Birth plans: worse than useless

Yesterday I wrote about birthzillas, pregnant women who are hypersensitive, obsessively controlling, and rude to healthcare providers. They justify their behavior with the all purpose excuse “It’s my special day.”

Several commenters took umbrage at the idea that a birth plan is the hallmark of a birthzilla. What’s wrong with making a birth plan they ask? The answer: a lot.

Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. But the worst thing about birth plans is they don’t work. They don’t accomplish their purported purpose, make no difference in birth outcomes, and, ironically, predispose women to be less happy with the birth than women who didn’t have birth plans.

Birth plans were instituted based on the philosophy of various natural childbirth advocates such as Penny Simkin and Lamaze International. They basically made up what they thought would improve the birth experience for women without any study at all about what actually improves birth experience for women.

Joanne Motino Bailey, CNM et al. write in Childbirth Education and Birth Plans, Obstetrics and Gynecology Clinics – Volume 35, Issue 3 (September 2008):

Advocates of birth plans claim that they can improve communication with staff, enhance choice and control during labor, and make women more aware of available options for their birthing experience. Too raised concerns that birth plans offer meaningless choices and “create an atmosphere of distrust between patient and physician or have the opposite effect by setting up the patient for a sense of ‘failure’ if the birth does not go as planned.”

There are no randomized controlled trials that analyze birth plans and the literature that does exist reaches varying conclusions … Lundgren and colleagues found “although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.” Brown and Lumley stated that “women who made use of a birth plan were more likely to be satisfied with pain relief, but did not differ from women not completing a birth plan in terms of overall rating of intrapartum care, or involvement in decision making about their care.” Whitford and Hillan found that most women who completed a birth plan found it useful and stated they would write another birth plan in a future pregnancy, although most did not believe it made any difference in the amount of control they felt during labor and many did not think enough attention had been paid to what they had written.

Why are birth plans ineffective?

1. Most birth plans are filled with outdated and irrelevant preferences. As childbirth educator Tamara Kaufman writes in Evolution of the Birth Plan (J Perinat Educ. 2007 Summer; 16(3): 47–52):

… [Women] identify the Internet as the resource they use most frequently to gather information about pregnancy, birth, and birth plans… [M]any of the birth plans detailed on these sites are outdated. For example, several on-line, interactive tools start with questions regarding being shaved or receiving an enema. Because these procedures are no longer routine in most areas, such details may cause parents to devote too much attention to unimportant issues and cause the hospital staff to dismiss the couple as being uneducated regarding routine hospital procedures…

2. Birth plans are gratuitously provocative, as Kaufman notes:

On-line birth plans are frequently more than one page in length, which may inhibit the hospital staff from closely reading the plan. On-line birth plans also have a tendency to use phrases such as “unless absolutely or medically necessary”—a phrase that is not always useful when caregivers usually believe the intervention they recommend is medically necessary at the time …

3. Birth plans have no impact on outcomes. The most important component of any birth plan is requests around the issue of pain relief. As Pennell et al, point out in Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans:

Women who elected birth plans were primarily white, college-educated, primigravida, and under the care of a certified nurse-midwife. One-third of births were induced, 10% required instrumentation, and 29% were cesarean births. Nearly every birth was associated with at least 1 labor and birth complication, although most complications were minor. Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased. The majority of women agreed that the birth plan enhanced their birth experiences, added control, clarified their thoughts, and improved communication with their health care providers.

4. Birth plans encourage unrealistic expectations. Just the idea itself is unrealistic. There is very little that can be planned about birth: not the timing, not the length of labor, not the amount of pain experienced, not the relative size of the baby’s head and the bony pelvis, not the adequacy of contractions and not how well the baby tolerates labor. Yet all birth plans implicitly assume that labor with fall in the normal range in every possible parameter. Disappointment is inevitable.

In Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect.

It appears that the birth plan may have actually set women up to be disappointed with their birth experience.

5. It is not really surprising that birth plans fail to achieve their stated aims when you consider that they are not plans for births. No one writes in their birth plan that they want to have a 16 gauge IV in each arm at all times; no one demands active management of labor; no one insists on extra blood tests for the baby. A more accurate name for birth plans would be “I refuse all these things regardless of whether they are routine and/or medically indicated because I know much more about the scientific evidence than any obstetrician or nurse.” In other words, birth plans are an extended tantrum in written form.

Why do women write absurd ultimatums? Why do they think their a priori refusal of medically indicated interventions is remotely appropriate? Why do they think they have a better understanding of the scientific evidence than the professionals who create it, read it faithfully and are legally responsible for being completely up to date on it? Because people like Henci Goer (who has never delivered a single baby) and Ina May Gaskin (a woman with no training in midwifery, who let her own baby die, and who believes that birth is controlled by invisible “forces”) told them so.

Why do they write these extended tantrums (“I’m not gonna and you can’t make me!)? Because they’ve completely lost sight of the goal. Doctors and nurses are HEALTHCARE providers whose goal is to make sure that mothers’ pregnancy complications are treated or prevented and that they give birth to healthy babies. Their role is not to facilitate birth goddess fantasies. Women know so little about birth, and are so sure (erroneously) that complications are vanishingly rare that they’ve confused birth with a piece of performance art. Birth plans are not about birth; they’re about creating the most esthetically pleasing tableau.

That’s why NCB and homebirth advocates can, with a straight face, have arguments about whether a C-section is actually a birth. It makes sense when you realize that for them birth is not about the baby being transferred from inside the uterus out to independent life. For them, a birth is an intricately choreographed performance that follows a pre-approved script. Deviate in any way, and the performance is ruined.

Ultimately, birth plans are not merely useless for their stated goal of achieving control over birth. They are worse than useless because they are filled with outdated nonsense, alienate providers, fail to achieve their stated aims and, through unrealistic expectations, encourage disappointment.

By all means share your most important preferences with your providers, but think long and hard before you present your provider with a list of refusals and ultimatums. Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority.

  • Kris Hawkins

    Hmm… it kind of sounds like the person having the extended tantrum is YOU. See you’re assuming a lot of things and contradicting yourself a bit here. You are criticizing the birth plan due to women not feeling like they were effective and admitting at the same time that hospital staff tend to ignore them. Doesn’t that point at the fact that hospital staff ignoring birth plans would be the reason women don’t feel the birth plans had their desired effect? Also, I know how much educated people love to assume everyone else is an idiot but there are a lot of common practices at hospitals that are not evidence based and are actually far more detrimental than beneficial. People who educate themselves are realizing that this is true and so therefore they put their wishes in writing. If hospitals and OBs were using the best evidence based practices than we probably wouldn’t need birth plans. If you’d like I can give several examples here. This whole article sounds to me like one whole wounded ego whine fest because you don’t like that women have the audacity to tell you how to do your job. Well, guess what? Most people have some sort of “customer” they serve who gets to tell them what they want and no, doctors aren’t above that. If you can’t handle it perhaps its time to seek out another profession.

  • http://batman-news.com Brittany Finley

    I suppose if you want a birth plan, bring it up with your doctor. I’d say do it lightly and ask what he/she thinks about it and what kind of thing on the list is unrealistic. I mean, the worst thing they can tell you is something on your list is completely unreasonable (which i would love because I am a ftm I am always hunting for someone to just shoot down ridiculous things going thru my pregnant mind) and then just go from there. I have jotted down a few things I am concerned about that could happen at birth and i plan on bringing it up tomorrow at my 30 week appointment. Mostly I want her to know I want to try to not use an epi or pain meds and that i want to be able to push naturally. but a lot of it is to put my mind at ease and basically learn what exactly will happen (if everything is medically ok with me and baby) and what kind of desicioins i actually have the power to make. I wouldnt exactly call it a birth plan, maybe a birth guide for my own use? I will use it to figureout what questions to ask to better understand the way my doctor handles things and help me connect with my doctor. I think its good to have some kind of plan. If not for anything but a piece of mind.

    • The Bofa, Being of the Sofa

      Mostly I want her to know I want to try to not use an epi or pain meds and that i want to be able to push naturally.

      I don’t know anything about “pushing naturally” but I do know that they don’t give you pain meds without your permission. There’s no problem in telling your doctor that you don’t plan on using pain medications, but don’t be surprised if they don’t ask you again during labor, and probably multiple times.

      Not because they “don’t respect your wishes” or because they are pushing one on you, but because you have the right to change your mind, and, in fact, the nurses know full well that many women do. Regardless of what you tell your OB at your 30 week appointment, you still can get an epidural and it’s good of them to offer it to you. You can still say no, but you can say yes.

      Goals and wishes change, depending on the circumstances. It’s really hard to make a good decision about what you want until you are actually in the situation. You can talk about what you’d like, but be prepared to have circumstances dictate something else.

    • Young CC Prof

      Planning to talk it over in advance is definitely a good plan.

      It’s difficult to know what MIGHT happen, there are a lot of possibilities. May I ask why you want to avoid an epidural? Some of the information about them out there is incorrect. It doesn’t hurt the baby, and it doesn’t increase the chance of labor complications. (Pain medications taken in other ways can affect the baby, however.)

      There are various other interventions that may become necessary, depending on how labor goes, including drugs to speed things up such as Pitocin. Be aware that when these medicines are used at the right time, they actually reduce your probability of needing a c-section.

      Here’s what you can definitely control:

      Visitors- you have absolute veto power, if someone is annoying, you can kick them out.

      Pain medication

      Things like music, etc.

      Other things, well, it depends how the labor goes.

  • Jessica Chavez

    Gee
    why would a woman be concerned about things being done to not only her
    own body but her child’s? Wanting to make sure she was in control of her
    own body? WHY would you think being in control of what happens to your
    own body is a good idea? Well meaning strangers certainly are much better to be in charge.

    • Siri

      I was in far too much pain during my five labours to feel at all in control of anything, and was profoundly grateful to the staff who cared for me, supported and encouraged me, and made me feel safe. A birth plan would have made absolutely no difference to the experience, and would only have served to make me feel disappointed. If you are lucky enough to feel in control during labour, good for you, but in that case surely a piece of paper is redundant?

    • SporkParade

      No one said a woman wouldn’t be concerned about having control over her own body. The question is whether a birth plan is an effective means of accomplishing that. I am getting ready to give birth, and I assumed from the beginning that I would have a birth plan, but when I used the guide to creating a plan that my childbirth class gave to us, I realized that most of the questions were either a) issues I couldn’t care less about or b) choices that I did not have the medical expertise to even understand. And once I whittled it down to only the things I both cared about AND understood the medical significance of, I realized that there wasn’t enough material there to create a birth plan, and I would be better off just letting my husband enforce the one or two red lines I had.

      • Jessica Chavez

        Why is it that American and Brazillion women have so many more csections? Did our pelvises shirk suddenly over a couple generations? It wouldn’t have anything to do with how many OB we are graduating would it? Forget weather you need a birth plan or not. Educate yourself, it’s YOUR body and it’s YOUR CHILD. Find out what are the signs that there are problems, what are variations of what is normal. Find out how to deal with common issues. What to do if the cord prolapses. How much blood is too much. Educate your self this is not a trip to the movies. By creating a birth plan you can START to educate yourself about what is really going to happen if people just leave you alone and let your body do what it was built for. LEARN why in the world they want to put in an IV. Learn why they don’t want you to eat, look into how often your OB and your hospital does Csections compared to the rest of the developed world. EDUCATE yourself do not go into it only knowing you want to get to 10 cm and fully effaced.

        • Young CC Prof

          Um, women in Brazil and some parts of Mexico often choose to deliver by c-section. They prefer it that way.

        • SporkParade

          I agree that creating a birth plan is a good way to do that. In fact, that’s how I concluded that I didn’t know nearly enough about the medical significance of various options. By the way, the C-section rate is so high in Brazil because the culture is obsessed with body image, making it one of the very few places where “too posh to push” is actually a real phenomenon. It is high in the US because the US has a higher percentage of high-risk women, including older mothers and women of African descent. Also, the C-section rate is not an especially useful metric. For example, one hospital near me has a rate of 25% because it is the best for high risk cases. Another near me has a rate of 12% because it is the go-to place for VBACs. Both hospitals are very friendly towards natural childbirth, but women self-select where they will give birth based on their personal risk.

  • jenjen

    Apologize for so many typos on below post…sleepy

  • jenjen

    Wow, why do these people think it’s useless to have a birth plan. I just gave my to my OB (called it “birth preferences”. It was under one page and my information was up to date, I mean how hard is it to find up to date info. I’ve even toured my L &D unit at the hospital and asked the nurses there questions about standard procedures/protocols used during l & d before I presented my birth preferences to my OB. I wasn’t being rude to my OB, I just said to her that I’d like to quickly go over my b.p’s to see what she thought about it/give me feedback. She still looked at me crazy/annoyed. She said everything on it sounded fine to her, but I could still feel that she was annoyed at me. I don’t understand…I did this in order to try to avoid unecessary c-sections, being that our C section rate in the US is relatively high, so I want the least amount of interventions possible. If things don’t go as I envisioned them, then so be it, that’s fine, but at least I wanted to have an open conversation w/my OB and I wanted to more than anything get an idea of her philosophy or her approach to certain senarios. That’s a bad thing how? I’m not being an arrogant jerk, I respect my OB, but I also want her to respect me also, by giving me some freedoms/some say in the decision making, or at least have procedures thoroughly explained to be (risks vs benefits) if things deviate from my Bp.s That is all.

    • Stacy48918

      Birth plans/preferences are generally useless because you are trying to plan ahead of time for a completely unpredictable event. Like requesting as few interventions as possible based on the false notion that more interventions increase the odds of a C-section (that’s a myth, it’s never been documented anywhere). Your doctor was annoyed because you are coming to her with no medical training trying to tell her that how she practices is wrong and you REALLY know the way things should go, long before you’ve actually even been in labor. You’re telling her beforehand that if she wants to recommend a C-section for failure to progress or maternal exhaustion (legitimate reasons) that you already believe she would be recommending an “unnecessary C-section”.

      One doesn’t need a birth plan to have procedures explained to them. That’s called compassionate medical care. YOU are the one trying to dictate things beforehand. She just wants to make sure that you and your baby survive the process alive and healthy. YOU are the one with a specific goal for how your baby exits your body. I guarantee you your doctor doesn’t care whether the baby comes our your vagina or not.

      I highly doubt you’d ever provide your doctor with a “colonoscopy plan”.

    • PreggieLady

      It could just be pre-emptive annoyance since most women do not do all the prepwork you did in drawing up your birth plan. In fact, when we got a worksheet to help us develop a birth plan in my natural childbirth class, I was extremely annoyed to find out that the course instructors hadn’t bothered tailoring it (the course was developed in the US) to the country where we actually live. The midwives on the L&D tour specifically said that, while they respect birth plans, they kindly request that we refrain from presenting birth plans that are overly complex or just a list of “things I don’t want done to me.”

    • Busbus

      I really think the main thing is to get away from this idea that hospitals/doctors are out to give you unnecessary c-sections, or unnecessary procedures in general—and that’s kind of the idea that most birth plans are based on. It’s like saying, I don’t think we can have a normal, adult discussion about this; I will need to give you this in writing because I don’t trust you to listen; and if you don’t deliver, I will hold you responsible. (If she really didn’t listen, why would she read or respect the plan? If one really believes that, why have her as a doctor at all?)

      A birth isn’t like hiring a contractor—a contractor has reasonable control over the outcome and a contract makes sense, since it is a document that can be used to hold him or her responsible. In birth, however, no one has control over what your body or the baby or the labor will do, there are no guaranteed outcomes, and the doctor has to roll with the punches (just like, unfortunately, the mother). And doctors know this because they have encountered many, many complications that sent every plan out the window in a heart beat.

      I think, in the end, the best thing to do is to think about if there is something that is really, really important to you. Maybe there is one thing, maybe a couple, maybe even three. But no more. If you can’t boil it down to roughly a couple really important preferences, then I think you are worrying about too much and about the wrong things. And then, talk about those things with the doctor.

      The important word here is TALK, not write. What does writing them down help anyone? In the end, what I really want is to have that conversation with my doctor where I can get her responses and input, too. What I really want is that she understands where I am coming from and that she helps me understand how this looks from her end. I want to have her on my team. I want her to *want* to help me have the best possible experience the situation allows. I do not want to sit in her office with a weird written out plan about something I am not an expert on and risk, at best, spending my time discussing some stupid little detail that is really meaningless when the sh*t hits the fan, and at worst, setting up an adversarial relationship altogether where she is put in the spot of explaining to me why things might not go the way I have “planned them out” when the real culprit is the fact that labor is unpredictable (and maybe sometimes a hospital policy she has limited control over and that, usually, has been put there for a reason).

      I don’t see how a birth plan would benefit me in any way over having this general open discussion. I’d much rather the doctor makes her OWN notes about what I want based on our discussion, in a way she is likely to remember when the day comes. And in the hospital, these clear, basic preferences are something I (or my support person) can communicate quickly and clearly even when I am in labor (and knowing, also, that things don’t always go as planned).

      Personally, for example, if I was pregnant again, I would absolutely discuss with my doctor that I do NOT want to be in a situation where forceps/vacuum might be needed, I would MUCH rather have a c-section and so I would ask her to let me know if she feels that things might be headed that way so I have a chance to make that decision in time. Second, I would also talk about wanting to have an epidural as early as possible (my labors are fast!) and discuss things I can do to make sure that happens.

      Those are my two things. Other people have other preferences. Maybe you really want to be able to move around during labor, or maybe you really want to not have pain medicine if at all possible, or maybe you are willing to do everything possible to avoid a c-section, or maybe you want to have a scheduled, calm c-section this time—whatever it is, just keep it simple and stick to the 1-3 things that you really wish for and stop worrying about the rest. Everything else is overkill.

  • Vrock

    Let me preface this by saying that I am not a mother. I cannot say what I would do were I in a situation of labour, but I do know that as a person I always want my wishes respected when I am being treated medically.

    I seriously doubt that these birth plans are intentionally written as a tantrum, and frankly if they provide women with a sense of control, or even increase their knowledge about a birthing process, then great. Assuming that each birth plan is written by an uneducated person with outdated information is outrageous. Assuming a person does not understand is not fair, and if you feel that they might, perhaps you should try explaining it to them in a non-judgemental way. You have an obligation to ensure that a person is made fully aware of the risks, benefits and why something should be done medically.

    Last I checked every person has a say in their care and are allowed to make informed choices, so if they feel like they are informed and elect to write a birth plan, it is their way of conveying that these are my choices, and I want them respected as much as possible. It eliminates a lot of questions in a potentially stressful situation. While some items on the plan may be more of a guideline, other women have hard boundaries, such as not to bottle feed the baby or to remove the child from the mother upon delivery to name a few.

    As doctors, you have the obligation to respect every woman’s choices, and assist them if you feel like they may be lacking information. You cannot do anything else. Failure to do so results in violating patient rights, and even if you do respect it and turn your back and make posts like this, it comes across as horribly insensitive and discourages women from seeking OBs.

    You mentioned that the birth plans seemed more like tantrums, rather it mostly comes across that this is a tantrum. It truly comes across that you are fed up with stupidity, which in itself is a disappointment to women. It is a disappointment that you feel that a tool which is merely meant to help women explore their choices, options and preferences is such a hindrance. If you feel so strongly about crappy birth plans, you could always try having informed conversations with your patients pre-labour and delivery. This would increase a number of informed choices and reduce the number of “silly birth plans”. You cannot complain about a situation if you are not doing anything to solve it.

    For women who needed to deviate from a birth plan, it was because it was seriously warranted or they changed their minds, and that is okay! You may want to encourage women to start identifying guidelines with hard choices, since you seem to be confusing the two. It is not a patient’s fault that they might jumble them if it is not explained. And as you said, if their resources are non-medical, perhaps you should provide them or direct them where they might get better information.

    As a doctor, you owe it to each and everyone of your patients to respect them, and their choices. Maybe you should try to envision yourself as a patient who wants to feel involved and in control of a very uncontrolled situation. Educating your patients and respecting them is the only way you will ever see the results you want. Complaining about them is childish and only worsens the situation for you and for your patients.

  • Megan G

    Oh where to start.
    I did not have a birth plan with my son AND he was born in a hospital. It was a horrible, traumatic experience that almost sent me home without my son and to plan his cremation.
    I not only had a birth plan with my daughter. I also had her at a free-standing birth center. Your claims that disappointment is inevitable are ludicrous. Not only was my birth plan written based on up to date information and completely realistic, it was also followed 100% and I couldn’t be any more thrilled with my labor and delivery experience.
    And defy authority? Last I checked, only *I* had authority over *MY* body.

    • Young CC Prof

      I am sorry you suffered complications during the birth of your son, and I’m glad your daughter’s birth went more smoothly. I don’t see how the birth plan made this happen, however.

      • Megan G

        Reread, then.

        “it was also followed 100% and I couldn’t be any more thrilled with my labor and delivery experience.”

        Maybe it was complication free and absolutely amazing because my birth plan was followed 100%.

        • toni

          or more likely because she was your second child

          • Megan G

            Believe what you wish. I know without a shadow of a doubt, considering I know more about both births than you, that things went perfectly because I had a birth plan and was in complete control and was listened to. Of course there will be skeptics.

          • Young CC Prof

            Why do you think you know more about birth plans than we do?

            You remained in control because things went smoothly. Not the other way around. I know how scary it is to have birth go wrong, to have a baby in danger. I know how comforting it can be to believe that you can control birth. Unfortunately, it just isn’t true.

          • Megan G

            Why do you think I know nothing when you know nothing about me or my education?
            I remained in control because I had a team that listened to me and my birth plan. They weren’t in a rush to have me deliver and go elsewhere. They let me have full control, which meant following my birth plan. Again, there will be skeptics, which you are obviously one. But I can assure you that I know more about my background, my education, both of my pregnancies and both of my deliveries than you ever will and therefor I know what I’m talking about and you’re just assuming things because heaven forbid people admit they DON’T know as much as they think or wish they did.

          • Young CC Prof

            If you want people to believe you, a little more information might help. Or, you can just go and be happy because you’re RIGHT and everyone else is WRONG.

          • Megan G

            When I choose to keep information private and others make assumptions, damn right they’re wrong. If you don’t want to believe me that is fine, but it doesn’t make me wrong and you all-knowing. The sooner you recognize and acknowledge that and stop being a bitch when you are corrected the sooner you’ll be respected and highly regarded.

          • Amazed

            YCCP is being a bitch? Wow! Now, that’s rich coming from the arrogant poster who thinks she’s so special that her being in control magically prevented complications.

            Poor, poor fools who lost their uteruses, lost their babies, lost their full pelvic organ functions. If they had been as amazing as Megan G and found themselves a great team who would have let them be in control, everything would have gone as smoothly as it did for the amazing Megan.

            Fortunately, YCCP is too intelligent to care for the respect and high regard of such an embodiment of arrogance and offensiveness as yourself.

          • Megan G

            lol thanks for the laugh.
            When people start taking back control of their bodies in the US and stop entrusting OBs with their everything, maybe our fetal death rates and cesarean rates will drop dramatically. Thankfully I have an education under my belt AND the ability to speak up for myself, knowing what is right for me, and stand up for myself. If that makes makes me amazing then I will gladly accept the title.

          • Amy Tuteur, MD

            You were lucky. Being in control had nothing to do with anything. Plenty of women throughout history and around the world every day are in control of their births right up to the deaths of their babies and themselves. Like Caroline Lovell, for example, who was in control right up until she left two little girls motherless and her husband a widower.

          • Megan G

            My being in control had everything to do with it. My not having any control with my son is why he was stillborn and resuscitated. When women inform themselves of the process as well as their rights and don’t let others bully or scare them into making decisions they otherwise would not want, they are less likely to deal with severe complications including deaths.

          • Amy Tuteur, MD

            If being in control has everything to do with it, why have countless women died in childbirth while being in control?

          • Megan G

            Oh please Amy. Every post of yours is negative. You have a superiority complex (ie ‘defy authority’- you are not an authority).
            The US has a higher rate of maternal death than at least 40 other countries even though we spend more per capita than any other. Maternal deaths making up the statistics include medication errors. (NCBI)
            According to the CDC in a 1998 report more than half were preventable.
            These rates also include vehicle accidents, domestic violence and illness.

            It is my firm belief that due to unhealthy lifestyles and the jump to medications for everything (including rushing along labor when unnecessary) those who experience complications are more often than not attributed to the very medical system so many trust.

          • Amy Tuteur, MD

            Don’t try to change the subject. Answer the question. Why have countless women (and their babies) died while being in control?

          • Megan G

            It’s not my fault if you have reading comprehension issues. I answered your question 100%
            And in all actuality, you changed the subject from my initial post.
            Pot, meet kettle.

          • Bombshellrisa
          • The Bofa, Being of the Sofa

            They aren’t special, like Megan.

            That’s what this is all about. Megan is better than all those losers.

          • Megan G

            Right. Because that’s totally what I said.

          • The Bofa, Being of the Sofa

            Not explicitly, no, but from everything you have said? It’s pretty clear.

          • Who?

            Should women also inform themselves of their responsibilities to their unborn child, their existing children and extended family and the team who have to mop up when their ‘control’ doesn’t work any more?

            You had a good experience, that’s great. Unless your birth plan said ‘me okay, baby okay, by whatever means the professionals caring for me recommend’, then it had nothing to do with that outcome.

          • Megan G

            Everybody, regardless of gender, should research everything and arm themselves with all information necessary if they expect a positive outcome. This includes knowing that if you have X-condition, it may affect Y. This is not rocket science, it is common sense, which, unfortunately, isn’t very common.

          • Who?

            ‘Common sense’ is what we run to when we are afraid of thinking.

            Of course it’s good to be familiar with your body; what isn’t good is confusing that with knowing better than people with years of education and experience who came to work today to ensure their patient gets home in one piece, if at all possible.

            Not to provide a desired ‘perfect experience’. Despite what must have been a terrifying experience with your son, thanks to the work of the staff where you were, he was fine. If your daughter had needed the same expert help, was it there for her?

          • Megan G

            It was because of the staff that he almost died.
            And if something had happened to my daughter the proper education and experience plus tools were available. I’m far from an idiot. I would not deliver in a place where these things were not available.
            Just because I’m disgusted in this OB and many others out there doesn’t mean I don’t respect the medical community as a whole. FFS I work in the medical community.

          • Who

            Being disappointed with one doctor or team doesn’t mean every doctor or team should be tarred with the same brush.

            Mistakes do get made, things do get overlooked, it happens every day. No doubt that team reviewed what happened in your case with a view to trying to make it not ever happen again.

            You felt able to direct the midwives at your second birth-had it gone the same way as your first ie traumatic but a healthy baby at the end, would you have blamed the midwives, or yourself?

          • Megan G

            I’m wise and mature enough to place blame, even when on myself, when and where it is due.

          • FormerPhysicist

            Research *everything*? How many years did you study medicine before having children? And how many years did you study architecture and building before buying a house?

          • Bombshellrisa

            I have a friend whose birth plan said give me pitocin as early as you can, I don’t want a c-section. Her doctor and the nurses had to explain they don’t just start giving it unless it’s indicated.

          • Megan G

            Very different from everything I’ve heard.

          • Bombshellrisa

            Have you had a chance to work in L&D in the US. I know that in parts of Mexico and Ireland you WILL have pitocin and you will be holding your baby in 12 hours or less it’s the protocol there. I suppose it depends on where in the US and what type of hospital, but I have never seen pitocin being given if things are progressing and there isn’t any indication of distress in the baby or mother.

          • Megan G

            Yes I have worked in L&D. There’s a reason I left- pitocin and epidurals pushed on women in their most vulnerable states. Scare tactics that were far from truth in the given situation. Same with cesareans.

          • Bombshellrisa

            So being an OB or RN, you understand that these vulnerable women are carrying vulnerable little babies.

          • The Bofa, Being of the Sofa

            But, but, but…you did your research!!!!! And you didn’t find out about things like this?

            Apparently, your research is worth the paper on your bathroom roll.

          • Bombshellrisa

            I think toilet paper is far, far more valuable than false data. Toilet paper has a purpose!

          • Megan G

            You know nothing about my education and my research. With your snide and childish comments, I am done.

          • Bombshellrisa

            Going to take a leap and assume it had nothing to do with being an OB or MFM. So no matter how much you read, your learning was limited to knowledge as a layperson.

          • Megan G

            My birth plan included allowing me to eat and drink as I pleased, ability to move around as often and whatever position I wanted, limited people in the room, leave me alone unless necessary, no IV, no attached monitor, no medications, etc.
            Again I did so with an education under my belt and knowing what’s right for me. Nobody even tried to scare me into medications. They respected all of my desires.

          • Bombshellrisa

            I felt that I was very well educated being taught by some of the most well known midwives in my area, attending a school well known for training certified professional midwives and attending births as both a doula and primary midwife. I knew nothing.

          • Who?

            Up to etc, all those things are about your physical comfort and sense of safety. And if the people whose job it is to care for you are fine with all that, or don’t care one way or the other, why not? It’s when they aren’t fine with it that the trouble starts.

            If following your plan turned out to be against the midwives’ advice, and doing so ultimately led to damage to your daughter, would you take responsibility for that, or blame the staff for not explaining fully enough why they wanted to diverge from it?

          • Bombshellrisa

            That is true-who puts “I want to be dehydrated” on their birth plan? If someone states they don’t want an IV or a heplock but later need fluid, is the staff responsible or are you if you experience complications? If your baby is in distress and intermittent monitoring with a hand held Doppler doesn’t pick it up, is it the fault of the midwives for having a protocol that doesn’t allowing for thorough monitoring or your fault for not wanting to have ECFM? Birth plans are really birth wish lists and all the list making in the world doesn’t make you in control of an uncontrollable situation. (Now that I think about it, wouldn’t have a MRCS with your doctor be considered the most “in control” you could be with a birth?)

          • FormerPhysicist

            Yes, a MRCS is the most “in control” for many women and that is a large part of why women want them.

          • Who?

            Exactly so.

            Lists and plans are great for giving a sense of control-but they don’t control outcomes, only process. If the process is the outcome-like the 50 emails to 70 people with 50 different attachments, all on the same topic, that I’m composing and sending this morning, great. I made a list, and since I control the lot it will go fine.

            If I drove to work every morning with my eyes closed, even if I had a plan with the ‘average’ times it takes to get around this corner, through these traffic lights, I’d have an accident in no time. Why? Because I don’t control all the other things on the road.

            By no means a perfect analogy, I know, but not an impossible stretch.

          • Bombshellrisa

            I do love your analogy

          • Megan G

            If I’d had a birth plan like I did with my daughter, everything that happened with my son would not have happened. Again, I know far more about the situation than you. I have no desire to get into it (it was traumatic. Typically when things are traumatic the person has difficult discussing the details. It’s a shame you people can’t respect that but instead keep pushing and and being rude about it and making assumptions.)
            As I said in my edit, I am done responding. I’ve said my peace. I also have things to get done now that it’s cool in my house.

          • Bombshellrisa

            Don’t flounce, if you want people to stop making assumptions, you have to tell the whole story.

          • Megan G

            IT WAS TRAUMATIC. I don’t like talking about it. NORMAL people accept that. They also don’t make wild assumptions and mock people like they’re children.

          • Bombshellrisa

            Birth is life changing and traumatic. Anyway, nobody is mocking you. If you think that people pointing out that you have left out a huge amount of the story is mocking, then you shouldn’t have put it out there in the first place. Saying “birth one was traumatic but a birth plan made the second birth incident free” without facts to back up your hypothesis will make people make certain assumptions.

          • guest

            Why on earth did you post on here then? You have nothing to back up your statements with except “because I say so.” This whole thing is just an epic waste of time.

          • Who?

            Why come here and assert that your plan made all the difference, then get snippy when others don’t agree. It’s your truth, not mine or anyone else’s. Perhaps consider though whether telling this story in a militant way might encourage others to take the same path might put them or their babies at risk.

            It appears your second birth hasn’t ‘healed’ you, despite all the planning and worry that no doubt went into it, it seems to have made you angrier, which is such a pity.

            I am concerned you feel so threatened by being disagreed with, this is clearly very raw for you. If you can’t talk about your son’s birth, perhaps you need someone to help you work through it so you can get on with the rest of your life, rather than feeling so sad and angry.

          • Megan G

            The thing is- they do not know anything about the pregnancies or birth beyond what I’ve shared. I do not want to discuss what happened with my son because it was traumatic and I still have difficulty discussing the details, so I choose not to. Unfortunately many here cannot respect that. I am not, however, sad and angry. I’m disgusted that women act like rabid dogs and act like such cunts because I’m not giving them everything they want.
            Just like having a child cannot heal a relationship, the birth of a new child cannot heal past wounds. Why you bother to assume it should it disturbing.
            Again, I’m not angry as a whole. But I get irritated when I see professionals like Ms. Skeptical who many turn to for guidance being misinformed and told they are authoritarian figures when they are far from it. Such a shame.

          • LibrarianSarah

            So you want to come here, make assertions, fail to answer questions to clarify your position, hurl misogynistic insults at people and have us declare that you are right and Amy is wrong based sole on your word? Sorry but that is not how this works. If you don’t want talk about it you shouldn’t rely on it as your sole argument.

          • Who?

            When you call people cunts for disagreeing with you, that’s a sign you’ve lost it.

          • Young CC Prof

            So, you come in, make a few statements without context, and then, when questioned, refuse to elaborate on anything at all.

            No one is persuaded.

          • Megan G

            “If following your plan turned out to be against the midwives’ advice, and doing so ultimately led to damage to your daughter, would you take responsibility for that, or blame the staff for not explaining fully enough why they wanted to diverge from it?”

            *Looks back and rereads.* Nope. I didn’t say that at all.

          • Bombshellrisa

            Eating and drinking during labor, moving around and repositioning aren’t unique to having a birth plan. Not sure how much experience you have with hospitals, but the trend (especially with the whole Baby Friendly hospital designation) is to let women have a cozy experience as long as all is going ok. I couldn’t believe how many hospitals in my area are allowing water birth. I also couldn’t believe the nurses kept asking me if I wanted a snack or juice (I came in dilated to 9, all I wanted was a sip or two of something not a glass). Things had changed since I was a student, even since I had my daughter 7 years ago (I have a five month old too). If you are told to lay on your side, have CEFM or an IV is placed, there has to be an indication as to why. If you present a plan that says you want things a certain way and the staff has to explain to you why that can’t be, they are not scaring you and they are imagining that you are going to be able to understand what your refusal could mean.

          • Megan G

            I based things on both my birth of my son 8yrs ago and the fact that hospitals around here, even though a different state, operate with the same principles as the hospital I delivered my son.
            I have worked in hospitals for nearly 10yrs now, so I knew exactly what I was faced with if I were to go to a hospital with my daughter.
            IVs are automatic, no food and clear liquids in small portions, no water births (except for the hospital 2.5hrs away, which was not feasible when I was due in the middle of December), minimal movement, etc. Again, I knew then and I know now exactly what I’m talking about when it comes to my states. And no, I will not discuss my location. I’ve also been online long enough to know some people are absolutely nuts.

          • Bombshellrisa

            Nobody expects you to disclose your location. What we want is a solid example of how pitocin and c-sections were given to women who had absolutely no indication for one. Also how epidural were forced onto laboring women.
            You remind me of Patricia Couch, an Oregon midwife who delivers at a free standing birth center. She believes pitocin, epidural and c-sections are pushed on women, based on her years of “working in the medical community” namely in the L&D. As part of the cleaning staff.

          • Bombshellrisa

            That just have been the scariest moments of your life, waiting to hear him start crying.
            That being said, do you feel that had you been at home or a birth center with care givers who are trained but unskilled and inexperienced in NRP that the outcome would have been better? I ask as someone who has attended home births and birth center births.

          • Poogles

            I’m curious…what do you think of women who are in comas or otherwise unconscious who go on to have completely normal vaginal deliveries? They obviously had absolutely no control over their births. Just fluke chances?

          • Bombshellrisa

            And any other loss mother here whose birth plan was respected and followed by her midwife but left with empty arms and a broken heart.

          • Amazed

            Actually, it makes you arrogant. But go ahead, run to your freebirth center with your midwives (CPMs, I suppose?) again. You took back control over your body and I don’t care about what choice you make, as long as you know the risks. You clearly know them and don’t believe them. Your body, your mind, your choice.

          • Megan G

            CNMs accredited by the ACNM.
            Again, stop with the assumptions. They do you no good.

          • Medwife

            You know less than you think you do. The ACNM is not a credentialing organization. CNMs are accredited by the AMCB. They may or may not be members of ACNM.

          • Guest

            I was thinking something else. Yes- they’re accredited through the AMCB. Forgive me oh wise one that I got something wrong. @@

          • Bombshellrisa

            Or maybe we should just not let obese women, women over 35 or poor women give birth-that should clean up some of those numbers. Also women who develop gestational diabetes and preeclampsia. Of course, being educated, you understand that these women are the ones who are screwing up the rates that are so highly criticized by those who believe reading books and making a birth plan will prevent the dreaded interventions that so often save lives. (Snark intended here)

          • Megan G

            Seeing as how a thin woman can develop pre-e and GD, your snarky response has no weight.

          • Bombshellrisa

            Which is why I said “women who develop preeclampsia or gestational diabetes” and didn’t say “and obese women who are the only ones who can develop pre-e or G”.

          • Megan G

            Apparently you can give snark but can’t take it.

          • Bombshellrisa

            No, I thought you had read it wrong. But if the concern is the rate of something like C-sections, eliminating those women from the total number and putting them in a separate category would drastically change those numbers.

          • Poogles

            Well, I’ve never felt that I’ve lost control of my body, but then I have yet to experience pregnancy/birth. I do worry quite a bit that I won’t be able to try to have the type of birth I feel is best for me, after years (literally) of reading up on and “researching” the various approaches and the risks and benefits of each. The birth I desire would dramatically reduce (nearly erase, actually) the risks of my child suffering a birth injury. I highly doubt a birth plan would help me reach my goal, though.

            If only it weren’t so difficult to find an OB, hospital and health insurance company that all agree it’s a perfectly valid and reasonable choice for a pregnant woman to choose a maternal request CS, having been informed of the risks and benefits (as should also be done for vaginal birth, but those risks usually seem to get glossed over or not mentioned at all).

          • Somewhereinthemiddle

            I thought her reply was rather compassionate considering your hostile responses. I also had a traumatic first birth where I had a “birth plan” followed by two uneventful, awesome births (one of which was an unmedicated waterbirth in a hospital and would be the envy of the birthy, crunchy folks should I choose to present it that way) where there was no birth plan. The two do not always correlate. Lots of things go into a birth that goes smoothly, provider choice, policies of the facility where you birth, the health of the mother, and huge dose of luck.

          • Megan G

            They do not ALWAYS correlate. Your words, and you’re right. And in my case, they were 100% correlated.

          • Somewhereinthemiddle

            Which cannot possibly be extrapolated to any other situation other than your own.

          • Megan G

            I was only talking about my own, though I know I am not the only one.

          • Bombshellrisa

            Actually I am right and she is wrong-how else can I explain my two healthy babies (despite one being born late preterm and me with elevate blood pressure and GD) when I wasn’t in control of anything? My one and only intervention during birth was an IV (and CEFM if you want to count that). Just goes to show how different each child’s birth can be for the same woman!

        • LibrarianSarah

          Because as we all know, correlation equals causation.

          • Megan G

            Seeing as how I never said that, don’t put words into my mouth.

          • LibrarianSarah

            Uh… Yeah you basically did.

            You said that because the birth you had where you felt in control went more smoothly (correlation), births where the mother feels like she is in control go more smoothly (causation). You equated correlation with causation.

        • Bombshellrisa

          Couldn’t possibly be because it was your second child.

  • Mary Smith

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  • Jah See

    “Why do they think they have a better understanding of the scientific evidence than the professionals who create it, read it faithfully and are legally responsible for being completely up to date on it?”

    Because the power of the medical lobbyists’ $$$ compels these very professionals to overlook it.

    “Why do they think their a priori refusal of medically indicated interventions is remotely appropriate?” 

    It because of the fact that when the cascade of interventions snowball into worst case scenarios, it then becomes “we’ve done all in our power to successfully deliver, and thus we’re exempt from any litigation.”

    • Box of Salt

      Jah See “Because the power of the medical lobbyists’ $$$ compels these very professionals to overlook it.”

      Huh?

      Would you care to explain how you think a lobbying group, paid to talk to politicians and influence changes in the law, impact the way doctors and nurses interact with their patients on a day to day basis?

      Then you state:
      ” thus we’re exempt from any litigation”
      Exactly whom do you think is exempt from litigation?
      Obstetricians, who pay huge amounts in malpractice insurance to cover possible litigation costs? Why would that be an issue if they’re exempt from litigation?

      • Captain Obvious

        Most medical malpractice is to protect the patient as much as the doctor. At least patients have an avenue to litigate in case something goes wrong. Most Homebirth midwives don’t even carry insurance. Do you truly believe a lawyer, who is not a doctors friend, won’t take a case against a doctor if they think they could win? The way lawyers make money is different than how a doctor makes money. A lawyer can and do make a lot of money against medical lawsuits. But a lawyer likely won’t take many cases against Homebirth midwives, because there is so little to win.

  • Jah See

    It would seem to me that you are quite the inflexible OB, who only has regard for patients when you aren’t questioned.

    • Jah See

      ” Birth plans have been encouraged by ancillary birth personnel (childbirth educators, doulas) as a thumb in the eye of obstetricians. They accomplish nothing besides gratifying a desire to defy authority.”

      You are an obstetrician; a guide [in a doctor], not an “authority”.

      • Dr Kitty

        You know, instead of resurrecting old posts, you could come and post your insights on today’s post.

        That way more people are likely to read and reply to you.

        Assuming you actually want people to reply, and didn’t just parachute in.

        Birth plans need to be like military plans…lots of contingencies because you can’t predict everything.
        Most birth plans aren’t like that.

  • Kat

    I was always under the impression that the purpose for a birth plan (and I may stand corrected), is to be your voice when your unable to say what you want due to he pain of child birth. I think during pregnancy, especially for first time mums or VBAC’s (vaginal births after c-sections) they tend to have a certain idea of how they want their labour experience to be, now I don’t know about you all here, but I’m a worse case scenario person. I always like to know my options, but at the same time I think realistically about what the midwives can do for me. I’m actually a nurse by trade, which is good and bad at the same time. I know how hospitals work, and a lot of the time the situation is taken out of your own hands. It can be a very scary and dis empowering time, imagine that when your in pain and about to give birth…..I would s**t my self lol seriously I would! Despite working in a hospital before, I am probably the most vulnerable person when it comes to being treated. If anything I’m quiet and undemanding, mainly because I feel uncomfortable asking for things because I know how hard it is in the care profession. I think that birth plans are good, if it is up do date with current treatment for that mothers specific condition. It helps a lot to have a midwife read it before it is implemented, so that any requests do not sound too demanding. Okay I’ll shut up now I’ve written an essay here!

    • Young CC Prof

      Good point. A birth plan where someone who doesn’t know much about medicine makes a three-page list of every little thing she wants like she’s planning her wedding is dumb. Guaranteed that mother is going to leave unhappy!

      A much looser sort of birth planning, though, makes sense. Find out what the standard hospital policies are, and make choices about things that actually are a choice, like who’s going to be with you. Talk to your doctor or midwife in advance about various contingencies, especially if there are specific contingencies that you feel anxious about. Definitely, even if you’re planning med-free, I’d walk into the hospital knowing what types of pain relief they provide in labor.

  • ngozi

    I thought about making a birth plan at one time, but then I thought it would be better to just talk to my OBGYN about hospital policies, what my OBGYN’s policies were, educate myself from reliable sources, be honest about my own health, and be willing to say no to what I didn’t want or need. I think that has worked out well for me. The problems with staff that I did experience in labor probably wouldn’t have been fixed by a birth plan.

  • My Uterus is Magic

    Oooh! This article is going to piss some people off!!! I love it! thanks for speaking your mind. It’s great to hear another opinion than those of women insisting that I need a birth plan. I am 38 weeks pregnant with my first and there is a lot of conflicting information out there. I feel lucky that I like and trust my doctor and I chose to get my information from her instead of from the internet or an untrained consultant. Here is my birth plan: “Deliver a baby from the inside of my body to the outside, hopefully by way of my vagina and without pain medication, but by any means necessary. Thanks for your help!”
    http://www.myuterusismagic.blogspot.com

  • B

    Your insane. And an ass. And this article is bullshit and very insulting to pregnant women.

  • nadia

    we are supposed to be respectiveful of you, do you have the same respect for us? we are on you territory, not ours. why don’t obgyns help women with birth plans instead of being snotty after the fact?

  • J

    Hmmm… I have had two children, both in hospitals and both with birth plans. While neither of my births were “textbook” the things that bother me the most about my experiences were things that were in the OB’s control that were blatantly ignored. For instance, in my birth plan I specifically stated that I wanted to wait until the cord stopped pulsating to cut and clamp. Even though my son was completely healthy and required no resuscitation or interventions the OB specifically ignored my request and when I reminded him as he was clamping he blew me off and did what he wanted anyway. It’s that type of gross paternalistic “I know what’s best for you and your family and you get no say,” attitude that compels women to write birth plans (and hope and pray that at least some of their requests are honored).

  • lete

    Wow. “Women know so little about birth, and are so sure (erroneously) that complications are vanishingly rare that they’ve confused birth with a piece of performance art”. Glad you’re not my OB – I would run, or rather, waddle as fast as I could :). I have yet to see an OB observe a full labor, so I’m not sure how they learn “so much” about birth. You could educate them, then, or just keep mocking women – the people you’re supposed to be in a profession to help. Your poor patients who’d have to apologize for trying to avoid dangerous complications caused by interventions, at the same time that they’re trying to trust you to help them manage actually medically necessary procedures.

    • Amy Tuteur, MD

      You have yet to see an OB observe a full labor? What an excruciatingly stupid comment; do you think women OBs are asleep for their own labors?

      • Anj Fabian

        In addition, due to the miracles of information technology and monitoring technology, a labor can be documented in full for review at a later time.

        This is particularly useful when comparing evidence to various people’s memories of the event. The cumulative research on human memory shows that humans not only can’t remember events accurately, we have a tendency to rewrite our own memories to more closely align with a preferred narrative.

    • Shantel

      Agree. My cousin actually took an extra course where they got to go to the maternity ward and sit with a mother the entire time and see a natural vaginal delivery, no interventions/medication. It was not required but she wanted to do it so she would know. she has never experienced childbirth herself and wanted to be as prepared as she could be. She is now an OB and the only one I know of that has done this.
      The best way to get the hospital to follow your birthplan is to go to the hospital as late as possible. the further into labor you are the less interventions you are prone to. I am actually not sure why so many women go in at 3/4 cm. It could be HOURS and HOURS before you hit transition! Just silly to me.

  • Kim

    Things are clearly done differently in Australia… I am going through a birthing centre and will be birthed by a midwife only, the usual way here unless something goes wrong or you go private rather than public. It is connected to a hospital, so if anything goes wrong, I am literally 30 seconds away from help by doctors. The midwife has asked me to do a birth plan and my next appointment goes through that plan. Obviously, things change, me writing a ‘plan’ won’t make it set in stone, I know that if I need an epidural for instance, I can be admitted to the hospital, but at this stage, that’s not something I would prefer. Likewise, a c section may be necessary etc. That’s life. I think if a medical practitioner sat down with women with their birth plans, everyone would be on the same page. The women just want the best outcome – a healthy baby and mum. Instead of criticising Internet birth plans, perhaps hospitals should provide women with templates of care that can occur in their hospital and spend an appointment going through it?

    • Lizzie Dee

      In theory, a birth centre within a hospital is an ideal compromise. But, going from the various scandals here in the UK, it works less well if the midwives won’t surrender control. My daughter was IN hospital, under the care of a MFM. The midwives didn’t want her to have an epi, so she didn’t get one. They were a bit po-faced about administering the antibiotics she needed for GBS as well, but they got short shrift on that one. It was a “lovely” natural birth, and we are both still angry three years later.

      It is the supremacy of “natural” that has to be dismantled. Terrific if it turns out that way. Striving for it is unwis, and the advantages are over-played..

      • EllenL

        You make excellent points!
        I have a problem with any health care system that puts midwives in charge and makes them the gatekeepers to more expert care.

        I believe any woman should be able to have an OB in charge of her care, if that’s what she wants. In The US, that is the norm. Insurance plans pay for it. No one has to see a midwife if they don’t want to.

        Time and time again, it’s been demonstrated that midwifery-led systems don’t “risk out” to OB’s all of the cases they should. They erect roadblocks to prevent women from getting the pain relief they want (specifically, epidurals). They shame women who don’t want to “tough it out” in labor. They impose their philosophy and agenda on all women in their care. That is unacceptable.

        I am so sorry for what your daughter had to go through.

        • Lizzie Dee

          It wasn’t SO awful for her – second baby, young and generally healthy – but it wasn’t her choice. Such NICE young women, but more patronising than any doctor I have ever come across, and they did not inspire confidence.

  • Namebat

    epidural medication does get into the baby. there have been studies that confirm that it crosses the placenta. That said, the amount that the baby gets is very small, especially in today’s epidurals. Most babies have minimal to no effects from them.

  • Namebat

    My mother in law had a cancer plan. She had choices. Did she want a mastectomy with reconstruction, or surgery with radiation. Radiation meant that reconstruction in the future (should cancer resurface) was less likely to be successful. Her doctors discussed these options with her, informed her of the risks and allowed her to make her decision.

    There are some medical situations where patients have choices. There are some where they don’t.

  • Namebat

    You know, in ANY field clients who don’t have your training come in with a list of demands about how things should be done.

    When my clients do that I tell them where it is possible to meet their demands, and where it just isn’t. (I’m in engineering). It is part of the professional’s job to manage client expectations.

    • Amy Tuteur, MD

      Do they tell you HOW to do your job? What tools you may or may not use? What measurements you may or may not make?

      Do they tell you that you are doing it “wrong” and they know more than you because they “educated” themselves about engineering on the internet?

      Do they insist that the safeguards you build into your engineering projects are useless and done simply so you can pad your bill?

      How would you react if they did those things?

    • KarenJJ

      I’m in a similar field and have similar issues. Like you say it’s part of the job. I appreciate that there isn’t an entire industry on the internet promoting ‘natural engineering’ and how empowered it is to build their own bridge or hook up their handmade generator to the grid using fencing wire. I appreciate that when I say ‘this particular method won’t work for xxx reasons’ I’m generally believed or they can get a second opinion or whatever. Nobody’s telling them my information is useless or actively trying to undermine me. Clients come to me typically because they need something done that is difficult for them to do on their own and they appreciate technical input. I’m not accused of trying to manipulate their plan for a glorious unnassisted skyscraper..

  • Namebat

    Most of the studies you’re quoting say that women were satisfied with their birth plans and were glad they’d written them. I think that’s a good outcome.

    Also, birth plans with outdated info mean that the patient’s medical team could educate the patient about what will actually be happening. It’s a good opportunity.

    I wrote a birth plan after actually talking to my birth hospital. It included a lot of things that the staff found helpful. Conversations with patients actually make the big unknown of your first birth a lot less scary for them.

    For instance, I went drug free and didn’t want even the recommended hep lock (I hate intravenous things). My doc explained that the hep lock was a good idea because in case of blood loss, veins clamp down and it’s harder to get the needle in. That made sense to me, so in my birth plan I requested that they just tape over the hep lock really well so I couldn’t see it or feel it move.

    Also, I gave them a big warning flag about not allowing my mom in under any circumstances. I didn’t plan to tell her I was going into labor, but she’s mentally ill and weirdly psychic about stuff like that and I was afraid she’d show up anyways.

    Also, my husband gets low blood sugar when he forgets to eat and starts acting grotsky and sick. I put in my birth plan that if they notice him being less than his usual cheerful self, they should offer him some juice and he’ll become helpful again.

    Other than that, I let them know that I would prefer to labor without drugs for pain relief or augmentation. After researching my hospital, I learned that they had wireless fetal monitoring available, so I requested one of those. I let them know that I intended to breastfeed. That’s all they needed to know to support me properly in my birth. My plan was about 1/2 page long with lots of white space.

    I learned all this stuff by ‘breaking hospital protocol’ and visiting them before 28 weeks (when they usually allow you to schedule your appointment). I think they should allow this initial visit early for everyone so they know what to expect, what to research, and what to prepare for. It was great!

    I get that several pages of ‘don’t do this, don’t do that’ is frustrating for medical personnel. But telling moms (who are all a bit nervous and scared and don’t know the hospital staff) to just listen to all these strangers and do exactly as they say is scary. This is some very delicate, intimate stuff going on! Moms who bring in birth plans just want hospital staff to know something about their specific situations.

    Moms need to be educated by professionals as they research labor and delivery. They need to be told that unexpected things happen, so the birth plan is not a script. But they need to feel that their wishes are known and followed as far as is possible.

    • KumquatWriter

      If you’re expecting that level of attention to your husband, I strongly suggest an additional support person – for you or for him.

    • Bombshellrisa

      I totally understand about not letting your mom (or anyone else who shows up whom you wish wouldn’t) in your room. That is important.
      The part about your husband having to be attended in addition to caring for you too is unfair to the staff and could be solved by tucking some snacks and juice boxes into your hospital go bag and having him set some reminders on his phone.

  • utopicdream

    Dr. Tuteur isn’t laughing at anyone’s sentiments. If you had a serious complication during delivery, you’d end up seeing an OB/GYN or ER physician anyway. The details she addresses are subtle, and I didn’t think she applied broad strokes to all expecting mothers. She’s railing against obnoxious birth plans, that’s all. It’s standard for an OB/GYN to have routine dialogue with their patients and they’ll even ask: do you other concerns that you’d like to address. Being handed a list of ultimatums by a patient, however, violates the spirit of the professional, courteous, respectful doctor-patient relationship. The patient becomes the tyrant, under the auspices of “this is a big day for me.” That’s what I read from Dr. Tuteur’s comments. Not that she hates all expecting moms.

  • utopicdream

    And you’re seeing more of that sentiment in this thread, aren’t you? I’d bet that many of the know-it-alls are: predominately white/caucasian, college-educated, middle class and above. Some may be expecting their first child, others have had their 2nd or 3rd child. I know that pregnancy and the vagaries of bringing a child into the world are stressful and consume a lot of time for new mothers, but there is a MASSIVE health, legal and regulatory environment that doctors (ALL doctors, not just OB/GYNs) who will interact with you and your future child have to deal with. The number of practicing OB/GYNs is low, folks. When you get a serious complication and the midwife can’t tend to it (midwifes don’t know how to properly sedate you, conduct an invasive interventional procedure, maintain your blood pressure while, stabilize you while additional surgeons enter the picture to deal with any unexpected neonatal surgery), OB/GYNs are there. So are the OB/GYN support staff and medical support staff (nurses, medical assistants, nurse and surgical PAs. Labor and delivery is complicated, but knowing that you have a competent medical staff to get your through potential catastrophic clinical scenarios…that’s priceless.

  • Enrico

    This is the second time I’ve had the misfortune of stumbling across your blog. Your arrogance and churlish response in your comments is astounding.

    • T.

      I am always stroke dumb by people that confused being right with being arrogant.

    • Dr Kitty

      How, exactly does one “stumble across” a blog, decide that you don’t like it, comment to say so, and then DO IT AGAIN?

      Don’t like it? Then don’t click the link, don’t read it, don’t comment- simple.

  • Tomas

    Goodness, representing an industry that kills over 100,000 people a year (conservatively), you may wonder why anyone might wish to be a bit more involved in the process. Now, I realize OB’s don’t, but the medical profession must realize people die due to medical mistakes.

    As far as birth plans, if some moron has it written they want x, y, z IV’s for the duration, well, perhaps a psychiatrist may be more appropriate. In my opinion, a birth plan is a way to answer the questions you are going to be asked to consent to BEFORE you are at the hospital, excited to have the baby, or perhaps in active labor, and in no state to make rational decisions. Our last child (no plan) was given multiple vaccines some of which our child has no hope of ever encountering while young (hepatitis for example). I know you guys have your list of things, but just because you make a plan, doesn’t make it a plan I must follow. Since that day, the list of vaccines has grown to ridiculous length, regardless of your stance about injecting newborns w/ multiple vaccines, some of dubious origin, and a fair amount STILL laced w/ compounds known to be dangerous (just look at the materials safety sheet). I realize it is easier on the “pros” if the unwashed would just STFU and take their medicine. Some of us think we need to have a bit more info before blindly signing off on extra profits for the hospital. FYI, our son was kept 24 hours in NICU as a precaution (they left that precaution part out when they put him in there), nice little extra $5k charge to the insurance co. So, you might wonder why we non docs might be a tad skeptical at times.

    • Amy Tuteur, MD

      Really? Modern obstetrics kills 100,000 people per year? Please present some data for that claim.

      • utopicream

        Dr. Tuteur, they won’t be able to find these studies. They don’t know how to use PubMed and even if they did, PubMed would report “0 studies found”.

  • Amy Tuteur, MD

    Which part of “studies show that birthplans are ineffective” are commentors who have just parachuted in having trouble understanding?

    • Namebat

      I think it’s bits like this:

      “The majority of women agreed that the birth plan enhanced their birth
      experiences, added control, clarified their thoughts, and improved
      communication with their health care providers.”

      This was in one of the quotes you selected. Maybe the plans didn’t have any effect on the outcome of the birth, but most women still felt good about their plans.

  • FrustratedNurse/Anthro

    I would like to quickly point out that you are an MD, not a sociologist or anthropologist .. back in the day when you were trained there was no sort of humanities requirement when it came to your education. I think it is silly that you are representing yourself as an expert of human comfort when you resume seems to show that you focused you career on the mechanics of the human body. Doctors like you are the reason people are scared of Labor and delivery!

  • VeronicaHome

    Birth plans that are “filled with outdated nonsense” are an opportunity for medical providers to provide education. People should be encouraged to be informed about what to expect during labor and should have their choices honored. If a medical provider views a patient who is seeking an exchange of information as “defying authority” – they need further professional development.

  • Melissa

    A birth plan is absolutely necessary. This comes from a mother who did not institute one with her firstborn and knows why its important to make your wishes known to the service providers, the hospital staff.

    • Melissa

      Wow! i just read some of the other comments and must ask, since when is it offensive to make requests for services, especially healthcare, to be carried out in a certain manner? The patient that does not take an active part in his/her healthcare is foolish. Nurses and doctors are people, too! You should always question your healthcare provider! One should never assume that the nurse or doctor treating them is infallible. You are aware of the major medical blunders that occur every single day due to humanity’s never failing ability to make mistakes, right?! You must be very fortunate to never have experienced malpractice… Well, good for you!

  • DirtyOldTown

    Really? I seem to recall a reading post on this blog some time ago about midwives in a forum discussing their patients in less than flattering terms. Midwives laugh at patients behind their backs, too Keri. All the way to the bank.

  • http://www.facebook.com/ta.ra.5439 Tara Birth Doula

    As a birth doula (get out your pitch forks!) I wholeheartedly disagree about birth plans. Yes. Moms who have a birth plan that is unbelievably specific are setting themselves up for disappointment if they aren’t keenly aware that this is just how you would like things to be and NOT how things will go. I encourage my clients to have a birth plan and I help write one. It helps open up the conversation with them as well as their doctors about how they feel about sensitive subjects. Expecting women to blindly follow their doctors orders is absurd and reminiscent of something straight out of the 1950′s. Not all practices routinely done are evidence based and women should be educated and encouraged to advocate their approval or apprehension about certain routines. It’s time to face facts. Doctors are only human and they make mistakes or even decisions based on concern for lawsuits, convenience and countless other things that aren’t always in a mom/baby’s best interest. When 1 in 3 women are giving birth in the operating room, having a plan of action, list of procedures you plan to avoid is more than just a suggestion, it’s a necessity.

    • DirtyOldTown

      Please inform us, O wise birth doula, which practices that, according to you, are routinely done in hospitals, are not evidence-based. I’m eager to hear what particular piece of drivel you were taught at your DONA workshop.

      • Kristina Vazquez

        I don’t know what “particular piece of drivel” you are wanting to hear, but at least she learned something unlike you who obviously failed manners 101. Seriously? Is Snarky your middle name?

        • DirtyOldTown

          Oh, I’m sorry – is this Miss Emily Post’s Blog of Manners, Courtesy, and General Nicety? My mistake. I thought it was a blog where people had to back up any claims with evidence. Tara made a claim, I presume based on drivel, that hospitals routinely perform procedures on pregnant women that are not evidence-based. I’m willing to be proven wrong. (Just so you know, Snarky is actually my first name, but I usually go by Sparky, because I think it’s prettier.)

        • Simran

          A doula has no medical training. None. A certification in 3 days does not make them knowledgeable about “birth” practices. She didn’t learn anything.

    • Bombshellrisa

      We don’t do pitch forks, as we have some amazing doulas here who understand their scope of practice. They also understand the term “evidence based”, so would never suggest having a birth plan “makes things go” in any direction.

    • Erin

      Thank you for your post. Birth plans CAN be helpful to parents who have personal views about circumcision or even how soon to cut the umbilical cord. I can see how a doctor would be displeased what what seems like “demands”, but we are paying them for their services.

  • Gen Tor

    This article sounds more like a rant from a medical practitioner. My choice to create a birth plan is simply to help keep us on the same page. For instance, due to spinal problems, I cannot have an epidural. I’d rather just have that information on the birth plan. Furthermore, my husband and I would like skin-to-skin time with the baby and some time with just us 3 before my horrible mother-in-law comes in and starts making everyone uncomfortable. I’d like to request the nursing staff to help with these objectives. Anything more detailed than that, I’m sure I can answer myself that day.

    Women going into labor–particularly with their first pregnancy–face a number of issues as well as fears. Women who do not work in the medical field can feel very out of control of their bodies. I know I do. Here I think I have this ‘pregnancy thing’ figured out and a new symptom arises. Medical practitioners need to respect these fears and the need these women have to have some sort of input in this very frightening experience. It is a matter of patient dignity and comfort.

    May I simply say that your article here makes me even more grateful for my sister-in-law who is an RN and my doctor, who both support my choice to write down what I need in my birth plan and submit it to them for feedback. I wouldn’t use your services because you don’t seem to care for the psychological needs of the patient.

    Furthermore the comment below of the OB resident is disturbing. It states, “ob doc • a month ago−I’m an ob/gyn resident in my final year. Your summary of birth plans is spot-on.They are absurd and insulting. I didn’t sacrifice an entire decade of my life and go $200,000 into debt to have someone who knows nothing about medicine tell me how to practice.” I don’t care how much money you paid or how many years you were in school. This is my body–not yours. I have to live with it and take care of my child for the rest of life–not you. You think we owe you unwavering trust; you are sadly mistaken.

    You are one of those resident doctors that I will respecfully request NOT be in the room for the birth! You are unprofessional as well as uncaring. Continue laughing behind the back of your patients and it will come full circle some day.

  • Gen Tor

    This article sounds more like a rant from a medical practitioner. My choice to create a birth plan is simply to help keep us on the same page. For instance, due to spinal problems, I cannot have an epidural. I’d rather just have that information on the birth plan. Furthermore, my husband and I would like skin-to-skin time with the baby and some time with just us 3 before my horrible mother-in-law comes in and starts making everyone uncomfortable. I’d like to request the nursing staff to help with these objectives. Anything more detailed than that, I’m sure I can answer myself that day.

    Women going into labor–particularly with their first pregnancy–face a number of issues as well as fears. Women who do not work in the medical field can feel very out of control of their bodies. I know I do. Here I think I have this ‘pregnancy thing’ figured out and a new symptom arises. Medical practitioners need to respect these fears and the need these women have to have some sort of input in this very frightening experience. It is a matter of patient dignity and comfort.

    May I simply say that your article here makes me even more grateful for my sister-in-law who is an RN and my doctor, who both support my choice to write down what I need in my birth plan and submit it to them for feedback. I wouldn’t use your services because you don’t seem to care for the psychological needs of the patient.

    Furthermore the comment below of the OB resident is disturbing. It states, “ob doc • a month ago−I’m an ob/gyn resident in my final year. Your summary of birth plans is spot-on.They are absurd and insulting. I didn’t sacrifice an entire decade of my life and go $200,000 into debt to have someone who knows nothing about medicine tell me how to practice.” I don’t care how much money you paid or how many years you were in school. This is my body–not yours. I have to live with it and take care of my child for the rest of life–not you. You think we owe you unwavering trust; you are sadly mistaken.

    • Amy Tuteur, MD

      Which part of “studies show that birthplans are ineffective” are you having trouble understanding.

    • utopicdream

      I didn’t get from Dr. Tuteur’s commentary that she was absolutely against a birth plan, insofar as a birth plan constitutes open dialogue with your OB/GYN. This has everything to do with fine details: extensive, laborious lists of demands are exhausting. The number of practicing OB/GYNs is dwindling across the country. I would’ve liked Dr. Teuteur to maybe introduce a novel concept: the concierge OB/GYN. If I were to practice as an OB/GYN, I would take on fractious patients, but at a steep cost. Also notice, from the literature that Dr. Tuteur introduced (and no one has really commented on this peer-reviewed, evidence-based data, did they): these fractious patients are predominately first-time, white, college educated women. Not minority, less-educated, economically impoverished women. Pretty interesting.

  • Ali

    I used a birth plan for my first delivery, and I’m so glad I did. My doctor was not on call that weekend, and an OB I’d never met delivered my daughter. The birth plan helped communicate my wants to the nursing staff, and I was able to have a natural delivery. I edited the birth plan with my own preferences, which allowed me to request and not demand. I will probably not use a birth plan this time, but it definitely prepared me for the first birth.

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