Click here for a working sample and one to print off for your care provider!

A Little History

In most areas of the United States and Canada, expectant women and their partners have many choices surrounding their birth experiences. This concept of choice, almost always presented as informed choice, began with the childbirth movement in the 1950's. Proponents of women-centered birth advocated a woman's educated choice in birth practices. This ultimately lead some physicians including Grantly Dick-Read and Fernand Lamaze to reintroduced the birth partner/husband or coach into the birth environment. And both Dick-Read and Lamaze suggested that a woman in labor builds up tensions because of fear of the unknown. The tensions and fear create an antagonistic effect on the body's muscles causing pain: hence, the Fear-Tension-Pain Cycle. Birth partners play a significant role in breaking this cycle.

Dick-Read proposed that education would help women to comprehend the mechanism of labor, allaying their fears, easing tensions, and reducing pain. Lamaze, having observed Russian doctors Nicolaiev and Velvovsky, created the psychoprophylactic method (psycho means mind and prophylactic means prevention). With education as a key component, psychoprophylaxis sought to prevent the mind from dwelling on the intensity of the contractions through a combination of education and techniques including relaxation, massage/effleurage, focusing and breathing.

In the 1960's and 1970's, women embraced this more natural way to have their babies. This was in sharp contrast to previous methods of birth in industrialized countries which included total medically induced unconsciousness during labor and birth with emotional and physical detachment from both this life-changing process and the newborn.

Advocacy or Aggression?

During the last 30 years, some individuals (professional and lay) have taken an aggressive approach to promoting choices in childbirth. Sometimes, this aggression is born out of ignorance on the part of expectant mothers. These mothers who do not explore the options in their community, assumed that all physicians and hospitals operate on the philosophies of the past - medically managed labors and births (not true!). Aggression became their means of "getting what they wanted" rather than using education and compromise.

Additionally, this aggressive nature in expectant women was (and still is) promoted by a few professionals with issues and agendas of their own. They assist in spreading the aggression and air-of-doubt toward physicians and hospitals. Rather than work within the system, they choose to stand "outside of the box," demanding that changes be made. In some geographic regions, the birth place was (and is) a battle zone.

Not Without Fault
Further adding to this simmering stew of unrest came financial cutbacks for physicians and hospitals. Nurses face fewer coworkers and higher patient-to-nurse ratio. Overworked and understaffed, some nurses may prefer medically managed labors over "natural" labors because of the ability to anticipate the pace of the labor. They can predict when their patients would be at certain points in labor thanks to oxytocin/Pitocin. Patients are relatively painfree and don't need to be "baby-sat" thanks to monitors and epidurals. Some physicians also fall under the medical management spell as they now too can predict a labor's progress and this could easily work around office hours or other commitments. In some regions, induction rates have soared and epidual rates are 95%. The goal becomes get more patients in and out of the office, and more patients in and out of delivery.

If Birth Plan Becomes a 4 Letter Word
Having read the above sections, you may now be able to see why a patient who has her own thoughts and feelings about how her birth might go may not be treated like she planned. She is asking either the nurse or the physician (or both) to interfere with the finely tuned schedule. She may labeled the "problem patient," the "troublesome patient," or worse yet, the patient most likely to have a cesarean section. Regretfully, I have heard these very comments verbalized directly to patients by health care professionals. Imagine how destructive such diminutive comments can be to a woman's self-concept at a time when she needs positive reinforcement in her abilities to achieve. And it is a shame when health care professionals either do not share the same values or cannot express tolerance to the woman's basic needs.

Change May Be Hard But Not Impossible

Just like the women of the 1950's, 60's and 70's, you may be experiencing some resistance to informed choice in your community. In the absence of life-threatening complications, pregnancy is a healthy condition. Labor is hard work with a tremendous reward at the end. We urge you to explore choices in your community, examine differences between care providers and birthing facilities. Shop around. After all, you are the consumer.

References:

1. Dick-Read, G. Childbrith Without Fear. New York: Harper and Brothers, 1944.
2. Lamaze, F. Painless Childbirth. New York: Simon & Schuster, 1965.