Oh...birth plans. Frankly, I am not sure how I feel about them. I think they can be very useful in making sure your needs and wishes are communicated to those who care for you. But, on the other hand, they can be a barrier for those who care for you because they have this preconceived notion that birth plans=hippie, crunchy women who are resistive to medical care and think that you will inevitably end up with every intervention in the book before you have a c-section.
I have seen women who have very reasonable, flexible birth plans. Like, requests that pain medication or epidurals not be offered but if it is requested or asked about they are not opposed to receiving that type of pain relief; or requests that the baby be placed right onto mom's belly or chest at birth but are ok if baby needs closer assessment immediately at birth that requires the baby being taken to the radiant warmer/resuscitator.
And then I've seen very inflexible birth plans that request things like no fetal monitoring (absolutely impossible in the hospital) which basically ask for things that are better for a home birth. These types of birth plans I have no problems with in regards to what they want or not want, but often scratch my head wondering if these couples have taken into account that they are giving birth in a hospital. As much as I feel continuous fetal monitoring or even IVs are not necessary in every birth, some hospitals have environments, protocols, etc that don't "allow" for this. I really think those who want to avoid all interventions look into alternatives to birth sites because the second you step into a hospital you give up some things, like complete control. I wish this wasn't the case, and try very hard as a nurse to let women know about informed consent and choice, but there are very few hospitals I know of that go with any request a woman has.
What really gets me though, are birth plans that are so evident that the couple did absolutely no research on birth or hospital birth. For instance, I cared for a couple recently who had a 5 page birth plan. It was a birth plan that came from an website template, likely something where you just check off what you want to include on your written plan. And what they checked for what they wanted and not wanted completely contradicted itself in some fashion. Like this:
- I do not want an IV
- I want an epidural as soon as possible
Ok.... it was very evident that they did not do any reading or class on childbirth ed because epidurals require an IV. There is not an anesthesiologist in the world that would place an epidural without IV access. Not to mention that you need an IV fluid bolus in preparation for an epidural because a fairly common side effect of epidurals are low blood pressure; the IV fluid bolus helps to counteract a drop in blood pressure.
- Please do not separate me from my baby at any time
- It is ok to give my baby a pacifier if crying while away from me
- I do not want any students or residents caring for me
....when you are in a teaching hospital that has structured the care delivered by utilizing residents and involves other learners at varying degrees of involvement. Now, it is completely the woman's prerogative to not have learners involved in caring for them, but it seems a little weird to me that this woman would choose to come to a teaching hospital if she didn't want residents or students.
So I guess the bottom line is that I think birth plans can be a good thing if the couple has researched birth in the setting they will deliver as well as generally educate themselves on birth. But I can totally see why birth plans end up as fodder for negativity from care providers when it's plain as day that the couple has done no research on birth at all.