Growing a Skills-based approach to all pregnancies and every birth requires us all to understand the pros and cons of the present Choice-based childbirth trend.
As our modern societies were moving past Follow-your-doctor’s-order childbirth trend, birth advocates rightly wanted every birthing woman (not yet ‘family’ decision. Even birth advocates have had trouble truly integrating fathers-to-be into birth) to have choices.
In the US there had been no childbirth education classes in the Follow-your-doctor’s-orders trend. During the short lived Skills-based trend in the 1960s/70s there were heaps of childbirth classes … all skills-based. In the present Choice-based trend, the classes changed toward an ‘information’ format … giving women the pros and cons of medical assessments, monitoring and procedures so they could makes choices
These choices were gathered into a Birth Plan. Since the 1980s pregnant families have spent hours and hours formulating their Birth Plan … what they want and don’t want to happen during their birth.
We’ve got to put our minds together about this. As mentioned in previous posts, women did want change … many, many. Here’s just a short list that you can add to:
- Not have to remain in bed but be able to move around.
- Be able to eat and drink during labor.
- Have one or more support person.
- Bring scents and music.
- Bring their own food and drink.
- Intermittent fetal monitoring instead of constant.
- Birthing in the same room as labor
- Birthing in any position you want.
- No pain medicines
- No vaginal exams
- No stripping the membranes or rupturing membranes
- No induction
- No augmentation of contractions
- Wear what you want
- Be able to get into a birthing tub or shower
- Rooms that look more like ‘home’ and not so medical
- No standard episiotomy.
- Delayed cutting of cord
- Baby to belly
- Baby to breast
- No forceps
- Baby not checked for extended period
- No silver nitrate in the baby’s eyes
- No pulling on cord of placenta
- Letting placenta deliver naturally or delayed attempts to remove it.
- No Vit K
- Keeping the placenta to take home
- Rooming in
- no bottle feeding
- early discharge
What did this relatively long list do?
- FAMILY: Lots of time was spent in pregnancy discussing, reading about and researching every aspect of The Birth. This was very positive in some ways because women felt more ‘in charge’ and ‘in control’ of their birth experience. On the other hand every single ‘choice’ put a huge amount of pressure on the birth providers and the family. Everything women don’t ‘want’ is perceived of as ‘intervention’. This means the rise of shame, blame, guilt and disappointment is directly related to the growth of The Birth Plan. Everything a woman wants is perceived of equally.
- BIRTH PROFESSIONALS: Contrary to the message natural birth advocates promote, the modern medical maternity system has made huge efforts to make profound changes. Families birthing today don’t realize the positive changes. Yet, too often birth professionals feel they have not fulfilled the Birth Plans women put together.
There has been a realization that the initial Birth Plan concept wasn’t working. Women would come into hospital with pages and pages. While that is still happening, many women are told to put together a one page Birth Plan. So what is really important to birthing women?
The short answer: All of the above, none of the above.
This pretty much explains why birth professionals tended to throw up their hands when presented with Birth Plans. While an individual woman is thinking about HER birth, birth professionals are present at hundreds if not thousands of births/year. While the concept of ‘individual’ care should be the foundation for all health care, that’s unrealistic given the numbers of women giving birth every year … 3,800,000 in the US/year; 250,000 in Australia; 2,500,000 in South Africa and close to that in the UK; 58,000 in New Zealand.
Reality collided with reality … Birth Plans have and have not worked well.
There’s something else that happened. The message coming from Choice-based advocates was simple: You don’t need birth skills and fathers/others should merely support a woman’s choice and not tell her what to do (try to help her). Wow! The skills-based classes were less attended as information based classes evolved where only the very rudimentary skills were taught if any. Over the years, as it turns out, people find information based classes to be boring and childbirth class attendance has dropped significantly over the years. This is coupled with economic pressures on families and the rise of the Internet.
In hind-sight it’s sad that Skills were replaced with Choices. Part of the Movement to grow a skilled-based approach to all pregnancies and every birth is to encourage families to go ahead and create a conventional Birth Plan and also create a Skills-based Birth Plan. The conventional Birth Plan lets your birth professionals know what you want and don’t want … in other words a ‘delivery service’ by professionals to you. A Skills-based Birth Plan tells your birth professionals what skills they will see you use and how they can encourage you to use birth and coaching skills.