Great Expectations: The Birth Plan

Would you prepare for a marathon by fasting? Of course not. What your body is about to go through is a marathon, and you need fuel for it. Will you move your bowels during delivery? Possibly, maybe even likely. But trust me, every nurse, midwife and doctor has seen it before. You may not even be aware of it, they're usually so good at casually and quickly cleaning it up.

My first bit of advice, if you're planning on breastfeeding, is to arrange with the nurse to borrow a hospital grade pump the moment you walk in the door. It can take hours - or even days - for them to find one, get the paperwork done and get it up to you. If for any reason your baby can't nurse right away, you want to start pumping within a few hours after birth so s/he can get your colostrum through a feeding tube or bottle. It took them 3 days to get me my pump after an emergency c-section, and I will always wonder if that played a role in my milk production troubles ever after.

Second, is remember that you're not a patient, you're a CLIENT. Really, that's what they teach us in nursing school right now, and it's amazing the difference a word makes. You are paying all these people to perform tasks for you, just like you pay a tax attorney or car mechanic. Do they know more than you about specialized medical knowledge? Of course. But that doesn't mean you have to do what they say or that you're at their mercy. You always have the right to say no to any intervention you don't want. If they threaten you with dire consequences, that's assault. If they touch you to do something you don't want, that's battery. In either case, you can and should press charges.

Of course, you want everything to go well, and when someone in a white coat is telling you that you must take this drug or "things could get bad", it's tempting to turn your brain off and just follow orders. DON'T! 90% of the interventions commonly practiced in hospitals (pitocin induction, manual dilation, even fetal monitoring) are NOT put in place to ensure your safety or your baby's, but to protect them in the event of a lawsuit. The worst part of that is that even the seemingly harmless intervention of wearing an external fetal monitor greatly increases the chances of further interventions. Intervention has this way of snowballing all the way to a c-section you probably wouldn't have needed had they just left you alone for a bit.

Many hospitals have a "1cm per hour" rule, meaning that if you don't dilate at least 1cm each hour, they're going to try to start doing things to hurry it up. There is no evidence that this is beneficial in a normal labor. (Think about it - labor can take days and still be perfectly normal, and now they want us out of there in 10 hours or less?!)

Sorry if this is all scary sounding, but I think OB is the worst part of hospital care right now. I'm dreading my OB rotation next semester, because I know they're going to try to pressure me into performing interventions that are not in the best interest of the client, and worse, they expect me to talk the client into it.

Yes, you need to be flexible and realize that your dream labor and delivery might not be possible. But that doesn't mean you should be passive about your goals, either. You always have the right to refuse intervention. You are your own best advocate.