Are birth plans a waste of time?

[ticklish]

Ok, this is a question that has been bugging me for a while and just interested whether anyone else has had a similar experience.

DS was born by emergency c/s after a failed VBAC.

My birth plan was comprehensive and included my preferences in different scenarios.

The birth plan was first sighted and approved by my OB.

I made sure it was on my hospital file before admission - I took it there myself at 38 weeks and the midwives assured me that they had read it and were all fine with my requests upon admission.

Likewise, my DH had read it and I sent it to our Doula about 3 weeks beforehand.

Whilst in labour, I had requested not to be told how I was progressing - but I was (and yes, it wasn't good progress!)

My support people (DH and doula), both of whom I expected to advocate my wishes did nothing of the sort.

I am left a little jaded because I was not exactly in the best shape to do so myself

If it ended with a c/s - which it did - I wanted my baby to be kept with me in recovery. I wanted to b/f asap but he was taken away. I wanted to be present when he was given his first injection but I wasn't. I wanted to be shown the placenta but I wasn't.

Has anyone had a similar experience?

TICKLISH

[Beach Mama]

Firstly I'm sorry you didn't have a good experience for you birth or get your VBAC hun. I don't think birth plans are a waste of time, but I also know from experience that things just simply don't go to plan.

My main points on my birth plan with Izzy were, no drugs, I was terrified of an epidural and c/s and ended up with both as well. I also had lots of things like massage etc on there but DH and the midwives were a bit useless.

This time around I have gone through my plan with my doula, and I have pulled out just the absolutely necessary things like internals, IV, monitoring etc.... and I am leaving all the other "environmental" aspects up to DH and my doula. I am trusting them to make sure my birthing room is a calm, quiet dark place that I can do my thing! and I am trusting them to stick up for me mid contraction if they try to make me lie on my back for internals etc...
Having said all that, I am also aware that nothing is set in stone and that writing it on paper makes it very clear for me what I want, but I may change my mind and circumstances may change them for me too.
I hope that's not all too babbly! I'm a bit tired, but I think they are great to go through with your partner so you know what you are definite on, what you feel very strongly about and everything else needs to be pretty flexible.
I don't mean to offend also but I think that you should be able to trust your support people explicitly (although partners can be a bit useless seeing us in pain) but your doula in particular should have supported you better - birth plan or not. I would also maybe write a letter or speak to her about your disappointment hun.

[lila]

ticklish,
i am sorry to hear about your disappointing experiences.

i must admit, i had to push SOOO much to get what i wanted and in the end my anast. was the one who made it happen.
the midwives just ignored everything, although i handed out at least 10 copies.

but you said you had a doula, she should have reminded your dh to insist on your wishes (a doula herself is not entitled to do this)...


as tanstar said, i would talk to your doula about this and let her know how you feel. she may not even know and might appreciate your feedback, eventhough it might not be very positive, but it will let her understand your needs and give her more insight for her next client....

all the best
lila

[BellyBelly]

Whilst in labour, I had requested not to be told how I was progressing - but I was (and yes, it wasn't good progress!)

Unfortunately many carers do not read birth plans. Birth centres are usually quite good, they encourage birth plans and read them, but with so many shift changes in hospitals they often sadly don't bother to read it and their job in a hospital is all about progress... so they often tell you.

My support people (DH and doula), both of whom I expected to advocate my wishes did nothing of the sort.

I'm sorry you felt so unsupported - as lila said a doula cant turn around to a midwife and say 'dont tell her how she's progressing she doesnt want to know' as it creates tension, but I agree encouraging your partner to is a good idea. Was your doula experienced in VBAC or had much experience at all?

If it ended with a c/s - which it did - I wanted my baby to be kept with me in recovery. I wanted to b/f asap but he was taken away. I wanted to be present when he was given his first injection but I wasn't. I wanted to be shown the placenta but I wasn't.

Again sadly this is all hospital process and protocol. They dictate the whole 'what happens' in a c/s situation and it sucks. I would write a complaint to the hospital, as the more women who complain about this happening will make waves.

Birth plans are important, and it sucks but at the end of the day you have to be prepared to fight. I dont know if you went public, which it sounds like, but many public hospitals aren't very pro-VBAC and tend to make it difficult for women. Its very frustrating.

I would look into some birth debriefing, definitely speak to your doula but I have a feeling you might need more than just speaking to the doula.

[DANNIIM]

I am not sure if i fully agree that it is always hospital protocol and i am in no way putting down any persons feeling in regards to this topic at all.
However i didn't have a birth plan for my first, didn't even know they existed to be honest, maybe i just have a group of fantastic midwives three in total in the public hospital system. When they had the first shift change my lovely midwife came over knelt down to my level and asked me if i had any preferences in giving birth, didn't know fully what she was talking about cause all i wanted to do was meet my baby and i said no naively. I had a completely different midwife deliver DS due to another shift change and that midwife, another lovely lady asked me firstly and then showed me my placenta, not the nicest looking peice of organ but it serves a really good purpose and was glad i got to see it and its workings.
All i can say is that i am a person that doesn't like to plan things as they don't normally go to plan anyway, i just like to go with the flow and that is precisely what i am doing this time as well and DP knows how i feel about certain things anyway and i couldn't ask for a better support person anyway, but i really feel it also comes down to the midwives individually and if they are really there for the women, to listen and understand her ahead of time.

Ticklish sorry to hear you didn't get the delivery you hoped for.

[Smoke Jaguar]

I had a birth plan, borrowed from a few different sources and meshed to reflect my values and wishes. It was read by all midwives at the FBC, my DP knew what was in it and it was carried out beautifully without me needing to cite it when I went in, in labour. The only bit that didn't go to plan was the third stage, which had to be managed due to some PPH. The attending midwife apologised profusely about this, but there was no need to do that because I know they had respected me the whole way through.
Not a waste of time, especially if you birth plan correlates strongly with the values and procedures of where you are giving birth. In my case, my birth plan was often just a rephrasing of their own mission statement!
I felt a lot of ownership over the birth we had because of the birth plan and finding a place to birth that was consistent with my birthing ideals.

[BellyBelly]

Birth Plans - Is It Worth Writing a Birth Plan?

[~clover~]

On my ante natal card with DD1 it had a section on the back at the bottom that said Birth Plan.
All I put on there was 'as natural as possible'.
I ended up with gas & 2 shots of pethidine as I was progressing slowly, but that's all I needed. & for them to tell me I had to stop fighting the contractions.
I was crying when they gave me the first shot of pethidine coz I didn't want it, but she gave it to me anyway. Then said 'it's ok, I won't do it'.
'I'm not stupid' I said back.
I am glad they did that though, coz they were talking about taking me for a c/s. I'm just really glad my MIL was there to tell them to just see how I go.
The pethidine was enough to relax me & get me through it.

With DD2 I think I just put the same on it. The MW was GREAT! I waited at home this time til I couldn't stand it. I was 6 - 7cm when I got to hossy.
When I said I needed to go to the loo, she said it was time to push, so I did. After about an hour she did an internal & decided I wasn't quite dialated enough & that I had to hold off for a bit. That was the first time I was offered the gas. I had one breath on it & started to go tingly around the mouth so I dropped it. That was it.
With DS I refused gas when they offered, but towards the end yelled out for pethidine. The MW knew I wanted to avoid pain relief as I refused the gas so prefusely, so before she agreed to the pethidine she offered the gas. I wasn't gonna go there though.
So she went off to get the pethidine while another MW kept an eye on me. She took her sweet time & I think its coz she knew I could do it & the pethidine was pointless.
I finally got it & 10 minutes later DS was born. 10 minutes later she said the pethidine would be just starting to kick in!

I haven't been through any thing compared to some people & I do know just how lucky I am, but that'a probably why I would go MW care over OB any day.
DD1 was the only one I had that an OB had anything to do with. I was booked for an induction, but decided against it (I was supposed to have it done at 2 days over due), then the talk about a ceaser.

I've been a public patient for all mine & am 100% confident in MW care. I also have been very lucky!

I think it's once it goes past MW's to OBs etc that other interventions come in. Sometimes they are necessary, but alot of the time it just for the OB's convenience.
Thats really not fair.
I really wish others could have birth experiences like mine.

I would have a birth plan, but just be prepared. I didn't worry about it 3rd time around coz I knew after DD2 just how different every birth is & that you just don't know what to expect. Anything could & does happen.

I know I've just come in here having no idea what its like to be in your position, but I just wanted to wish you luck in the future. Due to your c/s's you don't have much choice but to have an OB involved, but I really hope next time you find one who is more willing to follow your wishes.

[Tobily]

This is a topic I've been thinking about for some time.

I'll say at the outset, that no I don't think they are a waste of time.

What I'm going to say isn't in reference to any of the choices you made ticklish. It is purely my observations on birth plans, mums and hospital politics in general.

I think a birth plan is a FANTASTIC tool but I think that women need to be realistic about what it can achieve. Birth plans are marvellous for making us think carefully about what we would like, what we would like to avoid and about strategies for doing that. The process of writing it forces us to research what actually happens during birth and that is very empowering. They are also good for opening dialogue between ourselves, our support people and our caregivers - giving everyone the opportunity to say what what they're ok with and what they aren't so that everyone feels they're on the same page.

In spite of this, the more hospital births I support the more I feel that they may be causing more problems for women than they solve.

I tend to feel that for first time mums in particular - with nothing to relate the birth experience to, and no real first hand experience dealing with hospital policy and personalities, and the power games that can go with that - having a birth plan can set them up to believe that it doesn't matter what choices they make in terms of caregiver and birth place, they will be protected - because it's on their birthplan that they don't want x,y, or z. I do feel sometimes that expectations of what a birth plan can achieve are too high...and this is why many women feel they are a waste of time afterwards. I've also seen alot of women who expect that a doula will be able to completely change the way their caregiver practices...this isn't what doulas do. For example, if a woman's caregiver has an episiotomy rate of 80% for first time mothers - doula or not there is a better than good chance that mother will get an episiotomy. Especially if she hasn't been forceful with her caregiver about her desire to avoid one before hand, and expected her doula to snatch the scissors out of his hands at the birth. While that might seem extreme, it illustrates the mother who doesn't want to put her caregiver offside, or doesn't like confrontation - so avoids these discussions before hand thinking the doula will deal with it. That's never going to end satisfactorily for her, or the doula. Women really must must must grill their careprovider mercilessly at the outset. Kelly has a list of questions to ask somewhere in the articles, will find the link later and post it.

If a woman is planning a natural and low intervention birth, a good birth plan (and even a doula) is only a small piece of a much bigger picture that she needs to put together to give herself the best possible chance.

The biggest deciding factor on what happens in your birth is the decision you make at the beginning - where and with whom to birth. I cannot stress this enough. No birth plan, and no doula will be able to save you from unwarranted intervention if you don't make this choice wisely. Only 3% of women who birth in Australian hospitals do so completely intervention and drug free. This statistic tells us a hell of a lot about what is happening in hospitals today - it tells us that before you even walk through those doors the odds are stacked firmly against you. We need to start getting realistic about this and if we don't like those odds, start seriously considering the alternatives.

Ticklish I'm sorry you feel so let down, I think you should talk to your doula and give her your feedback, but perhaps also find some other support to debrief as well, it sounds like you could use a hand to work through some of those (perfectly understandable!) feelings. All the best hun

Sorry I've ranted a bit, this has been on my mind alot

[Smoke Jaguar]

Tobily, that was excellent.
I guess this is what I was saying when I said about birthing in an environment consistent with what you want. An FBC is closer to the mark of what a lot of women want, yet access to them is getting tighter, or women are put off because they still think they need the OB supervising their normal pregnancies.
For me, our birth experience highlighted that we need a homebirth next time, and not because the FBC failed me in any way. Just because I feel no extra comfort, nor did I during pregnancy, that the maternity ward with bells and whistles equipment was across the corridor.
Anyway, birth plans do need to be discussed with your caregivers. I didn't just hand mine over and hope for the best. We talked about each point on my plan. They knew where I was coming from, how I had educated myself and what I was expecting from the midwives. And you have to have someone with gumption to be your advocate - not someone who will just as easily buckle under OB pressure for unnecessary interventions.
It's multifaceted, so there's no simple answer!

[Tobily]

Tobily, that was excellent.
I guess this is what I was saying when I said about birthing in an environment consistent with what you want. An FBC is closer to the mark of what a lot of women want, yet access to them is getting tighter, or women are put off because they still think they need the OB supervising their normal pregnancies.
For me, our birth experience highlighted that we need a homebirth next time, and not because the FBC failed me in any way. Just because I feel no extra comfort, nor did I during pregnancy, that the maternity ward with bells and whistles equipment was across the corridor.

Mayaness your experience is a perfect example of how a birth plan can work really well.

When you choose a birthplace whose philosophies support what you want for your birth, seriously half your battle is already won. Your birth plan then becomes what you intend it to be - a guide for your careproviders as to your preferences rather than a tool used to "fend off" things you don't want.

Even when things don't go "to plan" a birth place that is woman centred and in line with your own philosophies will, by definition do things that will minimize trauma and support you emotionally. And in the very worst case scenario, will salvage what they can of your birth plan rather than ignoring it totally.

[Mum0809]

In my experience a birth plan is a waste of time. Nothing was followed from my birth plan with ds. I don't think I would do one next time. It was very disappointing and distressing.

[~clover~]

IMO the best thing you can do is know as much as you can.
Read everything about child birth, the good & the bad.
Prepare yourself for ANYTHING & everything.

The first time you have no idea what you are in for, so its really hard to be prepared.
The second time you get a shock as well, coz you don't think 2 labours could be so different.

Once you really know all that & if you are lucky enough to birth vaginally the first time without too much intervention you will have more confidence in your self to do it better next time.

I think that has alot to do with it in some cases.

It is so hard to know what you will be in for til it happens though. IME the pain gets to the point where you get scared & give in.
When you are in that much pain its to easy to give in & give up, so a strong support person is helpful!

[Smoke Jaguar]

I gotta say, I prepared for what I wanted, as opposed to preparing for 'anything'. I knew what could happen outside of that and made provisions for it in my birth plan, but I actually prepared for the birth I wanted. I did HypnoBirthing, planned for a waterbirth and planned to labour entirely at home. I'm not saying that if you prepare for these things and don't get them that you have failed. I'm saying that if you don't prepare for what you want, you're not giving yourself enough credit and you're very open to being part of someone else's plan.

[~clover~]

I agree. It is best to have a good idea of what you want the out come to be.

I didn't know enough about any of that with my first to think of it. I was still a kid then myself.

You need to know everything possible, but you still need a goal. Just little things that will mean something to you. eg, the bfing & having baby in recovery after c/s, having everyone leave the room after baby is born so mum & dad have alone time with baby early on. That sort of stuff.
Active labour rather than being stuck on your back.

These are things that might not entirely work out, but there's more of a chance they will if they are in your birth plan.

[meow]

How disappointing Ticklish- I'm sorry you had that experience.

My experience was the same as Mayaness. I was so glad I wrote a birth plan as my attending midwife read it before we arrived at the birth centre and did everything without needing to ask me (such as knowing I preferred to tear than have an epi or that we didn't want the Hep B vaccine). That said, I also want a homebirth next time as I'm aware that the hospital rules still limits the birth centre's ability to cater to me exactly as I would like.

I'm sorry the midwives at your 38 week appointment didn't indicate a CS may go differently than your plan. As much as I didn't like it, the midwife who read mine when I had it put on file explained that some of my CS requests wouldn't be followed (such as delaying clamping the cord) so I guess if it came to a CS at least I was forewarned.

[BellyBelly]

Generally speaking - for the entire population - at the end of the day, if you want a birth a certain way you also have to take responsibility for the choices you make. So many people would love a natural birth. Yet they make choices not conducive to that. They choose private obs in private hospitals thinking thats the best care, yet it all goes pear shaped and think birth plans are a waste of time as they didn't make wise choices and wonder what the hell happened. Private hospitals and private Obs have the highest intervention rates by far. Public is less. But if you really do want less intervention and it means so much to you, then you need to make good choices. Read the right books. Attend the right classes. Choose the right caregiver. Choose the right birth support - someone who is experienced, known to you and provides continuous care. This is what results in the best birth outcomes and what I have been saying for a long time.

As much as we can blame the system, we also need to look at what choices we are making too. So many people say they are informed and educated, but are they really? This is my passion, I offend alot of people but this is modern times and modern times demands this sort of attention to our birth decisions. You MUST take responsibility for all of the things I mentioned above. If you are not comfortable having a private midwife, homebirth or whatever, you have to accept the major flaws in the system and the fact that your choices may be useless on paper. Don't blame the birth plan.

[*Efjay*]

I don't want to start a debate or anything but Kelly & Lila said

a doula cant turn around to a midwife and say 'dont tell her how she's progressing she doesnt want to know' as it creates tension, but I agree encouraging your partner to is a good idea.

If this is the case ,then what are the parents to be paying for? I thought a Doula was there to advocate the labouring mothers wishes. To be the voice of these wishes when she can't. To stand the ground & be the one who speaks up when Mum & Dad are preoccupied or not in the right frame of mind.
Not to just sit there & say nothing when things are clearly not going to the birth plan.

I realise that not everything will go to plan but something simple like nnot being told about how one is progressing isn't hard to step up & say NO, she would not like to know.

I would be mighty ****ed off if it was me & everyone ignored my birth plan, including my doula.

eta - also whats the difference between the doula creating tension or the partner?
I remember DH standing up for me while in labour with Glenn & the midwife treated him like crap. He felt belittled & made to feel stupid. Personally I would much rather my partner have just as positive an experience as I want. So again, this is where I thought it was the doula's paid job to be the voice.