Monthly Archives: March 2011

Birth Plans

The birth plan debate has been interesting to me. I have seen both sides yelling back and forth. To me birth plans just makes sense. Especially if you’re giving birth in a hospital, attended by L&D nurses you’ve likely never met. Having a short document which indicates your preferences regarding pain management, IVs, movement, and more, as long as it has been discussed and cleared by the OB, only makes sense. Not all women want the same birth, and knowing what your patient wants should help you help them better.

But if you say anything in favor of birth plans, you always hear, “Don’t be too strict in your birth plan, you’ll just end up with a c-section!” or “People with birth plans are crazy, they need to understand that birth is unpredictable and things may not go as you plan!”

Which yes, I get. But I don’t think most women with birth plans are looking to outline exactly how their birth will go. They are looking to express their preferences, and to stay included in the decision-making process. They want to be viewed as an active and respected participant in the birth, rather than just someone (or something) in the way of the baby being out who has to be dealt with.

Through My OB Said What?!? I found a link to this blog post. Which is, quite possibly, the best expression of birth plans I have ever seen. I mean, exactly.

 

I have heard some argue that a birth plan is trying to control the uncontrollable (the birth)…that it is almost guaranteeing that you will have problems because you are trying to dictate the way the birth will go.

First off…I can not disagree strongly enough – although, as I stated above, I concede that my definition of a birth plan is different than most are currently using. To me, a birth plan has nothing to do with controlling the birth or how the birth will unfold…it is ONLY about how you are treated throughout this journey. I haven’t read a birth plan yet that addressed the BIRTH (“I want to be in labor less than 10 hours” “I will feel it only in my hips and cervix, not in my thighs or back.” “My contractions shall not become closer than 5 minutes apart”)…..NO! The birth plan is addressing the choices and actions of those around you!

[…]

This in no way states anything about how the birth will unfold or trying to control events – it’s about how you are treated and the respect you are given in the process as an adult autonomous human with rights and freedoms. We aren’t treating a pathology…we are overseeing a biological function.

Yes, exactly. And if I go to a small midwifery group and know and trust all the people who may be attending my birth and spent 9 months of long appointments discussion my preferences with them…then there’s no real need for a birth plan. They already know it. And my husband and I will have discussed it, and he can remind them.

But I may write one anyway, in the event of hospital transfer. Because I do want my autonomy respected during birth. That was my earliest uncomfortable feeling with the whole traditional hospital birth, before I even knew other options existed. It felt like the birthing woman was treated as hysterical and unable to make decisions or really be a helpful part of the birthing process, and so things just had to be done to her to manage the negative experience she was going through. I don’t want to be treated that way. Others might want the control taken from them so they just have to listen and not think or decide. GREAT! That is where birth plans come in! They can express that there. But if I don’t, I at least want an expression of my desires while I’m still “calm and reasonable” given to them, in the hopes that they’ll listen to it.

Do I think I can plan my birth exactly? Of course not. I am not naive. I have no idea what the experience will be like or what will work best for me. But that doesn’t mean I don’t have an idea how I would like things to end up, and at least a starting point of my preferences. If I change my mind during labor, that is fine.

I just want to be the one to change my mind.

I don’t want someone else to decide a different way is better and either pressure me to do it their way or force it on me without consent.

And that is all a birth plan means to me.

You will treat me with respect at all times and I will maintain the autonomy that I had before entering your hospital. Before you touch me or intervene in the normal course of my labor/delivery, you will discuss it with me and obtain informed consent.

If this was a given in hospitals, there would be no need for birth plans. But since it so often isn’t, if only because you likely have never before met the people attending most of your birth and are meeting under extremely tense circumstances, I still maintain that respectful birth plans are often necessary for truly satisfying birth experiences today.

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Modern Medicine

One thing I love (love LOVE!) about the midwifery model of care is the continuity of care and presence that the midwife has with her clients. Prenatal appointments always last 45 to 90 minutes. The midwife is the one who takes you back, does all the initial readings, answering of questions, and more “professional” tests herself. She is with you throughout the entire birth, from when labor gets going until a few hours (at least) after the baby is born. She will let that time take as long as it takes, no intervening to hurry things along, but she also knows when to go to interventions.

Compare that to an OB/hospital birth. Prenatal appointments may last 45 minutes…but only about 5 minutes of that (maybe 10 if you’re lucky) are with your actual OB. Much of the rest of the time you’re waiting, filling out paperwork, or an assistant is asking you questions and doing procedures. The assistant takes you back and does all the initial readings. OBs are often frustrated that you have questions that expand the length of your appointment, and I know women who have even been told, “Well your questions took so long now we have no time to do any of the normal checks for this appointment.” The OB ducks in to do the professional tests, then ducks back out and sends results or follow-up info back in with the assistant. At the birth you are attended mainly by L&D nurses, who are likely to rotate throughout your stay. No one has ultimate responsibility for your care, it’s easy to pass the buck if something confusing happens. And it can be hard to notice long-term patterns, since there is no one with you long-term. The OB shows up just at the end to catch the baby…and not uncommonly you are told to wait for the OB to show up so they can catch. The other time the OB might show up is to try to get you more on their schedule, so you can deliver before their shift is over or it gets too late at night, by advising additional procedures.

This is so different. So wildly different. I know some don’t understand my desire to have a midwife over an OB. This is one of the many reasons. Social Anxiety Disorder, people. I will have a hard enough time relaxing in front of one person I trust enough to make good progress through labor (because yes, being scared, nervous or anxious can stop or slow labor), constantly changing nurses and whatever OB is on call at the time is not my cup ‘o’ tea. Especially when I don’t trust them to let me be me..possibly outside of the “average” progression or procedure of labor but still perfectly safe. I have had too many doctors not accept that I am the way I am and just try to “fix” me against my will, I don’t need to go through that at birth, too.

But my thoughts here were more than just birth.

I recently made the connection between this attitude in obstetrics and this attitude of all of modern medicine.

Recently I found a new doctor (recommended by a friend). I’ve only seen her once, but I thought she was fabulous. She talked to me for 45 minutes, really getting a history. She was happy to explain why she recommended everything, answering all of my questions without making me feel guilty for taking up her time. She recommended, and I got, 3 vaccines, but I felt pretty OK taking her recommendations, because she was happy to explain her reasoning behind them and every time she had a good, concrete reason.

Now I have to go back to get the follow up vaccine (since it’s a multi-shot series for one of them).

I called yesterday to make my appointment (because I am anal retentive and I wanted it scheduled waaaaaaay ahead of time so I don’t forget and then have to wait one extra day for an appointment but when I got the first one it was too waaaaay early to schedule the second). Since I first saw the doctor, and she seemed so happy to answer my questions, I had started a list of follow-up questions that I had been thinking of. I was so disheartened by past bad doctors I hadn’t made a big list before the first appointment (plus I had that one big issue on my mind), so I was excited for this next one when I could ask all those little things I’d been wondering about for early pregnancy and TTC.

As I scheduled the appointment, the scheduler let me know, “So if this is just for a vaccine you won’t see the doctor, this will just be an appointment with her assistant.”

It makes sense, given the modern medical model. The assistant pulls me back. She does all the basic intake tests. She delivers the vaccines. So why would the doctor even need to come in?

Except that I want to see my primary care provider. Because that’s who I go to the office to see. I want her to do my care. All of it. Start to finish.

I hadn’t realized how much this fragmented model of care kind of got under my skin. Not a lot. But a little.

The endless repetitive paperwork.

The re-answering the questions for the assistant.

The re-re-answering the questions for the doctor.

The doctors’ time just feels like it’s too precious to be spent with patients. You need your blood pressure read? Eh, someone less skilled could handle that. You need a prescription? Eh, I’ll send it back in with the nurse, if you have (any or further) questions you can ask the pharmacist. You’re coming in to get a vaccination? Eh, the assistant can handle everything there.

I’m pretty sure I’m paying the same price for the office visit, doctor or no doctor showing up (though maybe not). So why can’t she just stop by to look everything over quickly before giving me the shot?

I mean, heck, even the vets want to see my dog before just giving him shots.

*sigh*

I want continuous models of care to become common. So I don’t feel like I’m wasting the time of professional who I hired to provide a service by asking her to provide that service in depth. I just want to see her regularly. And, maybe more importantly, have her see me.

Not a big deal. Just feels kinda off. Something else for me to think about.

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A-Z Update

I’m doing pretty well so far this year, less than 3 months in I’ve already read books with titles starting with 11 of the letters of the alphabet! And considering I have 3 “S” books, and 2 more books that are half-done, I’m pretty pleased with myself.

And yes, I totally count re-reads. Because I may have just finished the Twilight series for the fourth time. If I read it through cover-to-cover this year, it counts!

So I need to update my reviews. I’ve fallen quite far behind. As always, click on the picture of the book to be taken to an Amazon link for it. Here’s a brief glimpse at what I’ve been reading (that I haven’t talked about here before):

Shattered Dreams: My Life as a Polygamists’ Wife

Irene Spencer

I think this is the best book I have read on polygamy in all of my exploring. Irene was raised in the FLDS church and entered into a plural marriage, but her family life was not idyllic. Her story is full of confusion mixed with confidence, and overflowing with heartache. We get a picture of life inside many typical FLDS communities, and an inside view of the strains of sharing a husband with so very many other wives. I cannot put into words how this book touched me, but it paints a picture that pulls at your heart strings in ways you weren’t expecting. This is one of very few books I’ve read that actually brought up some tears while I was reading it. I highly recommend it, whether you are interested in other cultures in general or polygamy specifically, this book is, in my opinion, the best introduction and overview out there, while being a captivating, easy read.

Favorite Wife: Escape from Polygamy

Susan Ray Schmidt

I was drawn to this book, partially by the captivating intro given on Amazon, and partially because it is written by one of Irene’s sister wives. This is another look into the same family as shown in Shattered Dreams, by a wife who came much later to the family. Susan was seen as the favorite wife by the other wives, but she never saw herself that way. Her story is very different than Irene’s, though it depicts many of the same times, and getting to see each of these women through each other’s eyes is fascinating. I did not enjoy this book as much as I did Shattered Dreams, but I did enjoy it and find it a nice counterpoint to Irene’s story.

The Hunger Games Trilogy
The Hunger Games
Catching Fire
Mockingjay

Suzanne Collins

I thoroughly enjoyed reading The Hunger Games trilogy, and have to thank a commenter on my 2010 A-Z Challenge for suggesting it to me! Within minutes of picking up the first book I was totally and completely hooked. [Early spoiler alert. This is revealed early but slowly, if you don’t want to know, skip to the next paragraph] It is set in the future when the country (world?) is divided into 13 districts which all support the one Capitol. To keep the districts in line the Capitol hosts the Hunger Games every year. Each district must send two tributes, adolescent children, to fight to the death in the arena, killing often with their bare hands or whatever rudimentary weapons they can find. The battle takes weeks as the 26 children are whittled down to 1. This year, the main characters’ number comes up. We follow her in her journey through preparation for and participation in the Hunger Games.

The books are not brutal; though they do include violence they are not about violence. When I started the first book I was completely captivated and could not put it down. I posted a status on Facebook to that effect, and my brother warned me, “Each one gets worse.” I do have to agree with him, while the first book is STUNNING, the second and third are each a bit more of a stretch. Partially this is because the characters are so fully developed in the first book (one thing I love) that there isn’t that much more developing to do with them in the future ones. But that being said, I still do not regret reading any of them, and I still enjoyed reading all three. I think the first book could have stood alone, without any follow up, but I still highly recommend the whole trilogy. Because once you read the first you won’t be able to resist seeing what happens to the characters in the future books, as they will have become so much a part of you.

The character development is fantastic, the world building is stunning. You will keep reading, searching for more scraps of information, to see if what you have guessed about the rules of this world could be true, if things really work that way. If you want an enjoyable, though slightly dark, read, I definitely recommend The Hunger Games trilogy.

Sunflowers

Sheramy D. Bundrick

This book was recommended loaned to me by a friend who knows I enjoy reading, and while it’s not my normal fare I definitely enjoyed it! The book tells the story of Vincent van Gogh from the point of view of the prostitute for whom he cut off his ear. There is very little known about this prostitute, here called Rachel, from historical documents, so the author (an art historian) writes a novel answering the question, what if there was a true loving relationship between Vincent and Rachel? She weaves this tale deftly, keeping true to history but adding depth and personality to the players. This book gives you an insight to what may have been, and you will never view van Gogh, or his paintings, the same way again. I have approximately zero interest in art (since I have approximately zero understanding of it), but I really enjoyed this book and it made me want to go see van Gogh’s paintings. I recommend it if you are looking for an enjoyable, light read.

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Sleep Irony

I have been suffering some pretty bad and constant insomnia, paired with lousy sleep. (I know, you’re totally jealous) My average time to fall asleep has thus been around 1AM, much to my frustration.

Tonight I was exhausted. My hubby sent me to bed at 7 because I was falling asleep, and I went gratefully, figuring I could read and get some extra sleep, maybe even pulling my average sleep time back to normal. I fell asleep at 7:30.

Of course, this being so much earlier than I normally fall asleep, my body decided it was just a nap.

And despite me fighting to remain unconscious, woke me up fully at 10:30.

So now it’s 11 and I just took a three hour “nap.”

I’m never going back to sleep.

Totally. Screwed.

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Excited

I’m not sure what’s up with me and one-word post titles recently, but it’s what’s coming. So I’m rolling with it.

Oh, you wanted to know why?

I’ve been contemplating how I can work on my signing and how I can do something that makes me feel productive and fulfilled during my days.

My solution? Volunteering in a Deaf/Hard of Hearing classroom locally. I used to do this a lot and I LOVED it.

(Granted, where I used to do it my mom was an employee and I was a better signer than most of their paid interpreters, so I was given a lot of responsibility and lee-way which did make it more fun, but still)

Finally got up the guts to write a local program.

Within hours got a response back. One of the teachers would love an extra pair of hands and is willing to take a random crazy person off the street.

Really quite excited.

Hope it works out as well as it could. We’ll see! But this could be really fun and fulfilling :-D

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