Are birth plans a waste of time?

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

Firstly I'm sorry you didn't have a good experience for you birth or get your VBAC hun. :hug: 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.
:hug:

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

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

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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.

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

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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?

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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.

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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.

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.

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.

Birth Plans - Is It Worth Writing a Birth Plan?

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.

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 :hug:

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

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!

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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.

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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.

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. :(

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!

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.

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.

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.

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.

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

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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.

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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.

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.

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2. You prepare dad to be a 'gorilla'

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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.

Don't have a doula then!

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.

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.

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.

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

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 :)

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.

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.

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 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!'

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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.

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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?

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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.

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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.

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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.

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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!

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 ;)

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 - 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!

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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?

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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.

I think it is a problem at the moment where people are hiring a doula (through good word of mouth etc) but they expect the doula to do all the work/fix/prevent everything. But they can't. They cant prevent things happening as a result of your choices. We are not miracle workers but we try our best to work in all situations, with what we have.

Reminds me of education - people pay school fees and expect teachers not only to educate their children, but to teach them morals and good values, manners, and set them up for stellar academic careers. The crux of my parallel here is that money can't substitute for responsibility.
I'm worried about the whole "that's what I've paid for" wrt doulas. We only pay for them now because they are not to be found down the road from every birthing woman, the way these birth support women were years ago. Nowadays, because women have been separated from that art, they have to pay for training and, now, travel expenses. You don't pay a doula to be your prize-fighter - they're not your birthing 'heavy', as a job description. To me, a doula is there to keep you 'in the zone' primarily, during birth, adhering to your values as much as circumstances permit.

As long as "as a rule" Doulas do & will speak up when needed. I don't expect a doula to go in with all guns blazing but as long as something is said when it needs to be then great.
I know creating conflict issn't the answer, but I just didn't see it as creating conflict if you are simply voicing whats int he birth plan for something like being told the details of progression.

It sounds as though a Doula is going to do what I would expect of them. I have just put across what I want wrong. I agree that conflict would be unproffesional & going the round about way is better.

This is the main reason I don't feel I need a doula, because I will happily stand up & kick & scream if somethig I don't want or feel I need is being pushed on me.
Perfect example was with Isla, the Ob wanted to break my waters the morning of the evening she was born when I went in for montioring due to being 12 days over. I pretty much told him to get stuffed & would do so again.
Even with my first birth I went in with what I did & didn't want firmly placed in my mind. Yeah it was a long, terrifing labour & birth as it was my first. But I wasn't going to be pushed in to drugs I didn't want. But back then I was just using my stubborness to get me through. Now I use my knowladge & expereince.

I think the good thing about talking my birth plan through with my midwife team at the FBC, and DP knowing it back to front, was that by the time I was in labour, everyone knew where everyone stood and I could get on with producing endorphins - there is no way I would want to leave any room for having to stand up for myself, because that would take me away from my peaceful birthing. Had I been going into a maternity ward, I would have probably had a doula to help keep me in endorphin-mode, and DP could do the fighting for me!
Labour is not a time I ever want to have to rely on my tenacity - and there aren't many people who'd say I don't have gumption!
We didn't have a doula for DS's birth. In hindsight I probably didn't need one whilst labouring at home, I was happy to just withdraw and use what I had practices from HypnoBirthing. The way we wanted it was that we would arrive at the FBC ready to birth, and we did. Our birth plan was, admittedly, not a problem because most of what it dealt with was rendered irrelevant by having laboured entirely at home! Everything else was in line with the FBC philosophy, as I've said.
My point is that I did the hard yards before the birth to ensure my birth plan was workable.