Are birth plans a waste of time?

[BellyBelly]

I have done it before, I had a client who was being ripped apart and was bawling her eyes out, and I was so cross I did it. But there was one time before that I ****ed off the Ob big time so much so she spoke to me after the caesarean and told me that I was better suited to homebirth. I have also heard of doulas being banned from hospitals for this.

So how do I advocate for them?

1. You thoroughly understand/learn their birth plan and help them prepare BEFORE the birth of any challenges they might have
2. You prepare dad to be a 'gorilla'
3. You give them tools like BRAND
4. You encourage them to ask for privacy to make any decisions
5. You put the questions onto the couple in a way which is passively advocating, i.e. if they say we want to put the drip up, then I would say to the couple, 'Okay, this isn't in your birth plan so would you like some privacy to talk about it and make a decision?'
6. Adocating is a small part of the job. The massive benefits cited in studies come from a range of things a doula brings to birth. Hopefully a doula has done enough work before the birth to empower her client in preparation for the birth.

etc. etc.

There are loads of doulas flooding into the system at the moment and many don't have much experience. Training is so accessible and navigating the system is so complex, you really need to find an experienced doula with testimonials backing it up. People either say they have an absolutely awesome doula and some say average... so you gotta find the awesome ones.

[*Efjay*]

2. You prepare dad to be a 'gorilla'

so rather having the doula banned, lets encourage obs & midwifes dread having the dad in the room.

Sorry but I don't think thats fair.

[BellyBelly]

Don't have a doula then!

[*Efjay*]

I certainly wouldn't be paying the fees most seem to charge to do something my mum could do thats for sure.

ETA - Surly if a doula was banned from the hospital then said Doula could then just be present as a "support person" minus the title.

[BellyBelly]

As I said, the doula fills in a gap, one that will never be filled, midwives will always work in shifts in Australia.

* Your partner is not experienced in birth
* The midwives aren't known to you nor are they continuous

Your mother is often the worst person to have in there. She may have had a bad birth experience, she is sympathetic and suggest drugs or don't know how to support a woman as they are not experienced in birth support.

[~clover~]

I thought that's kinda what doula's were for. To stand up for mum when she gets emotional, but I do understand why they can't really tell the OB/MW what to do & why they would need to avoid creating unnecessary tension.
I think a doula is more to help mum find different positions, hold the shower suggest massage to dad & all that stuff.
Mum's mum could be just as good as a doula, but I think that 3rd person who isn't so emotionally attached just to hold hands if Dad passes out, or hold the shower head while Dad holds mum's hand etc is something well worth it.
I personally wouldn't be able to afford it, but I can see the benifits. they may seem small, but I think in the end those little things really count.

[BellyBelly]

The benefits are huge. From 16 studies around the world:

Labour Statistics
• 50% reduction on caesarian rate
• 20% shorter labour
• 60% reduction in the need for epidurals
• 40% reduction in forcep use
• 40% reduction in Syntocinon use (induction)
• 30% reduction in analgesia use (narcotics)

Benefits for Mothers
• Better bonding with baby and partner after birth
• Lower rates of Post Natal Depression
• Higher rates of successful breastfeeding
• Greater sense of achievement
• Greater sense of support
• Greater satisfaction with her partners role in supporting her in labour

Benefits for Fathers
• Less pressure as the sole support person
• Ability to have breaks without abandoning partner
• Encouragement and guidance in how to support a labouring woman
• Emotional support and reassurance
• Greater satisfaction for the support you are able to provide your partner
• Greater sense of involvement in being able to absorb the birth experience

Benefits for Baby
• Less admissions to neonatal/special care nurseries
• Higher rates of breastfeeding success
• Higher AGPAR ratings after birth

[SamiH]

I am having a doula for the first time - 3rd birth

Reason - my darling DH was just hopeless and had no idea how to support me - he is soooo practical but I needed the emotional stuff too - you are doing a great job, rubbing my hips, etc - my doula will be helping him help me. He is strong though with supporting what I say (birth plan bit) so that is good.

We are both excited and looking forward to our birthing experience - he feels much better prepared (so that makes me feel less anxious etc) - my doula and DH get along great joking and same wavelength etc which is important for me.

So, IMO it is about making the best birth experience you can for you both as a couple - with some constant support - reminder to change positions - get food and drink if need be - and a constant familiar face

[*Efjay*]

I guess I am just extreamly lucky then because my Mum was great as my birth support for my boys.
Not only did she listen to me & what I wanted. She also applied massage, offered suggestion of different positions etc. When She was taken from the room so out of my earshot to be told to convince me to have drugs I didn't want,she didn't come back & push that on me. She came back & told me what the midwife had said and accepted & supported my answer of NO.

I do realise not everyone would have that kind of support in a family member.

All I am trying to say is that if a little conflict needs to happen in order for the labouring couple to get the birth they wanted, or at least have their plan played out as closely as possible for the current situation at hand then thats what the doula is being paid to do.

The example I quoted saying that a doula cant say "she doesnot want to know" is what I see as wrong. If it written in the birth plan then the doula can say "she does not want to know, maybe you would like to go over her birth plan again"

Which Im sure would happen, But to say that you CAN"T so you avoid tension is what I disagree with.
To train the DH to be the one to jump up & down to me is taking away his chance to be one with his wife while birthing their child. As I said, I would much rather see the Doula & midwife not seeing eye to eye then the father of the child being made to feel unwelcome at the birth of his own child KWIM.

[Smoke Jaguar]

FJ - you're shooting the 'messenger'. I don't know what answer it is you want and you seem unhappy with some of the choices presented here. I don't think it's fair to turn your energies against those who seek to empower birthing women, even if they don't have all the answers that make you happy.
There are birth plans that 'work' in good situations. There are ones that 'work' in some bad situations. There are those that don't 'work' in bad situations and we're just fleshing out why that could be. I've given my theory, as have others.
If it upsets you to realise that a good, solid birth plan is always going to be on shaky ground in a medicalised environment, then you need to reassess what it is you value, your own risk situation and how badly you want your way, all weighed up and considered.
I don't think I will ever understand why people get angry and attack the person (not saying anyone's been attacked here, I'm talking from experience!) who says birth can be wonderful for low-risk birthing women, and passively (almost eagerly) accept the horror stories and drug-pushing ('take the drugs, take the drugs' - do you know how many times I heard this as a response to my HypnoBirthing, waterbirthing plans? How utterly rude and obnoxious!) instead. I know which option I'd rather choose! Nice dream vs nightmare, no contest to me.
Anyway, I digress. Doula discussiona aside: If you have a birth plan that no-one is bothering to read or consult you on prior to the birth, you are probably in the wrong place (if you're having a normal pregnancy and a normal birth is predicted, need I spell that out again?) for your birth.

[BellyBelly]

In the labour room, there are two things a doula cannot do:

1. Cause conflict
2. Tell a midwife or doctor how to do their job (see point 1)

The majority of doulas manage to do this and have great outcomes. The drug free, vaginal births including breech, VBAC and twins, massively outnumber the c/s's, assisted and induced births.

[~clover~]

I wish I found this site earlier.
I'm not planning on having anymore babies, but I really would love to have a doula if I ever did have any more.
I'd never heard of them before.

With my first birth my mum & MIL were great, my 2nd it was only DH & I, but I had an excellent MW.
With DS MIL was there (DH had to travel from 2 hours away), but she sat in the corner & stayed out of the way. I had noone holding my hand for the hour or more til DH got there & the MW pretty much left me to labour. I felt pretty alone. Then DH nearly did pass out, & I was alone again.
I was hooked up to a monitor & couldn't really move due to macconium. I was lucky that it was a quick labour though.

But to have someone to help me through it like that would've been good. The MW's this time around were great too, but were only really there for the actual birth. & even though I screamed at them to 'pull it out!!' they said 'No, your going to push this baby out yourself!'

[*Efjay*]

In the labour room, there are two things a doula cannot do:

1. Cause conflict
2. Tell a midwife or doctor how to do their job (see point 1)

The majority of doulas manage to do this and have great outcomes. The drug free, vaginal births including breech, VBAC and twins, massively outnumber the c/s's, assisted and induced births.

But what I am trying to say is if its in the birth plan surly you CAN speak up for what the birthing mother wants? Even if it is by simply directing the mw/Ob back to the birth plan.

As I said it wasn't my intention to start a debate. I just disagree with the thing about not being able to speak up on behalf of the mother. If its not in the birth plan then fine but in this case is was. So why can't you stand up & say so?

FJ - you're shooting the 'messenger'. I don't know what answer it is you want and you seem unhappy with some of the choices presented here. I don't think it's fair to turn your energies against those who seek to empower birthing women, even if they don't have all the answers that make you happy.

I don't really get what your saying. But again, the messenger in my head is the Doula. So yes If I need to shoot her for not doing what I thought was her job then whats wrong? As I said I am disagreeing with the idea that a Doula can't voice whats in the birth plan.

I totally understand that the Doula can't just jump in & take over & say XYZ just because. But if XYZ is in the birth plan but no one is doing that then I thought the Doula can & should jump in & say XYZ if the couple are too overwhelmed to do it them selves.

eta - I realise that the not all births are going to go to plan & that the couple may need to step away from the birth plan & take whats going to be best to get a healthy bub & mum at the end & yes I can see a doula being a great support here.

All I am saying is when things are no track or something as little as not being told of details of progression which is stated inthe birth plan then this is where the Doula should step in.

[lila]

In the labour room, there are two things a doula cannot do:

1. Cause conflict
2. Tell a midwife or doctor how to do their job (see point 1)

The majority of doulas manage to do this and have great outcomes. The drug free, vaginal births including breech, VBAC and twins, massively outnumber the c/s's, assisted and induced births.

I have to agree here.

But, what we Doulas can do is, listen and "hear" what our client wants BEFORE the birth.
Be empowering, but also THERE. Sometimes a woman in labour and the partner with her, are so blown by what they are facing, as a Doula you know what the Midwife or Doc just said and you usually know how urgent things are.
You then explain things in a calm and private enviroment to your clients, rather then them have to say YES or NO that minute the MW/DOC speaking to them.
They might understand your explainations better- AND as a Doula you are usually choosen once the woman and her partner feel comfortable with you, so in other words they do trust you.
So you (the birthing mother) then can decide if you want to go ahead as per birthplan or if you do want to agree to an "maybe necessary" intervention, your Doula will give you the strenght whatever way YOU choose!

[BellyBelly]

Nah this is a good discussion and not a debate, whenever one person is thinking something then there is always something else so its good to clarify.

I do stand up for my clients, absolutely. One Ob said to me, 'Kelly, you convince them to have the syntometrine,' and hastily left the room. So while I wouldn't have said it while the Ob was there, I was able to have a quick chat with them and prepare them for saying no. Luckily this dad was the most confident I have ever worked with, and said no very firmly. The Ob also called them bloody stupid for choosing not to have it, even though she had very little bleeding. In that situation me saying something could have been disasterous. But I was able to empower and reassure that couple that their birth plan was fine and it was their decision, so my work was done. Births shouldnt be a battleground and I see it as unprofessional to cause conflict at someone's birth. There are tactful ways to stick up for women, and like I said I have spoken up where I felt necessary.

One client had slipped through their strep b screening, and they said they would class her as positive and put the ab's up. So I asked the doctor, so what is the risk, to which he answered, very small... so putting in little things like that help too. Its all how you do it, its such an art, it really is. We need to build the professionalism of this profession and conflict isnt the way. Midwives I havent met before are very funny with me until they work me out, this happens alot more than it used to and I hear horror stories from midwives alot more too, about doulas pushing women to birth plans, and all sorts. But when you build rapport with midwives its much easier, they relax right away and even recommend you. Then you can push the envelope a little more

[*Efjay*]

Im not saying there is no benefit to having a Doula.

I do want a straight forward answer to the question of "If its on the birth plan & its not being followed for no good reason, then can & will a Doula step & say something?"

Thats all I want to know. I thought the job was to be the voice. In the OP the poster said she was being told of her progression when she had it in her birth plan not to be told, neither her DH or Doula stood up & said something. Now I can accept DH not saying anything but this is where I thought the Doula comes in & speaks up. She knew what was in the birth plan, She should have been with it enough to point it out.
Am I wrong?

[Smoke Jaguar]

FJ - It just seemed to me you were getting angsty at Kel about the role and limitations of a doula.
The way I see it, a doula, as well as the birthing mother, is going to be compromised in terms of being able to reach full potential, by being in an adversarial environment to begin with. A doula can uphold a birth plan better if there is respect for the plan to begin with...and I'll go back round on myself and reiterate that choice of birthing environment will enhance the power of the birth plan. In most cases it's your choice; Medicalised or not?
To me, the role of doula is not primarily to be translator for the medicos and hospy midwives - she's there to support the mother and direct the father during birth (if he needs directing). To me, that's her main training. To have one that is a good advocate, that's when word of mouth comes in, as it's probably an 'added bonus' as far as doula's go!

[lila]

Im not saying there is no benefit to having a Doula.

I do want a straight forward answer to the question of "If its on the birth plan & its not being followed for no good reason, then can & will a Doula step & say something?"

Thats all I want to know. I thought the job was to be the voice. In the OP the poster said she was being told of her progression when she had it in her birth plan not to be told, neither her DH or Doula stood up & said something. Now I can accept DH not saying anything but this is where I thought the Doula comes in & speaks up. She knew what was in the birth plan, She should have been with it enough to point it out.
Am I wrong?

FJ-
as I said before ticklish had a very disappointing birth happening and I really feel for her. It must be frustrating, having hired a Doula and still feeling left alone.

As a Doula you should step in, but as Kelly said, we cannot interfere and tell the OB or MW to do or not do their job.
What we can do is remind DH or yourself about your birthplan and what Ob/MW try to do, which might be NOT part of your birthplan.
We can make sure our clients understand whats happening, so the mother and her partner are either happy to continue with their birthplan, regardless what the OB/MW offer OR they want to take the intervention.