22 March, 2008

Doula-ing & Birth Plans

Huge epiphany while vacuuming last night: I don't need to look at another birth plan. Even if I were to land in the midst of a couple's birth with no prior knowledge of them, their provider, or their fervent hopes & dreams, I could be a fabulous doula for them.

Birth plans are most useful for a mom and dad-to-be in honing their options and communicating their wishes BEFORE THE BIRTH. They can bring the plan to a prenatal visit with their midwife or doctor and hold a frank discussion about routine procedures, episiotomy statistics, etc. It can be a good way to assess if your care provider and you are seeing eye-to-eye, or if you're getting red flags about opening up and birthing with this person. As a dear friend and wise lady says "You can't order spaghetti at McDonalds." You have to order from what's on the menu. For example, if you envision a hands-off birth while your doctor believes that it is her role to provide perineal massage while your yoni is stretching around your baby's head, how are you going to achieve the birth you want?

I have a list of common events/interventions/ medications etc. that I review with parents prenatally to see if they have any questions or want more information. A birth plan helps me eyeball what their choices are or if they even know they have choices at all. But it's not necessary. We can have our discussion, they can convey their desires to me prenatally and at the birth without the magic paper. And their choices can change in an instant!

There is one OB/CNM practice here that offers its patients a pre-formed birth plan with checkboxes. It's the same mentality I use when offering my three-year-old "choices". Ultimately I am controlling the outcome while giving only the illusion of choice.

So how can I be a fabulous doula if dropped into a stranger's birth from a time machine? (Wow, can I wear a cape, too?) I can continuously reflect what I see happening back to the couple. "I see the doctor wants to place an internal fetal monitor." I can ask them if they have questions. "Do you have any questions about that?" I might even ask if they give consent if they have not indicated yes or no. "Are you okay with that?" Or ask them if they want time to mull things over. I can offer them comfort and love, mothering the mother (and father if need be!). And I can release my "stuff", my expectations, my shoulds, because it's not my birth.

I do realize that asking these questions means using lots of words, which engages the neocortex, taking a woman out of her instinctive primal birth zone. By not knowing a couple's wishes or vision I might need to use more language. However, if they are birthing in a place where I need to be talking so much, chances are there is already other chatter happening that has pulled mama away from her inner wildebeest.


Shekinah13 said...

Actually, you /can/ order spaghetti at McDonalds. They just don't serve it. As you said, it's not on the menu. So no matter how nice the new decor in the McDs is, no matter how friendly the staff seems, and no matter how much business the culture gives them... if you want Italian, you're gonna need to go somewhere else! Amazingly, I know people who won't compromise on dinner but /will/ compromise on their births. It's a puzzle to me.

Birthkeeper said...

Apparently they do serve spaghetti at McDonalds' found in Rome. Perhaps we need to change the metaphor?

Along the same lines as arguing for dinner but being more laissez-faire about birth: people willing to take on lots of debt for a home or a car, but unwilling to pay for a homebirth midwife, or unwilling to pay for a doula. Do you get what you pay for, or what you don't???