To say that I was naïve during my first pregnancy is an understatement. But then again, who really knows what they are doing before having a baby?
I swear that I must have been a Boy Scout in a former life because I live their motto day-in-and-day-out: Be prepared. When I became pregnant for the first time, I took that motto to a whole new level. I was going to make sure that I was ready for this baby, which included welcoming my newborn into this world exactly the way that I had wanted.
First, I found myself a midwife with an excellent reputation. Then, I signed my husband and I up for Hypnobirthing classes. I began a nine-month research project on birth plans. I read books, I talked to doulas, I joined online forums, and I slowly became a self-acclaimed expert in birthing plans.
My birth plan was exactly what it was supposed to be: flexible, not too lengthy, and, as best as possible, a partnership between myself and my healthcare practitioners.
Despite being a Registered Nurse and having a solid understanding as to the intricacies of the health care system works, I still believed that I could have a natural birth in the hospital setting. I had shared my birth plan with my midwife, who seemed on board during our appointments. (I would later learn that despite her agreement with my plan, she worked under the orders of a physician, who would be the one actually calling the shots.)
At 39 weeks and a few days, I woke up with a small amount of wetness in my bed. As I’m sure any pregnant mom can appreciate, I was not sure if this was my water breaking or pee leaking, as it was merely a small spot. I phoned my midwife who instructed me to go for walks, move around, and see if labor started. She indicated that if I was not in labor by 7:00 pm, which was 12 hours later, I should come to the hospital, so they could test me to find out if my water had broken.
I spent the day as instructed, walking a total of six miles. I bounced on my yoga ball; I took a nap. Nothing.
As instructed, I arrived at the hospital at 7:00 pm. I was “swabbed” and told that it looked like amniotic fluid. I was instructed that since it had been 12 hours since my “water broke,” that it was the protocol that Pitocin be initiated to induce my labor, as the baby could be at risk of infection.
Whoa, this was not in my birth plan at all. I handed my birth plan over to the nurse, who accepted it, but told me that the only “plan” she had was for me to leave with a healthy baby. I was not expecting that response. I felt deflated and defeated, and my labor hadn’t even started.
I won’t bore you with the remainder of the messy details other than to say that the Pitocin opened the door to every intervention that I never wanted. Only in hindsight did I learn that I could have had a very small amniotic leak, but that induction may not have been necessary.
The truth of the matter is that while some health care practitioners are supportive of a birthing mother’s plan, there are nurses, physicians, and midwives that ridicule said birth plans.
On one popular pregnancy website, a nurse writes, “I am an RN (10+years) & I find birth plans annoying, repetitive, & usually unnecessary. Ninety percent of the time, what most women want, is protocol anyway. As previously stated, why can’t you just use your mouth when the subject comes up if what you prefer doesn’t look like it’s going to happen?”
I wish that I had known more at the time, but in an effort to help other moms-to-be, here are the top five ways to protect your birth plan in the face of healthcare workers:
1. Bring an experienced advocate to your birth.
My husband was as supportive as they come during my labor. While he certainly advocated for my comfort, such as sips of water, he was utterly unprepared to speak on my behalf when it came to healthcare choices. Had I hired a doula or brought with me an experienced birthing coach, she may have been able to push back on the “12-hour-rule.” Minimally, she would have been able to discuss with the nurse the importance of my birth plan on my (emotional) behalf.
2. Be aware that your provider might not be present or in charge at your birth.
I incorrectly assumed that my birth plan would go as expected since my midwife had reviewed and approved it. What I did not realize at the time was that there is a considerable difference between how a midwife functions in the home setting verses the hospital setting.
While a midwife might be very supportive of natural birth, she is also working under the constraints of hospital policy. A hospital policy will always trump your birth plan. Further, your practitioner may not be at the hospital the day that you give birth. It’s important to discuss these contingency plans.
3. Give yourself a time buffer for all decisions.
Things happen quickly in the hospital, but not all decisions need to be immediate. In fact, most birth decisions can wait for some time. Therefore, add to your birth plan a “time buffer” for all decisions. Explain to your practitioners that you would like 15-30 minutes alone to make any decisions placed before you. Doing so will ensure that you have adequate time to think through all of the possibilities without someone standing over your shoulder.
4. Be realistic with your plan.
If you choose to birth in a hospital, you have to be accepting of the fact that it is a fast-paced, often stressful, environment. If you want your birth plan to be taken seriously, really hone in on what is important to you, keeping your birth plan as short as possible, while still addressing your most important goals. For example, while asking for a private room after birth is indeed worthy, it may not need to be included in your birth plan.
5. Have a home birth.
If you genuinely want to experience birth on your terms, you might want to consider a home birth. A home birth may be the most reliable way to achieve the birth that you desire, especially if your preferences are for an intervention-free birth.