I have written before that birth plans are worse than useless and a new study lends credence to that view.
Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. But the worst thing about birth plans is they don’t work. They don’t accomplish their purported purpose, make no difference in birth outcomes, and, ironically, predispose women to be less happy with the birth than women who didn’t have birth plans.
[pullquote align=”right” color=”#603b35″]The key to a safe, satisfying birth is to ditch the birth plan.[/pullquote]
For example, in Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:
… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect.
The new study is Birth Experience Satisfaction Among Birth Plan Mothers. It was a prospective controlled trial comparing women with and without birth plans.
Three hundred two women met criteria -145 had a birth plan and 109 birth plans were collected. We established 23 common requests. The most common requests were: no intravenous medications (82%), exclusive breastfeeding (74%), and no epidural (73%). The requests most fulfilled were avoidance of episiotomy (100%), erythromycin (82%), and rupture of membranes (79%)… A greater number of requests correlated with meeting expectations less (P=.04) and feeling less in control (P=.04). Having a higher percentage of requests met correlated with having expectations met more (P=.03) and feeling more in control (P=.03).
The greater the number of requests by the mother, the greater the chance that she had a negative birth experience. In other words, it isn’t birth trauma that causes bad birth experiences, it is Birthzillas.
Who’s Birthzilla?
As I’ve written before:
We’ve all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There’s an argument to be made that many homebirth and natural childbirth advocates are “birthzillas” who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse “It’s my special day.”
Consider:
Obsessive need for control – It’s difficult to imagine anything more obsessive than birth plans. Birth plans, in addition to being useless for their stated purpose of improving the birth, are attempts to plan the unplannable. You might as well have a “weather plan” for the day of birth for all the good it’s going to do you. Birth plans, like obsessive wedding plans, have the added drawback of irritating everyone around you. The need to ruminate on every aspect of the day, and share those ruminations with everyone else is boring at best and narcissistic at worst.
Hyersensitivity – Homebirth and natural childbirth advocates spend a lot of time being angry. The birth is not going according to plan. The hospital staff are not taking their desires as seriously as they take them. The hospital staff are not behaving as instructed. Everything is a slight. Offered an epidural? Have a fit. Labor support not exactly as desired? Accuse the nurses of evil intentions. Baby needs something different than the pre-approved birth plan? Who does that baby think he is? After all, birth is not about the baby. It’s all about, exclusively concerned with, revolving only around Birthzilla.
Outsize feelings of disappointment – Birthzillas are psychologically very fragile and make no apologies for their fragility. Baby needs resuscitation before being placed skin to skin with Birthzilla? The birth is ruined. C-section needed to deliver a healthy baby? That no longer qualifies as a birth at all!
Birthzillas have an outsize view of their own importance, a hypersensitivity to slights, a feeling of being persecuted when the birth does not go as planned, and an imperiousness and insensitivity to others who work with or for them.
Instead of integrating the inevitable disappointments associated with a birth, they get psychologically “stuck.” They experience their disappointments as narcissistic injuries and respond with rage and accusations of persecution. They have no time for and no interest in the feelings of others, and feel entitled to use other people for their own ends.
The ultimate irony is that the behavior of birthzillas often fails to produce the perfect birth. Because of their psychological neediness and fragility, they are unable to appreciate that every change in plan is not the “fault” of someone, unable to accept that unwillingness of providers to follow commands is not a sign of persecution and, worst of all, unable to enjoy what they have.
The key to a safe, satisfying birth is to ditch the birth plan and concentrate on the baby, not the creation of the perfect experience.
