practitioner/hospital staff taking offense to birth plans... - Mothering Forums

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Old 09-23-2010, 06:20 PM - Thread Starter
 
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I haven't come across this personally, but I have heard about it several places. More with hospital staff than practitioners, but some even with practitioners. The reasoning is... if you want a natural birth I know that means not to offer drugs, etc... or if you are breastfeeding we know that that means not to give your baby artificial nipples and formula.

After thinking about it, I can see how it might be perceived that the staff or practitioner isn't trusted, or isn't informed of these things. However, it might be the case that the mother is more comfortable with it being in writing. I can't foresee a practitioner having a problem... I mean birth options/choices should be discussed thoroughly between the two. An understanding one of the other should be reached.

Personally, I have went back and forth on the birth plan. I feel the plan I wrote for my first birth wasn't read, and it definitely wasn't followed. I didn't write one the second time as a homebirth was planned and I completely trusted my midwife and each visit was such that she knew what I wanted and didn't need a plan. But, at this stage I feel like a birth plan for a hospital birth is important. I'm just not sure the form it should take. You don't want a birth plan to smack you back... IYKWIM. If it is going to somehow convey disrespect to the nursing staff or your provider in the your feel for the need of a plan being misunderstood, then is it worthwhile. Who should we give a birth plan to?

Even as a doula, I like to see the birth plan of my clients because I want to be clear. I can't assume that if my client wants pain meds, that that means she wants to start with an epidural. Or, if I have a client birthing naturally that that means she would want a water birth. Or assume if my client is going to forgo the Vit. K or eye ointment that that means they also aren't going to circumcise or vaccinate. It isn't a one size fits all.

I've been sharing the Birth Plan on Mother's Advocate with my clients as it is short and sweet. But, if you know of, or if a provider/hospital staff expresses distaste with a birth plan, then should you present one, or consider going elsewhere. What if there aren't other options? Is there anything condescending about a birth plan? The clients that I have had have all had them, and I have even seen practitioners get them out to review them during the birth. Thoughts?

Appalachian mountain woman, radical homemaker, homeschooler, childbirth educator, and doula loving her DH and three powerful little femmes. Deladis 8-4-05, Ivy 4-28-08, and Gweneth 7-21-12 HBA2C! hbac.gif  -  blogging.jpg ribboncesarean.gif

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Old 09-23-2010, 07:13 PM
 
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Is there anything condescending about a birth plan?
There's nothing inherently condescending about making your wishes known. However, how would you feel if someone came to visit you in your home and chose to sit by themselves in the corner and shun you, refused your food and drink, refused to take their shoes off when walking on your new carpet, refused to use your restroom, and became annoyed any time you tried to make them more comfortable or make sure they were having a good time?
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Old 09-24-2010, 02:52 AM
 
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Present it as a birth ideals list not PLAN. Ask your doctor to look it over and ask him/her if they have an issue with anything and if there will be any trouble from the nurses. A lot of doctors/nurses will tell you right up front that a birth plan = cesarean, they say that because they've seen it. Make sure your birth plan does not communicate a wild-eyed, distrusting attitude - they will likely not even read it or take you seriously. I've been to births without a birth plan that went beautifully and I've been to births with a plan that still got bullied and intimidated into things that weren't actually best. It is all in the presentation.

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Old 09-24-2010, 10:51 AM
 
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There's nothing inherently condescending about making your wishes known. However, how would you feel if someone came to visit you in your home and chose to sit by themselves in the corner and shun you, refused your food and drink, refused to take their shoes off when walking on your new carpet, refused to use your restroom, and became annoyed any time you tried to make them more comfortable or make sure they were having a good time?
The point I draw from nashvillemw's comments is that a birth plan can seem adversarial to care providers. At least--that's how I see them being perceived, too often!

And really...in a way all birth plans ARE adversarial--they stand opposed to the Medical Prerogative and Custom of having total control over birth. Having that control is what med ppl like, feel is 'necessary for safety' and is just plain what they are in the longstanding habit of doing.

Personally, I think that if we hire service providers of any kind, we should be able to negotiate those services...just as an ordinary right. Still, people who provide services usually have things they can most comfortably do, things they 'might be able' to do, and things they can't or just won't do. When it comes to most services that people seek, we can shop around for the 'right' provider and services; we can find the one best suited to our desires/needs, and probably have some room to negotiate with that person.

But this is not so much the case with hospital birth in most places and with most OBs and hospitals. Western Medicine in general has created for itself a huge degree of psychological and political influence in our world...with our cooperation to some extent, and without our knowledge at all, in some ways (who knew that med lobbyists were busily helping push laws through that gave Drs and Western Medicine so much power in our lives and choices?). I mean, for so long ppl just accorded the total trust sought in Dr's authority--in Dr/medical development and hoarding of knowledge, and power to make all the choices for us. We 'empowered' them--gave them our power, the way we empower legislators to create laws for us all. Having that power over us, and also having a strong belief that 'Dr-controlled med care is best care', for so many years has led med ppl to oppose any changes in the scheme of things.

People tend to resist change....people in positions of power tend to resist any perceived loss of that power. This is just basic human psychology, I think.

I'm not settled with the idea of birth plans at all. Not only can I see that many/most med ppl tend to view them as 'essentially adversarial', well....I think the point is, if we really felt trusting and comfortable with our provider and place of birth, we just wouldn't feel a need for a birth plan! In a real way, having a birth plan is a way of stating that you don't trust the staff or the general protocols--that you are not just going to go along with their 'usual program'...KWIM? A birth plan so often is our way of trying to eliminate or reduce harm to ourselves through med care that we DON'T want, that we DO feel is potentially harmful to moms/babies on some level (if only 'harming bonding' but not bodies).

I agree--ppl have the right to choose their care, period. However, because of the very nature of the mindset of Western Medicine (control-oriented) and the administrative structure of hospitals (profit oriented and liability shy), I think it is nearly impossible to truly choose care for hospital birth, impossible to have truly and fully informed consent/refusal in that realm--at least, generally speaking though there are wonderful exceptions. There is a lot more I could say, but this is long enough....

Last comment: I'm starting to think that rather than writing birth plans, families might be better served to do 3 things: find care that already best suits their needs (instead of trying to mould care to their hopes); 2nd, learn about the protocols/routines of your hospital so you can be prepared when you meet with them; and 3rd, learn calm, assertive communication so you can use it during your birth--to be able from the very moment you enter the hospital, to be cheerfully and firmly willing to say "yes please" and "no thanks" as that applies. Which means--don't WRITE the birth plan...just ACT on your plans!
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Old 09-24-2010, 11:50 AM - Thread Starter
 
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Last comment: I'm starting to think that rather than writing birth plans, families might be better served to do 3 things: find care that already best suits their needs (instead of trying to mould care to their hopes); 2nd, learn about the protocols/routines of your hospital so you can be prepared when you meet with them; and 3rd, learn calm, assertive communication so you can use it during your birth--to be able from the very moment you enter the hospital, to be cheerfully and firmly willing to say "yes please" and "no thanks" as that applies. Which means--don't WRITE the birth plan...just ACT on your plans!
I'm thinking more this way myself at this point. It is more important to choose a care provider you are comfortable with and to talk your hopes over with them. Teaching the firm consent and refusal of things might be a little trickier. I suppose I am just thinking of women who don't have many choices of where to birth. How can you protect yourself in those situations without being offensive to people? How can you choose a setting where interventions are not routinely used, when that option in your area would be at home unassisted (assuming you are not comfortable with that for your birth)?
Would a simple sign for the door saying... Healthy Birth in Progress and stating 4 little things that would illustrate what your are hoping for be better? How do you convey confidence to your clients in their decisions? Sure childbirth education helps a lot, but then there is the pressure or the situation when it does occur.

Appalachian mountain woman, radical homemaker, homeschooler, childbirth educator, and doula loving her DH and three powerful little femmes. Deladis 8-4-05, Ivy 4-28-08, and Gweneth 7-21-12 HBA2C! hbac.gif  -  blogging.jpg ribboncesarean.gif

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Old 09-24-2010, 03:10 PM
 
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Maybe it is just me, but I have found far too many times that when women create a birth "plan" that leads to disappointment because either her plan wasn't followed or wasn't read. Like others have said I think it is more important to find a provider and place of birthing that already fits your needs. For example, when I was having my second to last baby I knew i needed to find a new care provider because the one I had previously was no longer catching babies. In my case I had the privilege of working with a lot of different providers as a doula, and the day I saw the "right" one I knew it. Quite honestly when it came to planning my birth I only had three things on my plan 1. take as many photos as we wanted 2. have dh help catch if he wanted to and 3. not be offered pain meds (this was written only because I knew some of my co-workers who might be my nurse might bring that up with me). When I had my son (my last child) I had the same birth preferences. Since I knew my doctor already did things allowing mom freedom of movement, food, position for pushing, placing baby skin to skin, etc I didn't feel those things were necessary to have on there. Quite honestly the three things I had there were simply to help remind my doula, husband and staff - for example, I wasn't sure if dh would be assertive enough when the time came to say "hey remember I want to catch" so having it there allowed everyone to remember to get him where he needed to be. Same thing with pictures - it was a reminder to everyone in the room that they could pick up the camera and take pictures - which did happen. My doula took some, my doctor took some, the nurses even did so I got different perspectives and it was great.

Sadly with clients what I have seen more often then not is clients who pick their doctor and place of birth and then want those places and people to conform to what they want, and that simply doesn't happen. Generally speaking people don't easily leave their comfort areas and then clients will go in with expectations that are never going to be met because the people simply won't change their ways of practicing for this one client and the families are disappointed.

I have a family member like this right now - chose her doctor based on lip service (you know the old "this is what I want" and the doctor saying "yeah, yeah we will talk about that as we get closer to your birth") even though she saw this doctor practice before with some of her friends. Now she is facing things she doesn't want in her birth and she is upset and trying everything she can to change it. Nothing I said could have changed her mind way back when and I can already see how this birth is going to go. I predicted it all way back when and sadly i was right - induction is now coming, and sadly I am afraid the cesarean will follow too. Had she really chosen a doctor who fit her needs instead of thinking she was strong enough to stand up for herself this wouldn't be happening and spiraling out of her control and she wouldn't be so upset.

Michelle married to my highschool sweetheart and mom to: DD '88, DS '90, DD '91, DD '94, DD '97, DD '98, DD '01, DD '08, and DS'09

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Old 09-24-2010, 03:20 PM
 
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I'm not a pro but we wrote a birth plan for our first that never really made it anywhere.

For our second my DH and I wrote three birth priorities rather than a plan:

1. Because of our previous infant loss, the safety of our child (and mother) is our first priority even if that means a higher level of intervention. We would like all appropriate monitoring.

2. If the labour is progressing well, we expect few or no interventions.*

3. We expect to be informed of any areas of concern or changes in condition and to be asked before any procedures are initiated (unless lifesaving).

That went over pretty well with the staff, but the staff were so excellent it's possible anything would have.

* I did have an epidural placed which was discussed in the context of probably having a c-section and wanting to be awake for it, but it was not a given - we discussed quite a bit with the nurse, OB, and anesthesiologist. However, it never got turned on as labour went almost scarily quickly from when I sat up to get the epi, so. That was it for interventions.

ETA: All the post-delivery stuff is pretty standard here like baby on the belly, etc.

~ Mum to Emily, March 12-16 2004, Noah, born Aug 2005, Liam, born January 2011, and wife to Carl since 1994. ~
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Old 09-24-2010, 06:13 PM
 
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I'm kind of with Ms Black on this one.

I want my clients to write a birth plan. I think they should know what they want, and I need to know what they want. And it's a good jumping off point to talk about SOP at the place they are delivering. But I have found that most people just don't read them in a hospital, and then some do but then act put out. So yeah, you and your advocates need to know what your preferences are, but it might be best in the long run to just go in and negotiate (or not) as it comes.

And yeah, it's best to find providers that match your way of thinking, but just because the ob you see when you go to the clinic agrees with you, doesn't mean that the on call doc you get in labor will. So I don't know that truly finding a provider you mesh with is all that easy for you average HMO covered American family.

So I'm a little torn on the birth plan thing. If I were to give birth in a hospital, I wouldn't bring one at this point. I would still sign the waivers to decline nb procedures and have them in my file.

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Old 10-07-2010, 05:42 PM
 
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I teach "birth mapping" in my childbirth classes. One destination, many possible paths. We need to be open to everything, see clearly and sometimes change course.

In my job as an L&D nurse, I preach the same. When I see a very detailed, very rigid birth plan, I worry for my patient. My facility is very medical, very high epidural rate and a c/s rate over %50. I encourage my patients to keep 2 things paramount: Health of baby & health of mama. I teach them how to read the FHM, tell them what a "bad strip" looks like and what a good one looks like.

I talk to them about maternal fevers & high or low blood pressures.

When docs come in and start talking shit, my patients have the power to decline interventions based on the clinical well-being of the baby.

That said, if I had $5 for every time a nurse/OB/anesthesiologist saw a birth plan and exclaimed: Open the OR! I'd be a rich, rich woman.
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Old 10-08-2010, 10:45 PM
 
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I had a birth plan with my first, and it was quite literally scoffed at when I arrived at the hospital. I was a newbie at dealing with hospitals and ended up with a section due to not standing up for myself and my beliefs. Fast forward to my 3rd baby, same hospital (5 yrs later) and again I had a birth plan. This plan was even MORE rigid, but I was also more informed about my part in PAYING THE DOCTORS & NURSES. Granted it was another section (had to be due to complications from the first one) but I had TOTAL respect from the entire staff (except one nurse who couldn't get off her high horse and join reality.) The only thing I did differently was TALK to my OB much more before delivery making it known that I knew my choices, had the head OB, Ped, and L&D Nurse Manager Okay my entire plan ahead of time, had a very extensive and pleasant convo with the nurse manager about 4 months prior to delivery, and took 2 dz YUMMY doughnuts to the hospital the day of delivery! With that birth, I was treated as an informed patient and not just as a bystander to what the health professionals wanted to do to just get done and out of there. The L&D nurse manager actually had me email her my birth plan ahead of time, and she came in on her day off to make sure everyone was on the same page and making sure I had all my requests met.

I think a lot of times the medical professionals think most women are just there looking for someone to take over, and they really don't know what to do when you get someone who is educated and wants to take an active role in their care. I think a lot of the problems arise from this kind of situation when the patient just "does what is told to do" during the course of the pregnancy, but then when it comes to labor and delivery they are all of a sudden a different person and the OB's are not prepared for what the patient wishes (afterall, they are people too and they could always use a heads up so they can also be mentally prepared!) I believe that if you are a consistent patient (either willing to submit to their total care, or a bold outspoken rule bending and breaking mama) it makes the entire process easier for all involved...patient, OB, and Midwife. Everyone knows what to expect that way.

Crystal- aka "Momma" toLara Karlene 1-1-05 ~ Keira Skyler 1-31-07 ~ Rohnin Viper 8-12-09 & stork-suprise.gif March 2014!!!!

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Old 10-09-2010, 10:32 AM
 
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In a real way, having a birth plan is a way of stating that you don't trust the staff or the general protocols--that you are not just going to go along with their 'usual program'...KWIM?
That's what I've been thinking lately. What you're doing is telling the hospital that you're going to give birth there but you don't want what they have to offer.

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