Birth plans – no laughing matter

In a heatfelt article, Sarah Bregel describes her experience of giving birth in the US:

“I thought I knew what I was doing, walked into the hospital and BAM. News flash, your birth does not belong to you. Get in the bed and stay there. Labor on your back until you can’t take it anymore and your unmedicated birth goes out the window. Watch the doctor pick up the scissors and slice you open up to your ass before you could say no – don’t cut me.’”

Bregel’s story seems fairly typical of the medicalised, doctor-knows-best approach to birth in the US, where only eight percent of deliveries (compared to 57% in Britain) are carried out by midwives. Although this medicalised approach is usually defended on the grounds of safer outcomes, the US has a maternal mortality rate three times higher than that of the UK, and one of the highest in the developed world.

The idea that a woman should be asked for consent to any medical procedures carried out on her isn’t, you would think, controversial. And yet it does often seem to provoke either anger (because women should be grateful that they’re lucky enough to live in a country where medical care is available during childbirth) or amusement: Bregel writes of “comment after comment after comment from nurses and other hospital staff saying ‘we laugh at women who come in with their silly birth plans.’”

The feeling seems to be that, because labour and birth can be unpredictable, a birth plan is a comical piece of hubris, a foolish whim from women who stupidly imagine that, because they want a birth to happen in a certain way, then it will happen that way.

But a birth plan is really nothing more than a statement of preferences for treatment during labour: “I would prefer to be able to walk around in the early stages of labour,” for example. “I don’t want to have my waters broken without my consent.” “I would like my baby to be put into my arms immediately after birth.”

Usually when it comes to choosing medical treatment, doctors seek a patient’s informed consent. A cancer patient can decline chemotherapy, for example, even if advised that it is the best option medically. Yet too often this principle flies out of the window when a woman is giving birth. As Bregel asks, “Why are we still telling women they’re control freaks for wanting some say in what happens to their bodies?”

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