Having been an NICU nurse for 25 years, I’ve witnessed many technological advances that have truly improved women’s health and chances of survival of so many premature and sick babies. Just as the passage of time has brought about technology, popular culture and the consumerism movement have changed the rituals surrounding the birth of babies in the hospital. At the turn of the century, most births took place at home, without anesthesia. A good many resulted in the death of the infant and/or the mother. Eventually births moved into the hospital wards with varying degrees of pain control. C sections were rare and risky. Most women were married and their husbands could be found outside the delivery suites in the smoke-filled waiting rooms. Then natural childbirth – synonymous with practiced breathing to control pain and hubby as the coach, became widely popular. These family-oriented births were demanded by the public. No hospital administrator nor obstetrician would have ever thought having the family attend a C-Section was a good idea. Then video cameras grew in popularity and they were hauled into the delivery rooms to record the blessed event. The first cameras were quite large, so some boundaries were set for safety’s sake. With technology the cameras became smaller over the years so this problem was thankfully self-limiting.
Although there are regional differences, epidural anesthesia is by far, today, the most popular birth method for pain control of labor. The prepared child birth curriculum is now more about “When you can get your epidural and what to expect” versus “How to breathe through your contractions in order to deliver without one”. Where I work, it is a rare occasion for a patient to labor without this “miracle” of anesthesia. Natural child birth at Presby Dallas now means “Birth without any make-up”. When it does occur, it’s by a non-English speaking Sudanese woman with no translator available to explain the epidural’s availability and clinical significance.
Birth plans now seem to be one of the hottest 21st century trend. These couples, regardless of whether they are married, single, same-sex, or surrogate, all come in with list of dos & don’t s and whens & wheres related to childbirth. They have each researched all of the available options and have developed written instructions for the health care team members. Some freely choose an elective C-section- one in which there is absolutely no medical indication. I actually saw “fear of labor” written in the medical record as the indication for one women’s primary C-section.
I am not a huge proponent of “The Plan”. I really think the last thing you want to do is to plan your labor, delivery, and post-partum period down to a beat. I see it as a sure way to have your baby, who has not been informed of your plan, admitted to the NICU. No need for more disappointment and feelings of failure. There’s already enough anxiety.
One time, we unfortunately had one of our least empathetic neonatologists, (okay, not one of but the undisputed worst) tear up the written plan in the parents’ face after they presented it to him. There is, of course, a more PC and compassionate way to let them know that we might have to make some last minute impromptu changes. For example, breast feeding isn’t going to be an option until breathing without artificial support can be established.
My advice: Let nature and good sense be your guide. Be informed, but remain flexible. Deep six the birth plan; it’s bad karma.
Another upside is that you will be on your way to surviving the next 18 years. Kids will inevitably spit up on the Christmas outfit sent by Grandma just as the photographer arrives, fill their drawers with a really big stinky job the second you arrive at the church, already running late for your brother’s wedding, get a fever and a rash while on the dream family vacation in Disney World, or suffer a concussion during their last football game of their senior year.
A deep cleansing Lamaze breath, not a plan carved into stone, will get you through it all.
cb
