I guess it takes direct experience to understand what I mean when I say 
that often (not always of course) the longer the birth plan, the more 
likely the c/section (or at least long, arduous labor).

Long birth plans often tell what the mother does NOT want as opposed to 
what she does want. You have to understand that some women who present 
this type of plan are already so rigid in their thinking that they cannot 
entertain the fact that their particular labor may not go exactly as they 
have learned or read about.

Of course, hospitals have to be "friendly"(I love that term) and many are 
(and of course many more are NOT), but those of you who are not directly 
involved with actual labor management on a regular basis may not have ever 
had the opportunity to work with someone like the rigid mom I have 
described above. Even with absolutely no interventions (except 
intermittant monitoring) some of these women are confrontational,scared to 
death (which is usually the case), and more important completely unable to 
relax and let their body do the job it has to do to give birth. For 
whatever the reason(s), these women's labors just stop. I think that 
sometimes these women have invested so much negative energy in worrying 
about what they don't want (and how the hospital is going to ruin their 
birth experience), that they have spent little time educating themselves 
about how they can help themselves and what the actual physiological birth 
process is about.

Even with a completely unmedicated or low intervention labor, none of us 
can predict what the baby is going to do, how the baby is going to lie and 
how the birth is going to go.

When you have a mother, for example, who has been ruptured 48 hours, is 
developing a temp and has a baby with tachycardia, you have to start to do 
something. Are we as practitioners going to be criticized for jump 
starting that labor? It would not be prudent or safe to continue without 
interventions.

We once had a diabetic mother lock herself in her bathroom once so the 
nurse could not monitor her (and I am talking intermittant monitoring 
only). Here is a confrontational mother putting her own baby at risk. If 
she didn't want any intervention, she should have stayed home. But of 
course, underneath, she knows she is at risk and knows she should be there 
and is scared, but instead, decides to come in and then refuse things. How 
much sense does that make.

I had a mother once wo had a skinny scrawny IUGR baby who had difficulty 
keeping warm. The baby needed a blood sugar. That's all. She refused to 
let me do a blood sugar (which might have shown that the baby's level was 
fine and that would have been that), but she insisted that I give the baby 
glucose water when it wouldn't nurse (she was pumping and getting nothing 
at all,nor had we been able to express anything). Giving the water was a 
far less optimal option that checking the sugar and leaving things alone. 
This is just another example of some who come with rigid expectations and 
often have no clue what they are or are not refusing. before anyone starts 
on me about did we do S2S,etc. yes we did.........

I know there are hospitals that are rigid as well and I would never chose 
to work in one. I am lucky not to have to do so. There are also nurses who 
can't "think outside the box" and rigid uninterested physicians as well. 
That is a realisty and something that will not change overnight. However, 
there are those women all over, who for whatever their reasons, chose to 
make their own experiences less positive just by the way they approach 
things. Sometimes I blame the childbirth educators for that as well. I 
have seen more than one Bradley method couple completely undone because 
the expectations set by the instructor could not possibly be met. When the 
instructor is out there in the real world telling all her couples that the 
hospital wants to "steal your birth experience" , if you get an epidural 
your legs will be "like dead wood." That's too bad, too, because Bradley's 
teaching and methods are just good common sense that can speed a labor on. 
The two quotes above are comments that I have personally received from 
Bradley couples over the years.

There is a poster on this forum who told me she tells all her mothers 
to "refuse everything." Does that make sense? No, it does not. What good 
does that do except to immediately set up a confrontational scenario and 
make the mother a perfect set-up for "failure."It's really easy to 
criticize something when you have little direct experience with something.

Healthcare is far from perfect. Physicians and nurses are far from perfect 
as well. However, the general public is often far from perfect and to 
immediately blame the professionals without demanding accountability from 
the consumer as well is not right. I see couples all the time who are 
afraid to ask their visitors to leave.......why would someone like that be 
able to stand up and ask for what she wants. My point is that often health 
care providers are more than willing to work with someone for what they 
want but if the mom is too afraid to make her needs known, all the asking 
in the world is probably not going to get her to say what she really wants.

Let's encourage all mothers-to-be to look into things, ask questions at 
each prenatal visit, change doctors if she doesn't feel heard, and other 
proactive actions. The consumer has to take some accountability as well 
and not always be looking to pass the buck elsewhere. We also need to 
remember that the baby doesn't always read the "guide book" either!

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