Wednesday, August 5, 2009

Birth Plans

With the infant invasion looming, I finally started to think seriously and in more detail about what the birth process was going to be like, and what I wanted from it. Like pretty much every American in my situation, all I had ever seen of birth was what I got from movies and TV shows, and those were all either highly dramatic, with women in crisis being whisked into the OR as the husband is left behind, or played for comedy with the wife threatening her husband for getting her into this mess in the first place. And really, that's pretty much everything I knew about birthing: you go into labor, are rushed to the hospital, you scream, maybe make some witty remarks, and then the baby gets pushed out.

Alex and I went into our childbirth preparation class without a lot of expectations. I hoped that we'd learn a little about what we should expect and unexpected things that might happen, and knowing about them ahead of time would keep us from freaking out. Still, I figured: labor, scream, baby, done. Probably an epidural in there somewhere, too.

It wasn't until after our first class that I realized that hey... this is kind of a big deal, with a lot of decisions to be made. I started looking things up, got a few books, and (belatedly) tried to learn everything I could about the whole thing. I was lucky enough to stumble upon some women's stories of their experiences that seemed appealing to me, and then I got Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience, and that's when things changed for me. It's by Ricki Lake and Abby Epstein, and is basically the companion book to their documentary, "The Business of Being Born," which has been described as being the Inconvenient Truth of birthing. If anyone is actually still reading at this point, you're probably thinking, "Um, maybe taking advice from Ricki Lake isn't the best idea." And I swear, I'm not drinking the give-birth-in-a-yurt-and-wrap-the-baby-in-buffalo-skin Kool-Aid, although I do have a lot more respect now for people who choose to go different routes. And I do have some problems with the book; I don't think that it was a particularly rigorous or balanced study and I think that statistics were massaged and spun a bit. Still, the medical professionals aren't playing fair either, so I'm okay with it having an agenda and promoting it.

The majority of women go into the hospital, and the nurses and doctors tell them what to do. You get Pitocin to speed up your labor if the doctor says that you're not progressing fast enough, and you get the epidural because the nurses say that pretty much everyone who has taken Pitocin does, and if you aren't able to give birth within a few hours of that, you get a cesarean section because the doctor says that's the safest way to deliver the baby. Why wouldn't you do it this way? They're the professionals, right? And how many women know that there are other options?

Unfortunately, I still only have small bits and pieces of the story, but I'm pretty damned sure that the way birth is handled in the vast majority of hospitals is not the best way for every woman. The C-section rate in the US is over 30%, which is insanely high. There are a lot of factors in play, including malpractice liability pushing doctors to perform them and the fact that it only takes about an hour to perform a C-section from start to finish. Having Pitocin induced labor and having an epidural are both associated with a higher likelihood of having a C-section as well.

I don't want to get into too many details and statistics about the other drawbacks of having an epidural, but after learning about all of these things, I've decided to try as hard as I can to give birth without one. Now that I've made that decision, I'm wondering if I can do it. We can't afford a doula*, and as much as we learned in two childbirth preparation classes, the whole situation is going to be completely alien to both of us. And, 90% of the women who give birth at my hospital end up getting epidurals, so I'm guessing that the doctors and nurses will be coming in periodically asking me if I want one yet, since everybody else gets one. Will I be able to keep saying no when I'm in agonizing pain? I really don't know. At any rate, even if I do end up with interventions like the Pitocin, epidural, and C-section, I'll know that at least I know that I have a choice, and what those choices mean. And that's a lot farther along than I was two weeks ago.

*A labor doula is an assistant who can provide non-medical ways to deal with pain and anxiety during birth (like positioning, exercise balls, massage, breathing, and acupressure) amongst other things. Doulas are often involved in pre- and post-natal care, too.


  1. I just finished reading that book too, and have had the same worries as you as far as being badgered into getting an epidural. I'm thinking about getting a certified nurse midwife instead of a doctor, because they're usually more supportive of natural birth and they're actually there with you while you're in labor instead of some random RN who would probably prefer that you get the epidural so she doesn't have to hear you complaining anymore. Anyway, just thought I'd throw that option out there as an idea. Also, your post below this one was hilarious.

  2. Tess: I would have loved to go the midwife route, but at this point, I only have 2 or 3 weeks to plan, plus I'm pretty much totally restricted to what my insurance will pay for. I forgot to rant about the fact that even though home births and births with midwives are much cheaper, insurance companies often don't pay as much or anything. Awesome. Did you watch the documentary, too? It really made me wish there was a birthing tub at my hospital!

  3. I didn't realize you were so far along, that is exciting for you! I've requested the documentary from the library, just waiting on it to come in. Do you have any other book or movie recommendations? That is lame that your insurance doesn't pay enough for you to be able to use a midwife. :(

  4. Yeah, I'm due in 4 weeks. We were too late to go the midwife route, even if it would have worked with my insurance (which I'm not sure about). I don't really have any other good recommendations for you. At least you have a good amount of time to figure out what'll work for you. It never even occurred to me before 34 weeks that I had options other than just going to the hospital and sticking with the doctor. Ah well... Next time?

  5. Elena- You can do it. And you won't believe how amazing and powerful you'll feel! I had a very long labor with my first babe- 23 hours. I had the epidural after the first 12 hours- just gave in. No regrets, that's just what happened. I was sure with my second I was in for another long labor- WRONG! 3 hours of intense labor. And by intense, I mean in-TENSE. He was also born during an ice storm, which meant the anesthesiologist on call could not get to the hospital. No drugs this time- not because I wasn't begging for them. But when it was over, I felt like I should be accepting an Oscar while crossing the finish line first at the Boston Marathon. I mean, I was high all day. If I were going to have another one, I'd go natural, for sure. But my first experience gives me empathy for those who choose the drugs. You know what's right for you!

  6. Thanks for stopping by my blog. I see that you are in for one of your big moments in life. The road is revealing while you are walking. I'm certain you will feel what's right when the moment is there. And afterwards it is the moments of bonding with the little Ninja. That's what I think is the most important phase of yours and Ninja's life together. The warmth, the feelings, the first experiences of this strange world, and the safetyness in your arms. Good luck to you and your little family!

  7. I will admit I know very little about the process of birthing, but I did read a feminist history of midwifery during my Women's studies. What stuck with me, specifically about childbirth, is that hospital births require the woman to be lying on her back for easier viewing by the doctor, whereas in non-hospital births, the woman is encouraged to walk around and be on her feet and use GRAVITY (yay physics) to help pull the baby. That just makes more sense to me.

    No matter what route you choose, at the end of it, you'll have a beatiful baby! And she's not going to care if you took the epidural or not, just so long as you love her senseless!

  8. I've seen that documentary, too. It really made me realize how much responsibility we need to take for ourselves, versus the conventionally wisdom of putting complete trust in doctors.
    For what it is worth, friends of mine who have gone the all natural route and the C-section route (two children) found that it was much easier to recover from an all natural birth. Yes, it was painful, but it is painful no matter what (all natural vs. C-section) and the all natural route's pain is shorter.
    Most importantly, they have all said not to be afraid to say "no" to the doctor if they try to go outside of your birthing plan. If they want to start to induce (possibly just to flip your bed) and you don't, then say no thank you and let nature do its thing. You have every right to refuse medical treatment you do not feel comfortable with. Watch "Knocked Up" for inspiration. :)