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.

  • Wendy Hinds

    My experience is that if women are treated kindly and emerge with a well baby and in reasonable health, they tend to be loyal to their birth choices, whatever they are.

    I would no more discourage someone from planning a drug free labour than I would discourage them from any other birth preference. I do tend to point out that they are very unlikely to get their drug free birth if they labour in any of our local obstetric units. Luckily we have a well resourced NHS homebirth service and excellent alongside midwife led units which most women can access. Low risk women who choose to labour in these units and at home have very high rates of straightforward and unmedicated births. God bless the NHS!

  • Katana

    I had a birth plan, but I did it with the understanding that if things went wrong, all bets were off. It was also great to have something in writing in case the midwife I saw all the way through my pregnancy wasn’t able to attend, which is what happened as she had to leave early.
    Amy, I get that you object to women in denial about the pain, but knowing that it is there, it has a purpose and every contraction brings you closer to a baby makes it easier.
    I had a beautiful waterbirth when my son was born. I only used gas as pain medication and between contractions was such bliss, I could relax and rest for when they came again. I was so relaxed during contractions I thought I’d fall asleep!

    And if/when I have it again, I’ll go the same way and no epidural. I was able to feel my baby move down and out of my body, something I won’t want taken away. I still remember when I felt him “leave” my body, like he was shot out of a cannon.

  • mythsayer

    Dr. Amy,

    I think it’s interesting that you said the pain is widely thought to be the worst pain you’ll ever feel. When I was 20 I started having pain in my upper right quadrant and would throw up and have these weird bouts of indigestion. Because I was so young, it took them 6 months to figure out it was my gall bladder. By that time, I was lying on the floor screaming in pain. I couldn’t keep ANYTHING down… not even water. When they did my surgery, they found out that, yes, of course I had gall stones, but what I really had was a blocked bile duct. One of the stones was so lodged in there that I was in full on liver failure.

    I was told later that gall bladder pain is either AS BAD AS or WORSE THAN labor. Combine that with liver failure and what do you get? Someone who was absolutely terrified of labor. TERRIFIED. Even though I knew I’d be asking for an epidural, I was scared to death of them not giving it to me because I wasn’t dilated enough and then moving too fast to get one at all. That happened to my cousin and a friend. Both went from a 3 to 10 in an hour and both were denied epidurals because they were at a 3. My cousin said dilating that fast was really painful.

    But anyway… that is why I wanted an elective C-Section. I joke (but not really) that I have PTSD from the gall bladder/liver pain. If labor is anywhere NEAR that, count me out entirely. I wanted nothing to do with it.

    I loved my C-Section. I am so grateful my OB allowed me to have one. I don’t know what labor feels like, and I don’t feel like I missed out on a thing 🙂

    • Amy Tuteur, MD

      I’ve had gallbladder pain, too, and had my gallbladder removed because of multiple attacks due to gallstones. Gall bladder pain was the closest thing to labor that I’ve ever experienced, but, for me, labor was worse because it latest far longer.

      It’s not surprising that they feel similar because the source of the pain is similar, a hollow organ attempting to push a large object through a small passage.

  • anne

    Not sure if it’s been shared here but it’s a short article and some photos explaining how documenting a c-section showed a photographer that c-sections could be peaceful and joyful.

    http://www.huffingtonpost.com/2014/11/04/c-section-photos_n_6084522.html

  • anonymous

    My wife and I had a birth plan for our first, it was to get to the hospital in a reasonable time, get ma, dad, mom-in-law and dad-in-law before the birth. Then the only thing we cared about was making sure that our girl came out healthy. What else can you really plan for?

    • toni

      I think it is good advice generally to not fret about the things you can’t control. It’s a waste of energy and makes people around you anxious as well. Perhaps I wouldnt have this huge grey streak of hair at 27 if I didn’t worry so much about everything and everybody I know.

      • The Bofa, Being of the Sofa

        Perhaps I wouldnt have this huge grey streak of hair at 27 if I didn’t worry so much about everything and everybody I know.

        Maybe the streak was caused by your sister with her magical powers freezing your head?

      • anonymous

        Yeah, the OBs were laughing at our plan when they realized it was tongue in cheek. It was something like:
        Call my mom and dad
        Call wife’s mom and dad
        Did we bring camera?
        Did we bring change of clothes?
        Do we have pringles(inside joke)?
        Is GPS programmed?
        Is wife in car?

  • oldmdgirl

    Ooh! I wish someone had given me the suggestion of loading up my iPod with music. All I had was the same damn infomercial playing over and over again on the tv in my hospital room. Some good music might have been really nice!

    How about 1) You can endure anything for 24-48h (tops). Yes, you can/will do this. 2) The way your baby comes out does not in any way equate to your value as a person or as a mom, 3) Giving birth is not another way to compete with other women, 4) The birth itself is the easy part. It’s then next 18 years (or more) that are the real challenge.

    I remember I just really wanted to have my husband cut the cord, and to have him see the placenta (because I thought it looked cool when I was on Ob as a med student).

    • D/

      I’ve always thought placentas look cool too and was disappointed when my husband, green-faced, asked my OB to ” Just put that away please” in the middle of her delightful show-and-tell after the birth of our second.

      My favorite placental reaction encounter though was one of a young Girl Scout who shared her sibling’s birth story with me. She had been instructed not to engage in random birth conversations about such a special and private event, but her enthusiasm for what she had seen was bursting. As her troop leader/ NICU nurse I was the perfect solution for sharing her secret story.

      She gave me a completely captivating account of everything she had seen and felt during her little brother’s birth but became quite conspiratorial at the end, leaned over and whispered, “but OMG, Ms D/, when that liver came out after he was born I thought I was going to die!”

      Much cuter than the hubby’s reaction, and I’ve had to suppress a smile for every placenta I encountered since 🙂

  • Guest

    Completely and totally off topic, but I’m just hoping to get an opinion from those of you who comprehend studies better than I do. I’m currently 14 weeks pregnant and planning on getting a flu shot this week. Of course I googled (when will I learn?), and came across this study: http://www.jpands.org/vol11no2/ayoub.pdf and it has me all freaked out. Should I get the flu shot or not? By the way I am a healthy woman in my early thirties, so I’m not at a particularly high risk other than the fact that I read that pregnancy makes my immune system not as effective.

    • oldmdgirl

      You should get the flu shot. The benefits FAR exceed the risks.

    • Who?

      The first author is on record as saying-around the same time as this article was published-that there is ample evidence that vaccines cause autism. With that as his calling card, consider the article.

    • Linden

      I don’t know about the US, but the UK guidelines are unequivocal: you should get the shot if you are pregnant.
      The flu can be devastating to pregnant women. I got the shot before I realised I was pregnant (I was trying to conceive, so it wasn’t unplanned). I got the second one recently (I’m still breastfeeding). So theres my sample size of 1.

    • araikwao

      Getting the ‘flu in pregnancy is associated with autism and schizophrenia, if you’d like a little reverse scaremongering! The shot is widely recommended in pregnancy, e.g. Mayo clinic, UK guidelines, I think Aus too.

      • KarenJJ

        I caught the flu while pregnant and scared the crap out of myself reading about it. Next pregnancy I got the flu shot.

    • theadequatemother

      Pregnant women are one of the groups that are higher risk and SHOULD get the flu vaccine. In my city we had Two pregnant women with flu on ECMO last season. If you don’t know what ECMO is, it’s like the cardiac bypass machine used during heart surgery and a way of oxygenating blood when lungs fail and mechanical ventilation is not enough. Mortality for the women is high and for the fetuses it is extremely high.

    • Julia

      In case you’re worried about the thimerosal issue – you can request a thimerosal-free flu shot. At the practice I went to all pregnant women got the thimerosal-free version of the vaccine.
      I also think the journal this was published in has an anti-vax slant, and does not necessarily provide objective information.

      • The Bofa, Being of the Sofa

        I have no problems with avoiding thimerasol, but for the right reasons. There could be reasons why avoiding thimerasol might be right (allergies, for example) but don’t do it because you are concerned about it causing autism or other such flim flam. There is no link between thimerasol and autism, and it is so much not a link that it doesn’t even make sense to avoid it “just to be on the safe side.”

        If the “thimerasol issue” to which you refer is autism, then there is no worry at all.

        • KG

          There is a well established heightened sensitivity of the developing nervous system to mercury. Why trust that even the small dose present in a flu shot is safe? There are thimerosal free options.

    • moto_librarian

      I got a flu shot during both of my pregnancies – with my second child, I was only 8 weeks along when I got it. At my CNM’s office.

    • AlisonCummins

      Consider the source. ‘The Journal of American Physicians and Surgeons’ sounds legitimate but it is NOT a scientific journal. It’s a political one with predefined conclusions.
      http://web.archive.org/web/20130419004328/http://www.neurodiversity.com/weblog/article/91/strange-bedfellows

      Other sources:
      Very long and directed at health care workers, but clearly understandable, stern and correct.
      http://www.sciencebasedmedicine.org/protect-yourself/

      Very credible. The CDC considers the totality of the evidence, not just single studies. There are a whole lot of studies out there. By the time you get the education required to understand them and then read them all you will have had the time to have five children.
      http://www.cdc.gov/flu/protect/vaccine/pregnant.htm

      Get the shot, for you and your baby’s sake. Remember that the “flu” is not just any respiratory illness, which ma

      • AlisonCummins

        From the second linked article above:
        (The opening statements are dumbass excuses.)

        5. ‘Flu isn’t all that bad of a disease.’ Underestimating Dumb Ass. Part of the problem with the term flu is that it is used both as a generic term for damn near any viral illness with a fever and is also used for a severe viral pneumonia. Medical people are just as inaccurate about using the term as the general public. The influenza virus directly and indirectly kills 20,000 people (depending on the circulating strain and year) and leads to the hospitalization of 200,000 in the US each year. Influenza is a nasty lung illness. And what is stomach ‘flu’? No such thing.

        6. ‘I am not at risk for flu.’ Denying Dumb Ass. If you breathe, you are risk for influenza. Here are the groups of people who should not get the flu vaccine (outside of people with severe adverse reactions to the vaccine): Former President Clinton, who evidently doesn’t inhale. Michele Bachmann. Wait, that’s the HPV vaccine. And people who are safe from zombies. If you don’t get the vaccine you do not have to worry about the zombie apocalypse, because zombies eat brains.

        10. ‘I received the vaccine and I got the flu anyway.’ Inexact Dumb Ass. The vaccine is not perfect and you may have indeed had the flu. More likely you called one of the many respiratory viruses (viri?) people get each year the flu. Remember there are dozens of potential causes of a respiratory infection circulating, the vaccine only covers influenza, the virus most likely to kill you and yours.

    • Squillo

      Here’s my flu shot scare story, FWIW:

      When I was pregnant with my second, I didn’t get the flu shot because of concerns about “the mercury.” I was a healthy woman in my thirties, but I got the flu in my second trimester, and it turned into a drug-resistant infection. In trying to avoid “the toxins” in the flu shot, I ended up getting three (I think) rounds of different antibiotics, a steroid, two different narcotics, two x-rays, anesthesia for two minor surgeries and hospital time. Plus I lost 20 pounds in six weeks, which was definitely not good for me, but fortunately didn’t seem to hurt my baby, who was born healthy at 40 weeks. She’s not autistic, but of course, I’m a bit worried about the possible schizophrenia connection, and I probably won’t breathe freely until she’s at least middle-aged.

      I understand the worries about getting the shot in pregnancy (my older child is autistic, which is what led to my worries), but I really, really wish I had listened to my OB and gotten it.

    • Lion

      My sister’s perfectly healthy 28 year old friend got flu in her third trimester and died.

    • Guest

      Thank you for all of your advice! I’ll get the shot ASAP. 🙂

      • The Bofa, Being of the Sofa

        I’m glad to hear that. No one has mentioned, btw, that you getting a flu shot also protects your baby from the flu after he/she is born. It’s true!

  • Guesteleh

    Meanwhile, real women in the U.S. are losing their civil rights simply because they’re pregnant: http://www.nytimes.com/2014/11/08/opinion/pregnant-and-no-civil-rights.html?_r=1

    Based on the belief that he had an obligation to give a fetus a chance for life, a judge in Washington, D.C., ordered a critically ill 27-year-old
    woman who was 26 weeks pregnant to undergo a cesarean section, which he
    understood might kill her. Neither the woman nor her baby survived.

    In Iowa, a pregnant woman who fell down a flight of stairs was reported to
    the police after seeking help at a hospital. She was arrested for
    “attempted fetal homicide.”

    In Utah, a woman gave birth to twins; one was stillborn. Health care
    providers believed that the stillbirth was the result of the woman’s
    decision to delay having a cesarean. She was arrested on charges of
    fetal homicide.

    In Louisiana, a woman who went to the hospital for unexplained vaginal
    bleeding was locked up for over a year on charges of second-degree
    murder before medical records revealed she had suffered a miscarriage at
    11 to 15 weeks of pregnancy.

    • Lion

      This is insane. It sounds like plots for far fetched movies. Please tell me these aren’t real?

      • An Actual Attorney

        The forced cs is In re AC. It happened in 1987 and the Court of Appeals said it was wrong in 1990. The case stands now for the proposition that a pregnant woman always has the right to control her care. It was a horrible lower decision and tragic facts. I think it’s also irresponsible to write about it like it was recent or like it ultimately wasn’t repudiated by the higher court.

        • Who?

          Just looked at that, how horrible a situation, created essentially by the agitation of pro-life activists.

          Very glad the Court of Appeal has said it was wrong.

          These new laws are awful too.

    • The Computer Ate My Nym

      There was also a case in Wisconsin where a woman who had a history of drug abuse but no active drug abuse was forced into an unnecessary and possibly detrimental drug rebhab program because she was pregnant. The thing that gets me about that case in particular is that she asked for a lawyer and was denied. If she’d had the baby then killed it and offered its body as an appetizer to the police she’d be given access to a lawyer because we do that for all people accused of crimes no matter what we think of the crime or the person who is accused of committing it. By not allowing her a lawyer the court was effectively saying that they considered her to not be a person but just a container for the fetus.

  • Guest

    OT: this article was GREAT. I wish more people didn’t feel “shamed” by having a c-section. http://m.huffpost.com/us/entry/6104136?ncid=fcbklnkushpmg00000037

    • fiftyfifty1

      I wasn’t crazy about her perpetuating the myth of the “husband stitch”.

      • The Bofa, Being of the Sofa

        How about the comment from the “natural childbirth educator” that she tells women about the benefits of NCB?

        Hmmm, is she an “educator” or a propagandist?

      • Jen

        How can it be a myth when it actually happened to the author? Or do you not believe women when they discuss their childbirth experiences unless it exactly jibes with how you believe labor should, and thus does, happen?

        • toni

          After I had my first baby and the dr was checking me he asked my husband if it was okay to leave it to heal on its own. It was a teeny little tear (I checked it myself the following morning it was about the size of a lentil) and he said something like ‘it probably isn’t worth stitching but what do you think? Look okay to you?’ He’s a good doctor and I do like him, I don’t think he would have ‘overstitched’ me but I did find that odd that he was consulting my husband and not talking to me. And as he left he said to him ‘you can have intercourse again in a month’. Which was great because my husband kept nagging me for sex 4 weeks later eventhough my appt with my usual ob (not the one that delivered us) wasn’t until six weeks after delivery. and I was really nervous about doing it before I was checked. As it happened my usual ob didn’t even look down there at the check up because I hadn’t had any stitches. So I got more complaints about delaying sex unnecessarily. sigh.

          • Medwife

            That is very disturbing.

          • toni

            which part? I wasn’t sure if that was normal to ask the husband for his opinion and not the patient, i was reasonably lucid though of course I couldnt see what they could see. And with the whole ‘you can have intercourse in a month’ is it common to even talk about that right after delivery? I’d just given birth with no pain relief and the thought of having sex within the next year was horrifying so i think that was premature and a little insensitive. I wish he had followed it with ‘if she feels up to it’ or ‘after her check up’ but maybe the doctor thought that was a given.

            Another surprise was the rough perineal massage as i was pushing. it was almost as bad as the crowning and it was never mentioned during my appointments that they would do that and he didnt warn me that he was going to do it at the time.i do think they could prepare you better for these things, give you a leaflet with ‘things that need to be done to you, things that may be done’. I just thought to myself the whole time what the hell is he doing but didnt say anything except ‘ow’. i thought i was dropping major hints lol but they obviously just assumed i was saying that about the other pains.

    • Guesty

      I wish more women didn’t feel shamed by having a home birth too. Shame is never good.

      • yugaya

        I wish women having homebirth stopped lying how it is “as safe or safer than hospital birth” because it is not. I wish no buffoon claiming to be human and women’s rights activist was ever under any circumstances allowed to tell women what their bodies were “made to do” without being laughed at. I wish that lying, manipulating, state-border hopping birth-addicted killer quack CPM midwives were outlawed, and I wish that in every decent country in the world the same standard of training and education was required to obtain a license to deliver babies.

        Lack of objectivity is never good either.

  • Dr Kitty

    Have you seen this?
    http://www.bbc.co.uk/news/health-29904132

    Twin study showing on particular bacterium is more common in leaner people, and that mice who had this bacterium introduced to their guts lost weight.

    Interestingly, it was a twin study, with identical and fraternal twins…
    And the identical twins were more concordant than the fraternal twins…which suggests that mode of birth is less important than genetics and existing familial microbiome.
    Waiting for the NCB spin on this…

    • The Computer Ate My Nym

      My response is basically “cool…shall we trial introducing the bacteria in humans now?” It seems a reasonably safe experiment since it sounds like the bacteria in question are normal flora and the worst they are likely to do is not help much. It’s certainly less extreme than gastric bypass and other such things.

  • Jen

    Good post. I *did* write a birth plan before my first was born and I was very glad I did – it helped me think about how I would like to proceed if x, y or z happened. I looked into different types of pain relief and so had a better understanding of what I wanted and when I wanted it when I was in labour. It included things like ‘if possible we’d like my husband to tell me the sex of our baby’.

    It was great – when I tried the gas and it didn’t work for me I just moved on to the next thing on my birth plan – pethidine.

    I didn’t bother writing one for my second – I knew how my Ob worked and trusted her and having done it before I felt pretty comfortable and confident that we’d get through it without one.

  • Amy M
    • Cobalt

      Wow. Quack city. I don’t know if I want to laugh, cry, or pull out my unvaccinated sharpie and start cashing in.

      • Amy M

        I looked at the reviews, and there were only a few I saw that saw this for the quackery that it is, and most of them were doctors. This stuff makes me so angry. I wish I had some power to sway people away from woo.

    • Samantha06

      Good grief!!!

    • “….help you have a better baby.”

      A better baby.
      Wow.

      Unbelievable.

      • Sue

        I had the best possible one, so I doubt the book could have improved on her 😉

      • Dr Kitty

        If you’re disappointed in your newborn infant, you’re not succeeding at parenting, and this book is not what you or your child needs.

        I feel pretty safe in saying that if you don’t think your kids are the most amazing people ever, there is probably something wrong with you.

        • AlisonCummins

          I don’t think it’s that unusual, especially after a difficult birth, to not feel much of anything when handed the baby. It then spends about six weeks in a sort of meatloaf stage (a meatloaf that cries a lot and deprives you of sleep) before smiling at you.

          Also, not everyone enjoys babies. We accept that first-time fathers sometimes feel distant from a baby but connect with a toddler who can move and play in ways they are used to. Mothers can feel like that too.

          A parent who feels let down at the birth of their child probably needs support, but isn’t actually failing at parenting unless they fail to meet the needs of the child. For instance, if they can’t get enthusiastic about an infant but withhold contact from friends/ relatives/ coparents/ babysitters who do.That’s failing at parenting.

          • fiftyfifty1

            “meatloaf stage (a meatloaf that cries a lot and deprives you of sleep) ”

            Love it! I like it better even than what out pediatric neurologist calls newborns: “A goddam 7 lb bag of reflexes”.

          • Dr Kitty

            Absolutely, I get that instant bonding doesn’t always happen, and that newborns aren’t the most emotionally rewarding humans to interact with. It definitely gets easier after they start smiling!

            However, if you are looking at your baby that coos and babbles and smiles at you, and think “well, this one obviously needs some improvement” I think there is probably something wrong with you.

            If you’re looking at your walking, talking child and thinking that they need some definite work to make them good enough for you, just go ahead and call Child Protective Services.

          • Elaine

            I think the audience for this is people who feel that their own health could be improved and wish for a health improvement for their kids (either born or not yet born) as well. I bet a lot of parents of kids with chronic illnesses would have liked to “improve” their child by avoiding those illnesses. (Of course, whether this book will actually do that is kind of a separate issue.)

        • Yes. And what do they mean by better? So, I have a five year old, and I’m freshly preggors with #2. If I buy this book, and commit to this diet…will this baby be BETTER than Lucy? Are they saying make your babies better than your previous kiddos? Or just better than everyone else’s baby. Regardless. That is SICK and why even put that thought in a mama’s head. This makes my blood boil.

          • araikwao

            Congrats! Obviously this baby will be awesome, too

          • Thank you!!!

          • toni

            Congratulations, Sally. How exciting!

            I’m hoping to be pregnant with our second in the next few months, fingers crossed. x

          • Fingers crossed for you! Yay!

    • Box of Salt

      from Amy M’s link, here’s the MBA coauthor husband:
      “He spent 15 years and $250,000 to hack his own biology, upgrading his brain by 20 IQ points, lowering his biological age, and losing 100 lbs without using calories or exercise.”

      I’d rather go with Steve Austin.

      And I’ll put up my own kids against theirs in any contest on any day at any tune, Smart, happy, healthy – and I didn’t need your book to get them there.

      • Dr Kitty

        Uhhhh…
        I don’t think a library card, some Soduku books , a gym membership and Weight Watchers runs to a quarter of a million dollars….

        But then again, anyone who claims 100lbs of their body weight disappeared without reducing their calories or increasing their exercise either
        A) spent the money on liposuction
        Or
        B) has difficulty with big numbers
        Or
        C) is gullible enough to give exorbitant amounts to any quack selling snake oil.

        • KarenJJ

          There’s a test for that.

        • Bugsy

          Or
          D) to quote Dr. Phil: “You don’t lose 100 lbs (that quickly) unless you cut off a body part!”

          Umm….can you confirm he still has all of his body parts?

          • BE

            Which episode was that said on? I saw the previews and I haven’t been able to find it since. I’m googling that memorable quote and that’s how I found you. I really want to watch because I think I know the bodybuilder mom who says she has 12 titles.

  • SorryI’veBeenLurking

    I do think in some cases having a concrete plan on certain things is necessary. I used to be a heroin and general opiate user and I really felt very strongly about not having an epidural. The last thing I wanted with my new baby coming into the world was to have terrible cravings, or even worse a relapse. So I had a birth plan that said ABSOLUTELY under no circumstances an epidural. I signed it beforehand with my OB that said in effect, even if I beg for one, do not give me it. Well I had a 32 hour labor and a 3 hour tirade at my OB to give me the epidural but I’m so glad he didn’t. My beautiful baby girl was born happy and healthy with a very tired but happy mommy.

    So in my case a birth plan was definitely the way to go.

    • RNMomma

      I may be mistaken, but it’s my understanding that you don’t experience a high with an epidural. The drugs never cross into the blood. Not that you were wrong by any means for being overly cautious. I just honestly don’t understand.

      • SorryI’veBeenLurking

        Epidurals do however contain drugs like fentanyl or other opiates which I have had a big problem with in the past. I don’t think epidurals get you high, I just know that for me and many other people who have had substance abuse problems and (in my case) past relapses and can be triggered by even the smallest thing.

        • theadequatemother

          It’s easy to provide an epidural that is completely opioid free I.e. Local anesthetic only…FYI if you find yourself in a position in the future where lower body anesthesia or analgesia is needed.

          • araikwao

            Another good reason for an anaesthesia consult prior to the event

          • fiftyfifty1

            Now if only it were recognized as useful and universally covered.

          • araikwao

            See, public health care really is great!

          • fiftyfifty1

            Huh? Are you saying that pre-labor anesthesia consults are a reliably covered service where health care is public? I sincerely wish that were the case! Having access to an anesthesiologist at all for L&D is a huge problem in much of Canada and the UK. I am greatly in favor of public single payer universal healthcare system for the US, but I don’t think it would fix the anesthesia problem.

          • Samantha06

            I’m in Canada and I work in a larger hospital. We have no issues with anesthesia coverage at all. We have our own OB anesthesiologist and they are available, in house, 24 hours/day. Pre-labor consults are standard here, at least in my province.

          • theadequatemother

            Any surgeon can refer a patient to an anesthesiologist for a consult. We see lots of antenatal consults and they are paid for by the provincial insurance plans. Unlike the USA where anesthesia consults were delisted by most major insurers a number of years ago.

    • fiftyfifty1

      Epidurals don’t make you high. That’s a myth spread by NCB. During training I had many patients with chem dep histories who used epidurals or ITN (intrathecal narcotics). None of them were triggered into a relapse.

      • SorryI’veBeenLurking

        Actually for me it had absolutely nothing to do with NCB, it was from past experience. That may well be for them but I have previously relapsed before after an epidural which I had when I received knee surgery. We chose an epidural then as it seemed the safest option, apparently for me it is not. Everyone is different. I’m sure you could see a million addicts get an epidural and not bad an eyelid but then I would be the one who comes along at the end and spoils the score.
        Maybe I just didn’t have enough will power or maybe I just wasn’t as strong as those others but I can assure you it does happen.

        • SorryI’veBeenLurking

          *bat an eyelid, apologies

        • fiftyfifty1

          If you wanted to avoid it, for whatever reason, it’s your choice and that’s fine. But it’s really important to distinguish personal anecdote from scientific knowledge, because pain and suffering matter. NCB pressures women not to use epidurals by telling them flat out lies like “it gets you high” or ” It primes your baby for later addiction”, or by just insinuating and raising doubts, e.g. “you just never know”. I have seen patients get the same sort of lies and pressure from within the recovery community. Their sponsor will pressure them into avoiding an epidural, or even tell them that they have to avoid tylenol and ibuprofen because “you just never know”. I have seen women suffer horrifically from this misinformation, and I’ve seen them transfer it onto their kids too, refusing to treat their kids’ pain.

          And that your doctor apparently went along with this seems to me an ethical violation. Seriously you begged for 3 hours for an epidural and it was denied? When you first made this birth plan why didn’t your doctor, at a minimum, talk about the option of a narcotic-free epidural (“Novocaine” -only type epidural).

          • SorryI’veBeenLurking

            I had a very good relationship with my OB and he knew exactly my history and exactly my wishes. I told him it was likely because I don’t handle pain very well that I would ask for it. He knew how much it meant to me to not have it. And part of my agreed care was that I wouldn’t have one. From my point of view, the me who was making my birth plan was A LOT more sound of mind than the me who was begging for three hours! Had mine or my baby’s life every been in the slightest danger I have absolutely no doubt that he would have acted appropriately. He was honestly the best physician I have ever come across in my life (and I’ve come across plenty) I don’t think that epidural are dangerous and I would never discourage anyone from having one, nor would I ever use my personal experience to try and discourage people from getting them but I was just sharing my personal anecdote which I recognize as such about why having a birth plan was good for me. Every woman is different and in my case it was an essential thing for me. Even narcotics free ones felt like a no no to me. I didn’t even want the worry of cravings coming back stronger. I just wanted to enjoy my new baby, and that for me would have put a stress on it which could be avoided. Call it what you will, superstition, misinformation, screwy personal choice whatever, but for me that was the position I was in. I think it is something that is nigh on impossible to truly understand if you haven’t had addiction problems. There is a huge difference between being one and coming across them in professional practice.

          • fiftyfifty1

            “There is a huge difference between being one and coming across them in professional practice.”

            Yes there is, just like there is a huge difference between being responsible only for your own health and being in a position of being responsible for the health of others.

            My perspective comes from seeing the damage caused by myths and pressure spread by the recovery community. I appreciate that you are making it clear now that your choice was idiosyncratic and that you don’t advise others to make the same choice. That’s good. Too many others don’t make that clear. When people get told that pain relief options will trigger them to relapse *they avoid necessary care*. They do things like birth at home, refuse colonoscopies, ignore their chest pain, skip going to the dentist. Remember when James Frey wrote that book with that dental scene where Hazelden supposedly make him get root canals without novocaine? That influenced people. The take away message for half of them was “Novocaine can cause a relapse, so I better not go to the dentist”. For the other half it was “I better not go into chem dep treatment, it’s barbaric”. Misinformation has consequences.

      • Guest

        Not respecting someone’s decision to NOT get an epidural is JUST as disrespectul as NOT respecting someone’s decision to get an epidural.

        • fiftyfifty1

          Get an epidural or not, either way it’s a personal decision and that’s great. What isn’t great is when people spread misinformation like saying that getting an epidural causes women to relapse.

        • Bombshellrisa

          But the decision was based on the idea that having an epidural can produce cravings or withdrawal symptoms and can cause relapses. This is a real issue and there needs to be better information given to these women.

        • Yes. I had a bad experience with an epidural [1980!] and I now have considerable back problems, which may or may not be related to it [specialists have told me that my ruptured disc has nothing to do with the epidural, while another told me it did]. All three of my C/Ss were with GA as a result. So too was my surgery for an ectopic pregnancy. So, when I faced hip replacement, I told the anesthesiologists I wanted GA. Boy, did I have to argue! And sign a zillion releases.
          Three different doctors tried to argue me into having an epidural.
          In the event, my surgery was without the slightest complication, and the staff was impressed with my quick recovery. My surgeon later said to me that I had been right to insist on GA.
          Moral: there’s no “one size fits all”.

          • Young CC Prof

            Interesting. Surgeons in the USA apparently don’t like conscious people, and these days they tend to use general unless there’s a good reason not to. I’ve heard it’s different elsewhere.

          • fiftyfifty1

            “Surgeons in the USA apparently don’t like conscious people, and these days they tend to use general unless there’s a good reason not to”

            Huh? I pre-op a ton of people. In my experience surgeons use regional/spinal whenever they can. Patients who have surgery phobias and who want GA instead really have to do a lot of convincing! Surgeons have no incentive to want a patient to be “out”, because even with regional/spinal the patient can be sedated enough that they are calm and often semi-sleep through the procedure.

          • Young CC Prof

            Huh. Maybe my experience isn’t representative, then, because no one’s ever offered to leave me awake except when my son was born, and all my other surgeries were shorter and less invasive than that one. Don’t know too many other people who’ve had regional, either.

          • fiftyfifty1

            From what I am seeing, most ortho surgeries are done without GA, but abdominal and throat surgeries are done with GA. I wondered why regarding the abdomen, because CS involves the abdomen and is a bigger cut than many other abdominal surgeries, and yet is done with spinal. But from what surgeons tell me, with the abdomen, especially if the surgery is detailed/small scale or near organs, it’s important that the patient not move, so they choose GA.

            But maybe beyond that, regional differences? Not sure

          • Dr Kitty

            I was perfectly happy to get a stuck Mirena and some cervical endometriosis rejected with IV fentanyl and Midazolam (apparently I sang throughout the proceedings, which I thankfully don’t remember).

            When they couldn’t get my cervix to dilate to insert the Mirena in the first place, even with a cervical block, a 15 minute cervical dilation and IUS insertion procedure under GA was a better option than an epidural. I’d prefer a very short nap to several hours of paralysis.

          • The classic procedure for a trapped head in breech when the cervix was only partially dilated involved deep ether anesthesia, as it apparently relaxed the cervix.

          • When the patient’s awake, the staff have to watch what they say. No more dirty jokes to pass the time [worst joke I ever heard was when I was scrubbed on a C/S and the surgeon was closing, a rather boring part of the op]. And the last thing I’d want to hear during a hip replacement is the sound of the drill, saw, and whatever used to cut off the head of the femur and attach the prosthesis

    • Guest

      Epidurals do not get you high. Period. But for many addicts in recovery, even the idea of use or the close proximity to the subject of a former craving can trigger a relapse. For example, a rum cake will not get you drunk and you are not forced to drink at a bar, but many alcoholics will avoid both.

      • SorryI’veBeenLurking

        And as I have said below I did have poor experience with one before. I definitely know that epidurals do not get you high.

    • cobalt

      My mother is an opioid addict. Knowing what that’s done to her, and the genetic predisposition I carry, I avoid narcotics (and painkillers in general) to an extent that a lot of other people just don’t understand. Just knowing that the drugs aren’t in my system, whether or not there is brain involvement, can create a feeling of safety from the beast. It took years for me to trust ibuprofen (and yes, that’s weird, but it’s the mental place I came from).

      • SorryI’veBeenLurking

        I feel ya! I get very nervous about it, reading and rereading the labels, trying everything other than medications to help pain, being suspicious of anything you haven’t read reems of information on or checked out with your doctor. It’s a kind of anxiety I don’t think the average joe understands that comes from being – or loving an addict – which is increased ten fold when it comes to anything to do with our children.
        Thank you for your reply! And I hope for the best for you and your mother.

      • OBPI Mama

        My mother and some siblings have had substance abuse issues and just in case I have a predisposition to it, I stay away from alcohol and heavy pain meds when I can. I’ve had to learn to be okay with them after my c-sections, but I don’t like it. After one of my c-sections I felt like I needed a refill on my meds, but just couldn’t bring myself to ask… I was so nervous I’d get addicted to the medicine. The other c-sections I was fine with one prescription though… hoping it’s the same with this c/s.

        I definitely understand women not wanting epidurals… I didn’t with my first child. I had such a strong fear of not being in control of myself (like not being able to get up and walk around sounded horrid to me)… turns out you don’t feel in control of yourself in labor anyway though! haha. I have them for my c-sections now, but still understand the want to avoid them (I get spinal headaches afterward). To each woman, her own.

  • And sometimes you can follow these steps and still wind up with a disaster on your hands/on your mind.

    • Who?

      Statistically speaking, a disaster will happen about one third of the time, if you follow these steps, compared to choosing a homebirth.

      And imagine the true horror of not being aware of these steps, or being aware of and ignoring them, being lied to by a homebirth ‘midwife’ about how birth is to be trusted, having a death or serious injury as an outcome, being shunned by your ‘carer’, then coming to the realisation that if you had chosen these steps you most likely would have had a better outcome.

      • Young CC Prof

        Do you mean one third as often? Because less than a third of births end in disaster no matter what you do.

        • AlisonCummins

          I think the “disaster” is c-section.

          • Samantha06

            Ask the mother who’s baby’s life was saved by that “disaster” C/Section, I bet she would disagree with you. Then ask the home birth loss mother who’s baby’s life WOULD HAVE been saved by that “disaster” C/Section.

        • Who?

          I meant to say that the risk of a dead baby at homebirth is three times higher than the risk of a dead baby following the Dr Amy Plan.

  • Sara M.

    I would like to take this moment to share my birth plan with everyone here. It’s the same as it was the first time. My plan is to do whatever I am advised to do by medical professionals to ensure a healthy baby. Also this time I will use formula if needed without the guilt. Don’t hate myself for LOVING the epidural. Oh and not ask my husband to kill me during labor. He won’t do it anyway (bastard). That’s my plan. Now nobody tell my friends!

  • KarenJJ

    I didn’t have a birth plan. I did have some samples from a hypnobirthing course I did that I took into my obgyn at one appointment and he and I went through one of them and he gave his opinion on them and reasons why eg “physiological third stage – injection is the same as the hormones anyway and being anemic you are at a higher risk of needing a blood transfusion if you were to start bleeding”. His eyes were really rolling by the time we got to the Vitamin K injection vs oral part.

    After ten minutes of that I just turfed the lot and didn’t bother. He knew that (a) my husband gets queasy and wasn’t at all sure that he wanted to cut the cord and (b) I wanted to have skin to skin if possible in the operating theatre if I did happen to have c-section.

  • Maria

    “Don’t trust people who lie to you about pain.” Love this! My hospital’s preference sheet for births was pretty straightforward and most of what the more crunchy people in our area would say you have to “fight” for were standard care at the hospital. You never know what is going to happen and that is how I went in the first time. I was nervous, of course, but my husband and I just rolled with it. It helped that it was an uncomplicated birth, relatively short, and my mental state and ability to listen to and respond to advice and information from the doctors and nurses was aided by the lovely epidural! Kid #2 went breech so I didn’t even bother filling out the form. Really lovely and peaceful c-section! I was pleasantly surprised by that.

  • RSM

    The best thing you can do is find an excellent OB/CNM and a good hospital/BC. If you want something particular, like MCRS or VBAC, make sure that provider is in agreement. This is about as much choice as you have, and if you can do this, consider yourself privileged.

  • Ellen Mary

    During my last birth, the hospital offered each woman a consult with a nurse, who created a document that looks exactly like any other part of your chart. I thought it was a great idea & it took a lot of stress off me to not have to produce this document which could supposedly shape my health future . . . I just wish that it had had more Cesarean preferences in it, I would have asked for minimal chit chat & maybe music in the OR . . . Skin to skin in the OR & nursing in recovery were standard though, so I didn’t have to state a preference there.

    They also had a class that featured a 45 minute Q&A with an anesthesiologist & a prenatal fitness class with a physical therapist focused on preventing, detecting & treating abdominal & pelvic floor issues. Plus a sweet sibling training.

    • Cobalt

      That sounds like doing it right.

    • NoFadsPlease

      Ugh, skin to skin is standard now? Thanks for the warning.

      • Lion

        Surely you can just say “no thanks”.

        • NoFadsPlease

          I don’t want the nurses to see me as a bad, uncaring mother.

      • Ellen Mary

        I think you would have to look pretty hard for a hospital where this is the case. I was on the West Coast. I am nearly certain that you wouldn’t find it outside of a large hospital on a coast . . . OB actually takes a pretty long time to adopt new practices universally. I almost said no because I was shaking, but as soon as they handed my baby to me, I was able to stop & it really helped my self esteem to be able to jump right into mothering my baby, at the time. However I was definitely able to hand my baby off as soon as I wanted to & I could have totally said no. Glad I didn’t tho.

        • fiftyfifty1

          “OB actually takes a pretty long time to adopt new practices universally”
          Not at all if there is strong evidence for the benefits of a practice. Take universal testing for GBS. Once it was proven that universal testing was better than risk factor assessment, it was adopted extremely rapidly across the entire country, big hospitals and small. In contrast, if an OB practice is NOT adopted rapidly or universally, you can be pretty sure that the evidence for it is weak, conflicting, non-existent, or a matter of fashion rather than fact.

          • NoFadsPlease

            What evidence is there for skin to skin in a hospital that has sufficient incubators? What is the benefit? Please don’t say bonding, all children bond with their caregivers.

        • ersmom

          I’m in BFE fly-over country, small level 1 hospital and we offer skin-to-skin for section moms.

          We’re so rural, it can take our patients an hour to drive to us through country roads.

        • moto_librarian

          I live in TN, and skin-to-skin is standard.

  • OttawaAlison

    People were trying to influence me and a few months near my due date something started to happen – I’d get painful Charley horses in my calves that left me screaming. They only lasted a minute or so, but were very painful. Though I’d tell people I’d wait and see, all I could think about were multiple Charley horse type pains happening every few minutes with no sign of immediate relief.

    My hospital had templates for birth plans and I kept looking at them unsure of what *I* actually wanted. I wanted the baby out. In the end I didn’t bother and no one asked me for it. I got my baby in the end and yes, labour hurt like a bitch and I got relief.

  • Mommybobs

    I had a birth plan for my youngest and it had things like – yes please all the pain relief, don’t ask twice, dear god get him out safely using all the medical equipment under the sun if you have to. Turned out that I didn’t need any of that and I think I may have gone a bit overboard in the writing of it because my charming OB wouldn’t stop asking me if I needed anything.

    So decided I would never have one again, agree with Amy that plans set you up for disappointment, or in my case just my poor doc feeling like a spare part!!

    Either way lets keep those happy healthy babies and proud mothers coming!

  • Jami

    Ooh I really like this one! I especially like the part about planning or not planning to have an epidural. How the heck can anyone predict what birth will feel like until it happens? And even though it’s only been little over 3 months since I gave birth to my son, I only sort-of-kind-of recall that the pain was oh-so bad. I think we forget the acuteness and agony of it.

    • The Bofa, Being of the Sofa

      I will say, I kind of find the “I don’t want an epidural unless the pain gets unbearable” to be an odd statement.

      I realize it’s possible to get pain relief preemptively, and I’m sure a lot of people do that, but isn’t it also true that most people decide to get an epidural once they find out whether it hurts or not?

      I would think that would be the default for most people, and “I want pain medication before anything starts hurting” to be more something you’d need to request. When it starts hurting, that’s when nurses are going to be asking you if you want an epidural or not, so if that’s what you want to do, doing it only requires telling them when (caveat: of course this doesn’t work if you are in one of those places that discourage epidurals, but then again, if that’s where you are you don’t need to tell anyone you don’t want one).

      So if your birth plan is “I don’t want an epidural until the pain becomes unbearable,” doesn’t that just boil down to “I don’t want an epidural until I decide that I want one?” because you are the final arbiter of what constitutes unbearable? Heck, in that respect, those who get it preemptively are doing it maybe because they find the idea of the pain unbearable.

      I guess I am suggesting that putting that in a birth plan means nothing to the hospital because they don’t know what you consider to be “unbearable pain.” “Unbearable pain” simply means the amount of pain that you don’t feel you can can (or want to) put up with.

      • Kathleen

        That’s how my birth plan went for both my kids. I requested an epidural once I couldn’t handle anymore. One of my friends got an epidural immediately. With my second, I had to laugh because when I requested the epidural the anesthiologist (my ob’s husband, amazingly) came in and was like “I figured you’d be requesting my presence soon.” Good doctors know things.

        • The Bofa, Being of the Sofa

          But why does “don’t get an epidural until I want one” need to be in any birth plan? Isn’t that pretty much by default? Ignoring, of course, those places that actively try to prevent you from getting one.

          • Who?

            Maybe the need to put it like that is a trace of the need to be in control. It’s not likely someone is going to pin you down and sedate you from the waist down, or do it while you’re not looking, but saying that you want to ask for it, as opposing to consenting when it is suggesting, might feel a bit stronger?

      • Cobalt

        I think unbearable is too late. You never know until you get there, but if you’re going to take on the risks it makes sense to maximize the benefits. The risks from an epidural are about the same if it’s in for 15 minutes or 8 hours, so I’d advise to aim for as soon as you think you might want one.

        • The Bofa, Being of the Sofa

          I think unbearable is too late.</blockquote.

          I think it depends on the person. For some people, "unbearable" may be too late, whereas for others, it may be earlier.

          The "unbearable" is put in by those who want to try to do it without but want to reserve their right to change their mind. Of course, they all have the right to change their mind at any time, which is why I find it odd.

          I think what you are suggesting is to get an epidural when it becomes clear that it will be imminent. In that case, there is no use waiting around, if you know you are going to get one anyway. However, those who are waiting are doing it with the possibility it might not get much worse.

      • Jessica Nye

        Yes, I made that mistake with my last (fourth) baby- I waited until I couldn’t deal with the contractions very well and by the time I got the epidural I was feeling like pushing (but said NO when the nurse asked me if I was feeling pressure because I was afraid they wouldn’t give me the epidural if I said yes.) Right after the epidural started working (like 10 minutes after she asked me if I felt like pushing) the nurse checked my cervix and I was complete. She was like, “uh-huh. That’s what I thought.” I guess the more babies you have, the less time you have to decide how much it really hurts, ha ha.

    • AlisonCummins

      The advice I heard was, “Tell them yes you want an epidural, but not yet.” That way they get you prepped right away and when you decide you’re ready you can have immediate pain relief. (Don’t know if that’s how it actually works, but that’s what I heard.)

      • The Bofa, Being of the Sofa

        But like Cobalt asks, what’s the point in waiting? If you know you want the epidural, and you can get an epidural, why wait?

        • Sara M.

          For me I had the epidural in a good long while and didn’t care for all that position shifting, then it wore off. They fixed it but for my situation, I think I will hold off a little bit longer, it’s just how my body reacted.

    • Up to a point, you do. Or the human race would have died out long ago.

      • fiftyfifty1

        Naw, because men were in charge and childbirth doesn’t hurt THEM.

        • SporkParade

          I disagree. I gave birth in the wee hours of the morning. Later in the day, I was feeling chipper and energetic. My husband was exhausted and vaguely traumatized, to the point that he said that I would have to be the one to convince him to make a second child. I highly suspect that the difference was my body producing hormones to cope.

          • Who?

            And I think it is easier to go through something than watch someone else go through it-how often have you seen your children going through something awful and willed yourself (fruitlessly) into their place?

            I was buzzy for days after both births-my husband was way more ‘awed’ by the experience than I was, and I suspect not a little traumatised. Though the midwives at the hospital kept him working-to the point that he thought they couldn’t have coped without him 😉

            New baby, feet that were visible without the aid of a mirror, what was not to like?

          • fiftyfifty1

            The idea of husbands and wives as equals and husbands watching births is all very new. Powerful men used to have multiple wives and/or concubines (in some places they still do). How many children a woman had was not dependent on whether or not she remembered the pain of childbirth. She was owned by her husband and had no choice in the matter.

      • Young CC Prof

        You know, my mother said the same thing. She knew it was bad, but she didn’t really remember all that clearly, which she believed was a special trick to encourage women to have more than one child.

  • Liz Leyden

    My birth plan was 5 lines. There was a significant chance that I could lose my daughter, so I really, really wanted photos of my babies as soon as they were cleaned up. I also really wanted my husband with me, and copious amounts of pain medication. In the end, I got 2 of the 5 items on my birth plan: pain meds and photos.

    • The Bofa, Being of the Sofa

      I think “take lots of pictures” is an AWESOME thing to put in your “birth plan.” Especially since (it sounds from your comment) your husband was not with you, there needed to be someone around to take pictures.

    • Smoochagator

      How did your daughter’s surgery go?

      • Liz Leyden

        It went well. We finally went home 6 weeks later. She’s 7 months old now, loves to eat, and loves to be held.

        • Allie

          My friend’s son had open heart surgery shortly after birth and he’s a happy, healthy, awesome teenager now : )
          I applaud your courage. It must have been so scary and heart-wrenching to watch your LO go through that.

        • Smoochagator

          I’m so glad to hear that! Congrats on your sweet babies.

  • theadequatemother

    My birth plan with kid 1 was to tell my provider that I had very low tolerance for uncertainty and that if the strip wasn’t perfect I wanted a cs. I didn’t want to sit on an indeterminate strip with internal monitoring. I just wanted the kid out. I thought that was a useful discussion.

    The second kid the plan was, “lets talk about how I can avoid having this kid on my kitchen floor” and “is my pelvic floor now screwed and will a second vaginal delivery make it worse or is the damage pretty much done?”

  • DaisyGrrl

    It’s interesting reading the birth plan forms that my local hospitals have on their websites. One hospital has a “birth preferences” form for you to fill out and bring with you. They say right up top that it’s “preferences” because you can’t predict how a birth will go and safety comes first.

    The second hospital has a two-page plan that’s also pretty good. It asks for the general preferences without judgement (who will cut cord, breast milk or formula, skin-to-skin or clean up kiddo before giving to mom, etc.). The only quibble I have with it is the section on pain relief doesn’t use the word pain. How will you manage your “discomfort?” Yeah, discomfort describes sitting in a hard chair for too long. I don’t think labour is anything like that.

    • The Computer Ate My Nym

      In the hospital’s possible defense, some people are reluctant to use the word “pain”* and they might have been trying to make it possible for women who can’t admit to being in pain to get relief by relabeling it “discomfort”.

      *Anecdote from residency: Guy comes in with an initial complaint of chest pain. He gets worked up and found to have active angina. He gets treated with nitrates and says his pain is resolved and is about to be transfered to the monitored cardiac unit. Then one of the residents looks at the monitor and realizes that he’s still got nasty ST changes and asks him, “Are you sure you aren’t having any chest pain?” He replies, “Well, I wouldn’t call it pain…” He goes to the ICU and cath lab instead and “Well, I wouldn’t call it pain” becomes a catch phrase in my residency program.

      • Dr Kitty

        I saw a guy whose truck fell off the jack onto his foot when he was changing a tyre. He walked (limped) around for a week, only seeking help for his multiple broken metatarsals and tarsals when he could no longer get his boot on because of the pain and swelling.

        “It pinched a bit when I did up the laces”
        Yep…his foot looked like hamburger, and it “pinched a bit”.

        Also the motorcyclist who wasn’t wearing leathers, skidded, and tore a strip of flesh off his chest, over his left 5th intercostal space. He was more interested in using his mobile phone to video his heart beating through the defect in his chest wall than in my offer of morphine.

        Pain thresholds are variable, and not always a reliable guage of what is happening.

        • An Actual Attorney

          Just that description makes me want a shot of morphine! Aaaaaaahhhhhhh!

          • Dr Kitty

            It was fun explaining to the anaesthetist that I could do a four lead ECG for our biker, but a 12 lead was out of the question unless they wanted me to put the leads directly onto his pericardium.

            He lost a nipple and got a pretty huge scar and a temporary chest drain, but no other issues. He was incredibly lucky.

      • DaisyGrrl

        Fair enough. And the pain relief section listed a bunch of different options, from hot baths to nitrous to epidural, so it’s not like they would have ignored a patient’s pain. Plus, they’re close to several large immigrant communities, so there may also be cultural issues at play.

  • I really like this! I thought when I saw the title that it was going to be a satire piece. But this is all really good advice. Trying to control and plan too much can hurt pregnant women going into labor. I remember being at the hospital with one of my doula clients and I was talking to the nurse and she asked about the couple, if they took classes, etc… I said “they took Bradley” and she goes “yikes… Bradley students always end up getting c-sections.” I thought it was a cruel thing to say but I think I get now why that may be…. all that tension and desire for control and doubting the care providers, it can’t be good for a laboring mom. Maybe that’s a part of it? Perhaps in letting go and just staying positive and having desires while remaining flexible, perhaps that can really make a difference.

    • atmtx

      I think I’ve seen it explained here that it’s the unwillingness to change from the plan, to reject early interventions that leave no option but c-section in the end, that make it seem more likely. I wonder if it really is that they end up with c-sections more frequently, or that they make such a show of avoiding everything that it makes the c-sections stand out more in the minds of caregivers?

      Before even knowing about the Bradley Method, just knowing that it was a type of birth class, I saw that it was every week for three months and was like “no thank you!”

    • Alicia

      I agree that being flexible helps. I had all of these ideals about my birth, but once I started to get to my pain threshold I realized that I didn’t have to figure out how to handle the pain, that there was nothing wrong with managing the pain with an epidural if it meant I could reach my ultimate goal, which was having the strength to push. So I was flexible, got an epidural, and had a peaceful and wonderful experience. So that’s what I tell any first time mom if the subject comes up: It’s good to have an idea of what you would like, but be flexible and prepared for the unexpected.

    • fiftyfifty1

      “Bradley students always end up getting c-sections.”

      I think the main reason for this belief is that such cases always stick out in your mind. I mean how unforgettable, a woman who is convinced she will NEVER accept ANY intervention who ends up with EVERY intervention! It’s like the belief that big tall tough men are “bound to faint” at the sight of blood. They are probably no more likely to faint than anyone else but when a 6’5″ 300 lb lumberjack tough guy goes down, it’s a memorable sight.

      Other contributing factors might be that NCB birth classes are more likely to be taken by older women, and older women are much more likely to need a CS than teens or early 20s. Also strong NCB beliefs may lead women to reject useful interventions like inductions and augmentation. I really doubt it has anything at all to do with tension.

  • Elaine

    I didn’t see a whole lot of point in filling a birth plan with “I want this” and “I don’t want that”, since a. a lot of it could change depending on what happens during the birth, and b. some of it I have agency over and can take care of myself. If you want to (say) wear your own clothes for the birth, for instance, why put it in the birth plan? Just do it. And if you want to (say) avoid a c-section if possible, why put that in the birth plan either? Take the birth as it comes, and if it gets to a point where the c-section is the best choice, you’ll do it, and if not, you won’t.

    So my birth plan basically boiled down to “wherever possible, ask me before you do anything” and a couple of other points.

  • Montserrat Blanco

    Great post. It is much better than the usual birth plans.

    Birth plans usually seem to me the most egocentric thing ever. For me the only important thing was a healthy baby. I remember the anesthesist to be the only person really worried about me at the OR (I did not worry at all about myself). The only time I freaked out during my C-section was when I did not see the neonatologists at the OR. They had to show themselves so the OBs could continue with the surgery…

    So it always surprises me when I see someone talking all the time about me-me-me in their birth plan. I am puzzled when I read something like “I do not want continuous fetal monitoring”. I simply do not get it. I do not get that you are willing to risk your baby’s brain function in order to avoid a minor disturbance (and yes, I had monitoring for one hour twice a day during one week, so I know what it feels like).

    • I had a birth plan but then I am in the Netherlands and was affraid I wouldn’t get pain relief. So I wrote it down, in a plan that was maybe a page long. Luckily, they read it and gave me my morphium shot. And I also had a doula. It’s weird that you need to do all these crunchy things here in order to have a non-crunchy birth.

      • Amy M

        Yeah, I had a sort-of birth plan: I would like an epidural at some point, I would like my husband with me, he doesn’t want to cut the cords, I would like to try breastfeeding. Pretty much a list of preferences that applied to any kind of birth situation.

  • Deborah

    This is the best common-sense guide to birth EVER. May I share it around????

    • Amy Tuteur, MD

      Please do!

  • Samantha06

    Love this… a straightforward, no-nonsense guide to letting go of unrealistic expectations!

  • C T

    Aren’t you going a bit far with #3? “Plan” on it being the worst pain? I’d soften that to “Expect that you are very likely going to experience.” Everyone is different, and some women really just don’t have very painful childbirths.

    • Roadstergal

      It makes sense to plan on it being that bad, IMO. Then if it’s really that bad, you’re prepared, and if it’s not that bad, your surprise is a good one. The old saying – you can hope for the best, but plan for the worst…

      • I agree. It’s better to prepare for the worst and be pleasantly surprised if it isn’t so bad. But then with my first I expected the pain to be so bad that I thought that I’d definnitely recognize labour. But I didn’t and when I arrived at the hospital 2 days later (because I was scared of the hospital). So I stayed at home until I couldn’t take it anymore (again it was not the pain but more the exhaustion, the annoyingness of it all) and went to the hospital only to find out I was 9cm dilated. Maybe if I had more pain, I would have gone to the hospital earlier, gotten pain relief, or something to help me sleep or whatever and she would have been out much faster.

        • Cobalt

          I’ve twice gone for a regular appointment and been sent to the hospital because I was in labor, more than halfway dilated, and didn’t feel it.

          • Karen in SC

            Now don’t brag…. LOL

          • Cobalt

            Honestly not trying to brag. I didn’t expect it and couldn’t earn it, it just happened.

          • fiftyfifty1

            Oh the ones where you get to tell the woman that she is in labor are so much fun! I wish I had the power to clone that experience for everyone (and I bet you do too).

    • Amy Tuteur, MD

      I’ve seen many thousands of women in labor. The number of women who didn’t consider their labor to be very painful is substantially less than 1%.

      • The Bofa, Being of the Sofa

        And for those who didn’t, the proper response is “I was lucky” and not “it’s not that bad”

        • Squillo

          Yes. I’ve said this before, but my labors–including the one I had the epidural for–were far easier than a few migraines I’ve had. And yet, I know lots of people who can function when they have migraines, whereas I end up curled up in the fetal position hoping fervently to die. Should I judge someone else’s ability to “handle” labor pain by my experience, or should I judge my ability to handle headache pain by my own? It’s so hard to know what I can be sanctimonious about.

    • Personally, I didn’t consider my births the most painful experience of my life. However, it was definitely the most annoying.

    • The Bofa, Being of the Sofa

      Again, pain in childbirth was recognized 3000 years ago to be so severe that it was attributed to being a punishment from God.

      I don’t see the bible pointing to any other pain and coming with some reason why we should face such punishment.

      I have not and will not ever experience the pain of childbirth. However, I don’t have to actually go through it to figure out that it’s unlike any other pain anyone will experience.

      A punishment from God is not just a variation on the theme of pain. It’s unique.

    • NoLongerCrunching

      Does anyone think there is any truth to the fear-tension-pain idea? I definitely felt more pain when I was tense and scared in my labors, then when I felt safe and relaxed.

      • Sullivan ThePoop

        I really think it depends more on other factors. I didn’t need pain relief in my last labor, but I was very nervous about why the contractions were so light and if I could actually deliver a baby that way.

      • Cobalt

        In my personal experience of pain, fear matters. I’ve taken a lot of trips through the ER with horse related injuries, and my pain level improves consistently when my scans come back showing nothing vital got busted. It’s not just the drugs kicking in, either; I typically can’t have my NSAIDs until after the work up is done and I don’t do narcotics.

        During labor, I perceive less pain when I can see or hear the baby’s heart monitor or a doctor I feel good about is in the room.

      • fiftyfifty1

        “Does anyone think there is any truth to the fear-tension-pain idea?”

        Depends what you mean by that. If you mean, “Is pain even more miserable when you are also experiencing emotional distress?” the answer is yes. If you mean “Is the pain of childbirth caused by a cycle of fear–>muscular tension–> pain?” the answer is hell no.

        I get anxious for any number of things (tests, icy roads at night, big presentations). But despite this anxiety, I never experience any pain.

        In contrast I was not nervous at all before having my first baby. I was delivering among trusted colleagues on the L&D floor where I trained. I knew they would take good care of me. Homebirth advocates always wax poetic about delivering at home in your own bed. Well that hospital WAS basically by own home, and those beds WERE my bed. I had spent almost all of my waking hours over the preceding 3 years there and every 4th night. So zero anxiety. But for sure the worst pain of my life. Very severe pain.

        • Sara M.

          I kind of feel like the fear-tension-pain theory is used in part to make us delivering moms feel as though if we “trust birth” the pain won’t be so bad. I am sure thee is truth to the idea that anxiety breeds more pain. But it could be turned around by the wrong person and telling the laboring mother that her pain is due to her fear. That’s wrong

          • Cobalt

            Fear doesn’t cause pain, but fear of pain and what it could mean can make it worse. If I know that even though I hurt, I’m going to be ok, it helps. At least for me, knowing that nerve signal doesn’t signify catastrophe makes it easier to mentally get past it.

      • theadequatemother

        I don’t. I think we all need to differentiate between the sensation of pain and your ability to cope with the sensation. Fear or anxiety reduces coping ability – we all have a finite amount of mental and emotional energy and if you are spending it on coping with fear you don’t have much left over for coping with pain.

        • Young CC Prof

          I get that. A few years back, I hurt my knee, and when I went to the ER, they x-rayed it, then basically wrapped it in an ace bandage and said I’d be fine. It was a week before I actually got it looked at by someone who would actually, you know, LOOK at it.

          That week was pretty ugly, and I spent most of it lying down unable to do anything. It wasn’t just the pain (the pain was bad enough) it was the fear. I knew I’d done something fairly bad, and I didn’t know what.

          Once I knew what was wrong, (hairline tibial plateau fracture) and that it would heal, I was able to cope with the pain a whole lot better.

    • Julia

      For me, it was by far the worst pain I have ever experienced. Luckily I knew that might be the case going in. Had I been convinced that labor pain is usually “somewhat bad but manageable” I would have thought I was dying or something was seriously wrong. Therefore, I think it’s best not to sugar coat it.

  • slandy09

    My birth plan for my next child goes something like this: healthy baby with as little damage to me as humanly possible.

    Having a high risk pregnancy really helps you get your priorities straight.

    • Sara M.

      I hear you! From the beginning with the twins ppl would tell me all sorts of crap, like all the ” pain is normal”, “fifth month is the best,” and the oh so useful “don’t let them make you have a C-section”. First these were mothers of singletons who had no idea what’s like to be in pain everyday during a pregnancy. Second, the 5th month was hardly the vacation, although I did have three good days in a row that month which I cherished. Finally, I just wanted to babies out the safest way possible.

      Now I am expecting a singleton which in some ways is easier, but I still stay with my original plan of doing whatever is needed and listen to people who know what they are doing.

  • Trixie

    Missing the S after the apostrophe in the title. 🙂

    • Amy Tuteur, MD

      Ugh!!!!!!

  • Jocelyn

    “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.”

    I love this. I’m totally using this in the future.

    • Sullivan ThePoop
      • The Bofa, Being of the Sofa

        Of course it would have to be Mercola. There isn’t a looney idea that he doesn’t embrace.

      • Jocelyn

        I give up on people.

      • Amy M

        It’s sort of the flip side of “Think positive!” or “Fake it ’til ya make it!”, taken to the extreme. It’s all well and good to think positive and believe you can control the outcome when you are talking about getting a promotion at work, for example. It doesn’t really crossover to health very well though, and quickly becomes victim blaming: You must have cancer because you did something wrong/failed to do something right. Which, of course, all comes down to: I don’t have cancer (thank god) so I must have done it right.

        No room for arbitrariness with that worldview. Good things happen to good people who do it right, and bad things happen to people who make mistakes. And they can always find a mistake. What do you mean never smoked a day in your life? Well, your lung cancer must be from toxins! If you had only eaten healthier, you’d be fine now! I have no idea how to get through to people like that.

      • Trixie

        Conveniently, Mercola has his own private label tanning beds for sale on his website.

  • luckymama75

    I think you’re so awesome Dr. Amy. I’m a newcomer, I only stumbled across this blog a few months after my second C-section. I now have 2 amazing kids but I kept feeling like and being told that I should be disappointed for not having a true birth experience. So instead of all the touchy, feely groups who were condemning the medical establishment for robbing me of my right to a birth experience, I went looking for a voice of reason to tell me I’m not less of a mama. To remind me my son and daughter are the most important thing, not some friggin “experience”. And here I am and haven’t looked back. I’m embarrassed for having ever bought into that crap, I’m embarrassed I acted like a brat at my births and I now say with pride that I have 2 healthy kids thanks to medical intervention. And now I’m going to post a few of your articles on a page that showed up in my newsfeed that made the dastardly mistake of saying “homebirths are now as safe as if not safer then hospital births”…..

  • Young CC Prof

    My birth plan went thus:

    1) Get baby out safely with a minimum of damage to me.

    2) I will probably ask for pain relief, please give it.

    3) Please see chart and do not give me any drugs to which I am allergic.

    4) I want my husband there, I don’t want any other visitors until after.

  • Bugsy

    This is a beautiful post. I’m bookmarking it to share with others.