Wednesday, September 8, 2010

Birth Plan

Shortly after I found out I was pregnant, David and I watched a documentary called The Business of Being Born.

Like most documentaries, it has a pretty clear agenda.  It advocates home birthing, midwives, and non-medicated childbirth.  It cites statistics of births in other countries compared to the United States and points out that the U.S. is basically leading the industrialized world in its c-section rate (25%-33% of all births in the U.S. are c-sections--it's closer to 7-10% in Europe).  The documentary explains the pressures put on doctors who face malpractice suits, and the desirability of a scheduled, predictable surgery that gets the doctor home in time for dinner with relatively little risk for mom and baby.  And then it explores those risks.  After all, a c-section is major surgery.

It comes down decidedly on the side of "natural," non-surgical, non-interventionist labor and delivery.  However, it also acknowledges that this isn't always possible for everyone (at the end, the director of the film ends up having to have an emergency c-section).  All in all, it was a thought-provoking documentary.

I admit I'm apprehensive about giving birth.  After all, I've never been much of one for putting myself under unnecessary strain.  Have a headache?  Pop an Advil.  Feeling tired?  Take a nap. Tummy upset?  Call David to fetch a ginger ale.  Do something crazy like run a marathon?  No thanks. 

I don't "power through" pain.  I whine and slump in defeat.  When I'm sick or hurting, I want to be babied, spoiled, waited on hand and foot. 

But the more I've thought about this documentary, the more I keep going back to the idea that being pregnant isn't an illness.  It's a totally natural, normal process that my body is prepared to handle.  It may not be entirely pleasant, and labor might actually hurt quite a lot (I've heard it compared to the lower half of your bottom trying to rip itself away from the top half), but it is not a medical problem that requires fixing.  It's just a biological process.

So, along with all of my reading about baby bargains, recommended car seats, crib recalls, best baby bottles, diapering options, parenting styles, and techniques to get babies to sleep through the night, I also started reading a lot about labor and delivery.

And believe me, there is a lot of stuff out there.  In the library, in the bookstore, and on the internet.

My doctor remarked the other day (after I quizzed him about my RH factor, my upcoming glucose test, and cord blood donation) that I was very well organized.  I told him that I completed my PhD in February, so this was my next big project!  He laughed and said maybe I could earn another PhD in pregnancy by the time I was finished.

I definitely haven't read as much about pregnancy as I have about Victorian novels (after all, my dissertation took years, and I only have nine months here), but it's still a pretty sizable amount of information that I am sorting through.  I'm lucky that I read fast.  And, really, this is what I'm trained to do--I read a variety of conflicting opinions, I sort through the reliable information, I return to primary sources (in this case, statistics), and I carefully arrive at my own analysis, taking all of the criticism and literature into account.  I spent all those years in grad school doing this--why would I stop now?

So I'm giving all of this a lot of thought, especially when I consider what kind of birth I would ideally like to have.  I know that these things cannot be entirely planned--I've seen this with a friend of mine who wanted to avoid being induced and avoid an epidural, but ended up having to be induced a few days after her due date because her blood pressure was high.  Once she was giving drugs that cause contractions, they became so unbearable that her hopes of going without an epidural went out the window.  Ultimately, she had a healthy baby and she was fine also, which of course is most important.  So I recognize that there will be factors that are entirely out of my control.

Still, I want to be as fully informed as possible.  I want to have a clear plan and vision.  My doctor has been so great about answering my questions and dealing with my minor neuroses that I feel incredibly lucky, but at the same time, I am not really worried about trying to be a model patient.  I mean, I'm not going to be a jerk, but I'm doing lots of research so that I can make informed decisions.  This means that I will definitely be a total pain in the ass if I think that it's the best thing for me and the baby.  I'm not worried about whether the hospital staff thinks I'm difficult and I'm not afraid to ask my doctor to clarify exactly why he is making certain decisions.  My body might be doing things it has never done before, but my brain still works just fine.

So as I filter through the information about episiotomies, epidurals, optional c-sections, unplanned c-sections, alternative pain relief, drugs that help speed up labor, I am doing a lot of thinking about what will be best for me and my baby.  I have to say that I am amazed by the way women who have non-medicated births practically become evangelicals for that birth plan--nobody says it doesn't hurt, but every single one of them says it was completely amazing.  Perhaps most interestingly, those who have had previous births with epidurals almost always say that the non-medicated birth was easier in labor and recovery.

At the same time, I have a close friend who asked to be induced, asked for an epidural and planned to have an episiotomy, and she was completely satisfied and perfectly happy with her labor experience.  Another friend felt sad about having to have an unplanned c-section with her first child and was determined to (and did) have a successful VBAC (vaginal birth after cesarean) with her second baby.  Then I have a friend who was thrilled that her doctor let her schedule c-sections for both her babies and she felt the recovery from that surgery was no problem.  Another friend had a terrible experience with an epidural, ended up with excruciating headaches after the baby was born, and wishes she had had someone there to tell her she could do it without the pain meds.  But I also know other know women who were sure they wanted to avoid an epidural initially, but in the end were so glad they got them and felt it helped them enjoy the birth experience more.

Ultimately, I can only conclude from these stories that because everyone's experience is so completely individual, the anecdotal evidence is pretty unconvincing.  So I find myself returning to books that summarize and cite medical studies and journal articles about what practices are typically best for mother and baby.  What this helps me keep in mind is that no matter what I decide (and no matter how things actually shake out for Baby Duck and me), it will not be a decision that I would insist is best for anyone else.  I'm not claiming that all this research will lead me to the right answer--I just want to find an answer that works for me. 

In the end, even knowing that things may not go as I plan, I want to make sure that I am doing what I can to make the decision that is best for us, even if it isn't the easiest decision.

Something tells me that this will become a familiar refrain for parenthood.


  1. Brooke L. and I watched "The Business of Being Born" after-the-fact. It was one of those movies we figured we'd like, but ended up rating it relatively low in our Netflix ratings because it did not reflect our general experience through the process, and seemed to be heavily biased (even moreso than Michael Moore movies). Maybe that's the way it happens in New York City, where the movie was filmed (I think?), but that certainly isn't what happened in St. Louis, to us or to my boss (that gave birth prematurely at Barnes within a few months of our birth).

    Two points, from the male perspective:

    1. I didn't (and don't) like the idea of having a home birth. My wife, Brooke L., does (or is at least open to the idea). I can just come up with a variety of different, crazy things that could happen that would prevent her from getting the immediate care she would otherwise need. Maybe if we lived 5 blocks from a hospital, I'd feel differently, but we live 15 minutes away from an ambulance, let alone a hospital. Even living in St. Louis, 2 miles away from SLU Hospital, I wasn't a fan of the idea. I guess I just like the idea of having Brooke a hallway away from surgical care, if need be. I know humans have had natural births since the beginning of the species. I get that. But we came up with modern medical technologies for a reason, even when those technologies are over-used and over-charged for.

    2. Brooke L. had a plan in mind, but it didn't go as planned. However, we still got a healthy baby girl out of the deal, and a healthy mother. Win/Win. I like to plan everything in advance when possible and, unfortunately, when it comes to babies, it seems like those plans rarely go accordingly.

    Regardless, just remember these three words: "It'll be alright." :-)

  2. When you figure out what's best for you, I will probably copy because you read way faster than I do.