Blogs, Facebook, and Twitter were bustling last week with back-to-back stories of doctors putting the kibosh on women’s right to self-determination in their birth. First, The Unnecesarean reported on a doctor who preemptively gives his own (awful) birth plan to all of his patients, and one woman’s triumphant experience firing him and hiring a midwife. Just a few days later, the internet lit up with a zillion copies of this picture of a sign in a Provo, Utah Ob-Gyn’s office:
Yes, paternalism is alive and well in obstetrics. Informed choice? Not so much.
The consensus among birth advocates about these two stories is that they may actually be good for women and babies. After all, too often women find out that their doctors treat their patients this way when it’s too late. It’s not really what we meant when we demanded more transparency in maternity care, but, hey, it’s a start.
It may come as no surprise that evidence that having a birth plan improves outcomes for mothers or babies is scarce. In fact, research seems to suggest just one consistent effect of birth plans: antagonism between women and hospital staff. Are birth plans obsolete?
Based on a rigorous review of the scientific research and recommendations from the World Health Organization, Lamaze International promotes Six Healthy Birth Practices that ease and facilitate labor, prevent complications, and protect breastfeeding and early mother-infant attachment. With a care provider and birth setting that offer these practices as the standard of care, a detailed birth plan is rarely needed. Unfortunately, fewer than 2% of women who give birth in U.S. hospitals actually experience this package of care. That leaves 98% of women at the negotiating table for a safe and healthy birth. A simple birth plan based on the Healthy Birth Practices can be a starting place for discussion. A good childbirth education class can give women the information and confidence they need to stand by these choices in the face of arbitrary hospital routines and “doctor’s orders”. If a care provider balks at this kind of birth plan in a prenatal visit, that’s a red flag and a cue to transfer care to another provider who will support your choice for a safe and healthy birth. Motivating women to change care providers or choose a new birth setting may in fact be the most powerful way a birth plan can change birth.