The Birth Plan that Got Skunked

Exactly six years and two hours ago, my little Tiger slipped out his wet, dark, fetussphere and arrived fully in this world.

I’d been apprehensive about his birth, because my first delivery had been pretty horrendous. (I’ll leave the scare stories to another day, though.) So here I was, this feminist critic of medicalized birth, wanting to avoid a c-section but hoping even more to avoid a life in diapers (for me, that is) – and demanding to be induced as the least-worst option. I figured that if I had another baby with a 99th percentile noggin, he’d better make his entrance sooner, not later. My ob went along with my reasoning.

I didn’t actually have a formal birth plan. My doctor knew, however, that I’d want an epidural, and that I wanted to minimize other interventions.

So at 7 a.m. six years ago, I slurped down a Yoplait yogurt smoothie (judged least likely to reappear during labor, and least offensive if it did) on the ride to our little local hospital. First thing, the doctor broke my membranes – and installed an internal fetal monitor. I said, “Hey, that wasn’t part of the deal! I don’t want anything screwed into my baby’s skull!” “It’s hospital policy,” he said.

From then on, though, things went swimmingly. I actually got taken off the Pitocin drip after an hour because my contractions were ferociously strong. I walked a few laps, at the urging of the delivery nurse, and then I said: “Epidural. Epidural. Epidural. Epidural.” There might have been some verbs in there. Also some saltier language. I’m not sure anymore.

Moments later, a skinny older gent with silvery hair and a handlebar mustache appeared with the epidural apparatus. As he leaned in, I smelled an overwhelming eau de skunk. (Or is that eau de skuncque?) He and his dog had tangled with one that morning, and all the tomato sauce in the country wasn’t going to remove the odor. If I’d had a proper birth plan, this sure as heck wouldn’t have been on it.

But the epidural was such a deliverance, I really didn’t care. He could’ve brought the skunk with him in a pet carrier, and it wouldn’t have disturbed my bliss.

The rest of the delivery went smoothly. I was fully dilated by 2:30, and the Tiger emerged at 3:15 after a reasonable number of pushes. His cry was lusty and loud. I didn’t require any major repair (maybe I got a stitch or two). I got to see the miraculous oddity that we call the placenta. (Didn’t take it home and bury it, though.) The only hitch was that another baby was born within minutes of the Tiger, right around shift change, and I ended up self-diagnosing a minor postpartum hemorrhage, which was promptly treated with the Pitocin I hadn’t needed during actual labor.

The Tiger remains lusty and loud. He’s playing a Blue’s Clue’s computer game while I write this, each of us noodling with words. And he’s thrilled to be six, finally, after counting down for the past two weeks.

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Would I have been unable to avoid the internal monitor – which left a crust of blood on the Tiger’s head for over a week – if I’d prepared a formal birth plan? Well, I might have become aware that it was policy. I very much doubt I could have altered the course of events. Nor would the internal monitor have necessarily been a deal-breaker. I knew I couldn’t handle a repeat of my first delivery.

Kate Smurthwaite recently published a smart and acerbic analysis of birth plans on the F Word blog. She observes that birth plans are in the ascendancy in Great Britain – and that they typically fly out the window once labor is underway:

Apparently the NCT [National Childbirth Trust in its prenatal classes] went on and on about how important it was for women to write a “birth plan” to take with them to hospital. Now it’s understandable that women would want to have a document in hand to tell nurses what they want in different scenarios, to avoid having procedures they didn’t want forced upon them when they are in too much pain to discuss things. However of those in the group who made a “birth plan” (Lynda refused despite repeated demands by class instructors) 100% ended up not sticking to it and then feeling they had somehow “failed” to have the birth they wanted. In any case who would write a birth plan that says “experience extreme pain, demand an epidural, discover it’s too late, baby’s heart rate slows, rushed in for emergency cesarean”. Everyone writes “no pain relief, baby slips out in 2 minutes, I look stunning”, and then nobody lives up to it. So sure take in some notes about particular things you’re worried about seems to be good advice, but stay open minded about what happens – don’t make too many plans!

During my first pregnancy,  no one had nattered on about birth plans, because – at least as of the late 1990s – they weren’t yet a fixture in the German maternity landscape. I knew a lot (too much!) about childbirth from my dissertation research but I signed us up for a prenatal class anyway, mostly so my husband wouldn’t be out of the loop. I knew I wanted an epidural and was unapologetic about it. Rather than writing up a birth plan, I sought and found a midwife I felt I could trust. No plans would’ve anticipated the particular complications we encountered, so we avoided disappointment by relying on relationships rather than a checklist. I saw first-hand the fruits of the opposite approach when a young woman was transferred from a freestanding birth center, needing a cesarean, and she was utterly furious. So angry, in fact, that she barely perceived her child. I now wonder if she might have suffered PTSD, which is not all that uncommon after childbirth. And mind you, I’m not judging; I’d lost so much blood and suffered enough tearing that I too could only look at that baby of mine, the Bear, in wonder and confusion. I was still too exhausted to love.

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The conference I attended last month (A Philosophical Inquiry into Pregnancy, Childbirth, and Mothering) devoted an entire panel to the implications of birth plans. The whole panel was terrific; they papers by by Barry DeCoster (Worcester State College) and Sonya Charles (Cleveland State) both amply demonstrated that Smurthwaite’s observation hold all too true for American hospitals. But why is there so often a gap between the plan and the events? And why do we persist in writing plans that are really no more solid than skywriting?

The panel’s third presentation, by Allison Wolf (Simpson College), offered insights into why we persist in trying to plan the unplannable. She showed how such plans, which puport to safeguard women’s autonomy, actually dovetail tightly with the values and priorities of medicalization. Wolf stated that medicalization shields us from animality and contingency, which are two basic facts of our humanity. (The following ideas are Wolf’s, but I take responsibility for any distortions of them.)

As animals, we’re mortal. We’re embodied, and we therefore experience the world in certain ways. This includes the experience of sensations as well as our reactions when those sensations seem to spin out of control. We seek to reimpose control, and one major arena where we do so is pain, including labor. However, this impulse to exert control bumps up against brute reality, which is often unpredictable and harsh. Material reality is not as controllable as we’d like to believe. Anything that deludes us in regard to these facts – anything that tries to conceal our animality and the world’s contingency – alienates ourselves from humanity.

Medicalization tries to support this delusion, offering an illusion of control. In the case of childbirth, medicalization holds out the promise of pain relief and exhorts women (who are now patients) to exert control over their emotions. In presuming that pain, fear, and stress, are entirely bad, medicalization denies our animality, and it obscures any possible positive role for pain. It also directly distracts attention from our embodiment (when, for instance, enemas are used in labor to try to sanitize the process). Finally, medicalization alienates from the fact of our own mortality. Childbirth brings our mortality into focus. Rather than encouraging denial of this and making false promises of perfect safety, medicine should guide and comfort women, helping them cope with their fears, Wolf argued.

Within this context, the birth plan may be regarded as helping women cope, as Wolf suggested. However, she and I both worry that it may feed false expectations. The process of birth is fraught with contingency. When women fail to follow their plan, they may experience this as their first failure as mothers.

I’d like to see birth plans look more like a decision tree. (That’s what’s in the doctor’s head, after all.) Or maybe we should abolish the plan in favor of a conversation between doctor and patient in which both discuss their values and priorities. One woman may say she wants as “natural” a birth as possible. Others (me, me, me!) will want their epidural as soon as they check into the hospital. A great many will change their mind during birth, and that has to be okay, because giving birth absolutely bristles with contingency.

This may be the biggest lesson to be learned from birth plans – and their failure. Like birth, parenting is fraught with contingency. There’s plenty of animality, too (from feeding and diapering infants, to watching school-age kids play soccer in the mud). Instead of mourning or blaming oneself when the perfect birth didn’t proceed according to plan, we’d do much better to regard it as our first big lesson in parenting.

And once we accept contingency and animality – once we recognize their inevitability and their accidental blessings as well as the tribute they exact – we’ll be better prepared to cope when the next skunk crosses our path.

Daylily currently blooming next to the downspout behind my house.

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