Re: [ozmidwifery] Your thoughts onBirth Plans?

Thu, 22 Jun 2006 17:59:17 -0700

The "problem" of birth plan seeming too hard to read at the time (yes, also at a loss to understand this one) can also be solved by what I suggest to women - that they have copies of the signed plan attached to their record. So as soon as that woman rings the institution, the complete stranger who has to care for her can pull out her record and read her birth plan. It's just not that hard! It's not like most women birth under 15 mins after arrival so fitting in 5-10 mins of reading to ensure that the client is serviced and supported in the way she most wants doesn't seem a big ask. Ideally, CPs will know the woman and know the plan already but we know how difficult it is to implement caseload midwifery so reading the birth plan is going to have to suffice : )
J
----- Original Message -----
Sent: Friday, June 23, 2006 10:44 AM
Subject: Re: [ozmidwifery] Your thoughts onBirth Plans?

I believe that seemingly small things, like softening the term "birthplan" into something along the lines of birth "preferences", etc, further undermines and weakens the power a woman has to demand what she wants for her care, and firmly expect to receive it. "Preferences" denotes a level of being ok with someone delivering less than your "preferred" care - it's "preferred", but not "compulsory".  Women are already in an extremely vulnerable and disempowered position in a Hospital environment.  Let's not increase that by encouraging a lack of strength in the way they describe what they want.  It shouldn't have to be about pleasing the staff or making them feel warm and fuzzy in order for the woman to receive the care she deserves and wants.  If things deviate from the birthplan (with the birthing woman's genuine consent), it's not about blame or retribution.  We just want our care to match our needs.  Simple, and not too much to ask.

I don't understand the complaint about birthplans being "too long", either.  Unless they're a 20 page War and Peace epic (and I've never seen one exceed 4 - 5 pages), it's quite simply NOT THAT HARD to flick through, locate the relevant point, and do your best to adhere to it.  There's far bulkier Hospy paperwork whipped out and leafed through during birth.  Most "long" (4 - 5 page) BPs are divided into specific sections which make it even easier to spot the precise area you're looking for at the time.  I don't see taking one or two minutes to check a woman's BP to be too much to ask.  In an extreme emergency situation, the CP should be thoroughly well versed with the BP anyway; so they should have a fairly good idea of what is desired, even in the heat of the moment.  The birthing woman will hopefully also have support people there who can assist in referencing the BP in any situation.  In all reality it's usually the "well informed" women who write "long" BPs so is the resentment of BPs we see sometimes in fact a subtle dig at women daring to know their rights, their facts, and demand nothing less? How can we be anything less than detailed about one of the most specific and important moments of our lives that involves the wellbeing of Mother, baby, and potentially the extended family and friends? It might make things a little "harder" on the CP (though I REALLY don't see how), but why should the birthing woman have to care, quite frankly?
 
Women aren't stupid. We know that if something in birth goes haywire, and we hadn't expected it or thought about our desires in that situation, then we go with what we believe is best at the time (considering our careprovider's advice when making our final decision). We understand birth is a fluid, changeable and highly unique event, every time. We don't expect to be unable to change our mind about something we included on our plan. We don't need to be coy about asking for what we want; it's fairly obvious who that level of shillyshallying suits - and it's not birthing women.
 
Imagine birthing women reading Hospy birth protocols and complaining they were "too long", "too concrete", and suggesting wording rehashing.  They'd be laughed out of town...but they're the ones giving birth, and it's ok for US to question THEIR birth documents?

----- Original Message -----
Sent: Thursday, June 22, 2006 10:04 AM
Subject: *****SUSPECTED SPAM***** Re: [ozmidwifery] Your thoughts onBirth Plans?

I always emphasise to women that one of the reasons they need a birth plan to birth in an institution is that the careprovider has one and their birth will run to it if they don't provide an alternative. Let's not kid ourselves that birth plans are respected though when even basic stuff like "Please don't offer me drugs I will ask if I require pain relief" is ignored so frequently. Birth plans SHOULD be treated with the same respect that living wills are accorded and until then they are too often used as a way to pacify women and make them feel that their birth is under their control when it isn't. I've heard from too many women who've had birth plans laughed at and actually even ripped up in front of them.
 
I also recommend to women that they take their birth plan to "important people" in the institution and have it signed so that in labour there are no arguments about having aspects of it implemented that are not usual - no drugs, physiological third stage, no vit k or hep b etc.
 
It's worth considering the argument in "Birthing from Within" that writing a birth plan indicates mistrust of the CP. I don't agree necessarily although experience has shown that institutions don't cope at all well in general with women having plans so perhaps the argument has something to it. I know that home birth plans, for example, look VERY different because women are able to assume that their wishes will be respected in a way that they just can't in the system. I have a TF plan so my support people are clued up on what I want even if I'm unconscious.
 
Unfortunately too few women labour unhindered in the system regardless of their desire so to do and as a result there's a misconception in the mainstream that birth plans are pointless. Given how few true emergencies occur when women are left alone to birth, this has now become a self fulfilling prophecy. Too many women come back to their peer group and say "There was no point having that birth plan because it all went pearshaped" without realising that had they not been induced/augmented/given an epidural, it wouldn't have gone pearshaped and their plan would have served them and their baby well.
 
Including the baby in the birth plan is also really important because once the baby leaves the woman's body it can too easily become the hospital's property and be given all manner of unnecessary tests and drugs and formula without parental consent.
 
Ultimately the staff have the final power to respect, or not, each woman's wishes in labour so maybe, Kelly, you'd be better serving women to address those who receive the plans in the hospitals/BCs - that's where the power really lies in this situation. Let's not pacify women further by kidding them that they have more control than the staff are prepared to share, hey?
 
This is from my website re: birthing outside of the home.
 
J
----- Original Message -----
Sent: Wednesday, June 21, 2006 9:27 PM
Subject: [ozmidwifery] Your thoughts on Birth Plans?

I am writing an article as we speak on birth plans (I prefer to say birth intentions or birth preferences and hopefully everyone else will too one day!) and I was wondering if anyone would be happy to comment from a midwife perspective?

 

I’d like to know:

 

  • What do you think of birth plans women are writing at the moment
  • What do you think about it being called birth preferences or intentions instead,
  • What you like and dislike when you read them – i.e. too long, too unrealistic or whatever springs to your mind

 

I won’t put your name to the comments so you can feel free to be open and honest about it, I would really love to add your perspectives if you are open to it. Thank-you in advance J

Best Regards,

Kelly Zantey
Creator, BellyBelly.com.au
Gentle Solutions From Conception to Parenthood
BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support

 

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