The final points on the doctor’s birth plan which I’d like to discuss are:
- the rate of birth complications increases rapidly after 39 weeks
- induction does not increase c-section risk or pain during labor
- the decision to deliver by cesarean section is the physician’s and is non-negotiable
In recent years, many obstetricians have steadily decreased the number of weeks they consider it safe to let a woman be pregnant. Initially, 42 weeks (2 weeks past the due date) was considered to be the point after which risks for the baby increased. There is a slightly higher risk of still birth after that time, and increased risk of fetal distress and meconium at birth. This is thought to be due to the aging of the placenta.
Recently, though, many doctors are wanting to move that 42 week guideline to 41 weeks. Then you have the additional problem of women who are insistent on being induced because they are tired of being pregnant and uncomfortable. Since we don’t even know clearly what causes labor to start, why don’t we stop and ask ourselves why we are messing around with the natural birth process and inducing all these labors before they are ready? Do all babies develop at the same rate? Children certainly don’t all mature at the same rate, why should we think that babies due? It makes much more sense to me to take each pregnancy on an individual basis, consider the mother’s health, how the baby is doing, and let labor begin on its own if at all possible.
Induction of labor is well known to be more painful than natural labor. Oxytocin-induced contractions peak more suddenly and remain at the peak for a longer period of time than a natural labor contraction, causing increased pain and increased need for pain relief. The September 2004 issue of the Journal of Clinical Anesthesia printed the results of a study examining whether induction caused increased demand for epidurals and increased risk for c-section. This is their conclusion: “Patients who have their labor induced request analgesia sooner and are at a higher risk of cesarean section than are patients who go into labor spontaneously“. There have been numerous other studies which support the same conclusion. 
Finally, the doctor’s assertion that the decision for c-section is his alone, and is non-negotiable, is ridiculous. Every woman has the right to consent or refuse surgery. Provided that the situation is not a true emergency, there should be ample time to discuss the reasons for a c-section and consider what alternatives there may be. This physician is dead wrong in his statement that it is his decision.
I believe this entire birth plan destroys the trust that should develop between a woman and her care provider during pregnancy. It is heavy-handed, and does not allow for the woman’s participation in decision-making surrounding her birth. As a midwife, I seek to empower women to take charge of their own health, to research and make thoughtful decisions about their care, and to speak up if they are uncomfortable with something I am suggesting. This does not diminish my ability to do a good job, but enhances it, because the woman and I are working together as a team to achieve the best outcome possible.
It may be true that it is the woman’s choice to consent or not consent to a c-section, but when you are in labor, in pain, and your doctor is asking you “do you want your baby to die?” it is hard not to consent.
I agree absolutely. That’s why I always caution women to look for another provider if you and your provider are not philosophically compatible. I’ve seen too many times where a provider tentatively agreed to a birth plan, but when labor began found a multitude of reasons why the plan needed to change. The ideal situation is to find a provider whose routine practices are what you would want on your birth plan. Such things might be encouraging freedom of movement, intermittent checking of the baby’s heart rate, encouraging you to eat/drink as desired, supporting freedom of position for birth and spontaneous pushing, limited vaginal exams, and immediate and undisturbed bonding with the baby following birth. If these are your provider’s routine policies, you can feel fairly confident he or she will support your birth plan without reservations.