Why I’m Skipping a Birth Plan

I have a *lot* of Google Docs, y’all. Spreadsheets for everything– what to pack when we camp in the summer, spring, or fall (three separate lists, obviously); literally every dollar I’ve spent this week; a running inventory of the freezer and fridge, by category and number of servings; u-cut Christmas tree farms organized by driving distance; family health histories; and guest lists for every last thing. I love lists.

I also love data– I’ve got (e)stacks on stacks on stacks of journal articles regarding various birth related topics, from the effectiveness of different pushing methods to the ACOG opinion on delayed cord clamping, from the impact of oral evening primrose oil on labor outcomes in low risk women to the efficacy of membrane sweeping. I like to think that I’m a pretty informed healthcare consumer.

Despite my love of lists and seeing things in black and white spelled out in front of me, despite my desire for a birth free of unnecessary interventions, I’m just not that into birth plans.  I mean, I kind of hate them. Don’t get me wrong– I think it’s great to know what you want from your birth experience, to go into labor with an understanding of your options and for preferences about those options, but I think that knowledge and agency start well before checking into L&D and continue right on through each and every contraction.

During my pregnancy with Winnie, I wrote four birth plans.  Two were before I was 20 weeks pregnant, one was for a birth that I am so glad I did not have to have (that one would have ended with Sascha-sans-uterus), and one was in earnest.  There are a number of boilerplate birth plans available online and in the myriad available pregnancy and birthing books–some of them more gag inducing than others–and not a one felt like it met our needs.  I wrote and rewrote the opening, “WE ARE SRSLY SO EXCITED FOR Y’ALL TO BE DOING MY CERVICAL CHECKS, REALLY!” statement about a thousand times, trying to convey that we were really happy with our choice of where to birth, that we were trusting and flexible, but there was an underlying implication with each plan that—for us—betrayed those basic principles of trust and flexibility.

I know lots of people find comfort and utility in birth plans, but despite initially being quite excited to put together this outline for the big day, despite pouring my whole self into hours of research about each and every possible preference I could have about the experience, it just never felt right.  Putting together a birth plan— or birth preferences or birth wish list or birth storyboard (no thanks!)— felt like sidestepping a conversation with my providers, like I didn’t trust them to respect my agency in the process or that I didn’t trust myself to communicate my preferences and engage as an active player who could make wise decisions.

And so, in a moment of wild abandon, I smacked my Hypnobirthing book closed and declared to Michael, “We’re scrapping the plans!”  He glanced up from the New Yorker and said, “Cool,” but I know he felt super liberated, too.  He held that magazine with a lighter grip, for sure.  It was like the whole issue just went Shouts and Murmurs on him.

It’s not because I wasn’t still committed to everything within that plan— I was and I am.  I still prioritize a healthy baby (like anyone ever prioritizes anything else, but that’s another topic for another day), a vaginal delivery, minimal intervention, and preserving a sense of agency in decisionmaking.  It’s because not having that plan enabled me to feel even more empowered to initiate conversations, participate in my birth process, and communicate my needs with immediate relevance.

After our first trimester worries flew by in my last pregnancy, and my attention turned to the whole “this-baby-needs-an-exit-plan” segment of pregnancy, I fastidiously went through each of the provider questionnaires recommended by natural birthing sites. Would I be allowed to have a hep lock rather than an IV? Sure, unless there was a medical reason for me to need IV fluids. Would I be able to have intermittent fetal monitoring rather than continuous? Sure, unless there was a medical reason for me to need continuous fetal monitoring. Would I be allowed to move from the bed? Sure, unless, you know, I couldn’t get out of bed due to having my lower two-thirds rendered useless for weight bearing by the whole “elective catheter in my spine” thing. Would I have to have an episiotomy? My doctor couldn’t remember the last time she had given an episiotomy, nor her colleagues. Could I labor in the shower? With a birth ball? Moan real loud? Get in touch with my inner llama goddess?  At this point my doctor looked at me and said, “Sweetheart! You can literally labor on your head for all I care, as long as everything is going well and there is no medical indication not to. THAT IS ALL I CARE ABOUT.”

The problem was, there was no way of knowing, for either of us, what that birth would bring. Premature rupture of the membranes? Non-reassuring fetal heart rate? High blood pressure? Probably not, and in my case, I didn’t have a single problem with any of those scary things. But what about the part where I didn’t go into labor, where despite all of our best efforts at shifting and moving and spinning that dang OP baby, her head just wouldn’t engage enough in my pelvis to dilate my cervix (Winnie was still floating way up high AFTER I was fully dilated, which meant I got to hang out with back labor funtimes while letting my babe take her sweet time down the birth canal)? I asked for Pitocin, and I asked for artificial rupture of my membranes, and before either of those things took place, I had a conversation with every person involved in implementing them.  When I checked in, a nurse asked me if I planned on getting an epidural as she took down notes that I was allergic to cats, dust, and codeine, and when I said “I don’t think so” that was the last time we talked about it (until many hours later when I think I maybe pulled a muscle begging Mike and our doula Jillian to please oh please go find an anesthesiologist and FAST). Mike and Jillian, with help from nurses, brought out birth balls and squat bars and rocking chairs as I seemed to need them, and tucked those things away that I wasn’t using. No one needed to consult a packet to find out if I wanted something. I just told them. 

I’m just not going to have a baby, or enter a practice, where someone can only push flat on her back or where episiotomies are routine or where a provider would perform a medical procedure on another person in an non-emergent situation without addressing it first.  I’m a human, and I expect that all of my healthcare providers know that, and that they’re humans, too. I realize that having the option of giving birth in a place where there isn’t overwhelming resistance to evidence-based practices might be a luxury, that I’m lucky to live in a place where evidence-based medicine reigns supreme, where statistics on birth interventions and outcomes are readily available, where medical education is ongoing and superb. But I also think that part of having a good birth isn’t luxury or luck, and it’s certainly not a piece of paper riddled with checkmarks, handed over with a box of cookies and a smile– I think that owning one’s birth depends largely on owning one’s agency, with maintaining a level of participation in each moment of one’s birth, and with building trust rather than opposition to one’s team of providers.

That’s my plan, anyway– to communicate my desires as I find them out, to ask all the questions I want and get answers, too. I plan for Mike to be my partner, to find out alongside him what works and what doesn’t. And if that doesn’t work, I probably have a Google Doc or two that will do in a pinch.

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