Are birth plans a waste of the paper they’re written on?

Are birth plans a waste of the paper they’re written on?

If you want to make God laugh, tell him your plans. If you want to make a midwife laugh, tell her your birth plan. I'd always mocked birth plans, even before having a baby myself and most certainly afterwards.

"They're ridiculous!" I railed. "Waste of paper!" I chortled. "You're just setting yourself up for disappointment!" I insisted.

Expectations, even if they're unspoken, can be very bad things to take into a delivery room. 

So imagine my surprise when I recently discovered that I did, in fact, have plans for each of my three babies without even knowing it. Which was fine, until one birth didn't go according to my non-plan and everything went to hell.

The realisation I was a hypocrite - and worse - began a few weeks ago when I heard an ABC radio report on post-traumatic stress disorder (PTSD). According to a research team from Griffith University, six per cent of Australian women go on to develop PTSD after giving birth, and it's often undiagnosed or misdiagnosed as postnatal depression. The two groups of women with the highest risk of developing PTSD were those who thought their birth would be fantastic and those who thought it would be horrific. The birth itself doesn't have to have been medically dangerous or even complicated; what matters is the mother's experience - something often framed by her expectations. Ka-ching, I heard softly.

I'd always thought birth plans were about candles, Norah Jones CDs and breathing, and were sprinkled liberally with words like "natural" and "active". I thought they were about trying to control the uncontrollable, predict the unpredictable, shunning "intervention" and using alternative methods of pain relief. Which is why it never occurred to me that I had a plan, because I wasn't interested in any of that. My plan for each of my births consisted of one word: epidural. Surely that's not detailed enough to be a plan?

It turns out that a birth plan can simply mean your expectation of something - written or otherwise. And expectations, even if they're unspoken, can be very bad things to take into a delivery room.

While women drive the birth-plan bus, men are big fans, generally. This is because it sounds a lot like a set of instructions. And how handy would that be when you find yourself in a room with a bunch of people clustered around your naked partner who seems to want something from you but who has replaced her speech with animal noises?

The idea of a birth plan also offers some written recourse in case your partner unexpectedly changes tack. "I know I said no (pant) drugs (grunt), but I neeeeeeed (gasp, pant, grooooaan) something NOW or I'm (moooooo) NOT DOING THIS!"

So what do you do now? Take her at her word and request an epidural or refer to the birth plan, which specifically states, If I ask for drugs, just help me focus on my breathing instead?

And also there was no mention in the plan of physical violence and what to do when your testicles are threatened. Help? Anyone?

My first birth went pretty much as expected: pain, epidural, birth. I'd been open to the possibility of a caesarean, but it wasn't necessary. I congratulated myself on not having a plan because I'd seen the angst suffered by women whose plans had ended up being derailed by complications or an unexpected need for pain relief.

My non-plan for my second birth was the same as the first: pain - probably excruciating - and then the anaesthetist would give me an epidural and I would be so grateful I'd ask him to marry me, and then the baby would be born. (Given that women in labour frequently propose to their anaesthetist, this might
be a good career choice for single blokes.) The end. Good non-plan.

I know you'll be shocked to hear it didn't go that way. I certainly was. When no anaesthetist was available, I had to give birth without pain relief, something I'd never expected. Good luck to those who chose to do this, but I was never among you.

I like epidurals. Damn it, I bloody love them.

So let's say I was a wee bit miffed, if by miffed you mean gobsmacked, indignant, furious, devastated and shattered - in that order.

Afterwards, when I was ranting to a friend about having to white-knuckle it with no drugs, she said, "Do you at least feel a little bit smug?" and I responded instantly, "No, not smug, just bitter."

In the days and weeks that followed, I now see I had many PTSD symptoms, even though they were mild. Repeated flashbacks to the birth, insomnia and a strange emotional disconnect from the world and my baby. I clearly remember one afternoon when she was a few weeks old, sitting and looking into her face and feeling the first warm pangs of intense emotion.

I called my husband and said, "I'm totally in love with this baby" because, suddenly, I was. It felt like waking up. Or thawing out.

I'm not going to end this column with any words of advice to future mothers because they get far too much of that as it is.

I'll just say this: the best laid plans ...

This column appears in Sunday Life magazine every Sunday. Mia writes daily at mamamia.com.au, and you can follow her on Twitter at twitter.com/miafreedman.

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