Posted by My OB said WHAT?!?.
Sep
10
Posted by My OB said WHAT?!?.
“…Don’t Make A Plan, They’re Stupid…”
“Don’t make a plan, they’re stupid, things go wrong all the time.” -Midwife/Childbirth Educator during prenatal classes.
There are 36 comments to this post.
So simply because the potential for things to go wrong is there… I shouldn’t have any clue of what I would like to happen? I shouldn’t make people aware of my wishes?
I think its more like “If you make a birth plan then we have to make some pretense of trying it and that’s stupid.”
Make the birth plan. Its not a bad thing to know what you want and to have it in writing so others know too.
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I did make a plan and was so happy when my OB signed off on it at 20weeks… but then at 38 weeks he decided to look at it again and said he wasn’t happy for half of the stuff to happen. I was gutted – if I’d known he didn’t accept what my “ideal, perfect world scenario” was then I wouldn’t have chosen him as my OB.
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Jane Reply:
September 10th, 2010 at 7:08 am (Quote)
So the doctor bait-and-switched you?
I’m not sure which scenario is more disturbing: either the doctor waited until he thought you had no choice but to go along with him, making it a power/control maneuver, or else the doctor routinely signs his names to documents he doesn’t read.
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I’m going on a trip next month, but I’m not going to make a plan, because flat tires happen all the time, and cars break down.
I’m going to be cooking meals for my family but I’m not going to make a plan because sometimes we come down with stomach bugs and nobody feels like eating anyways.
My husband and I haven’t been out on a date in… OK it’s been a while. But we’re not going to make a plan because that’s just stupid. We could go out to a restaurant and get food poisoning, crash the van on the way home, and end up in the hospital in traction for the next few months!
Oh yeah, and GOOD doctors and midwives ask to see your birth plan, because they know that a birth plan can be a great communication tool to discuss the parents’ wishes for the birth and for their new baby’s first moments after birth.
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The Deranged Housewife had this to say,
Sep 10, 2010 @ 7:36 am (Quote)
Wow, that’s some “childbirth educator” there. What a negative, naive comment to make – especially to a room full of potentially naive first time parents who don’t realize how wrong this statement is. This makes me SO mad!
Is this a CBE class like the ones where they spend most of the time talking about epidurals and why you should get one? You know, because this hospital-sponsored class believes that a quiet, drugged-up patient is a happy patient? Oh, and did we also mention that we have one of the highest cesarean rates in the county? 
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Well, a childbirth educator shouldn’t need a plan. She should have already done plenty of research and have a standing relationship with her provider. Now a group of first time parents. They need to do some reasearch. Even if they don’t present “their plan” to their provider. As we have seen before presnting the “plan” frequently sets up a “you don’t trust me” attitude. But not doing the research and following blindly will get you mistreated. So while I don’t believe in birth plans, I do believe in research. I would be more interested in asking the doctor what he/she considers a typical birth and see how interventive it is than let them know what I’m looking for up front and giving them all the information to bait-and-switch me.
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So, I think I’m like 6 years old inside because my initial response was “YOU’RE STUPID!” LOL Or maybe “I know you are but what am I (my birth plan that is)”
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Cmat Reply:
September 10th, 2010 at 9:00 am (Quote)
Lol then I am a 6 year old living in a 25 year old’s body. I think my first response would be to laugh and say the same thing. It is stupid to tell a family not to plan for a birth. Of course they need to plan. They just also need to know that things change and the birth plan may have to be tweeked.
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OK, as a CBE and doula who also happens to be an engineer (and very much a planner in all aspects of life) I feel a need to speak up here. I don’t know the entire context of this quote, and certainly “stupid” is an immature and unprofessional word to use in just about any CBE context. That said, the phrase “birth plan” is in that set of “birth” vocabulary that just sets my teeth on edge. Try as you might, you cannot “plan” your birth. I am all about:
* Doing research – discovering what your options are, when they might be appropriate, what the benefits and risks are.
- Exploring your feelings and examining your personal situation, and deciding which options you prefer (both for ideal, normal scenarios and for contingencies). Prioritize these options – what is really important to you? Do you *really* care about getting a saline lock, or about intermittent EFM vs auscultation with doppler, or fetoscope? What is most important to you?
- Discussing those options and preferences with your care provider. At this point, having a written list of whatever length you need (maybe even with research attached) is great, primarily to make sure you hit all points. Recommend making a special consult appointment to do this, as a “normal” prenatal is supposed to last 6 minutes for an OB or 20 for a CNM.
- You should now have an idea of what is routine with your care provider or birthplace, and of how realistic it is to get what you want with that CP/birthplace. Do you want to stay there? Do you need to switch?
- Once you have done all of the above, decided on a care provider / birthplace you will accept, take that huge list and cross off 1) anything you don’t care about, 2) anything you can’t control at the time (e.g. “let’s lower the lights,” “let’s break out the jasmine,” “no thank you, I don’t need a VE right now”), and 3) anything that is already your birthplace/care provider’s routine (e.g. Intermittent monitoring, and do you really thing they’re going to give you an enema?). If there’s still a whole lot on your list, you may want to do one more bout of soul-searching on your birthplace / care provider choice.
- Keep any wishes regarding unplanned cesarean on a separate wish list – it removes both clutter and negativity.
- If you are staying in a hospital postpartum and have any preferences beyond the immediate newborn procedures, a separate postpartum care wish list might be in order.
In the end, a birth preference list that you present to your birthplace in labor should contain nothing more than a brief introduction with anything personal that the nurses providing your care really need to know and a *very* brief statement about the birth you are planning for (e.g. “We are planning to use natural coping techniques for labor” or “We would like a late, light epidural to assist with transition and pushing,” etc), and any items (hopefully only one or two if any) that are 1) important to you, 2) not routine, and 3) something you need to request or emphasize ahead of time. It should be short, sweet, and fit on a letter-size or smaller sheet of paper that already has a photo of your family on it! 
While the “end product” of this process seems very small and simple, the process is very important, because in going through it, you maximize the chances that you, your birth partner(s), and your care provider are all on the same page, and that you’ve chosen the closest feasible fit for your birth care.
Yes, there are horrible, unethical care providers out there that pull a bait-and-switch. If you are still concerned about this after interviewing them, ask for references. Seriously. And don’t just ask if said references LOVE their care provider, of course they do! Ask what they love. Ask them to share their birth story, to make sure they didn’t LOVE their OB telling fart jokes during their unnecesarean.
OK, rant over. 
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Dreamy Reply:
September 10th, 2010 at 4:30 pm (Quote)
What you’re saying is reasonable, FTMP, IMO. But note, you said, “Try as you might, you cannot “plan” your birth” and turned around and said, “We are planning to use natural coping techniques for labor” is a reasonable thing to state (in writing, no less).
I would gently suggest that you are opposed to the phrase “birth plan” not because there is anything inherently or semantically problematic about it, but because you associate it with misguided and/or “control freak” women. I would also suggest that there are a couple of factors at play here. One, that women are rightly attempting to resist what they suspect is a messed up, one-size-fits-all system. They may not be doing it in the most “productive” way possible, but they often don’t know what they don’t know (like homebirth as an option, for example). And two, that women are trying to “control” birth or “order XYZ off the menu” because obstetrics/hospital policy itself has given them a false sense that someone CAN “control” birth.
What I mean is, I often hear criticism of natural/homebirthers that amounts to “You think if you do XYZ, nothing will go wrong, but YOU CAN’T PREDICT BIRTH SO YOU NEED TO BE IN A HOSPITAL/HAVE CONTINUOUS FETAL MONITORING/PITOCIN/ETC.” But most of the time, I think that is projection. Of COURSE you can’t predict birth outcomes. It’s usually proponents of hospital/highly-interventive births that present a false picture of safety and security “if you trust what we say and do what we tell you.” If you don’t do that, well, you’re a disaster waiting to happen.
What I’m getting at is that when doctors/policy treat birth as a mechanized, one-size-fits all thing, complete with “timetables” for labor and dilation, some sort of standard math to determine if your (unfixed) pelvis is too small to fit a baby’s head, a specific date after which you’re definitely “overdue,” a count for pushes, etc., etc…. it’s not surprising that many women get the impression that they can choose this from column A and that from column B and that will be that.
All this is aside from plenty of highly-informed women who just want to be clear that their preferences are enumerated and respected.
The resistance (and often, open derision) of hospital employees, CBEs, et al., to the idea of “birth plans” is really problematic and goes much deeper than semantics IMO.
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Tara Reply:
September 10th, 2010 at 6:12 pm (Quote)
Yep, you said it. A birth plan by any other name is still a birth plan. Call it a birth preferences list, call it a wish list, a birth poster (I’ve seen some lovely ones done by graphic designers)… Call it what you like – it’s the process, the communication it engenders, and a leg to stand on when you’re in labor that are important.
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WellBegun Reply:
September 10th, 2010 at 8:51 pm (Quote)
Hey, we’re on the same side here – but I have to say that the phrase “birth plan” is truly a bit problematic IME. Really. I’ve had many, many moms have much better results with “birth preferences” or “birth wish list.” Saying “we are planning to use natural coping techniques…” is not remotely the same thing, since this is not “planning” the whole “birth.” I have seen true nightmare “birth plans” that truly are plans, not a list of preferences… they were really trying to script something that can’t be scripted. Invariably, they were written by women who (generally rightly) did not trust their care provider/birthplace. I’ve even seen moms who were lawyers draw theirs up as a legal document – signed “Baby’s Mom, Esq” and everything.
For my home births, I don’t have any sort of “normal birth” document because I don’t need one (for obvious reasons), but I do have a “transfer preferences” list in case I were to need to transfer (very small and reasonable, as there would be a reason that I’m transferring).
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Glowless Reply:
September 10th, 2010 at 9:15 pm (Quote)
I can tell u that my birth plan consisted of one page of bullet points saying things like “please don’t offer pain relief, I know what is available and will ask for it” because I felt that I wouldn’t be able to say no mid-contraction to someone offering me relief!
Other things on there were contingencies should an emergency arise such as requesting my partner be allowed to stay with the baby at all times if he needed to go to special care or if I was given a general, and requesting a double line of sutures to have better chances of a VBAC.
It wasn’t a “this must happen or I will sue you” type plan, it was a list of preferences.
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Wendy Reply:
September 12th, 2010 at 7:34 am (Quote)
I agree that the language of “birth PLAN” is problematic; however, I doubt that any woman who writes one is actually trying to PLAN her birth. The big white elephant in the room that nobody wants to acknowledge is that women write birth plans because–with good reason–they do not trust the medical establishment to look out for their interests, welfare, and autonomy. Until hospitals and birth professionals work to regain this much-needed trust, the birth “plans” will continue to flood in.
As to how to reword it, birth “preferences” or birth “wishes” are too weasel-worded. As a paying consumer, I don’t “prefer” or “wish for” respectful and evidence-based care; I demand it.
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WellBegun Reply:
September 12th, 2010 at 6:05 pm (Quote)
I know that most (yep, that’s right, most) women who write a “birth plan” are not trying “plan” their birth. YOU know this, too. However, there seems to be some knowledge fail in the medical community in this regard.
The weasel-wording comment made me laugh, because it is the same reason I prefer “preferences” and am rather annoyed with “wishes” (though the medical community and many moms seem to love the “wish list” idea). I don’t think that using “prefer” in the sense of being a consumer is weaselly or “soft” at all; however, anybody who wishes to is welcome to write a list of birth “demands.” And if one thinks that the phrase “birth plan” makes nurses roll their eyes and prep the OR…
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Dreamy Reply:
September 12th, 2010 at 11:44 am (Quote)
With all due respect, we must be talking past one another, because one of my major points was NOT that there don’t exist women who are essentially (or appear to be) “control freaks” who really do think they can get everything they want, when they want it. Of course there are, and like you said, a lot of it comes from being with a provider or part of a system that they cannot trust.
All I’m saying is that it is (mostly) the untrustworthy system that has created them. And part of that system is set up to tell women that if they just do X,Y and Z (mostly “whatever the doctor says”), nothing will go wrong. It’s part of the vicious circle of litigiousness and doctors acting like infallible gods, rarely admitting any liability, etc. In that kind of environment, it’s not surprising that some women would think SOMEONE really CAN control birth like a play with a script, and they (misguidedly) try to take it into their own hands. YKWIM?
I also think the whole semantic “plan” issue is one of those linguistic/sociological things where a certain word or phrase picks up connotations that aren’t inherent to it, but the source of the connotations becomes confused…
Words and phrases really don’t have much meaning in vacuums. “Birth plan” and “birth preferences” aren’t really naturally too distinct when decontextualized. Like a pre-owned car vs. a used car… We understand there’s a euphemistic, slighly more pleasant sound to one, but there’s not a huge difference between the two, for most of us. But in this case, “birth plan” is associated with the movement of women in the last couple of decades to attempt to assert SOME agency in an unfriendly, paternalistic system– even when the plan itself is very mild and reasonable and even compliant. The connotation is generally negative for HCPs because they are defensive over the whole issue.
MOST women are well, WELL aware that their “plans” are “preferences.” To the point that most women with birth plans (IME) really aren’t asking for much at all. But they continue to be met with derision. Why? Because the very fact they are resisting even in a small and likely futile way is the problem. Not the word “plan.”
If they’re ignored and sneered at and watered down enough, they’ll stop resisting– at least that is the hope, and I’ve seen it happen. It’s the same thing that leads women to laugh at (or even yell at) FTMs who express a desire to pursue an NCB.
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Dreamy Reply:
September 12th, 2010 at 11:52 am (Quote)
I guess my more concise point is that little tweaks in the language an oppressed group uses almost never make any difference to the dominant group. The dominant group SAYS they will– this is called the “tone argument”– but on the whole, it almost never makes a difference.
There is always an argument of “If you weren’t so HOSTILE/IRRATIONAL/ANGRY, maybe I’d listen to you. In fact, I was almost just about maybe willing to possibly consider listening to you, but you ruined it by raising your voice one decibel. So sad that you lost your chance to convince me, because I was totally listening to you before you raised your voice that single decibel, even though I can’t seem to remember anything you ever said and never let you get a word in edgewise and live my entire life opposed to your philosophy. Pity, really.”
It’s bull. It’s playing a game where the other party owns the board and can change the rules at will.
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WellBegun Reply:
September 12th, 2010 at 6:12 pm (Quote)
“It’s bull. It’s playing a game where the other party owns the board and can change the rules at will.”
Yep, you pretty much nailed it. The fact is, many things that used to be in birth plans are no longer needed there because hospitals saw them on so many birth plans that they made them part of the routine (and, you know, they weren’t important anyway). Now the things left on most (intelligent) birth plans are relevant to actual care. Women aren’t (usually) cluttering their birth plans asking for pretty decorations or the “right” to play music anymore. Now the medical community needs to dig its heels in (or make real changes).
What this means is that birth plans in the context of a normal, healthy birth are no longer going to make changes. A more radical approach is needed. If you hate the system, if you don’t trust the system, then STAY THE HECK OUT OF THE SYSTEM.
If you need to birth in the hospital due to a pregnancy risk or underlying medical condition, that is really where we need to focus on *changing* the system.
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Serene Reply:
November 1st, 2010 at 8:50 am (Quote)
My nice gentle birth plan with number 2 was ignored. I wrote a list for number 3 that included “If anything on this list happens contrary to my wishes without the express written consent of myself and my husband I will file an indemnity claim” on the front page. It was 5 pages long. It was followed to the letter. I also backed it up with research and provided that too, and had a section dealing with the possibility of a CS and induction. I think what made it seem reasonable to them to look at is was that I had included provisions for induction, CS and everything else that might go wrong. I also wrote in big red font that I understood the risks associated with declining certain procedures, but did not want them offered. I proved that I KNEW what I wanted, and was reasonable about it. By reasonable, I mean that I could back it up.
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On one hand I think birth plans are a little goofy. As someone who used homebirth Midwives I didn’t really need a plan. I trusted the Midwives and knew we were on the same page.
I have a lot of people who tell me things like they want no drugs or no epi etc. so I ask them if they’ve discussed this with their doctor. I have yet to get a yes response which kills me. You and your OB, Midwife….whoever need to be on the same page period. Ask questions, say “I want ____”…. and if they aren’t 100% receptive (as long as things are going well) run for the hills ladies! The other thing that kills me is that women don’t talk to the person/people who will be in the room with them. HELLO! You may be just fine like me laughing, joking and answering the door between contractions but then again…maybe not. Your supporters HAVE to know what you want and have a big enough set of kahunas to stand up for it in the event that you are unable to.
That being said, putting together a SHORT birth plan for the hospital staff might not be a bad idea. But I emphasize the SHORT. They don’t have time or patience to read a 10 page birth plan. Keep it simple so they quickly understand what you want, get some notes in your chart and continue on with business. If you feel you need a long birth plan again, run for the hills!
Know your providers and talk to them or you are setting yourself up for a potentially traumatic experience with Dr. Douchewaffel and unfortunately you have no one to blame in that situation but yourself.
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Ha… I call my “birth plan” a “client care protocol/policy” and we always include “We understand that there are procedures which may become necessary for the health of the mother and baby, we also reserve, and are well aware, of our right to accept or refuse any procedure or medication.”
Plan seems wishy washy to me, and I know the best laid plans… blah blah blah… and while we have contingency plans for the what if’s there are just some things that are non – negotiable… and everything ( I mean everything) goes through me first, or if I am unconscious my husband… We’ll see how it goes this time… hopefully I don’t have anything to post this time ( we didn’t have a “birth plan” with our midwives last time I trusted them… this time, the dreaded hospital makes me sick just thinking about it)
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Mama Mirage had this to say,
Sep 10, 2010 @ 3:26 pm (Quote)
I find it morbidly fascinating how everyone’s allergic to the name “birth plan.” Reading through motivational quotes you’ll find things like, “the man with the plan is less likely to get knocked off course” and during disaster season I keep hearing my radio telling me that “to NOT make a plan in case something unexpected happens, is stupid.” Anyone who can’t respect someone making a birth plan, is lazy. They just don’t want to have to read through it and try to live by someone else’s plan. If the client comes in knowing what they want and what they want if something they want goes wrong, well then the doc just lost control. That’s all it is. Control. Now he/she has to follow someone else’s plan and doesn’t like it because usually the docs plan involves the easiest way to get from point a to point b, whereas the patient’s plan is more likely to involve the most (insert whatever is important to patient here, such as natural, safest, etc.) way and likely to require more waiting or more work or both.
I’m so thankful that my midwives not only didn’t freak out about my birth plan but they actually praised me to no end for writing it and then after reading it praised me for it some more. And when I gave birth a couple days ago the attending midwife reread the whole thing while I was in labor to make sure my wishes were fresh in her mind. It was a beautiful birth and was kept as close to my “plan” as possible. I feel very satisfied. And you know it’s amazing how peaceful and energetic I felt after getting to do birth my way. After my last one I was depressed and physically felt half dead.
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Its like the army!! (DH is in the army and rarely do they know what the heck they’re doing ahead of time. I don’t even know if he’s coming home tonight!)
Really though, everyone (at least those birthing in a hospital) should have a SHORT list of preferences whether or not they are planning a ‘natural’ birth. Are you planning on using an epidural? Other pain medications? When would you like them offered? Is Dad planning on announcing the sex or cutting the cord? Are there any specific religious requests such as whispering a prayer into the child’s ear as the first voice he hears? Would you like to use the nursery (if one is offered)? Breast or bottle?
Many won’t really apply (no use in saying ‘no religious preference’ if there is none) but not all of them are about mom. My own ‘birth plan’ has 5 bullets for Labor, 7 for delivery, and 6 for after delivery (altogether about half for me and half for baby). It feels like a good length for me and mainly covers things during the times I will be in a hormonal fog for.
The reason for the ‘plan’ is that I don’t want to explain everything over and over again. My doctor has many patients, the nurses will have many patients, and I’ll probably have more than one nurse during my stay. I can’t really expect them to just ‘know’.
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WellBegun Reply:
September 12th, 2010 at 6:29 pm (Quote)
This exactly… I have had many clients who planned on medicalized births, but they still had preferences to express. Regardless of what the preferences are, they should be honored. Birth preferences are not just for natural/low-intervention type births.
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Mama Wrench had this to say,
Sep 10, 2010 @ 10:44 pm (Quote)
Once again I feel the need to remind people that there are many women who DO NOT have the option of carefully selecting the physician who will attend the delivery. There are 1,462,170 women in the US military, of whom at least 30% are of child-bearing age. And, guess what, unless they’re in a region where there are no military OB-GYNs, if they get pregnant they are REQUIRED to go to a military hospital (except in case of emergency). You don’t get to pick your OB, you don’t get to request a private room or home birth, you get whatever’s available. For many women, especially low-income and impoverished women, they’ll get whichever doctor is on call when they show up. A birth plan is a quick, efficient and succinct way of expressing to your OB exactly what your preferences are if you’ve never met him or her prior to labor.
I’d never met my OB before giving birth, he just showed up right about the time I was 8 centimeters, and then I didn’t see him again till I started to push. Without a birth plan, how else was he supposed to know my preferences? It would be great if we lived in a world where every woman always got to sit down and have a nice chat with her OB or MW about her birth beliefs, but we don’t, so we utilize whatever other tools are available, because otherwise we’ll just get the “one-size-fits-all” treatment that we’re told we’re supposed to take and like.
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Mama Wrench Reply:
September 10th, 2010 at 10:46 pm (Quote)
(That should be, “of whom, at least 60% are of child-bearing age.”)
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Elizabeth Reply:
September 11th, 2010 at 6:12 pm (Quote)
I got really lucky on Tricare (military insurance) and was assigned to a wonderful civilian doctor who actually requested I write a birth plan because our MTF was over capacity. If it hadn’t been though I would have been stuck there with whoever they assigned me unless I could make a serious complaint about him and get paid attention to.
I do have to give *slight* kudos though for the MTF employing a few CNMs. At least someone somewhere is trying.
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Elizabeth F. Reply:
September 12th, 2010 at 12:40 am (Quote)
ITA. My husband is in the Army as well, and when I was pregnant with our second, first time with the military, I got to schedule my appointments with the same midwife for the about the first half of my pregnancy, but then I ended up bouncing around to a few different ones because of lack of availability, and I knew I would’ve just ended up with whoever was on call when I went into labor, however, I was planning a UC from the beginning so it didn’t really matter. Point of story is I believe it’s good to type out at least a few major points about the labor, delivery, and postpartum experience because many women, especially those in military or low-income do not have the privilege of having the same provider throughout their pregnancy and birth. And those that are active duty have it even worse; I just read a birth story about a UCA2C from a woman that was in the military, her first birth was an unecessarean and with her second she originally had a very supportive VBAC provider but then she left the practice and her replacement was unsupportive and said he had already scheduled her repeat section and if she didn’t show up for it she would be refusing a direct order and would be reprimanded, so she showed up to a completely non-medically necessary c-section because she *had* to. Even the legal department was unable to help her.
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I wrote a great plan that covered everything except an incompetent OB who sabotaged me. Long story short, we ended up in the OR for vaginal bypass surgery.
Even longer story short, have been told repeatedly by nearest & dearest that I set myself up to “fail” for having too much information and not trusting the doctors (know too much now to ever trust doctors again) and my expectations were too high, although I fail to see how expecting to have a natural vaginal delivery is expecting too much.
My future babies will be born at home with a midwife & yes, I will have a “client protocol statement” for them too.
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Caryn Weber had this to say,
Sep 13, 2010 @ 6:56 am (Quote)
A Midwife/CBE said this? Are you serious??? Is this an egotistical OB or Nurse in Midwife’s clothing? WOW!
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Plans are necessary BECAUSE things have the potential to go wrong! That’s why we have budgets, insurance plans, etc. So how is it stupid to have a birth plan that lays out your wishes in case something happens that you weren’t anticipating?
Remember, you never need to prepare for the good things. But the bad things–those you need to plan for.
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