Much has been said in the news recently about birth plan bans. Some physicians, tired of dealing with doulas they perceive as disruptive to the doctor’s plan of care, are writing their own birth plans. Birthing Beautiful Ideas blogged about the Kingsdale Gynecologic Associates’ birth plan ban letter sent to all patients. The Feminist Breeder shared a similar letter, written from WomanCare PC to their patients, banning doulas and discouraging birth plans. The letter states that WomanCare wants their patients and significant others to be part of decision making, yet the letter spells out what the decisions will be.
I have often seen the antagonistic attitude of nurses and physicians toward women who come into the hospital with birth plans and doulas. “Start sharpening the knives!” is a common joke as the birth plan is passed around, for the belief is that the woman who seeks to “control” and “plan” her birth is the woman who will end out with a c-section. I hate to say this, but it almost seems as if the c-section is done as a way to punish the woman for daring to think that she had the intelligence to make informed decisions for herself.
Over the past several months, I have been working on writing a birth plan guide (here comes the shameless plug part). I see birth plans all the time, as I encourage my patients to write their wishes and hopes for their birth out on paper, and share them with me. What struck me is how many women fill out a birth plan form, checking off their choices, without really understanding the evidence for or against the choices they make.
In addition, most birth plan forms deal only with choices for the time of birth. What about all the tests, procedures, and routines that it is assumed all pregnant women will accept without question during their prenatal care? What about a discussion about birth complications, and what alternatives there might be for dealing with these situations?
The Common Sense Guide to Creating Your Pregnancy and Birth Plan guides women step by step through each of the routines, tests, and procedures women will encounter during pregnancy and birth. It presents evidence for and against each procedure, as well as alternatives to many of them. It guides women through the process of finding a provider who will support their wishes, and what to do if you find out your provider won’t support you after all. Most of all, the book does not limit birthing choices to natural, unmedicated birth. There are many women who want a non-interventive birth, but for a multitude of reasons also want pain medication; or need to be induced, but would like to do it in as natural a way as possible. The Common Sense Guide includes options for these women, all intended to assist the laboring woman in having the best birth outcome and experience possible.
Knowledge is power. As women become familiar with the tests that will be offered (or pushed on them), and are able to make informed decisions about them ahead of time, they will be more comfortable discussing them with their providers. Knowledge will allow a woman to respectfully disagree when her provider tells her it’s better for healing purposes to cut an episiotomy than to allow a tear, because she will know that the evidence does not support this action, and she will have the references to share with her provider. Knowledge will arm her with alternatives to common interventions during labor, so that if things are not progressing normally, she can suggest an alternative to pitocin or a c-section.
Margaret Mead once said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever does.” Childbirth can be changed, one woman at a time. Each woman can share wtih another what she has learned, and as women stand up to their providers with information and intelligence, I believe we will gradually see a desperately needed change in the state of modern obstetric care in America.