Birth plans & drug-free birth - how much do you want it?

[BellyBelly]

I have been going to the Maternity Coalition's Choices for Childbirth sessions on Friday nights at Brunswick, because I am going to be facilitating the proposed Balwyn sessions, hopefully by the end of the year.

Last night's session was on Pain, spoken by Rhea Dempsey who trained me. I always learn something new or gain a new perspective every time she speaks, I think as does everyone! Anyway, she had just gotten back from a maternity conference from which 5 melbourne hospitals were represented with midwives. She said something that really gave me another perspective to look at birth plans, which I thought I would share.

Anyway, she said that they are in a pickle with the whole birth plan stuff. They love women having them. They love the idea of it. But what gets them in a pickle and not knowing what to do is when women present with a great birth plan saying no epidural and this and that, but at first signs of things crumbling, they scream for an epidural. So the whole thing falls to pieces as one intervention leads to another and this happens ALL THE TIME. So how much do we really want it? How geared up are we to work with pain? What are our expectations vs realities? How well prepared are we? I do know this, when they played the tape of contractions of a woman in labour last night, one woman asked one of the other facilitators, 'was that for real?' thinking it was a joke! The woman in labour wasn't even at transition yet and was having a home waterbirth and well supported and in control, embracing the pain, so to me, it sounded great. Lucky they didn't play the tape of the woman in transition!

Now, I can see how they can be very used to this, when a birth with intervention is around 90-95% of births. The midwives estimated that (and they negotiated and said, without a physiological third stage - so with the oxytocin injection for the placenta) that around 1-5% of women are having this 'natural' birth. I can't imagine what the actual number is who are having a normal physiological childbirth - if 0.3% of women in Victoria are having a homebirth, I guess it could be around this number, or a tiny bit less. This is extremely low so I can see how many have become very pessimistic about birth plans.

So, it got me really thinking about things and reinforcing that there is not enough quality pre-natal / birth preparation education around. There is not enough information on working with pain if that's what you really want to do.

But how many of us say we want a natural birth but actually mean it, and want to work with the pain and be supported well? I think that we need to think more carefully when writing our birth plans but also, if we would like to give normal birth a 'go' or if we are dead set this is what we want, we need to seek out further birth preparation than that offered in hospitals. The hospitals are not designed to offer you the best environment to bring out your best birthing potential - it is there to manage the process. So you can't expect it's pre-natal education to be doing any favours other than the three stages of labour and pain relief options.

It's got me thinking lots, what are everyone else's thoughts on pre-natal education and adequate preparation? Another point she made was that lifestyle (amongst many other things) is a problem - we have a much more sedentary lifestyle than we once had, it was once more physically demanding and we were used to pushing ourselves and being more physically active. But now, we don't do that so much and it doesn't take as much as it used to, to feel uncomfortable. And of course, there is that hospital medical model mentality to make things as comfortable as possible.

Who knows, maybe this is too out there for everyone! But the more I listen to my teacher speak, the more it makes sense, the more the pennies drop and I get thinking about if there really is anything we can do when so little women are having normal birth. will it all be gone one day? Those that do are in a tiny pocket of people, I think it's quite sad that we are losing so badly, especially when the WHO says that it could / should be the other way around - a huge component normal birth and a pocket of interventions. I wonder what will become of medicalised birth in the future? It seems such a difficult task.

[Tobily]

I think she raised some very interesting questions.

I honestly believe that there is not enough education or preparation about what sort of pain we're actually talking about here - the lady who was freaked out by the tape illustrates that.
Part of the problem I guess is that there IS nothing in our day-to-day experience that is really comparable to the pain of childbirth, so with nothing to compare to we end up going in thinking "well how bad can it be?? I have a pretty good pain tolerance, I can do this without drugs". But you ain't ever been in that sort of pain before sister There needs to be an acknowledgement of this instead of sweeping it under the carpet by saying "yeah it hurts but you forget it" or "it's a good pain" - these things are true but they AREN'T the full story because it does hurt worse than anything you ever felt in your life. How can you prepare for that if you don't acknowledge it?
Before I had my daughter I had always been fascinated by the process of birth, had spoken to many women about their births and yet I remember thinking when I was in labour that I still honestly had NO CLUE what I was in for. So how about a woman who has had no interest in learning about it until she is pregnant herself? What hope does she have?
I think we really need to speak in realistic terms about the reality of the level of pain, the realities of managing that pain - especially over a very long labour when you are sleep deprived which makes everything so much harder - if we want to give women real choices when it comes to pain management in labour. They have to know what they're in for before they can plan for it.
Perhaps my view of the pain is skewed as well because I had a synotocin induced labour. I'm sure I overdramatise the pain because of that LOL.

[Ca Plane Pour Moi]

I've had people decide to tell me "horror stories" - their words - and I agree, I don't think you can prepare really! Even watching videos isn't really preparing for it.

I'm just sort-of pleased that I learnt to deal with pain at a young age (I used to get terrible problems with my feet - even needed an operation on them - and do a lot of walking) but even that won't help too much. However, I hate drugs and no matter how much pain I'm in, I'm going to try and avoid them. I really, really hate even taking aspirin so aren't likely to let someone whack a huge needle in my spine! I mean, pain is there for a reason! (Not that I like being in pain, just I do accept it's there for a reason and work with it, rather than block out my pains.)

Does it hurt more than having your feet cut open, your bones re-moulded, then your 10stone+ sister (about 65kg+) sit down on your feet a couple of days later? I think that's the worst I've ever had. Actually, I'm not looking forward to hours and hours of that!

Ah well, just keep on with my stretching exercises I guess!

[Rachel]

I don't know a lot when it comes to the topic of pregnancy and i definitely don't know what it's like to experience the pain of labour. I don't think anything compares!! I have been told that there is nothing that can compare (although they say kidney stones are about as close to the pain that a man will feel!). I can't comment on prenatal education given that i'm not quite up to that stage yet but how can you describe the worst pain without scaring everyone to death???!!! Is there a way to describe this pain so that it can be made accurate and so that informed choices can be made regarding pain relief? I personally think from what i've seen and heard that you can have every woman under the sun explain to you what the pain felt like and even though you think you understand...you are still taken by suprise when the time actually comes for you. Having said this I don't believe in concrete birth plans...i think they need to be a fluid document because we don't know what the pain will be like so who knows what assistance we may need. I think a lot of the struggle comes by dealing with it psychologically first....you need to mentally prepare yourself and tell yourself that you can do it but that you're not a failure if you need help. As i said, i don't really know because i haven't done it yet...I've booked into a hospital that doesn't offer epidural as primary pain management which suits me to a tee because i don't want an epidural (unless there is a medical/emergency reason why i need it and then this hospital will do it). They do offer all other forms of pain relief and my thinking is...i don't know what it is going to be like...i think i can tolerate pain but have i ever had pain like this? I am hoping with my DH there helping me along i can do it...but if i need help...the options are there.

Sorry, i probably just rambled and went completely off track which i do often but i think what Kelly has said is a very valid point. An interesting topic.

[BellyBelly]

My teacher uses the term, 'crisis of confidence' which is something we all get at some point in labour - usually this can be at some time at transition, sometimes we can get several of them (as per an earlier point, my teacher says she sees it happening earlier and earlier on in labour now that we live the sedentary lifestyle we currently do - we aren't use to pushing / exerting ourselves physically as much), but we all face a crisis of confidence in labour somewhere. This is when we say things like, 'I can't do it,' or, 'I want to go home,' or, 'Just give me a caesarean/epidural!' and think that we can't do it or it's all too hard. Even women at home experience this - we all do. But the thing is, how much does this woman want to have the natural birth she has said she wanted in her birth plan? Does she want to be pushed or is it just a romantacised ideal? What has she researched about birth and how much does she know about the process and how much does this mean to her? And who's going to ask a woman about that during labour?!!!!!

Because midwives in hospital don't know you because they probably haven't met you, they wont know your thoughts and philosophy on the topic - so screaming out that you want an epidural must be hard for some of them - they obviously have a job to give you what you want, but also, if your birth plan says otherwise, does that mean that you want her to help you get through? Can she help you through or due to staffing issues, does she just go straight for the epidural because she knows she can't be with you? It must be a tough call.

Many women hire my teacher because they know she will get them through their crisis of confidence - and many women can be with the right support and pre-birth knowledge - but I can see it more from a midwife perspective on why some are so funny about them. If you really want to be well supported through the crisis(es) of confidence, then you have to get yourself and your support team well clued up on it - because if they crumble, then what do you have to help you through? This is why I think Birth Attendants are so important in the process! They will help you through these 'crisises' and not have to leave, and will keep your support circle (e.g. partner, family) strong too. They also would have met the mother before hand to know and understand how passionate she is about this birth, her attitudes towards pain and can help accordingly. Of course, in an ideal world, we would have one to one midwifery and it would be alot different.

[Fenella]

I think everyone prepares for it differently - personally I had no interest in watching the video of a woman giving birth as I felt it would only reduce my confidence and not offer any real insight into what the birth would feel like. Speaking to other women who'd had natural births (especially my mum who had 3 kids with minimal intervention and my grandma who had 8, about 5 of them at home with no medical intervention) helped my confidence a lot more. And for me, it was not so much "how much I wanted it" as "how much I believed in my ability to do it". IYKWIM!

[Lil_Pearl]

I think it's beyond terrible that childbirth education really doesn't exist, does it? In that, there is no education about the reality of childbirth, of childbirth as it has happened until the last century - natural, everyday, childbirth. Certainly not mainstream, free education. I mean, a woman screaming for an epidural, in my mind, is a wonderful, positive and encouraging clue that she is nearing delivery. Of course, some women DO need an epidural, if there is other types of pain involved (such as nerve pressure), or if there is an underlying medical condition that requires an epidural (such as v. high blood pressure). Otherwise,...they weren't even available until rather recetly when you think about it, and yet one screem and they're jabbing people with needles. It's just not right.

I think it needs to start in school...real birth education needs to begin at the beginning...women need to feel empowered before they even begin their birthing journey...women need to know their power...and men need to know it to! It's no use having a confident woman labouring well, and a husband demanding his wife have drugs. Education across the board needs to begin at the beginning.

I'm very passionate about this topic, Kelly, and I'm glad you brought it up. I would love to become a certified childbirth educator and to bring real education into the community....it is SO important!

[BellyBelly]

Yep I know what you mean! Did you know some hospitals are playing an old birth tape in pre-natal classes where the mum screams out to get a gun so she can shoot herself? Now you can see why this is not going to work for those wanting or hoping for a natural birth and they all walk out of there with NO confidence - but the hospital wont care as they will just freely offer drugs so the situation in 'controlled' and managed - you are easier to deal with under pain relief and need less attention to get you through! If anyone decides to watch birth videos, you need to watch those of the birth you want, even watching homebirths and waterbirths with no pain relief and where mum is embracing that pain as power, can be very empowering so you can see what your body IS capable of.

I think videos can also be useful for men, so they can see what their role is going to be, the environment etc to avoid the shock of there being this pain, noise, crisises etc and they haven't seen it before - its hard enough with them not having experience!

An epidural isn't essential for someone with high blood pressure though but they do like it when you have one as it has this 'feature', but there are medications you can take for high blood pressure instead.

[Lil_Pearl]

Cool...thanks for the info on the high-blood-pressure/epidural thing....I've only known people to have an epidural when they have high blood pressure, so this info you give me is very interesting, and makes me even angrier at the hospital system!!

[chocolatecatty]

Hmm. Very interesting thread. Question is: how DO we first time mums try to prepare for a 'natural' labour and birth.....watch the birth videos once a day for nine months to mentally prepare ourselves? Is the physical preparation (yoga etc.) more important than the mental prep or is it a matter of what type of person you are?
I'm not really expecting answers to this....

[Sal]

I've gotta be honest and wonder out loud (well, in typing) just what good birth plans really are. A woman is not going to know what she can/can't cope with until she is there, experiencing the labour. If a birth plan is evidence that a woman has considered all the possibilities of what can happen in labour, and has indicated in the plan what things she would/wouldn't want to happen to her, then that is surely a good thing. Of course, women who indicate before going into labour that they would prefer a totally non-interventionist labour are more likely to get their wish. But labour complications do happen and someone with high hopes of no intervention - vis a vis a birth plan - might end up more disappointed by their actual labour than if they hadn't had a birth plan in the first place.

I chose not to have a birth plan but had done all the research and had hopes of a non intervention labour. Regardless, my labour required intervention. If I'd had a birth plan I might have felt I didn't measure up to my birth plan 'standards'.

[BellyBelly]

chocolatecatty - all forms of preparation are important, physical as well as mental. Some people might read 'what to expect when you are expecting' and think that is informed or empowered. But there is much better out there and I think if you really want a natural birth you need to research which books are the right ones to read and not just rely on internet stuff too. Alot of preg/baby sites out there are not so good.

If you are motivated for a natural birth you might also seek out private birth education classes, as you will find out all the stuff that the hospital wont tell you or omits - like working with pain, facts and statistics, your rights - you can even decline monitoring - so much is optional but many women think they have to comply and not complain or ask questions - it's the way it's become.

I really try hard to include resources on this site which are empowering, are evidence based and often have studies backed with it. That's why you will read any one of the books in our recommended reading list and be shocked at the facts compared to some other books.

It is all open to interpretation too - I think with my second birth, I would have been happy to have an epidural before the birth, considering my bad experience the first time. I started saying i wanted one just before I got into hospital. But I got there and couldn't have one as it was almost push time. And straight after that birth, I felt blessed to have had some women there telling me I couldn't have one and I needed to do this and I could do this. The euphoric high you get from having a natural birth is amazing, it's like those people climing Everest would feel - birth is a rite of passage. So if we aren't used to being supported, held, pushed and coached beyond what we think we are capable of, then it makes it all so hard. We all deserve to have that euphoria if we want it! We just have to learn how to go get it!

Athletes know this all to well, my teacher interviewed a marathon swimmer, I think Suzie Maroney (?) and spoke to her about a huge swim she did. She was exhausted. She was getting stung by sea lice. She wanted to give up and her support team didn't know what to do. They radioed to fly in her mentor, Dawn Fraser. She told everyone else to **** off to give them some peace, and said things like, 'You know you want this. You have trained for months for this. You can do this so you get out there and don't you stop' etc etc - you get the gist - and she finished the swim.

With the right encouragement and motivation and support so much is possible, but often we don't have that and have the romantic ideal that a midwife or husband will be able to provide all that for us and we'll have what we want.

So, I think that if you have romantic ideals it makes it harder, if you want to leave it to fate it does too. If you have a birth plan you can stick to it more than you think, but it depends on more than a simple plan - if the only preparation you are going to have is making a birth plan, then it's like having third party property insurance on a home. Yes that's supporting the 'foundation'. But what about contents insurance? It leaves an important, valuable part to something so crucial, vulnerable. It's not much preparation in the big scheme of things, it's only saying this is what I want. So what are you going to do to make sure you get that? Would you go to a milk bar and ask for milk but not take money? Take a look at the other thread where I posted the stats for homebirth and you will see how little intervention we are capable of and how much hospitals have on offer. There is a bigger problem here, it's not just what we are capable of - it's what the system sets us up to be capable of. Like I said, hospitals aren't designed to have the perfect environment to unleash your birthing potential. It is an institution designed to be able to manage and control your birth - they are both very different things. So you have to think smart and work hard if you really do want a natural birth and have a serious think about your attitudes to pain.

I'm going to share as best I can a table my teacher devised. She works with ALOT of midwives and they all attend her 'working with pain' birth courses, she is very well regarded. When she devised this table and showed them, they were all amazed and say how EXACT and accurate this table is. The first time I showed Cailin, she was horrified I think LOL, but it's amazing, and I wonder if it helps anyone identify anything. Remembering that there is probably around 1-5% of women having 'normal' physiological birth and the rest is intervention of some kind. My notes were pretty bad, but I hope you can get the idea. You don't have to like it. But this is something the industry is saying so worth thinking about anyway.

She has made up five categories, to which she sees women belonging into one of these groups going into birth. Then, she predicts what will happen in the births of women in each of those groups. If she has supported over 1,000 births and been doing this for over 26 years, and midwives are saying this is so accurate, then it makes it all very interesting Of course, there are some minor deviations, especially when it comes to the midwifery care - you might be lucky to get someone coming onto shift who has come from a 'working with pain' model of care and gets you through a tough spot - someone might fluke it by getting great care from these people or on the other hand, be unlucky that a she gets a carer who's about to go home and can't help her through or working with the obstetric pain management model hat on - so there is that aspect of chance. And as she says, 'how much do you want to leave it up to chance?' How much do you really want this birth? Because the WHO is saying that the massive percent that have intervention now should be the massive percent having normal birth. So when you say, some women do need it - the WHO states with all things accounted for, it should be no more than 10-15%. But it's completely backwards. Why do we convince ourselves that so much intervention is warranted? Because we are not informed or empowered to our potential.

1. Pain Avoiding (approx 10-15%)

Strongly motivated to have no pain in labour. Opt for caesareans or epidurals as they want to feel nothing during the birth. The thought of labour being a painful event is not in the question and my teacher has even counselled women in this category when their labour was unexpected or fast and they have huge issues over having had a birth and felt pain - they feel ripped off that they didnt get the experience they want. But completely motivated to have no sensations of labour.

2. Status Quo (65%)

Doctors are trained, they will look after me and have my best interests at heart. If I need all that intervention then it must be they way it has to be. Satisfied that everything will be taken care of and I will need to do nothing - whatever is the status quo.

3. Wait and See (5-10%)

Don't know what I want. I will just wait until birth and decide what I want then.

4. Aspirationally Nieve (5-10%)

They have thoughts like, 'Women have been birthing since the begining of time! I am healthy, fit, well and a fine specimen of one of those!' If she hits a crisis in labour, it's the labour's fault - it was something that shouldn't have been for her not to cope. These women are not aware of the vulnerabilities they will face in labour, will often invite people into the support arena who they can 'perform' for - i.e. sister who had two caesars and wants to show her how strong she is and she can do it, or a partner who thinks she can't etc. Of course, the support people are inadequately prepared and think something is seriously wrong when all along they have been told, this is easy, I can do it, I wont need help. Often blames partner or support afterwards.

5. Highly Motivated for Normal birth (10-15%)

She has a good support team around her and is prepared that she will have at least one, perhaps several crisises of confidence. She is well prepared and knows what to expect and has thought about how she will cope with things. She comes out okay even if the birth was not as hoped because she knew she had good support. She realises that there will be medical need if required and comes out with a high birth satisfaction.

If you want to know the outcomes for these births, let me know

ps. for the birth plan thing, really we should be saying one of two things. 1. I really want a natural birth and want to be pushed, or 2. I would ideally like a natural birth, but am open to an epidural if I need. We need to be more specific and stop using internet based plans with click n tick options which aren't flexible! I think the confusion comes in when the foundations are rigid, 'dont want this and that' type stuff, but aren't very well prepared for what will come and how you will deal with it, so the birth plan doesnt match and the midwife confused.

[Lil_Pearl]

chocolatecatty - as far as birth preparation goes, I think, as Kelly said, it's all important (physical and mental/emotional). Ideally, you want to have thought about the birth process in detail, have imagined how it will go beforehand, and how you will choose to work with the pain. To physically prepare oneself sort of goes hand-in-hand....yoga and long walks help one prepare physically and mentally, and keep you happy, which is so important. When I was in labour with my second baby, I'd read, well, everything - stearing clear of the general 'your whole nine months answered' type pregnancy/birth books, because i don't think they're of much help at all. My sister is pregnant at the moment (about 8 weeks) and I've lent her a few books (without wanting to over-load her all at once!). I did loan her "what to expect" but explained to her that it is only good for the little niggles you may get, as a nice quick answer to the everyday little things, but that it has no substance and is no good for true birth preparation. I've lent her "Spiritual Midwifery' by Ina May Gaskin, as this has lots of wonderful birth stories, as well as information of ways a good midwife will handle situations during your labour, and these two things can really help to inform and empower an individual. While some of the birth stories include some pretty far-out language and hippy ideaology, I've told her to take the goodness of the book and just not be too freaked out by the 60's-ness of it. lol. I'm an anachronistic soul, so I just love it all! It's an amazing book, and Ina May is my hero! The other book I've lent her was one on the pelvis and the positioning of the baby, so that she has a clear knowledge of her body and the way it works with the baby, and how it's all quite natural and fine. That way she will have faith in her body during the birthing process and not fear the idea of birth.

sal - I love birth plans (and it's an important part of the role of the doula to help get one together). The great and very important thing about a birth plan is that it give you power. Medical staff are not allowed to go against your wishes, so are less likely to try to take advantage of you if you've shown that you've done your research, know everything about the different interventions, and have an opinion on the way you want to be treated. I think birth plans that simply say "I don't want a caesarian" for instance, are not a good help to you or the people at your birth. What leads to a c-section? Most often, other intervention comes first. Perhaps looking into the use of fetal monitoring and it's pros and cons, and maybe deciding that you don't want a bar of it, for instance, that'd drop your chance of ending up with a caesarian. So, I think birth plans need to cover everything, and also cover your choices should it be necessary to deviate from your birth plan - i.e "should I need an emergency caesarian, I want a spinal, not a general...I want to hold/breastfeed my baby immediatly", etc. This way, no matter what heppens in the end, you feel that you have had an empowered birth experience. Really, my belief is that a birth plan should cover anything you can think of that matters to you (and if you've read a lot of good birth books, you'll end up with a lot of opinions!). Down to "should the baby need to be transferred to intensive care while I am in recovery, my husband will occompany him/her". Different hospitals and different staff have different ways of handeling situations, and some love their power trip, so be specific and clear in your determination, and your more likely to get what you want. I had an in-depth birth plan (and dot-point is good) for my daughter and forgot to even hand it to anyone! But it was still good that I'd made it, as I had empowered myself with information and had the birth I wanted anyway. But when your in labour, it isn't only difficult to communicate, it really should be avoided when possible....you should have the freedom to just "go-within", so a birth plan allows for everyone to do as you wish, without you having to order them around when you have better things to do!

[Lil_Pearl]

chocolatecatty - as far as birth preparation goes, I think, as Kelly said, it's all important (physical and mental/emotional). Ideally, you want to have thought about the birth process in detail, have imagined how it will go beforehand, and how you will choose to work with the pain. To physically prepare oneself sort of goes hand-in-hand....yoga and long walks help one prepare physically and mentally, and keep you happy, which is so important. When I was in labour with my second baby, I'd read, well, everything - stearing clear of the general 'your whole nine months answered' type pregnancy/birth books, because i don't think they're of much help at all. My sister is pregnant at the moment (about 8 weeks) and I've lent her a few books (without wanting to over-load her all at once!). I did loan her "what to expect" but explained to her that it is only good for the little niggles you may get, as a nice quick answer to the everyday little things, but that it has no substance and is no good for true birth preparation. I've lent her "Spiritual Midwifery' by Ina May Gaskin, as this has lots of wonderful birth stories, as well as information of ways a good midwife will handle situations during your labour, and these two things can really help to inform and empower an individual. While some of the birth stories include some pretty far-out language and hippy ideaology, I've told her to take the goodness of the book and just not be too freaked out by the 60's-ness of it. lol. I'm an anachronistic soul, so I just love it all! It's an amazing book, and Ina May is my hero! The other book I've lent her was one on the pelvis and the positioning of the baby, so that she has a clear knowledge of her body and the way it works with the baby, and how it's all quite natural and fine. That way she will have faith in her body during the birthing process and not fear the idea of birth.

sal - I love birth plans (and it's an important part of the role of the doula to help get one together). The great and very important thing about a birth plan is that it give you power. Medical staff are not allowed to go against your wishes, so are less likely to try to take advantage of you if you've shown that you've done your research, know everything about the different interventions, and have an opinion on the way you want to be treated. I think birth plans that simply say "I don't want a caesarian" for instance, are not a good help to you or the people at your birth. What leads to a c-section? Most often, otehr intervention comes first. Perhaps looking inot the use of fetal monitoring and it's pros and cons, and maybe deciding that you don't want a bar of it, for instance, that'd drop your chance of ending up with a caesarian. So, I think birth plans need to cover everything, and also cover your choices should it be necessary to deviate from your birth plan - i.e "should I need an emergency caesarian, I want a spinal, not a general...I want to hold/breastfeed my baby immediatly", etc. This way, no matter what heppens in the end, you feel that you have had an empowered birth experience. Really, my belief is that a birth plan should cover anything you can think of that matters to you (and if you've read a lot of good birth books, you'll end up with a lot of opinions!). Down to "should the baby need to be transferred to intensive care while I am in recovery, my husband will occompany him/her". Different hospitals and different staff have different ways of handeling situations, and some love their power trip, so be specific and clear in your determination, and your more likely to get what you want. I had an in-depth birth plan (and dot-point is good) for my daughter and forgot to even hand it to anyone! But it was still good that I'd made it, as I had empowered myself with information and had the birth I wanted anyway. But when your in labour, it isn't only difficult to communicate, it really should be avaoided when possible....you should have the freedom to just "go-within", so a birth plan allows for everyone to do as you wish, without you having to order them around when you have better things to do!

[Smoke Jaguar]

Birth plans, written with regard to alternative scenarios, are a valuable resource, not only to the birthing mother, but to the midwives. My birth plan was in dot point but I had dot points that covered the event of me being transferred to the maternity ward from the birth centre, should any intervention have been required.
I had written that I wanted to labour at home and I nearly forgot this when I was labouring. Thankfully, the midwives had read over the plan and persuaded me to stick to my plan ("for your own sake") and they got me back on track when I said I might want to come in sooner in the labour. This would be the wavering confidence that Kelly was talking about in the stats!
It was only after the birth that DP and the midwife went over just how much of the birth went to plan. It was after the birth of my boy that we departed from the plan, but by then I didn't care. The main parts of the plan that went to plan were labouring fully at home, not wanting any internal checks done, dim lights, essential oils in the burner, relaxing music and, my favourite part, having a waterbirth. My midwife apologised profusely about the active expulsion of the placenta, as she finished her shift, but I assured her that as I had got my waterbirth, a bit of post-partum haemmorhage was quite incidental.
I had people scoff at my having a birth plan ready and I really resented this. They thought that because I was a first timer I was out of touch with reality. In fact, I was aware of what COULD happen, but I operated on the basis that my normal pregnancy was going to end with a normal birth (what others call a 'natural' birth, or, as some put it, 'alternative'!).
I did go and seek out-of-hospital birth education in HypnoBirthing classes. My facilitator was great in that she also used other hypnotherapy methods she has in her 'toolbox', with my partner and I. It was well worth the expense. I thought, during some of my labour, that the HypnoBirthing may have been a waste of time because I didn't realise I was even using it! By the time I presented to the birth centre I was ready to start 'pushing' and I thought it might be too soon (watched too many movies as a child!), but the midwife team must have realised, from my birth plan and my interactions with them, that I was more in tune with my birthing body than I was consciously giving myself credit for and told me to go for it! I then went into my 'zone' and had a painless birth - not sensation-free, by any means, but I couldn't honestly call it 'pain'.
I felt so strongly about being allowed to have a natural birth that I unconsciously gave permission to my body to do just that and it didn't listen to me when I tried to pike at the last minute!
I had read in magazines about mothers who had made a list of what they would do 'next time' in terms of assertiveness, and decided that I didn't want to leave these things to the benefit of hindsight and that I would learn from these women's experiences. I know a lot of people thought I was ****y and probably think now that I 'fluked' it with Oscar. I didn't - I made that happen, in a society where we are told to trust the medicos.
To have a fulfilling birth experience, unfortunately, women need to know that good education exists, but must be sought. I stumbled across Belly Belly and this site really helped steer me in the right direction for what I wanted, even though I had a fair idea of the kind of birth I wanted (above all, a waterbirth!). What about the millions of women who don't stumble across this kind of empowering information, or who are not as naturally determined as I am to do the hard yards for a rewarding outcome?
I admit to considering drugs and intervention...but only in the car on the way to the birth centre! In the end I was there for less than 45 minutes before Oscar was born...just as planned.
To say that birth plans are a waste of time is to have a misconstrued idea of what a birth plan is and should be. It is a PLAN, not a blueprint.
Anyway, I DO feel ****y when people ask how my birth went and I have to reply "Great! It was very zen, just like I said it would be".

[Liz]

For me, preparing for the birth was almost scientific. I read up on all the ins and outs of how it all works. I had faith in my body's ability to produce its own "pain killers", and for me, picturing what my body was actually doing helped a lot.

As for birthplans.. I didn't have one. Me & DH knew our "plan". I guess it wouldn't have hurt to have written something down for the benefit of the midwives.. coz I guess all they saw was a 1st time mum in pain, and not knowing my plan was to have no drugs, they kept telling me it was ok if I needed something for the pain. DH ended up going out and telling her to stop offering. I guess she really had no idea what I wanted, and if I had put in a plan that I wanted support for no drugs, they may have been a little more hands-on in helping me with alternatives. (possibly? hehe)

Hospital education. It's hard to say, I liked our ante-natal class, and I found the midwife who conducted it was more than willing to discuss things with us, and it was very pro- active birth in my opinion. They encouraged learning pain management techniques, and only using drugs as a last alternetive. However, having said that.. it could be improved by telling us WHERE to learn the pain management techniques! hehe. I found the classes complimented my own research really well, but if that was the only education you received, I think it would be lacking.

The crisis in confidence.. yup.. had that! lol. Transition is a very real thing.. and I was almost ready to scream for an epidural myself! Being aware of transition and having your support partner aware of it too is really important I reckon.

Describing the pain - I've never really experienced bad pain before. I knew it was going to hurt, but I also knew that it was going to hurt in waves. And I think that's what I focused on rather than the ouchies if you know what I mean. Heck.. if it was constant.. there's no way I could do it.. but knowing i was going to get a break (even a small one!) inbetween helped me through each contraction. Hate to be cliche here, but you do forget the pain. If I really think about the labour, I certainly do remember it, but it wasn't the horror pain that some people describe it as (and I was augmented with syntocin drip!).

Sorry this post has been bits and pieces with what's been talked about here. Will just check what Kelly's original question was!.......

hmm.. I wanted a natural birth and definitely meant it. When I spoke to other people about it, they pretty much scoffed at it, and I guess they thought I was a bit detached from reality with my "ideals". But my wanting a natural birth was backed up with me doing lots of reading, and finding a way to have just that. I found for me the information on the benefits to the baby were the best motivation. I wasn't focused so much on the natural birth suiting me, as I was for wanting my baby to be born naturally.. if that makes sense. (??)

[Lil_Pearl]

Ivana_baby - great name, by the way! Yes, the bodys own painkillers...this is the sort of education that is lacking in hospital birth education classes. It may be mentioned, but not gone into. The hormonal interaction that takes place in a birth where the mother understands all that is happening is truely wonderful. Of course, we have it better these days than they did only a matter of years ago, when woman - although they had 'natural' deliveries in most cases - didn't understand what was going on at all...many woman only found out where the baby was going to come out from while they were in labour! The fear these women experienced meant that most had a natural, but not empowering, birth experience. Now that oxytocin, endorphins, and adrenalin are understood, it's crazy that (probably most) women labour without an understanding of their roll in labour and birth.

Transition is full-on in most cases, and, yes, it's so important for partners to know your wishes, because you really shout out anything during transition, don't you? This is a reason why men need to be just as educated about the birth process as women. It takes two! When I was going through transition with my daughter, I said "I want an epidural"...now, I was in a birth centre, and would have had to be transferred to have an epidural in any case, but I really didn't want an epidural at all, not even when I was saying it. What I wanted, and needed, was to express my tension, to let go of it, to release some anger and exhaustion. My husband said to me "are you sure about that, you'd have to be transferred...the bath is running for you" I immediately said "no, I want a bath". I just needed to let go, you know. I was already entering 2nd stage, really...it was the real over-lapping 1st - 2nd stage part, the full-on transition part, and I didn't want an epidural in the slightest....but I wanted to say I did, and I understood the untruth and hilarity of it, even while I was saying it. Imagine if I was in the labour ward, or if my husband didn't understand the process...they would have all thought I'd lost control, and tried to take over, I think. I was int eh bath within a couple of minutes, and Ava was born about 20 minutes later.

I too thought of contractions as 'waves', and...you know when it's coming on but there isn't yet any pain, you just feel the power...I'd then imagin I was climbing a wave, like body surfing, and when the conraction was at it's peak, I felt that I was on top of the wave, and then felt myself wash down again. I felt it physically, truely. I think it's a great visualisation.

[BellyBelly]

I think in regards to transition, yes it is full on and there is lots of 'crisis' going on, but it's important to remember that it's not only the most intense stage, but shortest too. So if the support person can get her through, it will only get better - second stage or pushing usually results in fewer, less strong contractions and they can feel a little different too. They are not those huge, dragging, opening contractions but the big, pushing down contractions. Most support people have no idea or no strength to coach a woman through transition - I guess that is evident from the stats too, that women are not getting through it without intervention. Then there is the issue of having your 'crisis' before transition. It's a tricky one. I think it's all down to good preparation and good support at the end of the day, if you say you want a natural birth. It's much more acheiveable if you do. Of course the choice of carer can be an issue as well as the place of birth.

So women, if you want a natural birth, YOU CAN DO IT! GET YOURSELVES EMPOWERED AND KNOW HOW CAPABLE YOU ARE OF A NORMAL BIRTH!!! I'd love to see the stats tip more towards what the WHO says is possible.