If there is a topic related to obstetrical anesthesia that you would like to have discussed, please suggest it in the form of a comment.
Do you know this old joke? “How do you make God laugh?… Answer: Make a plan.” Nowhere in life is this lesson-within-a-joke more applicable than with the birth of a child. Birth plans are something I had never heard of until about ten years ago. I believe they are a manifestation of the Internet with its ability to spread information (as well as misinformation) around the world in short order. Birth plans are touted by the non-medical, non-scientific community, such as lay midwives, doulas and bloggers. Most OB-Gyns will say, “Sure, if you wan’t to make a birth plan, I’ll do my best to abide by your wishes.” In my experience, it’s fairly rare to see the labor of a woman with a birth plan go as planned. More often than not, hardly anything goes according to the plan. This is because God (or nature / fate) is in control of what is going to happen and the laboring women are at the mercy of these divine powers. We as doctors can make our meager little interventions, but the grand scheme of things is still outside of our realm of influence.
I guess the whole point of this post is; go ahead and construct a birth plan if you so desire, but please be advised that in so doing you are probably taunting God and things will not go as planned. Also, medical people will be professional about it, but they will be secretly rolling their eyes in their minds, because they will have never seen a birth plan actually work.
I do submit to you today my recommended birth plan. It’s based on the plan I follow in my dealings with other doctors when I am their patient.
1. Do what my doctor(s) think I should do and follow their recommendations, because they have many years of science-based training and experience. They have seen what works and what doesn’t work. They have formed habits and practices that keep their patients safe from harm.
The video we made of me placing an epidural should go over 1000 views in the next day or two and it’s only been up for about 6 weeks. I am encouraged by the amount of interest the viewers have shown.
Many women who are having a baby for the first time are frightened of the prospect of having an epidural. Some have heard frightening stories from friends and family members. Others are just afraid of needles. Whatever the reason, many women are scared the first time. Once they decide to go ahead and have the epidural and have it placed, they almost always say, “That wasn’t that big of a deal. Heck, the I.V. was worse.” By the second time they come in to the hospital for delivery, they are not scared at all. In fact, they are often saying something like, “Epidural, please,” when they walk through the door.
The risk is very minimal and the benefit is huge; no pain.
Some women are ideally suited to have babies without anesthesia. They are generally highly motivated, focused and tough people. They are willing to withstand the pain in order to experience childbirth the way God originally designed it. This, however, does not describe the average woman. The majority of women want very much to have artificial measures used to decrease their labor pain. That usually means an epidural.
In spite of the fact that the majority of women want epidurals, there is an almost cult-like undercurrent in the population that tries to make women feel ashamed of themselves for wanting to labor without pain. The Cult of Pain is what I call all the people that try to convince, scare, shame or coerce women into not getting epidurals. I am obviously biased. I make my living from women who choose to have labor epidurals. Conversely, there is a large group of people who make their livings from women laboring in pain. This group consists of midwives, doulas, owners of birthing centers, people that teach, blog and write about “Natural Childbirth”. Omitting an epidural doesn’t make childbirth natural. True Natural Childbirth means delivering your baby in your bedroom or out in the pasture without any help except your family. If you deliver in a hospital you will have electronics, tubes, catheters, and IVs attached to you. Even in most birthing centers, electronic fetal monitors are used. There is nothing natural about all of that. That’s why I think we need a refinement of the naming system for labor. A woman who delivers a baby without a labor epidural should not be said to have had “Natural Childbirth” but rather “Painful Childbirth” or “Childbirth Without Anesthesia.”