child has an unexplained cognitive disability. even when the birth goes well, the ways of parenthood are beyond our control. i feel lucky to have had safe home and hospital options.
4
When asked, I told my doctors that my birth plan was to leave the hospital with a living baby. A birth plan seems to be a fantasy/privilege of those who didn't endure fertility treatments or miscarriages. When people ask others about a birth plan, they are making assumptions--or continuing to make assumptions--about the person who is pregnant and their experience. Imagining that we have any control over childbirth is for those of privilege.
27
As someone who struggled with infertility and multiple miscarriages, I respectfully disagree. Birth plans don’t have to be very detailed or rigid - instead, they can simply outline preferences (“if possible”) with the obvious caveat that the health of the mother/baby need to be the priority as the situation unfolds. I agree many women of privilege are more likely to have the time/opportunity to prepare a birth plan, but ideally they can be useful to ALL those giving birth. A women who suffered a miscarriage in the past may request more regular verbal updates on the health of the baby (e.g. more frequent fetal monitoring) for example, or a cultural norm may lead to difference decisions (e.g. what to do with the placenta). This essay and many of the comments seem to miss the point of a birth plan, which, beyond informing care providers, is also a learning tool and preparation exercise for the expectant mother as she visualizes what may happen in birth. I feel having a rough birth plan allowed me to feel more confident going into both of my labours. Did everything go exactly as planned/hoped? Of course not. Did I feel more empowered? Absolutely.
28
In the end, birth is not about YOU, but about the child you are bringing into the world. Your plan should start with being flexible, as anything can happen during labor and delivery. Birth is just the first of many occasions in that child’s life when you will have to adjust your expectations and go with the flow. My five children’s births were as different as their personalities: some more stubborn; some more easygoing, but all dictated by my willingness to do whatever it took to ensure a healthy delivery.
23
My dear wife experienced a normal pregnancy, but her water broke at 4 in the morning at home, and she experienced a cord prolapse, in situation in which the umbilical cord precedes the baby. Cord compression leads to oxygen deficits to the baby and possible brain injury if not death.
A very quick trip to the hospital and an immediate C section saved our baby, who suffered no effects. We never considered birth at home and glad we did not.
27
This article reminded me of some key observations and teachings that I encountered during my obstetrics rotation 46 years ago as a medical student. Despite the best of plans, all that matters is that the baby comes out healthy, and the mother is fine afterward. We learned that for all the care givers for that birth and for the family around the mother, if they are not furthering those goals, they should leave. Some women give birth with a large entourage of family members, who sometimes need to be brought back to focus on the mother and child. Also, people need to consider the role of the spouse or partner of the mother. Gone are the days when that partner, especially if male, will be relegated to a waiting room as the birth happens. Often that person is not prepared for the process of birth, and they may need some guidance on what happens with the birth and what is expected afterward.
9
Agency is a good thing, and women in labor should be allowed to enjoy theirs. But above all, let us remember that the process is just a few hours out of a mother's life time, and all that really matters is a healthy baby at the end. (And yes, I have been there.)
11
All that matters? How about a healthy mother?
My twin sons were born at 32/33 weeks. Instead of experiencing a quiet home birth for which we had planned, I gave birth in a hospital delivery room containing 15 doctors and nurses. We didn't know if the second born twin would live or die for the first 48 hours. Today, they are Ph.D scientists. Yes, I told them their birth story.
25
My birth plan allowed me some better choices. Mainly, it signaled to the admitting (nurse practitioner) that I had educated myself and had discussed options. Despite my high risk almost everything went wrong labor and delivery, I had a modicum of choices that made us all feel better. I can’t imagine that being a bad thing.
8
It can be the most intense and memorable experience of your life. It can make you proud to be a woman to bring forth creation. It is to be celebrated with great understanding, nuance and care which needs to continue long afterward. Unfortunately that is often not the way of society or the medical industry. Women do not tell the truth or the mystery in so many cases and this does our daughters no favors.
9
Congratulations to all of you who have been able to give birth and hold a little miracle in your arms. No, there is no exact plan. Drop the competition! My 'natural' baby was also a bottom-first breech, this fact only discovered while I was in labour, but I met my doctor's criteria, had an Xray and avoided a C section. (My husband felt a total lack of control.) My firstborn son was a forceps delivery -- I think the anaesthesiologist gave me a double dose. I was numb waist down after giving birth, and shivering. I hated that my son was pulled out with forceps. Then followed the birth and soon after, passing of a baby son born with a rare series of defects; our sorrow was mingled with joy at having known him. We entered a fallow season. Then finally, years later, I had a healthy son, born on New Year's in a new country. There were fireworks outside -- they were for him, and all the others being born that night, too.
18
@Nancy Barnard Starr To add to that last drama, my son was large, had the cord around his neck (though his heart was monitored) and he was induced. 10 hours of ouch, more intense than his brothers' births.
2
First to the author—I am so sorry that your birth was so frightening and am so glad you and your child made it through. However, I do question whether this experience would have somehow been better if you hadn’t made a birth plan. Lots of plans do not go as hoped, whether for birth or any number of events, momentous or not. I actually prefer the term “birth preferences,” which take into account how one might handle various scenarios—some people seem to confuse a birth plan with a birth fantasy. I’ve never met anyone who would refuse a lifesaving c-section and who wouldn't want anesthesia for it. That doesn’t mean there’s anything wrong with saying you’d prefer not to be pestered about an epidural if you don’t need one. Again, I m glad the writer’s story got to a good ending despite the terror along the way. Note: Spouse of the account owner.
12
I never wanted a birth plan, which turned out to be a good thing. Labor was no worse than monthly cramps (admittedly pretty severe). I had an emergency c-section under general anesthesia. Thank goodness, because my doctor discovered ovarian cancer and removed it. If I had delivered “naturally” (whatever that means) I would have probably died. Medical intervention is not always the worst thing. In fact, it can be life-saving.
What worries me is the rise in mortality among mothers after delivery. Especially the increasing rates among mothers of color. Medical staff are not paying as much attention to mothers. I have had so many friends develop eclampsia, even weeks following the birth. This health discrepancy is far more important than “a plan” or “the theme” for the baby’s space.
21
A thousand times, this.
Births often do NOT go "as planned."
My youngest child was 11 when we learned that she had a moderate neuromuscular disorder. I had to have at least a mild form.
This explains why I have these impossibly long, exhausting, impossible labors. I have contractions which last 5 minutes (and don't release) with 30 seconds to breathe. They bring almost no progress. My first labor lasted 36 hours. It did not go as planned, but the baby was alive, healthy, and even though I felt like I'd been hit by a bus, all was well. No complications.
During my second labor, they couldn't tell my water broke. Once I permitted an epidural, the floor staff completely ignored me, not a single check for 5 hours. To the point that I nearly gave birth in the labor room. My daughter was crowning, when they wheeled me into delivery. She, too, was safely delivered and healthy.
For my third birth, I made a birth plan. I chose a freestanding center. I was going to PLAN. I labored in a whirlpool. I didn't use any medications. The other deliveries had been uncomplicated. What could go wrong?
And then...
It took something like 70 seconds between 10 cm and delivering my daughter. I didn't even push. I just relaxed. I heard her POP out. She was born a light, silvery-blue color, the umbilical wrapped around her neck twice. It was the longest 90 seconds of my whole life until CPR produced her first bleating cry. She was weak and limp, with spindly limbs. She could barely nurse.
So much for planning.
12
My wife, a physician, had a doula and wrote up a birth plan. When she began to develop preclampsia, she researched OCOG guidance and saw that inducing was recommended if preclampsia presented and the baby was at least 37 weeks.
We scheduled the induction and called the doula to inform her of the updated schedule. She tried to argue with my wife (again, who is a physician) that IV oxytocin & breaking the water was an "intervention." We told the doula her job was labor support, not medical advice, and to be at the hospital at 6PM.
Having an IV in place (another "intervention" in the natural community) allowed my wife to stay hydrated prior to delivery (since she had naseau, she would have been much worse off without the IV). Delivery was still vaginal without an epidural.
A birthplan is the same as a battle plan...no plan survives intact once contact with the enemy is made. A willingness to follow the advice of experts (aka physicians) is critical for the health of mother and child.
36
As a nurse midwife in a birthing center, I saw a lot of birth plans. I made clear that we would do what we could but that the safety f mother and baby trumped all other considerations. I had a client who lived in the Virgin Islands come to me (Florida) in her last trimester so she could have a water birth. She had a long list of requirements. She was adamant that it would go her way. I informed her of my safety requirements but she was unable to even consider that things could go wrong. She had a history of herpes and I told her that if it became active, she had to have a caesarian birth. Sure enough, with the stress she put on herself, it did become active and she had to have a surgical delivery. Preparing for a birth with education and classes is important to make a birth easier and safer. That said, be realistic and prepared for any eventuality.
11
@ExPatMX My own experience leads me to believe that herpes patients are not given enough info about what's known of their condition and childbirth. Or what can happen to a baby whose mother has been in denial.
My neighbour had a birth plan, she was a full on mommy vlogger as well. But things went sideways: delivering her second child she died. Yes, it still happens.
24
As an anesthesiologist for 27 years and several thousand epidurals, c-sections, post-partum hemorhages etc. experience I can tell you for sure: birth plans may be helpful when everything goes as planned, but in my opinion often lead to feelings of guilt and failure if it does not. I even know of a colleague who saved the mother but was sued by her afterwards because it (obviously) did not go according to her birth plan.
25
The responsibility of a pregnant woman is to keep her unborn child safe while in utero ie. keep herself healthy, avoid dangerous activities. The responsibility of a woman in labor is to assure that her baby is born in the safest way possible. The hoped for out come is a healthy happy baby who becomes a healthy happy adult.
It is not all about the mother and her “birth experience “. Trying to orchestrate a delivery to make it a memorable event is not only foolish but can be quite dangerous for both baby and mother. In the end Mother Nature controls what will happen. The best approach is to assure that there are skilled medical personnel available to address any problems that may arise. As a NICU Nurse I have seen what happens when a birth has been poorly managed.
There is ample time for a mother to have gratifying experiences with her child during the many years of child rearing. The birth experience is about the baby and a safe delivery.
41
A birth plan isn’t there to make the birth into a „memorable experience“ (which it is anyway, no matter how it turns out). Birth plans exist to make sure that the woman actually giving birth is seen as a *person* with her own history, fears, concerns, and, yes, wishes. And those are important, too! Nobody wants to push through their birth plan at the cost of losing or severely damaging their baby, just because they want an instagrammable experience. But avoiding PTSD and postpartum depression caused by a horrific birth experience in which a woman is treated like an obnoxious and stupid piece of meat is a good thing. Birth plans can help accomplish that.
19
@Alessandra Navetta Actually, keeping the mother alive is kind of important, too.
1
@Alessandra Navetta
You say "The hoped for outcome is a healthy happy baby ..." No! The hoped for outcome is that mother and child are healthy and happy.
You say "The birth experience is about the baby ..." Do you remember your birth? I sure don't remember mine, nor have I ever heard of anybody who does. My mother remembers my birth very well.
Not Ted Barnett writing, but his wife.
I was content to just enjoy reading these comments until I got to the last of several comments in the vein of "birth plans are for OB nurses to have a laugh, in between checking on laboring patients." How cruel and dismissive, and how wrong-headed.
Childbirth is like most things in life--it goes better if you plan it. Yes, you sometimes have to alter and ditch your plans. Does that mean you don't plan?
I had a birth plan for all 3 of my births. I was able to avoid interventions and I am so glad that I got to experience childbirth that way. That's an understatement, and that's all I'll say. For those women who are interested in planning to give birth this way, the best book at the time of my pregnancies was "A Good Birth, A Safe Birth" by Korte and Scaer (last revised in 1992). That's a long time ago, but follow the thread of that book to get good guidance.
26
The US ranks 33rd in the world for infant mortality at an astonishing 55th in the world for maternal maternal mortality. Prudence would suggest making a birth plan that mimics the obstetrical practices of the five countries with the best results. With numbers like these, blind trust that whatever the medical system does is always necessary, evidence based and in the best interests of women and their babies may be a head in the sand approach.
40
@Alex Live birth statistics are reported according to the specific country's standards, not a fixed standard. For example, in some countries a death within an hour of birth isn't counted as an infant mortality, rather it is just not counted as a live birth.
https://www.sciencedaily.com/releases/2016/10/161013103132.htm
"Infertility treatments, which often lead to twins or triplets (who have poorer survival rates, perhaps primarily because they are likelier to be premature), have also been blamed for infant mortality numbers."
14
@Alex
Expanding on what James said: I believe we also have older mothers and higher rates of obesity and other comorbidities here than in other developed nations. Those factors will lead to more complications on a population basis.
5
Three women I worked with at my last job each went into the hospital with a birth plan and came out with a C-section. And with babies, so it's not all bad. But the problem is less with plans and more with the hospital approach to birth as a medical event.
I did very well at home three times, with a midwife and her assistant.
20
@HoneyBee same. The hospital approach was not for me.
1
@HoneyBee Have birth with a midwife but at the hospital. That is the responsible thing to do.
I'm an almost-60 mom of three; the youngest is 20 and the oldest turns 29 in a few months. I went to an ob/gyn practice that focused on "natural" childbirth, which jibed with my own thoughts. The ultimate goal, though, is a healthy child.
I never developed any particular "birth plan"; all I told them that unless absolutely necessary, I didn't want painkillers - I have a (probably irrational) fear of them. I told them, "no epidural, no Demarol" and all three times I went without. One of my favorite memories from the second one's birth was yelling at my husband to "get out of my focal point" - the spot in the room I used to concentrate on to try to not focus on the pain.
A little while after our oldest was born, a woman I knew who went to the same practice ended up with a c-section. She was terribly disappointed - she built herself up for that ideal natural childbirth. She had a healthy daughter, and that's what really mattered.
12
Birth plans = here to stay. You also get to have birth disappointment. Please don’t translate that into putting more rules on how your daughter approaches her birth.
Birth plans are not just about perfectionism or unrealistic expectations. Making them is a tool to manage fears of the unknown. Sharing them is a way to increase communication with health care providers. And reflecting on them afterward (as you are doing here) is a way to process a massive event.
50
How about a well-being plan in lieu of a birth plan for the birth AND the first 3 mos of motherhood to help prevent isolation & depression?
122
@JennaLee
Oh so wise.
On a more humorous note, be careful what music you have while you labor. For my daughter's birth in 1992 I chose The Moldau by Smetana. It invokes the feeling of a rolling river- good to encourage birth, right? And it was. But for a few years after that whenever I heard that music I had the oddest feelings in my pelvis.
36
In 1984 our childbirth class instructor -- well regarded -- announced that this class was a "Caesearean prevention class." By learning about natural childbirth, practicing hee-hee breathing, being informed about the dreaded triumvirate of induction/epidural/Casearean, we would manage "natural" births without interventions. We would challenge the medical establishment by making sure we had vaginal births and thus denying the surgeons and others their fees for unnecessary Caesareans!
I have always tried to be an "A" student, so of course I wrote out a detailed birth plan to hand to the nurses and doctors. After 24 hours of labor, which included induction and an epidural (I told the anesthesiologist that he has the most wonderful profession on the planet), I did in fact have a Caeseran -- and a healthy baby boy.
But I began to cry when the childbirth teacher called to find out how things had worked out for me. I was determined to ace the Caesearan-prevention class, but I had royally flunked! And it was probably all my fault -- I had been too weak to endure 24 hours of labor without an edidural, which led to my not being able to push adequately, etc.
36 years later I realize how ridiculous this all is, but at the time, my sense of failure added to all the other challenges of being a new mom. Thank you, Ms. Counter, for this essay -- I hope some other moms surrender the image of perfection and hope only for a healthy outcome for mom and baby.
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@Elizabeth
You didn't flunk. You had a healthy baby!
I had a 36 hour labor due to what was, then, an undiagnosed mild neuromuscular condition. You cannot always know what is going to happen. You do your best and sometimes stuff happens.
You get out alive. The baby gets out alive. If you both get out whole and alive, THAT is success.
Failure is when one of you dies or experiences significant disability from the event. You didn't fail. You had an unexpected event.
10
@Elizabeth How funny: I had the same thing as to the shame, but I also I told the anesthesiologist who gave me an epidural (unusual in the Netherlands) something similar: “What a wonderful job you have; taking pain away from people.” I was able to say that because at the moment the pain ceased I returned to my body, and was able to speak, which I had been incapable of for hours.
7
Elizabeth,
What malpractice that the birthing class allowed you to think C sections were a failure! In 2015 I took a birthing class and experienced the SAME THING. Why after all these years are they still pushing the same misinformation on women about epidurals and C sections? If I hadn’t had a C section both my breach, restricted growth baby and my fibroid filled body would be dead. I’m thankful my doctor knew what was best rather than the quack who taught my birthing class. That person even suggested doctors should be more open to delivering a breach baby- no way, I want my baby born safely.
My first experience of labor and delivery taught me that it wasn’t my birth, it was the baby’s. I had preferences, but they were quickly discarded as we recalculated based on what the baby seemed to need. I was just along for the ride, and it was a bumpy one. Never had second thoughts about any of it.
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@PDX
I am a OB-GYN physician and I couldn't have put it better.
For those parents with home delivery included in their birth plan, please be aware that if an infant is born with a poor respiratory effort and/or low heart rate, adequate resuscitation must be accomplished within about 5 minutes in order to avoid possible neurologic injury to the infant.
35
I'd also advise expectant mothers not to be too hard on themselves if their fantasy "breastfeeding plan" doesn't work out. Sometimes the breast just doesn't cooperate, or babies need to be in the NICU for a while and pumping may or may not be sufficient, or latching on doesn't happen, etc. Try not to be too hard on yourself if it doesn't work out for whatever reason. Just know your baby will be fine regardless. Because s/he will be.
69
@Kate while I’m not religious, I am still comforted by my pediatrician saying, “There’s a reason God invented formula.” Breastfeeding was far from easy for me but I did what I could and made sure my baby didn’t go hungry when I couldn’t.
1
I’m amazed that there has not been more research into “artificial uteri”.... Pregnancy and childbirth is still so dangerous for women. Not to mention that we are often left with long term health consequences ( urinary incontinence, chronic pelvic pain.) I decided as a teen never to have children; my sense always was that my body would have been irreparably damaged by the process.
19
@GBR - Yes, a body is "irreparably" changed (not damaged) by childbirth - especially your heart. I birthed twice "naturally" with a midwife and decades later, the memory of fearful pain has been long supplanted with a ferocious love I could not have anticipated. Despite the pervasive and extremely harmful gender discrimination in our world, I generally feel sorry for men, who can't have this primal experience. As you suggest, artificial uteri might be essential to some eventually, but human procreation seems to be overall adequate in these times.
2
@Jenny
Oh, it’s definitely possible to love a child ferociously, as you describe, without the child having burst forth from your own body. I can attest that adoptive parents 100% experience this love, as do biological fathers I’m sure.
5
@GBR I don't know you but that sounds like a wise decision.
1
Instead of writing a birth plan on paper, and then heading to the hospital (where the standard protocol significantly increases your statistical chances of ending up with induction and the cascade of interventions that typically follow, from epidural to complications due to the lack of being able to get in the right positions, to fetal distress, to c-sections), I set myself up for having the kind of birth I wanted by choosing an experienced midwife and birthing my first child at home. Things still didn’t go as expected of course (as everyone here notes, every labor is different), but broadly it ended up as I had intended it to be. I thought I’d just be in the tub to relax during mid-labor, but ended up having an (unplanned) water birth as my labor went so fast (20 min of pushing, 20 min after getting in the tub), and the midwife thought I was earlier in the process than I was and walked in the door as I started pushing, but I didn’t tear, hardly bled, recovery was as fast as it could be and if I were to do it again, I’d just “plan” for the water birth from the start as that helped SO much. Would these hace been my outcomes if I’d headed to a hospital with all of these ideas on a birth plan? I doubt it.
14
@Elizabeth H. You were very fortunate.
My birth plan was please do what’s best for my baby and me and I prefer less pain.
Noting went in any sort of expected way and it was rough but my daughter was born healthy and I was ok.
You can’t plan for the unexpected. I just refused to pretend I had control.
Same with raising kids.
And pretty much life in general.
36
I remember writing a "fantasy" birth story in a Bradley method class before my first child was born. The delivery went fine but it wasn't a fantasy and, as profound an experience as pregnancy and childbirth is, the real focus should be on the fact that you will be raising a human being. If you're lucky, labor and delivery is about 24 hours in your life; motherhood is lifelong. I knew this by the time I had my second child, and didn't compose any plans or stories--I just hoped for a healthy child and felt extremely fortunate when that was the outcome.
20
@PSEK Interesting that you had such a different experience with Bradley than I did. My sister also used Bradley with much success. We both had birth preferences, used midwife in hospital and had, between us, 4 healthy, unmedicated births. But my comment specific to yours is that the mental techniques I learned in my Bradley classes have lasted me my whole life (so far - I'm nearly 60) and I've pulled them out and dusted them off in other stressful situations with good results. Good tools for life - at least in my case.
2
I've read all the comments and I'm terrified - even though I've given birth twice. Used hospital midwives both times and they were wonderful. (no drugs, no complications) Both kids born at 37 weeks. First one came in four hours, start to finish. My main plan was "no drugs." When you arrive at the hospital 9 cm you can't have drugs anyway. I remember thinking there could be no reward big enough for all this pain. (I was wrong, of course) The midwife called it "rapid labor." The second baby took seven hours and I remember the fear caused by not knowing how long it would continue. I got to the hospital at 7 cm - What if I don't progress? I think that is the essence of the terror. How long will this last? You have no way of knowing. The midwife doesn't know either. Add in the intense pain and the thought that maybe it can get even more painful. Again, you just don't know. I understand why most people would turn to drugs at some point.
I have several friends who planned wonderful births and wound up with C-sections. It's very hard for them to let go of the disappointment. The regret follows them for years. I can't help but think it's the expectations our society is putting on women that make this even more difficult.
Planning is good but curb the expectations.
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You should totally plan for childbirth. Of course. You should also let go of a "fantasy birth story"! My birth plan was not a document; it was a set of preparations -- choosing a provider (a certain group of midwives), a preferred location for labor/birth (home, with transfer to hospital if needed), and discussions with my partner. The birth didn't diverge from those conditions, in my case. I would say, though, that the experience could not really have been imagined beforehand. It was hard and strange and everything turned okay (and more than okay), for which I am eternally grateful. I have learned from listening and talking to others who have gone through it that childbirth is many things, and it is certainly unpredictable.
14
Birth happens while you plan! my daughter and I are lucky to be alive 100 years ago we would have not survived. I was very fortunate to have had a very experienced midwife on the floor who helped me through it all. I never dilated had high blood pressure to the point of fear of a heart attack and the cord was wrapped around the neck of the baby. the emergency bells went off in a second as the heartbeat dropped and the room was full of people on Christmas night.
We had to stay a week but we made it! Hurrah for medicine! 18 year later she is ready to graduate embarking on her own live saved by modern medicine.
23
Grandma would most certainly have been surrounded by a group of concerned and knowledgeable women - her extended family, neighbors, and local midwives. She would have had both advice and practical help. No electricity, but someone to reassure her and take the baby, and someone to watch the older kids and do the cooking.
17
Every mother has her story and I appreciated reading yours Ms Counter. Evoked memories of my first child's birth, the planning, the upsetting of all the planning, the pain, and Whew, a healthy baby at the end of 48 hours of labor. With my second baby I studied & practiced the Lamaze method and it worked like a miracle for 3 more births. Young moms-to-be don't seem to use Lamaze anymore and I think it should make a comeback.
9
My birth plan was basically "Give me lots of pain meds and take pictures." I ended up being life flighted, and my babies were delivered by an OB I had met about 30 minutes before the C-section (which involved at least a dozen people from 2 different hospitals). In an earlier time, my daughter would have died a few days after birth (if she survived at all) and I would have died about 2 weeks later.
My parents grew up in the segregated south, where mothers who couldn't get into a black hospital delivered at home with a midwife, whether they wanted to or not.
19
For my first childbirth, a woman was giving birth to twins, so the one delivery room in the hospital was otherwise occupied. Four other mothers in the labor room came and went, screaming bloody murder (their childbirths were induced) before I followed suit. My obstetrician was nowhere to be found. My daughter was delivered by a resident. We stayed in the hospital for five days, the norm at that time and place, and the nurses made fun of me because I wanted to breastfeed. Nothing went as planned and I felt like a pawn in some game that was completely out of my control. My second childbirth experience was even worse, but there isn't space here to adequately complain about it.
16
For my first childbirth, a woman was giving birth to twins, so the one delivery room in the hospital was otherwise occupied. Four other mothers in the labor room came and went, screaming bloody murder (their childbirths were induced) before I followed suit. My obstetrician was nowhere to be found. My daughter was delivered by a resident. We stayed in the hospital for five days, the norm at that time and place, and the nurses made fun of me because I wanted to breastfeed. Nothing went as planned and I felt like a pawn in some game that was completely out of my control. My second childbirth experience was even worse, but there isn't space here to adequately complain about it.
3
My two births plans for my pregnancies? Healthy babies and me just fine. So, 46 and 40 years later, that's what I have.
9
I found our birth plan a few months back while cleaning out some files and laughed out loud at my naivete eleven years ago. I too was induced and my son was finally born 36 hours later via emergency c-section because he was absolutely not interested in being born. It was a good first lesson in parenting: very little goes according to plan.
14
When I was a resident on OB rotations, we used to say that the likelihood of an emergency C-section was directly proportional to the amount of stuff the patient brought into L&D — the more objects, boom boxes, CDs, fluffy animals and blankets, huge rubber exercise balls, etc., the more likely that their elaborate plan would be foiled by Nature.
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My doctor asked how I felt about epidurals. i said if it's relatively fast, I wouldn't bother; if it was long and drawn out I may go for it.
That was pretty much it for a "birth plan" and I wouldn't change a thing.
First kid, after 12 hours and a raging migraine I had one, next two were faster and I didn't. Again, wouldn't change a thing.
7
My first birth was like what this author describes. And that’s why I had a planned second birth at home with two midwives. The differences in outcome for me, my baby, and my family were stark. Birth in America is overmedicalized, often leading to cascading and harmful interventions. We have high infant and maternal mortality. There’s a better way. Home birth with hospital back up care if needed.
12
@LM, As an L&D nurse who provides “back up” for failed home births, I will tell you it is not always as easy as just a 5 minute drive to the hospital when your home birth plan falls through.
I’m not totally against home birth, if that is a woman’s preference in the right circumstances. But thinking that you can just change your mind in the middle of an emergent situation and the hospital will make it all better within minutes is ill informed and naive. Home birth should require adequate informed consent the same way hospital births do, in order for everyone involved to have realistic expectations.
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@Jane K And any legal midwife holding herself out as a provisioner of home births should be required by state licensing authorities to have adequate malpractice insurance, which shockingly, many states do not. If home birth is safe, then we must assume that the insurance actuaries would only demand a very reasonable premium.
10
@LM It really depends on the characteristics of the mother in question. Certain health problems (diabetes for example) make having a home birth a lot less safe for both mom and the baby.
7
A woman's body is just going to do what it is going to do. My two sons were born within 5 hours and 3.5 hours from the beginning of labor. I wasn't opposed to an epidural but everything moved along so quickly. There wasn't time! All of this was unpredictable. I think it's best to be relaxed and literally go with the flow that your body dictates.
10
@Thorina Rose - Of course a woman’s body is just going to do what it’s going to do - until it doesn’t. Hence, the uncountable numbers of women who died in childbirth before modern obstetrical medicine came along. I guess someone should have told them to relax and go with the flow, right?
We were actually encouraged by the hospital nurses at a birth class a month before our due date to “Please, write out a birth plan!” So, we did. Almost all the choices we were guided to make felt arbitrary, as we had never been through birth before. Some seemed sweet, like father cuts the umbilical cord. Some seemed frivolous, like please let me wear my own clothes. Anyway, it was never even glanced at once we arrived at the hospital and began the actual event. After 15 hours of labor and then an obviously unplanned c-section, (and healthy me and healthy baby), we were laughing that we had been encouraged to dream such dreams. Within the year of my own pregnancy and the birth of my baby about a dozen friends also gave birth. Not a single mother followed her birth plan. Not one. I read somewhere that the happiest mothers are those who feel they have some measure of control in how their births unfold. I imagine this has something to do with the proliferation of birth plans. I feel lucky to have had a great doctor who gave me guidance and allowed me to make decisions as the birth happened. My advice to expecting parents: don’t sweat the small stuff!
15
@Sally While I disagree with you about birth plans in general (had one for both births, understood quite clearly that the plan could change and had no disappointment or regret at all), but for one small thing. In my first birth, I chose to wear my own clothes. I didn't anticipate what blood and meconium would do to the fabric of my favorite nightgown. Second birth I wore a hospital gown. Live and learn!
4
Not all doctors use the kind of teamwork your doctor used with you. That's one reason women feel the need for birth plans.
Funny! Thanks for sharing!
Life happens while we are busy making plans. In my childbearing years I was pressed to make a "plan" by well meaning friends. My daughter had other ideas so any plan I had wasn't worth the paper it was written on. Same with child number 2.
I don't mean to suggest to just go with whatever a doctor or nurse suggests if you don't want to do it. But don't be so wedded to any plan that you can't respond to things that don't go according to your plan.
20
@Carole Goldberg That’s just the problem: telling women not to plan pushes them to give up any decision marking options they do have. I delivered my children with midwives who asked me to plan in advance but understand that stuff happens. When it did, they at least knew what my priorities were. There’s enough “check your brain at the door” in American hospitals as it is without pressuring women to give up their autonomy altogether.
32
After giving birth to my daughter, I completely understood why doctors used to put women into twilight sleep during delivery. If that had been an option, I would have gladly taken it. The romanticization of childbirth in contemporary Western culture is bizarre. It is a bloody, intensely painful, and dangerous process - there is nothing “beautiful” about it at all.
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I’m sorry this was your experience, and I respect it. But I disagree with your generalizations. Every woman is different and every birth is different. Birth can be dangerous, yes - and thank god for modern medicine and skilled attendants when it is - but it doesn’t always need to be “treated”. And sometimes intervention can make it more dangerous, not less so.
Both my birth experiences were intense and “painful” and bloody but also undoubtedly beautiful. I was able to deliver twice without drugs, which was my choice, and I’m grateful for that. Because the awareness of my body and what it was doing - and it was the hardest thing I’ve ever done - is something I wouldn’t change for the world. For me they were awe-inspiring and empowering experiences.
11
I agree with you, Sarah. In my experience, the comments on NYTimes articles about birth are predominantly anti-homebirth/midwives and pro-hospital/medicalized birth, lacking much nuance around the emotional impact of birth for the birthing woman. I’m not sure why this is but I guess I shouldn’t be surprised as many NYTimes readers (or at least commenters??) seem to skew pretty conservative. I had two difficult homebirths myself; both were transformative in a positive way. In BC Canada we have very good outcomes for homebirths in low-risk births. I encourage readers to check out our data with an open mind.
3
Bizarre is right! And Instagram doesn’t help. I will be forever grateful for my sister who kept it real for me. She let me know it was going to be the animal kingdom for a while and to just go with it and focus on the baby. I look at friends’ pictures posted the day after their births and even though they look radiant (makeup and filters)...the reality is that they too were sitting in an ice-diaper, desperate for sleep, support and guidance. I think if women kept it real we wouldn’t feel so much pressure to pretend everything is magical.
2
I totally agree with the author of this article. We have little control over how things go and progress during childbirth. I am a control freak in all aspects of my life expect during childbirth because my main priorities is for me and baby to come out of it in good health - so I will do what it takes for that to happen. I feel like those who try to plan too much end up inevitably disappointed that things didn’t go exactly as they wished they would.
7
Couldn't agree more with the author. As an ob/gyn I can't count the number of times a woman has said to me "The one thing I DON'T want is an emergency c-section," only to have me left trying to explain that emergencies are, well.. not planned. Women who become overy invested in having their birthing experience be "just so" put themselves at risk of delaying necessary care. There is no such thing as a second class birth so long as mother and child are well.
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One way to plan a birth is to choose a practitioner who shares your values, and bring someone with you who is comfortable with the topic. If you choose a practitioner who has a high c-section rate, your chances of getting a section are higher. If you choose a practitioner who is not comfortable delivering a baby without doing an episiotomy, you'll probably get an episiotomy. You can't ask a professional to do something that's not part of their practice, or to refrain from doing something they think is usually necessary. Decisions made before the birth can go a long way, because during labor it's hard to make a rational decision. (And for the record, I had one hospital birth, one planned home birth, and one planned home birth that ended up at the hospital, all healthy, full term, no sections, but each over 30 hours.)
28
@Amy Not true about the higher cesarean rate. If an OB provides support to a lot of midwives, then the midwives will transfer the high risk patients to the OB, producing a low cesarean rate for themselves and a high rate for the OB. Don't try to disempower OB's that support midwives.
12
@C N A Lot Not my intention at all. I was supported by a great OB for my last birth (the transfer) so I agree. I would hope that people might get to that level of detail in discussion with their practitioners ahead of time. Thanks for bringing this up! Important point.
2
I was one of the fortunate few who gave birth to three children with no need for intervention or pain medication. I did prepare by taking a Lamaze course and practicing the breathing exercises, and I used them during labor to maintain control during strong contractions. The biggest complication was a tear due to the size of our oldest son’s head (99th percentile). My kids were born in 1978, 1986, and 1990, so I think my experience was due to a combination of personal physiology, determination, and luck rather than any planning or even medical protocols.
17
Labour and delivery nurses love these plans! They make for hilarious reading on quiet night shifts. Seriously people. Grandma was right. The best plan is that everybody comes out alive and well.
105
@Catherine Fast Medical professionals ridiculing their patients is unprofessional and thoroughly unfunny.
1
@Catherine Fast
nurses laughing about patient requests?! One of the reasons everyone would benefit from a doula.How dare you mock patients for your own amusement. Is this a HIPPA violation?
1
I was encouraged to make a birth plan by a doula, but I knew that we’re fortunate if everything goes right. Instead of focusing on the what (unmediated vaginal birth or whatever), I focused on the how. I knew I wanted to feel respected and informed at each step, no matter what happened. I wanted to be given time if it wasn’t an emergency to make decisions.
One good thing that the birth plan I used did was prepare me for things not going my way- it asked me to think through a c section and even a stillbirth. If that had happened, I would have been grateful for the chance to to say goodbye on my terms.
18
tl;dr: it's possible to encourage women to keep an open mind without disparaging their efforts to keep autonomy and feel safe and cared for.
Too often a woman's autonomy is taken away during birth. The birth "plan" is a way to insist on that autonomy.
It's easy to be dismissive of birth "plans" but they are a written record of birth "preferences" of choices women should be empowered to make, without ceding those choices to others if they want to make them themselves. of course health care providers should review them and discuss what could happen and not just what will happen in an ideal scenario.
That's why I wrote 3 birth preference sheets- 1 for the "everything's fine" birth at the planned birth center, 1 for the non-emergency hospital transfer, and 1 for the emergency hospital transfer.
I didn't expect everything on that sheet to be blindly followed. I expected best effort according to appropriate circumstances. I expected health care providers to inform and consult with me when plans needed to change. If they knew what I was okay with from the start, there was less to negotiate and discuss.
In the end, I was glad I kept an open mind, but it was luckily an uncomplicated birth. And because my preferences were respected and embraced, I felt safe, which I believe had a lot to do with how well everything went in the end. The birth was a wonderful, almost painless (unmedicated) and empowering experience, which made it easy to start our new phase of life joyfully.
40
It isn’t a bad idea to know what you’d like to do, so pregnant women should entertain their thoughts and jot them down. And know that everything might go south. But it really might not, and in that case, having a plan is a nice option. My first birth went off the rails, but the second one was smooth and quick. My main plan was to go without drugs, so it was nice that i could refuse the heparin lock when the nurses kept telling me i had to have it. You don’t have to do anything you don’t want to do - it’s your body and your decision, and if things are going along as they should (ie no complications), it’s nice to be in the drivers seat. My daughter was out with three pushes. The nurses kept telling me to stop because the doctor had not yet arrived. I was like, that’s pretty hilarious, I’m no sooner not going to push right now than stick a bunch of needles in my eye. So I guess in this case, the hospital’s birth plan didn’t go according to their protocols. Birth can be so out of one’s control, may as well choreograph and direct what you can, when you can.
25
But why not have a heparin lock?
If everything goes south you don’t want people desperately looking for IV access during an emergency.
Surely that wouldn’t be detrimental to you or your baby.
1
Having been an OB/L&D nurse for 30 years I am pretty sure that any first time mom who comes to the hospital with a birth plan will probably require every intervention the birth plan says she doesn't want. It's called unrealistic expectations.
98
@Barbara I’m so saddened that you have such a negative preconceived bias against any woman who has educated herself about her choices and plan of care for childbirth. Have you ever thought that these results you see might be a self-fulfilling prophecy? You and your coworkers may have prejudices against women who want to assert their autonomy, and these prejudices change the way you talk to them and treat them, which contributes to the many interventions used on your clients? Many OB nurses I work with feel the opposite of you— they love when their clients are educated and prepared. I’d encourage you to check out my resources at Evidence Based Birth. We have a growing number of Obstetric nurses in our ranks at EBB, and I’m so thrilled they are working to change maternity care, support client autonomy and better, safer care.
49
@Barbara I would like to echo what Rebecca had to say. I am so very glad the L&D nurses I encountered did not share your point of view. They were kind and respectful of me and honored my wishes. As I have already commented to another poster, a medical professional with such an attitude would be very unprofessional, indeed.
10
My daughter was born after an emergency C-section that saved both our lives. To my astonishment, the expressions of comfort and sympathy from nurses and the birthing-expert-types starting pouring in right afterward. They were SO sorry that my childbirth hadn't gone as planned, that I hadn't been able to experience a "natural" childbirth. They even gave my a pamphlet with information about how to deal with my grief and offered counselling.
And here I was, overjoyed to be alive and well. My baby had been trussed up like a bug in a spider web in her umbilical cord, and the C-section saved her life. And yet apparently I was supposed to be grieving my lack of a "natural" birth experience.
To this day, 25 years later and my daughter a science teacher, I wonder what on earth those people were thinking. And I'm still grateful.
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@Diana - Seriously, as though it’s not enough to make it out of the whole business alive and with a healthy baby. It reminds me of those smug, catty women who claim that a mother isn’t a “real” mother unless she gives birth vaginally and without pain meds. It’s bizarre. There is no reason for any woman to mourn having had a C-section. People these days are very strange when it comes to the particulars of childbirth. We are fortunate that we live in a time in which there are two ways to deliver a baby. For most of recorded history there was only one way, and if a woman couldn’t successfully deliver vaginally then she and her baby died, usually in agony. What makes people think that a woman these days will need grief counseling because she couldn’t deliver vaginally? Personally, I’d rather have a C-section than end up dead.
1
This story really resonated with me. I read all kinds of books and thought I was prepared for a smooth and relatively drug-free birth when I went into labor. Thirty hours and one C-section later I felt very humbled and embarrassed about my own hubris.
55
I totally agree with this article. I also didn't entertain any rosy plans because I read far, far too many terrifying birth stories (one word - mistake!) and I was 40 and 43 at the time of my two births and those old (!) first time mothers often have difficulties.
At my prenatal class I did tentatively put forth my idea that the actual birth, while important, was really the very least part of having children. I saw it as work to be got through, challenging and sometimes difficult and potentially dangerous. Wow, I should just have held my tongue (this was 20 years ago)! Most women seemed to see the experience through rose-colored glasses! Though I do think the childbirth educator who was an OB nurse really appeciated my point of view...!
In the end my first labour was truly labour. I went into labour on Friday evening and my daughter was born (via forceps) on Monday morning at 11. I did not sleep that whole weekend with back labour and went home looking like a panda....while truly horrible for me my daughter was perfect in every way and never faltered during labour which was why a C-section was never considered.
My son 2 years later was a cakewalk by comparison. I guess my old uterus had learned a trick or two...
Don't have expectations and plans: just try to roll with it!
33
I had an overdue baby-a 40 weeks pregnancy. She was induced with Pitocin. The pain was horrible and relentless and lasted 14 hours. For 12 hours I never dilated beyond 3 cm. She was posterior presentation ( meaning backwards but not breech-this presents an unfavorable angle for getting the baby out-they tend to just get their head pushed further into your spine instead of exiting into the free world ). She was over 8 1/2 pounds . She was finally dragged out with mid forceps and a very bruised little eye. I was ripped and torn in ways I will not describe.
By the way it was a well respected N Y City teaching hospital. I don't consider it their fault. It is a dangerous process. An obstetrician I had later for my second child just said : " Any baby over 6 and 1/2 points is hard to get out for an average sized mother."
Anyway my little girl is fine; a 37 year old professional and a mother herself. Her child had the cord wrapped round his neck requiring an emergency C section and he is fine as well. Thank goodness for monitors. My lived experience is that having babies at home is a risk. I would surely have died and my baby probably as well if I'd had her at home. Well-actually it seemed like I would never have spontaneously gone into labor at all. This can happen. I'm glad we are talking about maternal complications. For a long time there has been secrecy.
51
I gave birth to a 10.5 lbs baby at home just shy of 42 weeks. A very long and difficult labor with shoulder dystocia at the end, but ultimately safe and healthy. A hospital transfer was never discussed as the midwives were able to handle all situations that arose. They are well-trained to do so, at least in our jurisdiction (BC, Canada). Not saying this to “one-up” you but rather to say that you might not have necessarily died at home. In my case I feel the lack of interventions which would have been routine in a hospital is what actually helped me have a safe birth for my child.
2
@Consuelo we have twin birth stories. Same Pitocin, anterior presentation, 7.5 lb baby, fetal distress. 52 hours in labor. In her newborn photo she has a conehead from the suction device used to help her be born. She's a 27 year old now! I only had her that experience pretty much put me off another birth experience. The only part of my birth plan that worked was the part where I didn't have any pain meds. I thought they would slow down labor. Ha.
Birth plans are just psychological tools to give parents-to-be the enough illusion of control to keep calm as the delivery date approaches. Signed, veteran of two emergency inductions.
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@Working Mama Birth plans are a way to think about different scenarios, express preferences, and research and understand the birth process. I personally don't know any women who don't understand that a plan can change when circumstances warrant. Birth plans started as a tool to prevent doctors from making decisions out of their own habit and convenience, without consideration of the mother. They evolved as a tool to express preferences proactively, knowing that those preferences may change. I'm sorry you had two emergency inductions. You are one woman. Other women will have different experiences and should not base their choices on your experience.
7
It doesn't hurt to think about what you might prefer in the best of situations, but I totally agree with this author that childbirth is an inherently uncontrollable experience. My son's unexpected induction at 35 weeks and near death 24 hours after his birth after an otherwise normal pregnancy taught me that in all too real ways. (He's doing great now by the way.) I think the mistake lies in using the word "plan," which suggests agency and control. A better term might be "birth wishlist." So go ahead and make that wishlist, but remember that nothing is more important than a healthy mother and child at the end of it all. I wish I hadn't had to see my tiny baby on a respirator to full appreciate that.
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I recommend sharing all the details with your daughter, when she's pregnant. My mother's first child was 2 weeks overdue. My first was induced more than a week overdue. My mother's second child was born barely after my mother got to the hospital after labor that would stop for an hour or two, making her think maybe she wasn't in labor. My second child was born 15 minutes after I got to the hospital after labor that stopped for an hour or two every few hours. My husband was sure it was Braxton-Hicks contractions and we were days away from the birth. Even the nurse didn't think I was in labor when I called the hospital to say I was coming in --- my labor was taking a break.
The real plan people need it to plan for real possibilities, induction, c-section, tearing --- those all have probabilities attached. For perineal tearing, the probability is high.
17
My mother wanted lots of children and enjoyed all of it from pregnancy to raising them, and my sister as well. Both loved it and were good at doing it. It was a fulfilling hard work. They did so without any concerns about it once their material circumstances could support it.
In our modern society we forget that the rates of deaths from childbearing has been extremely high through nearly all of human history. The extremely extended childhood of humans demands care givers beyond the parents for the species to survive and living in enduring groups has been how our species adapted to the loss of children’s parents. Our modern society long ago found ways to adapt to these needs while allowing a seeming independence of the nuclear family structure. For most of human history assistance with birthing was only possible in fairly large groups which only helped their own members.
9
Little went as I planned. I was on bedrest for many weeks, which meant no childbirth classes. I ditched my plan and decided to go with the flow and follow suggestions from the nurses and my OB (epidural, vaginal delivery.) I had a healthy baby and that's all I wanted. My childbirth experience prepared me for parenthood. Whatever you plan for your children, they have their own ideas about how it's going to go. You have to go with it.
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My mother passed a while back and I am/was her only child. Starting when I was quite small, she shared EVERY gory detail of her miserable pregnancy and hideous birthing experience - even though hospitalized.
The spinal pain blocker shot they gave her resulted in a life of migraine headaches that leveled her for hours. Certain foods would forever turn her stomach after those fateful moths of trying to cook while pregnant. She was basically a good natured and strong woman but the signal she sent me was "do not put yourself through this unless you really want to." I never did and I've never regretted it!
Be honest with your daughters, moms.
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@Nadia
Honestly, I enjoyed being pregnant & giving birth. Assisted by excellent doctors I trusted, everything went pretty smoothly.
I am lucky.
I don't question other moms' harrowing & hair-raising accounts, but my 3 experiences were not bad at all.
Honest.
14
@Nadia Exceedingly unlikely that the spinal blocker resulted in a life of migraine headaches. Whether or not foods 'turned her stomach" was entirely psychological. Sounds like she really resented childbirth and decided to dump this on you, which is sad.
@Nadia My mother's 3rd birth involved inappropriate medical intervention that led to my sister being severely developmentally disabled. As a result, for children #4 & 5 (me being #5) she insisted on natural childbirth at a time when it was highly unusual. She was inspired by Grantly Dick-Read's book Childbirth without Fear. She passed that book down to all of her daughters and, among us, we had 6 unmedicated births. Of course physiology had something to do with it, but so did preparation. You would prepare to run a marathon, so why wouldn't you prepare for childbirth? I'm glad my mother, and my sisters, shared their birth experiences with me. I found it quite helpful.
Thank you for this powerful article. As my mother had generally uncomplicated deliveries, I was hopeful mine would go smoothly as well. Well, thank goodness I was in a modern medical facility with numerous interventions available. I went post-dates and was induced, and it turned into a long and complicated delivery ending in an unplanned but non-emergent Caesarean section. And I won't get into the issues with feeding and post-delivery follow-up and managing expectations of family and well-meaning family friends who were eager for visits.
It still is difficult for me to look back on that time. At the same time, despite my gratitude for the medical interventions that were available, I miss the close geographic connections that enabled new mothers to have some support from other women in the family. I missed living near my grandmother, who assisted in multiple home deliveries for her relatives.
Your essay is honest and non-judgmental. Thank you again.
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People have always practiced population control without the permission of the invisible divinities who they believed ran the world. That’s because there are and always have been limits to how many people and people who require special help to survive any group of humans can support. Fetuses have been aborted, infants exposed, elderly abandoned, and the weak killed. It’s a part of human experience that is often never discussed because the memories are dreadful to recall. But these acts saved the rest of the people because trying to save those who would die anyway caused others who might be saved to die. That’s the sharp end of existence that our well ordered human societies makes so rare that we cannot see the reasoning involved.
For humans, the strategy should be to reduce the overall all numbers of people by assuring a maximum of one child for one parent, this will assure a decline over time. To do this means allowing abortions and social regulations controlling who has children and who must not. To be fair it must be according to a consensus and policies decided democratically.
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@Casual Observer China recently abandoned its "one child" policy. It resulted in a huge shortage of marriageable females.
Yes, it reduced the population too drastically. One per parent would allow two per family but still might have unintended consequences. However, population sustainability requires 2.1 children born per family so reducing that to no more than 2.0 would reduce the total number of people over time.
Blood transfusion certainly existed in 1927. Blood banks themselves were formed before WW I. I’m pretty sure some forms of anesthesia for epidurals existed too. One was called cocaine, back then. But birthing at home was pro forma outside city limits. But both my grandmother (1895) and mother (1926) were born in hospitals in Pennsylvania. Giving birth still could be a dangerous process for many women. It still is, if you are of a less fortunate sociopath-economic class of women. With so many expectant mothers in the workforce, I have no idea how much time women have for chats on their phones and tablets. Best wishes to anyone pregnant to stay healthy and have a healthy baby.
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@Tom
The first US blood bank was opened in 1937. The first labor epidural catheter was placed in 1931, although they didn't become widely available until the 1970's.
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There's a great deal of hubris in thinking that we get to control our health at all. We don't. You can do your best to remain healthy, eat well, exercise, and still develop the worst health problems.
The best way to avoid a traumatic birth experience that doesn't go the way you wanted it to and scars you psychologically is to not get pregnant. The second best way is to understand that not everything is nice, fun, and fulfilling. It's a lesson you need to learn to be a parent anyway, so might as well get it into your head now.
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Just in my own circle of close friends and family, I know three women who would almost certainly have died in labor without ever delivering had we been back in the nineteenth century, and five babies who would probably have not survived the birth process without modern medical interventions. Modern medicine has turned childbirth from an extremely high-risk "natural" situation in which many mothers and many, many infants die to a remarkably safe one over all (though less so in this country than in others). We should all be very grateful for that.
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When I had my first child, 22 years ago, I wanted to talk to my OBGYN, an older gentleman, about my birth plan. He said, Don't worry about how he's going to be born. Worry about you're going to raise him. It seemed insensitive to me at the time, but he was right. It's like putting all your focus on the wedding and forgetting that the important thing is the marriage. I don't think my kids have ever asked about the details of their births, details long subsumed in the haze of memory and that ceased to matter, anyway, as soon as the babies were safely here.
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@Anna It does indeed seem insensitive, considering that people die during childbirth, and frequently experience medical procedures they would never consent to.
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Sadly I think you are right. My two natural births are perhaps my most cherished memories and I tear up when I think back. The planning was very important: My doctor tried to forbid me from delivering on my hands and knees yet I was able to convince him to allow this because I had done a lot of research on the subject. I now know that had I been forced on my back, the pain would have been excruciating. For me, 12 hours of labor was no big deal and giving birth by myself the second time (doctor was late!) was an awesome adventure. But in the long run, having such amazingly positive birth experiences doesn’t make the nights any easier and within 48 hours people stop asking how the birth went so you feel less like a super star having given birth to a devine cherub and more like a sleep deprived new mom with a flabby tummy and the hardest parts of child rearing ahead of you
2
36 years ago I had a birth plan to deliver at home with a doctor, a midwife, my husband and several friends, along with the local fire department ambulance on alert just in case of need. The only thing that I had not anticipated was that my labor would take all of 60 hours -- from the time my water broke to the minute my daughter was delivered. No complications, no crisis drama, no stitches. Much loving support in my bedroom with freedom to wander the house whenever I felt up to moving about. But there was a whole lotta pain I wasn't fully prepared for... I do not recall anyone prior to my labor ever telling me it would be as excrutiatingly painful as I experienced. Or that a home birth could go on for so long. But the great thing is my successful home delivery without any pain medication taught me I was stronger than I ever knew, and affirmed that I had made the right decisions FOR ME, though I acknowledge under some very lucky stars. Now that my own physician daughter is about to deliver twins there is NO way I would ever recommend to her a home delivery, not even if she were only delivering one baby. Just sayin'... it's a personal decision with many beautiful ups and some big downsides.
30
While I can't speak for anyone else, all I will say is thank god for modern medicine. Our son needed to be delivered premature (like 10% of births nationally) and while the birth itself was relatively straightforward (though there were a few scary moments in there), he needed to -immediately- be in the NICU right after delivery and for many weeks after. (Incidentally yes, we needed to induce. It worked fine, and was the best option as staying in was no longer an option!) In a previous era, and without a hospital with a level IV NICU, he would not have survived. My husband and I have no romantic sentiments about home births or birthing in other settings: it really is hard to predict what will happen with your specific pregnancy and delivery. We never expected any of this would happen - completely normal, non-high-risk pregnancy. But we're glad that a century of medical progress made it possible for our boy to survive and now thrive.
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What's up with all the black-and-white thinking? You can have a birth plan outlining your preferences AND still know that birthing is an unpredictable process where things may not go according to plan. The two things are not mutually exclusive. Having a plan means going in informed and pre-informing your doctor because you know you may not be in a state to communicate well during the labor. That's why people make plans -- not because they are incapable of imagining that things could go wrong or that unexpected circumstances might arise.
In what other situation in life would people be made fun of for making a plan and trying to act in an informed way? Do we make fun of hikers who change plans due to changing weather conditions? doctors who change surgical plans depending on what they find when they open a patient up and examine their heart during surgery? college students who discover they love another subject more than their originally intended major?
Making plans is an act of hopefulness and responsibility. I think the reason people make fun of birth plans so much is because people are still so uncomfortable in thinking about women, and in particular birthing mothers, as capable rational people and not vessels/something to be controlled.
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@cs :
untrue, from my perspective as a mother of two and a former L&D RN.....
So many women don't learn about their bodies or about pregnancy or birth. Yet they want to determine the tiniest aspects of childbirth.
They demand Epidurals when barely in labor.....(that WILL slow down labor to the point of almost guaranteeing a C-section) or want about 6 or 8 relatives in the room....which is a hazard and makes it nearly impossible for the RN's and Doctors to do their jobs.
Just a couple of examples. Rather than being an anti-woman thing, sometimes advice is given for reasons of safety, and best outcome.
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@RLiss "Epidurals when barely in labor.....(that WILL slow down labor to the point of almost guaranteeing a C-section)"-- This is just not true. I'm sorry a person who says they are a nurse posted this, as it drives up fear among pregnant women. The evidence does not support the claim, nor does my own experience. You may choose not to have an epidural if you wish, but please don't fear-monger to convince other women not to.
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@Spanish A quick Google search shows that it's not a settled issue - the most recent study shows that it does not affect labor duration, but the researchers acknowledge that more work needs to be done. However, RLiss asserts that getting an epidural when "barely in labor" is the problem, but all of the studies assert that use of an epidural is only controversial during the second and final stage of labor. "Barely in labor" is apparently an ideal time to get the meds.
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Almost 26 years ago when I had my son (alive and well and thriving now), I was 40 years old. Having a baby at 40 was considered a lot older than it is now and because I knew I would be subjected to all kinds of invasive tests and condescending attitudes that were the norm in those days, we chose to avoid traditional doctors and hospitals and hired a midwife.
She was a lovely young woman who had delivered 100s of healthy babies and she said she would love to help me deliver our baby at home. I thought delivering in a big hot tub full of warm water (and I think sea salt) would be a wonderful way to welcome a new soul into the world, so we borrowed one from someone she knew, and a week before I was due, planted it in the living room (we lived on the ground floor) and filled it up.
When the time came, needless to say, it didn't quite work out that way and after 20 hours of switching between the tub and the shower and not dilating, my wise midwife said it was time to go to the hospital.
20 hours after we arrived my son was finally born by cesarean section. Although they didn't listen to her (no, she does NOT have preeclampsia, I heard her yell at one point) they did allow her to stay with me until I went to the operating room.
It took me a year to recover from that experience but all the books in the world couldn't possibly have prepared me for what happened. I'm just grateful it had a happy ending.
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Of course I have no way of knowing your story, but for many women "failure to progress" is a result of being strapped down, unable to walk/eat/change position, in short, do the things that mammals in labor do to make labor progress. And poor pushing effort is often the result of long hours of deterred labor. Caesarean is an almost inevitable result, which in part accounts for our ludicrously high Caesarean rate. The hospital setting may indeed have saved your life and the life of your child, as it does for many. However, in many cases it is the hospital setting, and its strapped-down-flat-on-the-back protocol which CAUSED those complications. A birth plan that says "I will stay up, walking, stretching, eating, showering, pacing, etc." is not a woo-woo luxury. When it gets respected, it's also a lifesaver.
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@Kate
When I had my baby 33 years ago, I labored in a hospital but I wasn’t strapped down. I was free to move around my large room, I could walk, change position, and lie down as needed. I spend much of my labor in a rocking chair.
After 24 hours of labor, 18 of them at the hospital, and three hours of pushing, I had a c-section. My baby weighed 10 lbs 13 oz and there was no way she was going to co e out theoufh my pelvis. We would have both died in the days before modern obstetrics, and I will be forever grateful I lived in a time when when it was available.
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@Kate I agree. The childbirth classes I'd had emphasized getting up, moving around, and letting gravity do its thing. But when I got to the birthing center, I was hooked up to every kind of machine imaginable. Shuffling across the room to the bathroom was almost impossible and half-reclining with feet in stirrups does not seem to me to be the most efficient and least painful way to birth a child. Whatever happened to birthing stools? You kneel, you grasp the back of the stool, and you let gravity do its job.
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@Kate :
as a mother of two and a former L&D nurse, I know of NO ONE "strapped down" in labor, unless perhaps they had "twilight" sleep and were endangering themselves trying to get out of the bed. (See my post about Twilight sleep above).
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My mother who had me at the age of eighteen in the USSR was in labor of 12 hours. She never went into any details but I knew it was brutal. And while I always wanted to have biological children, the idea of natural birth terrified me. I did not want any birth plan. I just wanted it to be over. I knew that nature is indifferent, brutish and uncaring and that the best thing we can do is to develop civilization as the protection against evolution’s malevolence. Still when I had my first son at the age of 21, I reconciled myself to going through the birth process and having my body torn, even though the idea sickened me. When I arrived in the hospital, I was told the baby was in breech presentation and offered a Caesarian. I immediately said “Yes”. This was the best decision I ever made. The pain of surgery was minimal, I was alert and conscious, and my body was not disfigured or damaged in its most sensitive parts. When I had my second son four years later, I opted for a Caesarian immediately. Nature is not our Great Mother, said Oscar Wilde, and he was right. There is nothing sublime or beautiful about natural birth and I’m glad I had never experienced it.
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@Mor I had the same experience and feel the same way. I think there are a lot of us out there. Natural can be overrated and the mother's body counts, too.
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@Mor I agree completely with you, Mor. I had all of the same reservations (and more) about vaginal childbirth that you stated. When it comes to childbirth, I believe very strongly that, to each woman her own.
Personally, I had no desire whatsoever to have "a birth experience." I'm not against vaginal birth per se, but I always knew it wasn't for me. I viewed vaginal childbirth as something that was physically, emotionally, and mentally devastating - a perception that was rooted in my childhood and reinforced over and over by all the women I knew growing up who had to deal with the irreversible health consequences of extremely traumatic vaginal births.
I knew I wouldn't be able to handle giving birth vaginally. And the thought of being forced into something I knew I couldn't handle terrified me. What was more, I didn't want to handle it. I flat-out did not want to experience vaginal birth. The most important to me was being a mother, which I could accomplish via an elective cesarean. Had I not received a guarantee in writing that I could deliver that way, I never would have become pregnant.
People can flame me for this all they want. I couldn't care less. I got what was most important to me, which was (a) having my wishes respected; and (b) leaving the hospital with not only a healthy baby, but with my physical, emotional, and mental health intact. And it happened in a calm, controlled, predictable, and relatively painless process that was over in less than 30 minutes.
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@Josa
Good for you. There is a reason why so many female ob/gyns chose elective c-sections when they give birth. And it’s not because they don’t understand the science, are taken advantage of by the system or are trying to help their colleagues get to the golf course on time.
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In hospitals in us more than a century ago women were more likely to die than if they had been at home. In the 60s my mom asked for no drugs and they literally knocked her unconscious anyway. My stepmoms questions for her doctor in the same era included this line ‘will I be restrained’. C section rates are currently way above WHO guidelines. When I gave birth i remembered my mother’s story of giving birth to me, I could feel her sense of sadness, the lack of agency. I chose my caregivers carefully. This is a very blithe piece.
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@Sheryl Schulz The WHO admitted in 2015 that their "ideal" 10-15% C-section rate was pulled out of thin air, They also said practitioners should offer C-sections to women who need them, instead of focusing on a certain rate.
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Cesarean sections should be offered to whatever woman needs one or wants one. There is nothing magical about vaginal birth, and no woman should be forced to endure it if she doesn't want to.
I had a birth plan. Nobody looked at it. The OB-GYN broke my water without consent, without an explanation or warning. My contractions became very painful and constant during my entire labor. I persisted without an epidural knowing it could stall my labor, knowing it would come to pass. My husband was my emotional support. He did his part beautifully. The midwife was in and out checking me out. She called the doctor as I was crowning. He wasn't coming. She called again and I told her we didn't need him. He entered the room, looked at me from 15 feet away, turned around to get his scissors, I told the midwife, no. I didn't want to be cut. She relayed my wishes to the doctor. He didn't like it one bit. It wasn't medically necessary. I delivered my daughter, ignoring him. 21 years later I am still angry. Another man who put me down, treated me like I have no brain. Add him to the list. Women are just trying to keep some dignity, and some sense of empowerment when they have a birth plan. Of course, we know it doesn't always goes as we wish, it rarely does.
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@Pascale Craff-Geck Visit a graveyard that has been in operation since the early 1900s or earlier. See how many family gravesites have the same death date for both a mother and child.
20% of crash victims who don't wear a seatbelt may survive, but that doesn't mean that not wearing a seatbelt is the correct advice.
Said another, if your child hadn't been born healthy, you would have been the first in line to sue the physician that he didn't do everything medically possible when a situation of distress occurred.
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@Pascale Craff-Geck We now know epidurals clearly do NOT slow down labor. It has been exhaustively researched over decades by the worldwide OB community. In many cases it accelerates the process by helping the mother and her muscles relax. There may be other reasons why someone may decide not to get an epidural such as very, very low risk of bleeding, infection, or headache afterwards. However slowing down labor has been disproved.
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@Ethan At the time Pascale Craff-Geck was having her baby, epidurals were really changing a lot. I had an epidural for my first birth - I'll call it the "dead fish from the waist down" epidural, and things slowed a lot, and I had to wait until it wore off to push. I also had one for my third birth seven years later, commonly referred to as a "walking epidural" that did just what you mentioned - allowed the baby to reposition - and I could feel my legs and didn't have to wait to push. Very different experiences. I think there was a lot of progress made in response to women's desire to feel heard and empowered, in addition to the health benefits of a better procedure.
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Thirty three years ago your lawyer mother had a child as you say "au naturel" in a hospital.
But if you go back 50, 60, 70 and 80 years ago, women were routinely given sedatives for "twilight sleep" in the hospitals. They weren't there for the births of their children and neither were their partners.
My mother had given birth while she was knocked out by twilight sleep six times in the 1950s and 60s. She hated the experience. She said it left her groggy and confused. So she was relieved to learn about Lamaze in the mid 60s.
For my brother's birth in 1965, she wanted my father to stay with her as she gave birth by the Lamaze method. This was allowed only until the actual delivery of the child and then my father was kicked out of the room by the doctor. For my birth in 1970, she frantically called around to different hospitals in the weeks ahead of my birth to try to find one that would let my father stay for the whole birth. This was in the NY metro area, by the way, not some backwater.
She finally found one hospital that would allow my father to stay for the entire birth and I was born healthy.
My mother became an advocate for women having say over their own births for the rest of her life. She was a feminist at a time when most doctors were men and thought they infinitely knew better than the women giving birth.
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@Seanchai So my mom had 4 children by "natural childbirth" in Ireland, then moved to Canada and had me with the "twilight" drug. She thought she had died and gone to heaven. Loved it.
Twenty five and 23 years ago I had two boys by natural childbirth (in hospital, no drugs). That was my birth plan and so I was prepared to at least wait as long as possible to ask for any drugs, which I didn't have. (Did ask during the second birth but it was too late.)
As someone earlier said, it is a good idea to have a plan but to understand that it will go as it goes.
6
@Seanchai
This is true. My mother told me that after she woke up they told her she had a baby girl. They did induce labor so I could be born as we were to move out of the country but I had to be born first. My dad was already gone so my mom was alone with three other children under the age of five. He refused spell my name correctly and blamed my mom for a different spelling than what he wanted on my birth certificate. Crazy!
I think a lot of the "birth plan" trend comes from a) women being older and better educated, and culturally conditioned from a young age to micromanage everything from their college applications to their wedding b) women actually having options about childbirth (epidural or lamaze, birth center or hospital, etc) and c) our culture of Instagram and Facebook that turns every moment into An Event or An Experience.
It puts a lot of pressure on women.
Childbirth is great preparation for having kids; it is good to have a general sense of how you would respond to various situations. But you are now dealing with capital-N Nature, which has its own agenda that you cannot control. Your childbirth will be what it is, and to a high degree, your children will be who they are. Parenthood is not a term paper or a work project.
So request that epidural, but be aware that you might not get it in time. Plan for a natural birth, but be aware that a C-section might be necessary. And prepare yourself to be joyful with what happens, no matter what, as long as you come out of the hospital with a healthy baby.
And if I could give new moms one piece of advice - GET OFF SOCIAL MEDIA. Get off The Bump, Get off Facebook, Get off Instagram. Don't compare yourself to other moms' carefully curated feeds. Don't put yourself under pressure to have a Perfect Social Media post of every birthday / milestone / snow day / first day of school, etc.
Seriously, for you sanity, get off now.
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Excellent comment @CF!
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@A F Well-said!
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@A F get away from goop, as well. It's a fairy tale.
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Thank you for your story - and I'm sorry to hear of what sounds like a high stress birth.
I am the mom of seven, all homebirths, including a set of twins. Indeed, all things don't go as planned; the uncertainty of life is the uncertainty of birth.
Don't choose to *not* plan, though. Don't not imagine a peaceful birth. Certainly never submit to suggestions that the welcoming of a child must include any of the particular oddities of modern birth. Because it doesn't - and constructing a birth plan is perhaps just an artifact of a culture, our control-obsessed culture, that needs certainty.
But it is also, mostly, the wish of a mother to safely birth her child, just like your grandmother. And, sometimes, it is also the desire to embrace birth as sacred. There is, perhaps, room for lots of interpretations of birth plans.
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@April SEVEN?? Why?
Birth plans are important because they are opportunities for the health care provider to educate the parents-to-be. This article, and many comments, represent upper-middle-class views from people who are educated about the process of birth and knowledgeable about their options. But, childbirth is mysterious and scary for many. Making a birth plan with the aid of a compassionate provider demystifies the birthing process and allows for better understanding of the stages of labor, what can be planned/wished for, and contingency planning for "just in case" scenarios. Going into labor planning for a natural vaginal birth, but suddenly having to switch gears and opt for an epidural, pitocin, or Cesarean can be traumatic if one has not mentally considered all the options.
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Childbirth is something that happen TO you - not something you DO! I swear I remember every second (three times, 25, 21, and 20 years ago), but with a complete sense of wonder and no sense of having been in control! And yes, I tell my daughters it was "not so bad" and "totally worth it" and will til they experience it themselves. (My mom only spilled the real beans after my first kid was born!)
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it's different for everyone. the birth of my son was almost entirely pain free, and truly a beautiful, empowering and emotionally intense experience. right after I had him I was so happy, I was ready to have ten more.
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@Sara Kaplan best comment!
So glad you both made it through! The contrast between the hoped for natural birth and a drawn out, life threatening ordeal can be very traumatic and can take a long time to get over.
Even in 2020, there are no guarantees. And the U.S. has terrible care for people of color. We rank with third world countries for infant mortality.
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I never birthed a child as my pregnancies fizzled out early. Reading this, I alternated between puzzled, amused, annoyed and jealous. What a luxury to “plan” your pregnancy and delivery! What a blow it must be to find that nature isn’t cooperating with your plan. Curious to know if the women who plan a delivery down to the smallest detail were coming from the perspective of having been successful in planning their college admissions, careers, mate-finding and weddings? I can’t imagine who else would think they can control labor and delivery.
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@Julie Zuckman There is an entire industry selling the concept to woman that they can manage the birth process without interventions. Unfortunately, it doesn't align with reality. I know I personally felt like my body had betrayed me after my labor and delivery. I'm sure I'm not alone.
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@Julie Zuckman
Besides signing up with two doctors I really liked, trusted, and knew for a long time, I didn't do much birth story planning.
I was pretty 'open to the universe', trusted my excellent medical team, and got lucky.
I am sorry you were not able to give birth to a child, Julie. <3 <3 <3
Sort of agree with your theory about how super planning pregnancy & delivery moms might also hyper-manage the whole raising the kids thing.
I love my kids very much, but mixed a lot of laissez faire into their raising.
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@Julie Zuckman I don't know about Millennials, but their immediate predecessors, the Yuppies, seemed to believe that they could control absolutely every aspect of their lives. But we all have our stressors. I'm sure that my mother, of the Silent Generation, would have snarled at me that I, a Baby Boomer, was doing childbirth wrong.
Thank God for hospitals and doctors. We almost lost our first child due to complications at birth. The pediatrician was right there and saved our child. That child is now grown and a Foreign Service Officer serving our country in Haiti.
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@Tony Mendoza I'm sorry to hear about your near-loss. I had a homebirth because I knew doctors don't live in hospitals: 80% of women in America give birth in hospitals that don't have an OB, pediatrician or surgical team on site 24/7. ACOG's recommendation is 30 minutes to call in the doctor and assemble a surgical team in case of emergency- and there is no information how many hospitals can actually meet that standard. Whereas it takes me 5 minutes to get to the hospital from home and I can call ahead. At home I have a professional midwife undistracted by any other patients or concerns supervising my the entire of my birth, who carries IVs and Pitocin, and other basic lifesaving equipment. Statistically the home birth lowers the risk of complications and the need to rush in for treatment in the first place - but if we need it it's there. Now if hospitals could cooperate with and support home births - ideally offer it themselves - women would have this safe option.
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I have seen many first time and repeat mothers vary so much on this situation.
I always asked for what the mother and the couple wanted, with a dose of reality that said I was there for both of them, and the health of the infant was paramount with no discussion about what some object or rubbing or whatever if the delivery resulted in an emergency. I wanted the trust they knew I'd do the right thing, but also would be very supportive of what they wanted their birth to be like.
Fortunately almost all the deliveries over 20+ years were wonderful, and all walked away with smiles. I won't go into the few that still make me very sad to this day, including cords around the neck and so on.
I find it both wonderful that this one great thing which can be anticipated with great joy but may take a very bad turn in seconds vs. disappointment that the baby needed oxygen for a few moments and that the father and mother couldn't hold the baby immediately is something mothers and mothers to be can discuss.
I'd be extremely remiss if I didn't give lots of credit to the nursing staff at both the hospitals for understanding and communicating better with the family unit than I ever will. I took many cues from them and indeed unless there were an emergency, their being in attendance was more important than me being there.
A wonderful event. Blessings to all, and be ready for anything and agree to do what is best for the long run rather than following a script.
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@reid, you sound like a great, empathetic provider that puts the true priority of birth in place, balancing the requests of the parents with the safety of both your patients, infant and mother.
Thank you.
I love how doctors induce a mother's birth, which means they chemically force labor before the body is ready. Then they numb the very body parts a mom needs to use to push a baby out. A cascade of problems follow, caused by these interventions and others, the obstetrician (a surgical specialist) performs a c section thereby "saving the life of the mother and child." The surgeon is a hero and also makes their T time, the mother gets 6 weeks off to heal and everyone makes a heck of a lot more money. The mother may have post postpartum depression, but there's a pill for that. Sounds like Great Grandma was doing fine.
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@Sean
Exactly correct. Another triumph for our for-profit healthcare system.
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@Sean
But a lot of people's Great Grandmas did not do fine.
I had a scheduled induction with my third. It was by far my best birth. Got the pitocin and the epidural, fell asleep, and woke up a few hours later with the doctor tapping me and saying "time to push!" One push, and there was baby. Easy, painless, and very stress free.
The worst birth I had was the precipitous one where we didn't get to the hospital in time for the "numbing" of those parts. I have never experienced pain like natural childbirth before and would never care to again.
As a woman and a mother am so thankful that they can both "induce" and "numb" those parts if you request it.
But then I am also one of those bad moms who liberally used the Well Baby nursery so I could spend my hospital stay sleeping and eating cheesecake instead of "rooming in" and nursing 24/7 like the La Leche League lady told me to do.
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@Sean My labor was induced and I had an epidural. There was no "cascade of problems" caused by these interventions and after 6 hrs of labor I pushed my 8 lbs 3 oz daughter out with my "numb" body parts just fine. My daughter was healthy, I was wide awake and not wrung out by my labor experience and able to sit up and nurse her right away. Can we please stop being so strident and sure that "our way" is the only way to have babies? Every situation is different and nobody is evil for choosing what works best for them.
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As a former nurse manager of Vermont's first in-hospital birthing center and the author of Birth Stories: Mystery, Power and Creation, I would suggest that all pregnant people make their wishes known to their health care practitioner regarding what they would and would not like to happen at their birth.... and then let it go. Babies are born in their own way and time. There is no one "right" way.
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@Jane D as a registered midwife I perhaps need to correct you. I do believe that Vermont's first in-hospital birthing center was opened in 1978, in Gifford Hospital in Randolph, Vermont.
That birth-centre (2 rooms, lovingly decorated) were the result of the initiative of Dr Thurmond Knight a GP who attended many many home births (including mine).
I had the very good fortune to work along-side Dr Knight in 1978-79 as a 'lay midwife'; an experience that laid the seed for me to pursue formal training, a Bachelor of Midwifery degree and certification in New Zealand, many years later. I continue to work as a research midwife for Imperial College, section of Neonatal Medicine here in London.
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@SJ self-correction! It was 1977, not '78 when Dr Knight opened the birth center rooms at Gifford Hospital, Randolph, Vt
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@SJ Yes, I was at Gifford from 79-'84 and worked with Dr Knight and all the other lay midwives he trained as well as a wonderful staff of nurses and other doctors. Not sure what in my comment would make you think otherwise.
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Plan to be flexible. My birth "plan" went out the window. My first was born at St. Vincent's in 2009. I was scheduled to be induced, going past my due date at age 40. It was first pregnancy and I read all the books, went to the pricey classes. I chose the closest hospital to my home rather than the trendy birthing center uptown, somehow I knew being close was imperative. The date came. I woke up to my water breaking. I wandered around aimlessly trying to count contractions while taking a bath. Three hours later, I arrived for my scheduled appointment in full labor 9cm dilated. My baby was coming too fast. All the mothers sat neatly in their waiting room beds, while I was screaming at the top of my lungs. (The birthing class neglects to mention the automatic-screaming!) One angel nurse, I thank her-said let me get a doctor's opinion, I just saw a case like this, I think we need to slow this right down. I was whisked away for two epidurals stopping my contractions for eleven hours, when the doctors decided to jump start labor again with pitocin. Over-medicated, I was pushing into an abyss. The attending nurse what shouting "encouragement" at me. All I wanted was silence and focus. She had a slowed heart beat and her umbilical cord wrapped around her neck. Thankfully, I had a no-caesarian practice, but when I failed to push her out, my doctor left to get the forceps. Before she returned, I pushed her out, 8.3 lbs of beautiful perfection, eyes wide open.
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@West Villager
Lots of babies come fast. I wonder why since you were dilated, why didn't just catch the baby? Hard to second guess things, but the question lingers.
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@West Villager what is a baby coming too fast??
@West Villager : what is a "no caesarian practice"? they don't do caesarians EVEN WHEN INDICATED? even when it save the life of mom or baby or both?
That's hysterical fanaticism. I wouldn't let those fools touch me or my baby!
Also: this is what you get when you wait until 40 to have your first baby. Sorry, but it is truth.
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Childbirth is the only medical condition in which you go to the hospital, suffer pain and injury, but come home with a prize!
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@Madeline Conant
"... but come home with a prize!."
Only if you're lucky. Let's not forget that.
Let's also not forget the fact that the pain and injury that many women suffer when giving birth does not get left in the hospital; instead, it often plagues them for the rest of their lives.
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@Madeline Conant
That also describes kidney stones.
@Madeline Conant : oh but what a prize!
Keep your eyes on the prize!
It doesn't matter over time, if you had a birth plan or no plan, or a natural delivery or a c-section.
All that matters is a healthy baby and mom.
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