Dr. Amy’s plan for a safe, sane, satisfying birth

Portrait of infant resting on mother moments after birth at hospital

Regular readers know that I consider birth plans worse than useless, utterly ineffective at achieving their objectives and nothing more than a recipe for disappointment.

I’m offering this alternative plan in an effort to mitigate the guilt, disappointment and self-recrimination engendered by standard birth plans. What follows is NOT a plan to manage birth, but a plan to manage expectations around birth in order to ensure a safe, sane and satisfying experience.

This is NOT a plan to achieve the birth of your dreams. The birth of your dreams exists in one and only one place — in your dreams. Planning the birth of your dreams is the equivalent of planning to have an infant who sleeps through the night at 3 weeks of age. It could happen, but it’s not likely and expecting it to happen is a virtual guarantee of frustration, disappointment and anger.

This is NOT a plan to achieve bragging rights. In my view, birth is an intimate experience reserved for those closest to the baby and the medical professionals needed to ensure the health of the mother and baby. It is not an opportunity to feel superior to other women, any more than having painless periods or great oral sex is a reason to feel superior to other women. It is none of their business.

This is NOT a plan to empower you. You can’t be empowered by birth any more than you can be empowered by menstruation or digestion. It happens, regardless of what you think about it, or whether you think about it at all.

This IS a plan to ensure, as much as possible, a healthy baby, and a healthy, non-traumatized, happy, satisfied mother.

Here’s the plan:

1. Don’t plan. Planning your baby’s birth makes as much sense as planning the weather on your next wedding anniversary. It is a natural process, and, as such, you have no control over it. You have no idea what your labor will be like, no idea what position the baby will be in, no idea how much pain you will have or how you will tolerate that pain, and no idea how or if your baby will tolerate labor. You can plan what music is on your iPod and perhaps what color popsicles you’d like to suck on in labor. That’s about it.

2. Respect birth. Birth is a wild, powerful, potentially life threatening process. It’s like a hurricane or a tornado. You can’t control it; you just have to do what you can to stay safe and ride it out. Don’t trust birth. Birth is no more trustworthy than hurricanes or tornadoes. Only a fool trusts that her thoughts can prevent a tornado from hitting her house. Sensible people go to the basement and hope that the storm passes by.

3. Expect to experience the worst pain of your life. There is a reason why the writers of the Bible imagined that childbirth is a punishment from God. It is widely recognized among specialists in pain and pain management to be the worst pain you are likely to ever experience. It is absolutely essential to have realistic expectations about the pain of labor. In my experience, the single biggest source of disappointment for women is that they believed the lies about pain spoon-fed to them by the natural childbirth industry: that the contractions are not pain but “surges,” that there is a difference between “good” pain (childbirth) and “bad” pain (all other sources of pain), that the pain is beneficial, that birth is “orgasmic” or the racist, sexist fabrication of the originators of natural childbirth that it is fear that leads to pain. No, it a a baby being forced from your body that is the source of the pain. Do you find Super tampons uncomfortable? Extrapolate and you begin to get the idea.

I say this not to scare you, but to prepare you. I have contempt for healthcare professionals who tell you “this won’t hurt” in an effort to gain your cooperation when they know it will hurt a lot. Honesty is a bedrock value in medical care. Don’t trust people who lie to you about pain.

4. Don’t make any decisions about pain medication until you feel the pain. Deciding before labor begins to refuse an epidural is the equivalent of vowing not to use an umbrella next Tuesday. You don’t know what the weather will be next Tuesday so it would be the height of foolishness to make plans before you know. The ONLY people who encourage you to make decisions about pain management before you actually feel and assess the pain are people who benefit from your decision to refuse pain relief. Make decisions based on what is good for you, not what is good for them.

5. Trust yourself. Understand your own priorities and don’t get fooled into substituting someone else’s priorities for your own.

6. Trust preventive care. Obstetrics is, at heart, preventive care. It’s all about the tests and procedures that monitor for complications so they can be managed early, long before disaster strikes. Opposing obstetric tests and procedures is like opposing colonoscopies when you are over 50. Sure, most people who have a colonoscopy don’t have colon cancer, but that doesn’t mean that most colonoscopies are unnecessary. It is always better to prevent a complication then wait for it to happen.

7. Don’t keep secrets. Obstetricians and labor nurses are not mind readers. You are a unique individual with unique experiences and fears that can impact your experience of birth. Have you been a victim of sexual assault? Do you have a fear of needles? Let your healthcare providers know. Most are extremely sensitive to individual fears and will try to do what they can to mitigate those fears.

8. Don’t be confrontational. Natural childbirth advocate encourage women to be confrontational as an effective way to undermine the trust between women and their providers. It serves the interests of natural childbirth advocates to set up barriers between you and the people who are caring for you. It does not serve your interest at all.

9. Don’t pretend that your thoughts have the power to avert or cause disaster. Imagine if someone told you that you can cause skin cancer by wearing sunscreen and prevent it by planning not to get skin cancer. Utterly foolish, right? But that’s the thinking of natural childbirth advocates who claim that thinking about complications causes complications and that ignoring them and imagining that they won’t happen will prevent them.

10. Keep your eye on the ball. In this case, the “ball” is a healthy mother and a healthy baby. It is not a specific birth experience. You can recover from disappointment. You will never recover from the death of your baby.

The best way to have a safe, sane, satisfying birth is to have realistic expectations, plan on pain, decide about pain medication when you feel the pain, trust preventive care, keep your eye on the ball, and, above all RESPECT BIRTH. It is wild, powerful, unpredictable and unplannable, and anyone who tries to convince you otherwise is not being honest.