More thoughts on birth plans

Shieva Ghofrany: [00:00:00] Good morning on a Monday, I decided I wanna do a little part two about birth plans because it sparked some discussion in my, in my dms and my messages. And I really wanna be clear about how I feel about birth plans, um, in general. Meaning I very much want women's births, humans who are birthing to have the most collaborative experience possible. 

And I will keep using the word collaborative because that is what comes to mind. I think the modern notion of birth plans has not achieved that. Now, there might be those of you out there who say, Nope, I had my birth plan and it worked perfectly, and everyone listened, and it worked great. Great. Just like, you know, I planned my, let's just say it was a wedding or a trip or whatever plan you have. 

Sometimes it goes off exactly as you thought without a hitch, and other times, and I would argue many other times, it doesn't go off as you. But that doesn't mean it can't be wonderful when you've decided that things are going to still [00:01:00] be okay in the end. Like your flight got canceled, your hotel room was different, all those things. 

And if you've chosen not to overdramatize it, you can still achieve a beautiful experience. Now you might say, okay, well what's the difference? Let me just do a birth land, just like I would do a wedding plan or a trip. But here's the huge difference that I feel like we are ignoring. If we say write a birth plan just like a trip or a wedding, the differe. 

Planning a wedding and planning a a trip are far more controllable. Even as uncontrollable as they are, far more controllable. You can control who's gonna be there, how many people are gonna show up, all those things to a degree. Now, Five more people might show up because you thought they said no. All those things can happen, but again, it is more controllable. 

Labor is not very controllable. We can keep talking about nature, but as it stands, and as I've said this, I'm talking to you in a phone, I'm in a building, I'm clothed. I am not. Living in my one little space as we were thousands of years [00:02:00] ago, only procreating with the person who literally lives in proximity. 

To me, we are a global world where we have altered nature to such a large degree that we cannot expect nature to just show up and do the right thing every single time. And I've said this before to anyone who will listen. We, it seems unfair that we have not set the table for nature to come in to our party, and yet we expect her to show up willfully, happily, all dressed up for the party and always produce the end. 

This whole notion that, but in nature, women deliver vaginally is simply not true. First of all, even if a word shoe back in nature, Then we've strayed from nature, right? We have women who are Iranian, genetically living in America, procreating with my partner, my husband, who is a genetically Arab male who lived, who grew up in what is now considered Israel, right? 

Like he and I were not meant to have children together, and yet there we were procreating [00:03:00] and creating. Who may be anatomically, physiologically were not a match for my pelvis, let's say no one's exploring that, everyone's saying, but in nature, we'd deliver vaginally. So first of all, not every baby delivered naturally meaning vaginally because women died in childbirth. 

Second of all, I am not prorating with a person I was in nature meant to procreate with, nor was I meant to procreate when I. 40 years old, that's not really true. Cause I actually got pregnant on my own spontaneously. But still I was not meant to procreate at 250 pounds, which is how much I weighed when I had my first two children. 

So again, so much was not following nature. So why did I all of a sudden expect nature to be like, okay, well I'm supposed to live vaginally, it's gonna work out. Now should I make every effort to try to have that workout if that's what I'd like? Of course. So I wanna be very clear, I am not negating any human or women's. 

To have a beautifully collaborative experience because I think that is of paramount importance. I think that we can make it beautiful and [00:04:00] collaborative, but the huge difference in my vision for you as a woman, and I think many women who have experienced it with me will agree, my vision does not mean therefore it has to be vaginal. 

Therefore, it has to be without an epidural. Therefore, it has to be, there's no set end point other than the end point being, let us make sure that we are constantly communicating, and I don't mean constantly every. But throughout the process of your pregnancy and your labor, we are communicating so we understand each other so that when an outcome occurs, we can respond appropriately to it so that our ultimate outcome is that you and the baby are healthy now. 

Does that always mean vaginally? It doesn't. And if you always set your sight in your birth plan as that, then unfortunately, a large percentage will be disappointed and they won't be able to experience the beauty of a truly collaborative birth. I have had patients with amazing births. Self-reported, this is not my interpretation of them. 

They have self-reported to me that it felt beautiful and collaborative despite pushing for four hours and then ending [00:05:00] up with a C-section, pushing for five hours and having a vacuum, having such a rapid delivery that they didn't have time to do anything on their plan. All varieties. Of births. So what I would offer is that this notion of birth plan that probably came about in a time where people did feel very disenfranchised from medicine, which I understand and they probably still do. 

And I would say it's partially the fault of doctors, partially the fault of the system, partially the fault of the rise in um, information that confuses us. There's so many factors I think involved, but in an effort to try to kind of take back control. The notion of a birth plan has come about Now, in reality, it also was in an effort to, I thought, create more collaboration. 

But in fact, what it's become is a very contractual document, right? A piece of paper where someone comes and says, this is my birth plan. Now again, I am all for like, let's discuss like what? What? You know, what you don't know, what you think, like what do we do at our hospital that you don't actually even need to ask us because we already offer it If you want it, and if you don't want it, you don't need. 

Um, so to me that's [00:06:00] valuable. You should talk about that with your doctor and nurse and your midwives because there might be a lot of things you don't even need to put in your plan. I, again, like many of us would rather it be discussed as preferences. Like, in a perfect world I'd like to have this happen, but I understand that this might happen and I think the more you view it as such, just like life, I always say it's a little parable for life. 

I'd like my life to look in a certain way, and I, I manifest and I visualize all the time while knowing that the underlying likelihood is that things are not gonna go according to my plan at every step, but that my end result is gonna be beautiful and happy. And my end result, by the way, might not even be what I envisioned. 

Maybe I envisioned myself that I was gonna be, again, a jewelry designer at age 60 and instead I'm a doctor at age 51. Right? I mean, it might not be, but I could still be happy because I have collaborated. Myself and those things in my life. So again, to anyone who thinks that I'm saying, don't have a birth plan and just listen to your doctor, I'm not [00:07:00] actually saying that. 

I don't necessarily say blindly follow much like my teachers, I use this as an example all the time. My children's teachers, I do not blindly follow what they say regardless of what they're doing, but I generally trust them and have faith that they are doing the right thing for my child and that we have the. 

End result in mind and the root with which they take that I do not micromanage because I do not know how to teach. That is why I assign the teachers to teach my children because I know what I am good at, which is not teaching. Right? And so because of that, it doesn't mean. Blindly follow them. But it means if I try to micromanage and say to them, here's my plan for my child, and what I just need is actually for you to implement my plan. 

I don't really need your expertise. I just need you to implement my plan. And by the way, yes, I guess if my plan goes off a little bit, then like you can step in, but I'm gonna question when you step in every single time. And when you do step in, I'm not necessarily gonna agree with it, even though you've actually done this. 

And I think you have my child's best interest [00:08:00] at heart, but I'm not really sure if you do. So I'm just gonna step in. Is not gonna create a collaborative experience. And so my, my, um, feeling about it is that if you have a practitioner that you don't feel faith in, that you feel like you have to micro minute it, that you feel like you have to control because you're not sure of her desire to have the same general end result as you. 

Meaning happy, healthy, mother, happy, healthy. Then rather than micromanage her or him, maybe find a different practitioner, which is not always easy. I understand that. But I think the worst way to go about the relationship is to try to micromanage. I don't think that ever, ever ends up well. And I will tell you that patient after patient, after patient who have the best experiences are those who felt that they had a collaborative practitioner and that did not. 

Oh my God. She followed my birth plan. It meant she and I discussed things and I felt heard, and she felt heard. She meaning me [00:09:00] as a practitioner, because this is a two-way street. We're not just servants showing up to just do whatever the patient needs. This is what I have to do all day every day. I have to live with myself all day, every day knowing that I have tried to do the right thing and that I've had as good outcomes as I could possibly achieve. 

And furthermore that I have emotionally engaged with my patients. So this is a two-way. So that's a long-winded birth plan discussion on a Monday morning. Hope that makes sense. Bye.