What should I be thinking about when it comes to a birth plan?
December 12, 2016 3:48 PM   Subscribe

Hi all. I am about 4 months pregnant with my first, and I've started to get questions about who my providers are and what is important to me in a pregnancy/birthing experience. I've never really thought about it before, and I don't really know!

No one in my close family has had a child in the last 25 years, but I was raised fairly crunchily generally. I don't know what questions I should be asking myself when I try to think of what things will be important to me during this process (because I guess I just figured I would go to the hospital and have a baby and then wing it from there?), but I'd like to take more control over my pregnancy experience and be more deliberate about selecting a healthcare provider that matches my values (and also takes my insurance ;). I've also considered getting a doula because friends have really liked having that support and I anticipate being rather stressed out during my third trimester and immediately after birth due to my job and being far from family, but I'm not sure how to provide effective direction to this doula as to what I want help or assistance with.

What kinds of questions could help me tease out my priorities and what I want to look for in healthcare providers w/r/t the pregnancy, childbirth, and postpartum experience? For those out there who have been pregnant, what expected or unexpected questions, concerns, or desires came up for you? If you had a doula, what did you like or not like about it; and is there anything you would do differently in your pregnancy after having been through it?
posted by likeatoaster to Health & Fitness (32 answers total) 17 users marked this as a favorite
Best answer: This is way more than you will probably need but here is a long page of things you can think about with regards to your birth plan. It covers some things like "if I have a cesarean, here are things I want" and what sort of newborn procedures you do and do not want (or when). Doulas are great because they can step up as much or as little as you need them to if you pick one that you really click with. Also,unlike you, they've been through this a lot and so can help you make some of those choices or explaining even why you would make them. One of the things I like about this plan is a lot of things to think about regarding what your partner might encounter and what they might want. Every happiness to you two.
posted by jessamyn at 3:59 PM on December 12, 2016 [4 favorites]

"No plan survives first contact with the enemy."

OK, there are no enemies here, but I mean to say that while it's a good idea to think about what you want, if you aren't prepared to be flexible and sensibly react to events, you're setting yourself up for extra stress at a time you really don't need it. The list jessamyn linked certainly looks like a good start to think about your crunchy and less crunchy options.

We had a doula, and it was extremely helpful, I thought. If nothing else, they've seen lots of contingencies where you can prep for them theoretically. Also, as the non-laboring partner, it was nice to not be the only support such that I didn't feel awful if I needed to take a bio break myself. Your doula is a service provider and you should interview a few until you find one you'll be comfortable with. We were looking for one comfortable with evidence based medicine who wouldn't fight against intervention if needed (which it was!). The postpartum visit was also helpful and reassuring. I would definitely recommend it.
posted by stevis23 at 4:14 PM on December 12, 2016 [5 favorites]

The short answer is, start talking to doulas in your area. They will walk you through what the birthing process and aftercare really look like, much more than any OB will. Bonus points, they know all of the OB's in the area, and know which ones are more likely to respect the parent's wishes vs attempt to force or intimidate you into doing things their way. (Protip: if your OB can't recommend a doula or two, and then you start calling them yourself and you hear more than one say they won't work with your OB, run far and fast from that OB).
posted by vignettist at 4:14 PM on December 12, 2016 [1 favorite]

Remember, OBs are not your only option for birth professionals. You might want to consider a midwife. Midwives facilitate births in hospitals, birthing centers, and home births. They have as much medical training as an OB and will be able to care for all but high-risk pregnancies and births because of the elevated risk of surgery. And even if you use a midwife, if surgery ends up being indicated, any midwife could refer you to an OB in that circumstance.

And the advice to start meeting doulas relatively soon is good. You don't have to worry about providing direction for a doula; she'll be an experienced professional who will help you think about and decide how you want to proceed. I would say the most important criteria in choosing a doula is that you feel super comfortable with her. You'll be with her during a very stressful time, and you don't want to be stuck with someone who rubs you the wrong way.

Good luck to you!
posted by primate moon at 4:37 PM on December 12, 2016 [1 favorite]

Best answer: Partner of a recently pregnant person here. We got an experienced doula to attend the hospital birth and it was a very very good decision. We're not much into the New Agey stuff often associated with the profession, but my partner wanted to give birth naturally if possible and was concerned about the "intervention cascade" (where induced labor leads to more difficult labor leads to pain meds leads to c-section) that does seem to be a very entrenched part of US medical practice. Having a doula on-hand meant there was someone with us who:

- Helped advise us on when to go to the hospital after my partner's water broke without contractions beginning.

- Had attended hundreds of births and knew how to interpret what was happening as labor progressed.

- Was an advocate for my partner's wishes from outside the hospital culture, who was nonetheless familiar with that culture and who unlike me was not going to be overwhelmed and distracted by emotion while trying to negotiate any suggested interventions. It can be hard as a layperson to discern the difference between someone in a white coat saying "I think we should do X next" and "We need to do X immediately or there will be dire consequences," but a doula can help distinguish between medical emergency, excessive risk aversion, and trying-to-make-tee-time.

- Was present for the entire labor, across hospital shift changes, and was able to help fill in the rotating nurses and doctors on what was happening (and even at one point to pull some strings and help get a preferred doctor assigned instead of one we emphatically did not want to deal with again.)

- Was invaluable in coaching my partner through active labor, again offering her a perspective informed by experience that she would not have gotten from the nurses or doctors who were busy with the technical details and certainly not from me, however good I was at handholding and cheerleading.

We went to a group OB with the intention of doing the delivery with their midwife, but learned that because of the complication of my partner's water breaking without contractions her delivery would have to be handled by an MD. I'd recommend using a midwife if you can and would like to avoid medicalizing the birth process, but be mindful that depending on how labor goes they may not be with you for the whole thing. A doula can attend the entire birth even if you end up needing some medical intervention, and after our experience I'd strongly recommend hiring one, even if just to be your advocate in that contingency. The aftercare was nice, and she taught a childbirth class that we attended and that was good too, but having her there to guide us through those intense couple days in the hospital was absolutely crucial.

As far as selecting the doula, remember that you're basically paying for their experience. We talked to a younger early-career doula who was cheaper and who we both liked, but we ended up going with the one who charged more and had more experience, and were glad for it.
posted by contraption at 4:53 PM on December 12, 2016 [6 favorites]

Yes to midwives. They're really wonderful. I'm a crunchy homebirther and the biggest thing I got out of it is that I really like the midwifery approach to birth care and women's healthcare generally.

Just FYI, a postpartum doula is typically different (and more expensive than) a doula who you would hire during birth.
posted by PhoBWanKenobi at 4:55 PM on December 12, 2016 [2 favorites]

We were the opposite of crunchy in our preferences, preferring hospitals and OBs for our birth. One important thing I felt like we did was prepare ourselves for we'd do if the doctor started talking about cesarean. It's easy to plan for the plan, and not for written and why you deviate from the plan. We've known six babies born this year and they were all c-section, including ours. Knowing up front when we were ready for that made the decision much smoother at 3AM when it happened.
posted by Bulgaroktonos at 5:35 PM on December 12, 2016 [2 favorites]

I'd encourage you to think of your birth plan as being less of a road map and more like a list of preferences. I feel like birth plans give people the illusion of control when ultimately, it's going to happen the way it happens. My sister in law really wanted to have a natural vaginal birth so then when she had a c section after 24+ hours of labor, she felt really bummed. I got pregnant thinking I'd give vaginal delivery a shot but if that didn't work out, oh well. When I got preeclampsia and had to have a c section at 34 weeks, I was sad that my daughter had to spend the first two weeks of her life in the NICU but I was okay about having to have surgery. Similarly I was interested in having a doula but I wasn't sure so I gave myself time to think about it and then ended up with a c section anyway.
posted by kat518 at 5:55 PM on December 12, 2016 [3 favorites]

When my birth got complicated I was really glad there was a medical professional there I already trusted and who understood my priorities. A doula or a birth plan cannot substitute for trusting your doctor.
posted by yarly at 6:27 PM on December 12, 2016 [3 favorites]

I appreciated the perspective watching The Business of Being Born gave me, knowing going into it that they are pro-midwife. I did not like my OBGYN (who was very surgical minded, and her nurses were cold dictators) and chose a home birth with a midwife instead. That is just what worked for me. I felt most comfortable and cared for with a midwife. So I would recommend watching that documentary, but go into it with open eyes knowing they have their own agenda.

I also read books like The Bradley Method (husband coached birth) which was reassuring that good births could happen. (Again, they are trying to sell you something, so go into it with your eyes open.)

I have had multiple friends who had very traumatic first births where they were induced and nothing happened and then a shift change and the new doctor decided c-section. They felt a complete loss of agency and felt like failures. And then their second birth they had a planned c-section and loved it and felt validated as parents and mothers.

I watched birthing videos, too. (Remember to clear your history afterwards!) My favorite was a water birth of Ivy Claire. (Age restricted YouTube link but you don't actually see any crotch shots, just a mama in a tub giving birth) This was my favorite because in between contractions she's talking to her kid who wants a snack, and generally being the exact opposite of all those ladies in labor on TV and movies who do nothing but shriek in pain.

I've heard nothing but good things about doulas. One friend called them "the captain of a ship in a storm with no emotional ties to the storm itself", which, after two days straight of labor, was much appreciated when she and her husband were just wiped out.

So I guess gather your info. Find what feels right to you and find a health care provider that feels right for you, too.

Congratulations and I wish you and your baby the best of luck. Pregnancy, birth, and parenthood are such visceral experiences.
posted by jillithd at 6:56 PM on December 12, 2016

I too am sort of anti birth PLAN, but pro birth preferences. If you're the sort of person who likes to be in control enough that making a plan seems like a calming thing (as I am!), then you're probably the sort of person for whom going off the plan may be really upsetting -- and you will go off the plan. (I've had three babies and only one arrived more or less as expected.) So I'd advocate learning about options and thinking about your preferences, including in case things go wrong, but keep any "plan" super, super loose rather than idealizing it.

I go to an ob/gyn practice that includes both midwives AND obstetricians, which I very much enjoyed. I was planning on a midwife birth, but when there were complications and I had to have a C-section, I was seamlessly handed off from the midwife to her doctor colleague whom I'd already met at the practice, and I was able to continue receiving care from both of them, and it made the (fairly frightening at the time) C-section a lot less upsetting, since I didn't feel flung in the deep end with strangers ... my midwife helped me navigate the transition to the doctor and the surgery and offered to attend the surgery to hold my hand even. (I was cool with the doctor and my husband.) Also you know that doctors in a combined doctor/midwife practice value midwifery; even when I ended up in VERY MEDICALIZED emergency birth situations TWICE (including once with the NICU crash team), the experience was very positive and mother-and-baby-centered. If you can find that sort of combined practice, I strongly recommend it.

Many practices (although not all) will let you "interview" providers, which I did with both my ob/gyn and my pediatrician. You can always call and ask, and typically they'll give you a 15-minute appointment to chat with the doctor and decide if they suit you.

In terms of doulas, my local friends have mostly found that having a spouse/partner who took the birthing class, or a grandma willing to attend, obviated the need for a doula, but we also live in an area where hospital midwifery is big and respected; friends in other places have found themselves more in need of an advocate during birth. So I would ask around local friends if you can and get a sense of the hospitals and practices in the area, and whether doulas are helpful or unnecessary. (I literally sent an e-mail to a women's group I'm a member of, and posted to local people on FB, asking for practice and hospital recommendations and went from there.)
posted by Eyebrows McGee at 7:10 PM on December 12, 2016 [2 favorites]

FWIW, my experience was you only need a birth plan if you're in an environment/with a provider that you're not completely on the same page with. I had a birth plan basically to try and counteract the medicalization of birth in American hospitals, but once I switched from an OBGYN/ hospital to a midwife/birth center I felt zero need for a birth plan. So if you do well in picking a provider you may not need one.
posted by rabbitrabbit at 7:24 PM on December 12, 2016

Best answer: One way to figure out what your priorities are might be to do some reading or learning about pregnancy and birth care. If that's of interest, a couple of really great resources are Emily Osler's Expecting Better, and the Evidence Based Birth website (this is a link for the parent side; they also provide info aimed at birth professionals). Both are based on evidence from medical research, and are balanced and trustworthy sources.

I am a doula, and when you say you anticipate being a bit stressed and that you are far from family, I think that at least investigating doula options could be a good move for you. A big part of a their/our role is "just being there"... so that would include being ready to take your calls any time to provide reassurance, info, and support during the third trimester, obviously all of the birth support stuff, and being there for you in the immediate postpartum period as well. Part of the deal should be adapting to the kind of support or assistance you need, as it comes up. A good way to find out more about doulas is actually to go ahead and meet with a couple. Most (all?) offer an initial free get-to-know-you meeting to prospective clients. In addition to letting you know what their service looks like, a good doula will absolutely be able to provide information about the options available to you and help you tease out your preferences. In fact, this is a great way to screen doulas: they should be all about your preferences, not expressing their own preferences strongly; and they should be able to talk about the kinds of help/assistance they usually offer so that you can evaluate how that sounds to you.

I am also a nursing student, and in this role I've found that labour and delivery nurses and obstetricians are very vocal about recommending doulas for women who are interested in giving birth without an epidural. So if that is, or could be, something that you're interested in, that would be another reason to explore doula options.
posted by snorkmaiden at 8:01 PM on December 12, 2016 [7 favorites]

My friends with birth plans either 1) had AH-MAY-ZING experiences and are now birth plan evangelicals, or 2) had to abandon the plan and ended up being incredibly bitter about their birth experience. I didn't have a plan other than to have a healthy baby, didn't really sweat the details of giving birth, and I had a perfectly fine experience that neither changed me as a woman nor traumatized me. To be clear - becoming a mother changed me, but physically having the baby did not. I am definitely not saying you should be as (likely too) relaxed about it as I was, but be aware that birth planning builds a narrative in your head that can be comforting up until the point where it flies out the window, at which point some women panic because they had a plan and now they are having to wing it.
posted by gatorae at 8:33 PM on December 12, 2016 [2 favorites]

I would agree that it is extremely important to be prepared to be flexible, and to make sure that the number one priority in your birth process is that you and your child both survive it the best that you can.

As a physician, I am aware that it is commonly believed in obstetrical circles that the more detailed your birth plan is, the more likely it is that you will medically need whatever the complete opposite of your birth plan is and your complex plan will go out the window. That being said, I did have a very bare bones birth plan myself, which was not to discuss with my doctor, it was for my husband to use so that he could help make sure that if an option was there to have things the way I wanted them, then he could advocate for that. Not medically critical issues, just minor things that were emotionally important to me, like letting me give my baby its first bath. It helps to be familiar with the various decision points that arise during labor and delivery and the reasons behind them, and what the policies and practices of your hospital and healthcare provider are so that you'll be able to see where the options might be for you. For that I would strongly second the recommendations made by snorkmaiden - they're both excellent. The information contained therein could not be summarized in an answer here.

What I think is very important for people to know who are considering how to plan for their child's birth is that from a physician's perspective, home birth is not safe. It's something that is likely to turn out OK, odds being what they are, but there is also no way to guarantee that nothing will go wrong during childbirth no matter how low risk a candidate you seem to be. There are a lot of medical scenarios that midwives can deal with, and a lot of other scenarios where if something started going wrong and you just headed on over to a hospital, you could be successfully treated. But when the problem is that your baby is not getting oxygen, you don't have enough time to get to a hospital before they get serious brain damage. That's a risk I'd never, never be willing to take. Getting to hang out at home during birth might be really nice for a day or two (hopefully not two, for your sake), but anoxic brain injury is a terrible thing and that lasts forever.

And before I completely step off my soap box, I was dumbfounded by the above comment:
They [midwives] have as much medical training as an OB
That's absolutely untrue, so untrue that it's painful to read. Obstetricians have exponentially more medical training than a midwife. Midwives are great, I had one during my pregnancy and was happy with her, and I can understand why many people opt to use midwives who can typically afford to spend more time with them than physicians can. Midwives know a lot about pregnancy, labor, and childbirth. But obstetricians go through 4 years of intensive medical school training and rotating through all the medical specialties before doing another 4 years of specialized OB/GYN residency training covering primary reproductive healthcare, urogynecology, reproductive endocrinology, gynecologic oncology, amongst other things, and many do a year or two of additional fellowship training on top of that. The training is rather vastly different.
posted by treehorn+bunny at 9:03 PM on December 12, 2016 [17 favorites]

I interviewed a local midwifery clinic and got a recommendation for the doctor that they often used when things went pear-shaped. If I'd known then what I know now, I would have gone back to him for my second child's birth, also.

Have two people on your team as advocates who can stay with you throughout the labor and delivery. Your main advocate may be sick, or otherwise unable to attend the birth. And my anxiety level increased when my husband left the room.

Try to stay in your happy place and ignore the negative advice you will get. Happy mom / happy baby is the goal. It seem like the methods go in cycles, and those with toddlers will say one thing, and those with middle schoolers will say the opposite. Find out what your obstetrician says.

Get some rest now. Get some rest during first stage labor. Get some rest after delivery. Get a lot of rest at home. This is a theme.
posted by TrishaU at 10:08 PM on December 12, 2016

I am a recent first-time-baby-haver, and I have Opinions about this.

The thing that actually prepared me to give birth the most was reading every birth story on the "Baby Bumps" subreddit for the 4 months before I gave birth. There were unmedicated/ medicated/ emergency-c/ planned-c, basically every permutation of birth you can think of and people's perspectives on their experiences. It gave me an idea of the range of what might happen to me and what I might have to be prepared for.

I had a doula and chose to give birth in a hospital (a teaching hospital in fact). I had seen The Business of Being Born, and also read Expecting Better by Emily Oster, and wanted to maximize my chances of a healthy vaginal delivery while also minimizing risk from any complications that might happen. I figured out my "birth plan" - mainly as others have said, a set of preferences. I wanted to avoid an epidural because I didn't want to stall out labor and get a cascade of interventions leading to a c-section. 2 months before my due date I talked to my OB (who was an amazing resident), and at first she seemed a bit defensive that I wanted a "birth plan," but when we talked about what I wanted we were on the same page about almost everything except being allowed food or drink during birth, to which she said she didn't recommend it but wouldn't stop me if I wanted to eat or drink during labor. She's a young doctor and was just really up to date on the latest research and I liked that about her a lot.

If you decide to go the unmedicated route, do NOT leave the pain management techniques to the last minute. At 36 weeks 4 days, my doula did an at-home session with my husband and I introducing us to some pain management stuff she does, and we resolved to finally watch some youtube videos that week and get our shit together. Well, I naturally went into labor the next day and was totally unprepared for how shitty 7 cm dilated with no pain meds is. I went 12 hours from, "huh, I feel weirdly gassy" to "there's a baby in my arms," and when it ramped up so quickly I could not focus on pain management in the hospital setting while getting IVs and blood tests and stuff. My doula is a lovely woman, but she didn't get to the hospital until the aforementioned 7 cm pain, and I wanted nothing to do with her or my husband while I was in that much pain. Once I got the epidural I was blissful and the doula was nice to chat with, but we didn't have labor issues past that point, so her presence was a bit unnecessary.

I was personally very glad in hindsight to do a hospital birth, even though I didn't follow my birth plan (which was no pain management). I was unprepared for the pain and it stressed me out so much, I felt like a wild animal. The epidural might have slowed things down, but I could still feel contractions and push effectively when it came to that, and I didn't end up getting a c-section. My son ended up having a temporary but severe complication shortly after birth, and I was happy to be in a hospital where it could be noted and treated effectively.
posted by permiechickie at 10:13 PM on December 12, 2016 [1 favorite]

Best answer: I've given birth twice and hands down the most useful thing for me was to identify what things make me feel calm. I found a pregnancy yoga class that focused on preparing for birth really helped with this. My goal was to find out rituals, skills, and techniques to keep myself from panicking during birth, regardless of how the birth progressed.

When it came to birth choices, I tried to choose the hospital/doctor/initial approach that made me feel the safest and most calm.

I'm firmly in the camp of birth being a mental game. Which isn't to say you can avoid a c-section or whatever if you just think the right thoughts. But, birth is tough and (at least in my experience) requires some mental training so that you can deal with whatever physiology sends your way.
posted by brambory at 12:20 AM on December 13, 2016 [1 favorite]

Go hang out on /r/babybumps and you'll get to see example after example of birth plan and birth stories. Hearing birth stories helps, as you'll see (e.g.:) that having an epidural means you won't be walking around, that certain kinds of pain relief leave you feeling drugged and woozy (while others just remove the pain), that things can go faster or slower than you expect.

The thing about birth plans is that they're mostly standard practice in the good hospitals. I wrote one, and the only things that were useful were to clarify that we wanted few cervical checks and less interruption (e.g., food delivery, taking out the trash) during the postpartum days. Everything else turned out to be standard practice. But I read stories in which they were not. So, I'd find the best set of providers you can find.

The other big thing is that nobody can adequately communicate what it feels like to be in pain. I read story after story with sentences like "this was the worst pain I ever felt," and still, when I gave birth, I was like "what is this pain? this is absolutely ridiculous." Also, most hospitals won't even admit you until 4 cm, which for me was like ... 36? 48? hours into regular contractions? So even if you plan to get an epidural, take pain management seriously, be that via hypnobabies or whatever.

This is where the doula comes in. The massage they can do is absolutely incredible. If you can afford it, get a really experienced doula. Like someone above, we interviewed a young doula who was awesome, whom we thought would make a great friend. But we selected a more experienced team even though we didn't click in quite the same way. We are glad we made that choice. It's not about making conversation; it's about their ability to help while you really need pain relief. Find ones who will come out early and don't hesitate to call them, because in some ways you need them more during those hours before you have doctors and nurses to let you know that this pain is normal and things are going as expected.

Also, I'll echo the talk about the value of being in a hospital setting. My son's birth was overall a wonderful experience for me (once the doula helped me get the pain under control), but there was one scary moment. We all ended up fine, and a midwife might've been able to address the situation in the exact same way our MD did. But if the MD's approach hadn't fixed things as quickly as it did, we might've needed intervention quickly. I was glad we'd been in a hospital. And it was nice that our MD could do a medical test that confirmed that our minor issue truly had been minor, so we didn't have to wonder. Yes, hospitals do medicalize things to a certain extent, and it's helpful to know about some of that ahead of time (e.g., that they might say that no solid food is allowed), but if you get a good nurse, they can help with things like creating a peaceful atmosphere and otherwise supporting the approach that you want to take.

Good luck!
posted by slidell at 1:47 AM on December 13, 2016 [1 favorite]

I'm 4 1/2 months pregnant, and I've been thinking about this a lot. Personally, the birth plan I've come up with goes like this: find a doctor I trust (which I have done) and then trust her to help me have a safe delivery. I think it's okay to not have a long, complicated birth plan.

I found my OB/GYN by asking my GP, because I like my GP quite a bit and have liked the other specialists she's sent me to when I needed recommendations.
posted by colfax at 2:15 AM on December 13, 2016 [1 favorite]

In Western culture, we get a vast, vast amount of messaging about birth, and almost all of it is that birth is something done in a hospital and filled with pain and emergency-level fear. Even if we know this isn't the only truth, it is pretty much the only version of birth we see on television and in movies. That's pretty powerful messaging, and for most of us that's as close as we get to birthing babies until we are actually in a birthing room. It isn't an awesome setup really.

So my feeling is that for women who want to explore some other models of birth, a good starting point is to read books that act as an antidote to that messaging. Ina May's Guide to Childbirth is a good starting point, written by the woman who is basically America's leading homebirth midwife. (If that appeals, her Spiritual Midwifery is filled with very crunchy birth stories, though it isn't for everyone.)

In the more mainstream, Penny Simkin's Pregnancy, Childbirth and the Newborn has excellent evidence-based stats and manages to lay out all of the options including how to maximise your chances of giving birth without surgical intervention in a variety of settings. It also covers c-sections in a totally non-judgmental way. It's a super guide for pregnancy, birth and infancy and really gives you a lot of knowledge to work with when making choices.
posted by DarlingBri at 3:46 AM on December 13, 2016 [2 favorites]

Response by poster: Thanks is much for all the responses! A few quick follow-ups: no need to convince me on the hospital birth, I'm there with you; and I don't really know much (and fall more on the type b side of the spectrum than type a heavy planning side) but I do know I want the drugs. I love drugs, and I hate pain.

I found the doctor I have seen so far based on what took my insurance and her availability. She was okay, but she seems overly concerned about my weight in a way that is making me uncomfortable (I'm not thin, but I'm also not obese, and I'm not going to diet while I'm pregnant for heavens sake). How do I evaluate who is a good doctor for me, aside from trying one out for awhile and waiting to see if they do something that makes me feel vaguely unsettled?
posted by likeatoaster at 4:25 AM on December 13, 2016

Expecting Better, as recommended upthread, definitely discusses the weight issue (I'm not in the US, but the author is, and apparently her doctor was similarly overconcerned with her weight).
posted by threetwentytwo at 5:58 AM on December 13, 2016

How do I evaluate who is a good doctor for me, aside from trying one out for awhile and waiting to see if they do something that makes me feel vaguely unsettled?

Honestly, this is the thing that worked for me. I also had most of my appointments with a Nurse Practitioner which was great! I find them to be far less judgemental and better at listening.

In terms of a birth plan, mine was basically:

1) When I show up, please give me all the drugs. Everyone should be administering drugs to me except people in the back room inventing new and better drugs.

2) I would really prefer not to have a c-section; if the doctor suggests it, I'll ask if we can wait an hour or two and try then.

3) Of course my top priority is that the baby and I be healthy so if a c-section is the best way to ensure that then absolutely go for it.

I also, and this is super morbid, talked to my husband about what to do if something went dramatically wrong and he had to choose between me or the baby. Thank God this didn't happen and of course there was a very low chance it would but I didn't want him to have to make that decision without me in a very stressful situation. My body, my call on that one and I wanted him to know what I wanted. Really I would just think about any decisions that might need to be made and make sure the people on your team (husband, &c.) know what you want done.

All of that said, one thing that's true for me now is that the birth was the most important part of the pregnancy and the least important part of the baby's life. I thought about it quite a bit while I was pregnant because it felt like something for which I could plan but now (five months after the kraken emerged from her watery lair via c-section) I really don't think about it at all. Of course you want to plan and have as many decisions made as possible ahead of time but don't worry about "doing it wrong". I totally understand focusing on this right now but, barring unusual circumstances, the birth part probably won't end up mattering that much long term.
posted by Mrs. Pterodactyl at 6:09 AM on December 13, 2016 [3 favorites]

How do I evaluate who is a good doctor for me, aside from trying one out for awhile and waiting to see if they do something that makes me feel vaguely unsettled?

Go with your gut. Remember that you and your body and your peace of mind is JUST AS IMPORTANT as the fetus. There is so much self-sacrificing in the mom world, which really doesn't do anyone any good. If you don't like how the doctor or their staff treats you, find a new one. (Or, if you are that kind of person, tell them what you don't like and if they don't change, find a new one.) A few months from now, you will be in a vulnerable position, and you want to have a team of people around you to support you that you trust.

You have this stranger on the internet's permission to do what makes you feel happiest and healthiest, because your pregnancy is a unique time in your life, and you deserve to feel happy and healthy and cared for and special.
posted by jillithd at 6:52 AM on December 13, 2016

When I was pregnant and thinking about delivery, I really liked The Birth Partner by Penny Simkin. Yes, it's aimed more at your partner than at you, but it covers the process of giving birth really well, including things that can happen and different options that are available.
posted by beandip at 8:56 AM on December 13, 2016

Is there a local mom's group on Meetup or Facebook? They'd be my first choice as a resource for OB recommendations. It's also great to identify a group for participation while you're home with a newborn and looking for reasons to get out of the house.

I also recommend not thinking of it as a birth "plan." That just makes it seem like something that either goes right or wrong. The more flexible you are with your expectations, the happier you'll be with the outcome.

Penny Simkin's Pregnancy, Childbirth and the Newborn and Emily Oster's Expecting Better are the two books that stand out in my mind as well. But what really helped the most was taking part in online due date groups where you can follow along with others' experiences (and "read ahead" to labor stories). You can find forums that aren't all sparkly signatures and poor spelling... altdotlife isn't as active as it once was, but there's still a pregnancy section. I also had a good forum experience at the fertilityfriend.com forums.
posted by Kriesa at 9:27 AM on December 13, 2016

My baby is seven weeks old :-)

Our attitude as far as a 'birth plan' went was pretty much 'go to the hospital and do what the doctors tell us to do.' But I did find there were things I was glad I had talked about with my husband first. For example:

- Feelings about having an induction. Toward the end, I developed blood pressure issues. They told me that if my numbers were five points different in either direction, it wouldn't be up to me. But as they were, it a little bit was. Once I hit 38 weeks, all I had to do was say the word and they would induce me, or monitor and see instead, as I wished. I was glad my husband was on the same page as me with that.

- Breastfeeding. There was massive pressure at the hospital about this. It didn't work for us for various reasons. I'm glad we had talked this out and my husband could support me in doing things in the best way for us.

I didn't get a doula for the birth but I did get one afterward. She was hugely reassuring to me. Our baby was born small and seemed very delicate to me at first. He made alarming noises when he ate. He excreted fluid from more than the expected places. I needed someone to tell me that the things he did were normal. She watched me feed him, watched me give him a bath, watched me prepare the bottles and reassured me that was doing everything properly. She even showed me how to use a baby wearing wrap, how to dress him correctly to go outside in the winter, and how to use the diaper genie, humidifier and some other at that point unopened gear. She was totally worth it!
posted by ficbot at 9:44 AM on December 13, 2016

Pick the hospital first, then a doc who delivers there (and I have no clues on that, honestly---it's tough). A lot of your experience will be about the hospital than the individual doc.
posted by Rock 'em Sock 'em at 9:52 AM on December 13, 2016

"How do I evaluate who is a good doctor for me, aside from trying one out for awhile and waiting to see if they do something that makes me feel vaguely unsettled?"

Interview them! Ask them about their philosophy of practice. Tell them straight up, "I've been uncomfortable with how my current ob is handling my weight, how do you deal with that?" You'll get a sense of their vibe from talking -- whether they seem calm and caring, or dismissive and uninterested -- as well as some idea of how they'll handle issues that are important to you.
posted by Eyebrows McGee at 9:54 AM on December 13, 2016

L&D nurse here. I worked a 16 hour shift yesterday/today and was only able to sleep for a couple of hours when I got home, so let me apologize in advance if my ability to put words together is impaired.

First things first: you get the labor and birth you get. When it comes down to it, what your body does during labor and birth is largely out of your control.

That doesn't mean it's bad to prepare, to think about your options, to understand the possibilities, and have opinions about things! It just means that all the prenatal classes and doulas in the world aren't going to keep you from getting preeclampsia or having a prolapsed cord. Nor does a plan for an epidural as soon as possible mean that you won't have a precipitous birth where there's barely time for anyone to get a pair of gloves on. By all means, have an idea of what to expect in various circumstances, but don't get attached to any one way of doing things.

Second things second: very nearly gone are the days of a private practice obstetrician who sees you for every prenatal appointment and then shows up at the hospital in the middle of the night to catch your baby. These days it's all about the team approach, so your doctor will likely work with a large number of other doctors who will rotate their L&D call schedule. Any one of them could be the doctor on call the day your baby is born. Lots of practices will encourage you to have prenatal appointments with as many of the different physicians as possible before birth, so at very least the person with you at birth will be someone whose face you've seen before.

Third things third, and perhaps most important: first-time mothers are usually in labor for 24-36 hours. During that time, you will see your doctor for a sum total of about five of those hours. The rest of the time, it'll be the L&D nurse that takes care of you, helps you manage your pain, notices and fixes any problems as they arise, and pushes with you until she decides it's time to call the doctor for delivery.

There's certainly some professional bias to my opinion here, but I've also had SO MANY postpartum mothers tell me that they had no idea how little they would see their doctor during labor, and how much of what they thought would be done by the doctor was actually done by the nurse. Your nurses are likely to be orders of magnitude more influential to your satisfaction with your birth experience than your doctor will be.

Which brings me around to my 16 hour shift. I woke up at 8:00 am yesterday, and got to work at 3:00 pm. I left the hospital at 8:00 am today, having been awake for 24 hours and engaged in active patient care for 16 of those. I didn't get relieved of patient care responsibilities to eat or nap, though I broke Joint Commission rules and ate at the nurses' station so I didn't pass out.

As you might imagine, by the time my 15th hour of work rolled around I was not my best and brightest self. As far as I know, I didn't make any dangerous mistakes or errors in judgement. I did my best to be very, very careful. But study after study has shown that after more than eight hours of work, errors increase. After 12 hours, it gets worse. And you don't have to read a study to know that being awake for 24 hours is bad.

Every hospital I've worked at plays a numbers game with nurse staffing. Nurses cost money, and hospitals hate to lose money, so administrators always try to make sure there are more profits from births than expenses caring for patients. Frequently that means really borderline nurse staffing, like what happened at my hospital overnight last night when lots of women were in labor and there just weren't enough nurses there to provide good care.

Asking around or reading reviews about other women's experiences with their birth at your local hospitals will give you a sense of what kind of attention you can expect to receive from your nurses while you're there. Hearing or reading things like, "Our nurses left us alone for long periods of time while we were in really active labor and struggling with pain," or "We had to call the nurse to the room every time we needed something; she never just stopped by to check in," or, "I had to wait in an observation room for a long time before I got moved to a labor room," or, "My nurse always seemed like she was in a rush to leave the room," are all warning signs that the nurses on that unit are overextended and not able to devote as much attention to you as they'd like.

I can't encourage you strongly enough to choose a hospital that prioritizes adequate nurse staffing. Nothing will be more effective at ensuring your safety and the safety of your baby.
posted by jesourie at 6:50 PM on December 13, 2016 [6 favorites]

!! MeTa !!
posted by sestaaak at 8:16 AM on December 16, 2016 [1 favorite]

« Older What to do alone for four days?!   |   Looking for a Shelter that Helps Trans Teens in RI... Newer »
This thread is closed to new comments.