Women are strongly encouraged to write up and discuss a "birth plan" with their healthcare provider in the weeks before their anticipated due date. The plans include details about whether drugs should be used and when, whether or not the laboring woman will be able to walk around, how many people should be in the room, how and how often the baby will be monitored, whether or not an episiotomy should be performed, whether forceps should be used, who should cut the cord, under what circumstances a cesarean should be considered, who should hold the baby immediately after birth, when breastfeeding should occur, whether the baby should be given a bottle or pacifier, etc, etc... The advantage of a birth plan is that it allows you to communicate clearly to your doctor what your wishes are regarding your birth experience. The disadvantage, however, is that drawing up a birth plan may give parents a false expectation that things are actually likely to proceed as outlined in the plan, when they very well may not.
Whatever attachment I might have had to the idea of a birth plan went out the window when I found out we were having twins. Suddenly, the probability of an uncomplicated, vaginal delivery at term plummeted. Granted, the possibility still exists, and I still hope for it, but the chances are remote and it would be foolish to plan on it. At least in my case, I had advanced notice that my delivery was likely to be complicated, when at our 7 week appointment, our first ultrasound showed two little blips instead of one. Unfortunately, many women have no such advanced notice and their less than perfect birth experiences are therefore an unpleasant surprise to them.
Probably the most radical change in birth plan that women are likely to experience is when a planned vaginal delivery becomes impossible for one reason or another, and the baby is delivered instead by c-section. There are any number of feelings a woman might experience when this happens, but I would encourage women to include gratitude among them. While there is plenty of evidence that suggests that an uncomplicated vaginal delivery is better for both baby and mother, isn't it wonderful that modern medicine allows us an almost as good option for those instances where there are complications? Advocates of natural childbirth and home birthing often say, "Women have been having babies for thousands of years without the help of doctors." They're right. But women also used to die 100 times more often in childbirth than they do today, and babies died 10 times as often. If your primary motivation for getting pregnant was to squeeze 7 lbs of infant through your birth canal, then having a c-section instead is, indeed, abject failure. If, however, your primary motivation for getting pregnant was to become a parent to a healthy, live infant, then a c-section delivery is, in the grand scheme of things, a great success.
I know there is lots of controversy swirling regarding the rates of c-section in the U.S., and even the medical community acknowledges that they occur more often than is probably necessary. The reasons for the inflated rates are probably more often due to fear of litigation, and less due to doctors wishing to accelerate your delivery so they can go home (an accusation I've heard recently). I would certainly encourage women to talk to their doctors about their preferences and discuss the various reasons why a Cesarean might be necessary. If a "natural", vaginal delivery is exceptionally important to you, you need to have this conversation early in your pregnancy so that you can make sure you have a doctor who seems to be on the same page and, if not, consider finding another doctor while there's time. But once you've found a doctor that you're comfortable, I would also encourage you to trust them, and trust their judgement. By all means, be an advocate for yourself and your baby, but also remember that you have a doctor for a reason, that she spent 4 years in medical school and at least another 4 training in her specialty, that she has already delivered countless babies and that, more than likely, she chose her specialty because she understands how important it is to help babies into the world safely. So trust her. Make your preferences known, but trust her judgement in the end.
I trust my obstetrician. I have just enough medical training to make our conversations about my pregnancy easy and to understand under what circumstances we can reasonably try for a vaginal deliver, under which circumstances we will absolutely plan for Cesarean, and where lies the gray area in between. I have a document that I plan to share with her on my next visit. Rather than calling it a "Birth Plan", I've labelled it "Birth Preferences". It could just as easily be labeled "Birth Hopes". I hope, I prefer... but I don't expect.
Probably the most radical change in birth plan that women are likely to experience is when a planned vaginal delivery becomes impossible for one reason or another, and the baby is delivered instead by c-section. There are any number of feelings a woman might experience when this happens, but I would encourage women to include gratitude among them. While there is plenty of evidence that suggests that an uncomplicated vaginal delivery is better for both baby and mother, isn't it wonderful that modern medicine allows us an almost as good option for those instances where there are complications? Advocates of natural childbirth and home birthing often say, "Women have been having babies for thousands of years without the help of doctors." They're right. But women also used to die 100 times more often in childbirth than they do today, and babies died 10 times as often. If your primary motivation for getting pregnant was to squeeze 7 lbs of infant through your birth canal, then having a c-section instead is, indeed, abject failure. If, however, your primary motivation for getting pregnant was to become a parent to a healthy, live infant, then a c-section delivery is, in the grand scheme of things, a great success.
I know there is lots of controversy swirling regarding the rates of c-section in the U.S., and even the medical community acknowledges that they occur more often than is probably necessary. The reasons for the inflated rates are probably more often due to fear of litigation, and less due to doctors wishing to accelerate your delivery so they can go home (an accusation I've heard recently). I would certainly encourage women to talk to their doctors about their preferences and discuss the various reasons why a Cesarean might be necessary. If a "natural", vaginal delivery is exceptionally important to you, you need to have this conversation early in your pregnancy so that you can make sure you have a doctor who seems to be on the same page and, if not, consider finding another doctor while there's time. But once you've found a doctor that you're comfortable, I would also encourage you to trust them, and trust their judgement. By all means, be an advocate for yourself and your baby, but also remember that you have a doctor for a reason, that she spent 4 years in medical school and at least another 4 training in her specialty, that she has already delivered countless babies and that, more than likely, she chose her specialty because she understands how important it is to help babies into the world safely. So trust her. Make your preferences known, but trust her judgement in the end.
I trust my obstetrician. I have just enough medical training to make our conversations about my pregnancy easy and to understand under what circumstances we can reasonably try for a vaginal deliver, under which circumstances we will absolutely plan for Cesarean, and where lies the gray area in between. I have a document that I plan to share with her on my next visit. Rather than calling it a "Birth Plan", I've labelled it "Birth Preferences". It could just as easily be labeled "Birth Hopes". I hope, I prefer... but I don't expect.
No comments:
Post a Comment