Birth plans

The past few months have been full of long work days and as much skiing as we could squeeze in on days off. Over the course of this ski season, Chris has had more opportunities to ski than I have--and he has gone from being nervous on the bunny hill to cruising down black diamond runs. I'm very proud of his progress and excited that he's providing me with a new ski buddy!

{View from the top! Lincoln Peak;
A spring skiing day in early April}

Over the past month, whenever I haven't been out skiing (i.e. most of the time), I have been catching babies on labor & delivery. I have been fascinated by the degree to which expectant parents try to plan their respective birth experiences. They arrive to the labor & delivery unit bearing detailed outlines of how they want the process to unfold. The bullet points vary widely: We would like to listen to music, I want to experience an orgasmic birth, we would like to bring the placenta home, I want a water birth, no medical students in the delivery room. Most of the requests are fairly reasonable, though some are a bit bossy: Dad SHALL NOT be asked if he would like to cut the umbilical cord. 

I am wholly in favor of education about and preparation for the delivery process. In fact, it would be even better if people were more educated and prepared for the entire pregnancy before it begins: planning the timing of the pregnancy, optimizing the mother's health, understanding the stages of development of the fetus...the more {health-focused} education and preparation, the better! Knowing what to expect is empowering. It reduces fear and stress, which is ultimately healthier for everyone involved. And I'm in favor of limiting interventions as much as possible--why interfere with the process if it's going well? (I'm fortunate to be training in a very non-interventionist hospital; I've definitely been in hospitals that are far on the opposite end of the spectrum.)

However, I do wonder whether some of the preoccupation with having a magical birth experience is misdirected--if a baby is born by c-section because of a placental abruption or induced because of premature rupture of membranes, should the parents be upset because their experience was ruined? Is their baby's life off to a "bad" start? After all, if mom and baby are healthy in the end, how important is it that there was a medical student helping hold one of mom's legs or if the doctor (heaven forbid) offered dad the scissors to cut the cord when he hadn't wanted to do it? 

Another factor that I find troubling is how people in general spend relatively little time planning for the opposite end of life's spectrum--that is, planning how we would like to die. Too many times, I have seen lives prolonged (or, often more aptly, hearts continue beat) as a result of painful, unnecessary, or futile interventions simply because of a lack of thoughtful discussion ahead of time. 

Perhaps it's because "birth plan" has a much more pleasant ring than does "death plan"? Maybe the advance directive websites are less appealing than is thebump.com? Or perhaps we find the prospect of a loved one's death is so terrifying that we are willing to subject their failing bodies to veritable torture for even a glimmer of hope that they will pull through and go on living as though they hadn't had a stranger cracking their ribs and shoving tubes into every bodily orifice. While some people may wish to have the doctors "do everything" to save their lives, when I ask patients about their code status (as is required with every hospital admission), almost invariably they will say, "I don't want to be kept alive with machines."

Like birth, death is something that happens to all of us. Of course, with both birth and death, we may simply have no choice about how events transpire. But it's possible that we (or our family members by proxy) may have some say in the medical care we receive at the end of life--shouldn't we try to plan for that too?