LOS ANGELES -- Women are wielding a lot more power these days in
one of the most vulnerable of situations: giving birth.
From the type of music in the labor room to elective Caesarean
sections, a growing number of expectant moms have begun showing up
at hospitals with custom "birth plans" listing dozens of personal
preferences for the blessed event.
The plans make it clear, right up front, just exactly how moms
want to be treated -- everything from how they want to be prepped
for giving birth, limits on those exams, and whether water, ice
chips or an IV should be offered in the throes of labor.
"All my friends who had babies are asking, 'Have you finished
your birth plan?"' said mom-to-be Lainie Josephson of Sherman
Oaks.
Monica Barron, 34, also of Sherman Oaks, is due in April with
her first -- a son she and husband Steve plan to name Logan. She's
looking into birth plans and likely will complete one.
"I think it's a good thing, but there are a lot of questions
I'd rather have the doctors decide," she said. "I know things can
be changed, but I like the idea.
"One thing that's really important to me: I want to hold the
baby right away, before they dress him, before he's wrapped in
blankets. I've heard that's really important."
About patients' rights
To Carol Velas, a veteran labor and delivery nurse, nursing
instructor and longtime childbirth educator, birth plans are all
about patients' rights and medical professionals respecting women's
choices.
"When I get a birth plan, I read it from top to bottom and I go
over it with them," said Velas, who teaches at Moorpark College
and practices at three Ventura County hospitals.
"I make sure they know I'd be happy to abide by what they say
as long as it's OK with your physician and in the best interest of
you and your fetus. But if something goes wrong, everything
changes."
Birth plans typically cover three areas -- preferences during
labor and delivery ranging from pain relief to who decides when
it's time to push; how the baby should be treated in the hospital,
from who cuts the cord to breast- or bottle feeding; and what
should happen if something goes wrong, primarily medical problems
for either mother or baby.
"The circumstances dictate what's going to happen," said Diana
Limon, a labor and delivery nurse and childbirth educator at Kaiser
Permanente Medical Center in Panorama City.
"The birth plan helps moms think about, what if you don't have
the 'normal' labor. Let's think in advance about what we're going
to do if things don't go as planned.
"The whole process gets you to think."
Where to find surveys
Some doctors' offices distribute birth-plan surveys to patients,
asking them to be returned around the 30th week, about 10 weeks
before the baby is due. But plans also can be found online from
literally thousands of sources.
Obstetricians and labor-and-delivery nurses stress that the
plans are not orders, but simply preferences, and insist medical
care will not be compromised.
"In medicine, you have many ways of doing things," said Dr.
Jerry Konialian, an obstetrician who specializes in fertility at
Northridge Hospital Medical Center. "As long as all the options
fall within the standard of care, the patient should have some
input.
"I think it's good for hospitals to start catering more to the
women."
A typical birth plan covers some 40 or 50 questions, including
some obvious topics such as the mother-to-be's picks for who's in
the delivery room, whether she wants an epidural and if she will
breast-feed.
But they also go further -- much further. Patients are deciding
how they want to be prepped for delivery, whether their unborn
babies will undergo continuous fetal monitoring and even when they
can begin pushing.
Women also can choose what they'll wear in the delivery room and
opt for massages, time in the Jacuzzi or "labor imagery" for
relief from labor pains.
A sample birth plan on earthmamaangelbaby.com offers a
collection of options to induce labor ranging from herbs to having
sex. It also has boxes to check under pain relief for such
treatments as acupuncture and hypnotherapy.
Josephson, who's expecting a daughter in April that she and
husband Gregg will name Ellie, is amazed by the questions listed in
the birth plan provided by her doctor.
And she's finding that many of her newfound choices simply raise
more questions.
"I'm ill-equipped to answer a lot of the questions," she said.
"Fetal monitoring -- I don't know why I wouldn't want it. Is there
a risk? I want the doctor to decide.
"And they ask ridiculous questions like what kind of mood music
I want. Do I want the room dimly lit? No, I don't! I want the
doctor to be able to see everything. It seems so new-age."
Plans uncertain
Shoma Seelall, 27, of Canyon Country -- who's expecting her
second child, a son, in April -- also is uncertain about birth
plans. While she's eager to have a say in her delivery, she's
reluctant to make her own medical decisions.
"It's interesting, it's great that women are getting all these
choices," Seelall said. "But really you want the doctors and
nurses to do what they think is best."
One option women are taking is Caesarean births simply because
they don't want to endure labor, Velas said.
"When I started practicing 18 years ago, to do a primary
Caesarian section as elective surgery was unheard of," she said.
"But some women say, 'It's my right. I don't want to go through
labor.'
"We're saying you have the right and as long as that person
gets informed consent and understands the risk, it is her right and
I'm going to support her."
What helps make birth plans viable is that women are educating
themselves. And obstetrician Peter Weiss said birth-plan surveys
can work as marketing tools for hospitals.
"Who really buys health care? Mostly women," said Weiss, who
practices at Cedars-Sinai Medical Center in Beverly Hills. "They
want to go where they're comfortable.
"They have their baby there, they introduce their family
through pediatricians at the same facility. If somewhere down the
road the husband needs surgery, a hernia or appendix acts up,
they'll go back to the hospital they know.
"It's business. When you get down to it, it's business."
c.2007 Los Angeles Daily News