Today I want to say that ICAN is about supporting the first time mom, too, not just those hoping for a VBAC. It is a great resource for preventing that primary cesarean birth. As is the VBAC facts site and Jen Kamels who runs it and teaches a workshop around the country and online.

http://www.ican-online.org
www.vbacfacts.com

Our local ICAN of SEPA:
http://icanofsepa.wordpress.com
https://www.facebook.com/groups/411506922273373/

I'm also linking a story here that offers a great explanation as to why we fight so hard to help mothers avoid their primary (and too often unnecessary) cesareans and to birth vaginally. It details the risks and dangers to mothers of multiple cesareans. This mother is not alone, more and more of these examples are making news because they are becoming more prevalent problems in pregnancies and in the OR. Just to be aware, though, I had tears in my eyes the whole time while reading. She does a great job writing so that the reader can almost feel her fears through what was a very scary experience. To clarify, MOST 1st and even 2nd repeat cesareans will be manageable by most hospitals and with what blood they have on hand for possibility of transfusing...I do not want to scare moms facing a repeat cesarean where they NEED to trust and depend on a doctor to keep them safe, but this story also shows how a mother did her homework to do just that - be in the best place with the best team to make sure she'd be going back home to her kiddos. This was simply the situation she ended up in during her 7th pregnancy. Her placenta became deeply implanted into her uterus and cervix after multiple previous surgeries to her uterus. 

As a doula, I never want my clients to have any good answer to the question, 'what else could I have done to prevent my first cesarean?' This is especially important when moms desire a larger family. I have had friends and family members tell me that their doctors never once mentioned to them before, during, or after their first cesarean that they'd need to consider limiting family size due to having that surgical birth and the increased dangers of multiple pregnancies and cesarean births following. And not just that, but that they'd not been offered a chance to VBAC and instead told that it is dangerous to try, safer to schedule ANOTHER cesarean, and just accept having 2 children or at most 3 if she really really wants to risk it, but no more! Women are being told this AFTER their second cesareans when their options are nearly nil at that point! It's infuriating. And sad. More women need doula support through their first pregnancies and births, good information, supportive care providers, and to visit their local ICAN group before having their first babies if we want to stop this trend from continuing. Women need the truth! They need their options! They want to make informed choices! 

I recently met a nurse who told me there is a doctor on her floor who frequently says all babies should be born by cesarean and has no problem recommending tube tying after the second to all mothers. I seriously hope he is in the extreme minority. But I have a feeling that while we do have docs who truly believe in the safety of and support less medicalized vaginal birth, the number of docs seeing their norm everyday be cesarean deliveries is increasing by the day. This will just continue to have an effect on moms and babies (physically, mentally, emotionally!!!) if we don't advocate for ourselves and surround ourselves with professional support and evidence based information. 

And while I'm thinking of it. Hug another woman today. Love her with that hug, if even for just a few seconds. We don't always know each other's journey. 

How's this for informed consent? First time mom says to her favorite doctor at 38 wk check up,

SO. MANY. PROBLEMS. WITH. THIS. Where to even begin? Now, I feel pretty comfortable in my knowledge base of the evidence as well as ACOG guidelines, etc., so there are a few things glaring at me that I want to JUMP on... big time. But I fear if I start to address each untruth and danger within this OB's responses, I will write a book tonight, not a blog post! And frankly, I don't have the time! Ok, Breathe. In....all things good and right in the world, Out....all things &U#&$$*ed up....ok, again....nice and deep and slow. Repeat.

Ok. If this was your sister, friend, or anyone you cared about - what would you say to keep it short and simple!?!? For you doulas and childbirth educator's out there - what information would you be sure to relay to this client/student?

I tend to think that if I was involved with this woman either professionally or personally I might start with this:

I realize we can't save every woman and baby from similar doctors who are, believe me, absolutely still out there practicing in a hospital near you - but, if you heard a similar conversation being relayed to you, WHAT DO YOU SAY? And why do you speak up or not? I'm curious of the different perspectives on this topic.

Ah, the BIRTH PLAN. Dreaded by some, held on dearly to by others. I have to admit, my thoughts on these have evolved quite a bit since I wrote my own birth plan over 6 years ago and even as a newer doula just 3 yrs ago. After attending so many women in labor in different hospital settings in various labor situations, I have developed some, more experienced, ah hem, opinions. Overall, I think the more care providers and hospital staff see them, the less dismissive,  condescending, 'superstitious' they’ll be about them. But, TRUTH - Women are mostly overdoing it when they write these up. And it's not their fault - they don't know better! Maybe it's because of the millions of options presented when they look at the birth planning worksheets all over the internet, I don't know. Moms should also know: all of the major things you 'want' should be verbally communicated with your nurse upon arrival at the hospital no matter what - whether it be for a planned cesarean or unmedicated birth. Talking and connecting with your nurse goes a long way. Humanize yourself. They might need the reminder. They are human, too.

But anyway - I think it's helpful, NO, scratch that - necessary to work on a BIRTH PLAN and  then 'turn it in' like homework that you probably weren’t assigned. Ask to discuss it with your care provider at that time, and also necessary to bring with you to hospital when in labor because... well, things like that don’t tend to transfer ;). Ok. Now while all that is necessary, the purpose of these is not so much to guarantee you'll get everything on your plan but that you learn and grow more aware and confident through the process of writing and discussing it with both your partner and care provider.  Through writing it, you realize all the things that can commonly come up while birthing at a hospital and you find yourself having a mindful discussion with your partner about each of them. You might look into the risks and benefits of things you never heard or thought of or ask your doula or childbirth educator to explain why they might be harmful when used routinely but also when they might be helpful tools. You may discover why you want what you do or why you don't, what to include in your ‘plan’, what not to, how to simplify it, figure out what feels most important, etc. And by the time you've written one up, you REALLY know what you want and SO DOES YOUR PARTNER. That is the goal. Then you put those details aside, take a breath, smile, and refocus again on the simplicity of this event! Birth is normal. I can do this. Women do this and have done this for forever. I know I trust in my body and baby and that I can decline anything I don't feel I need or want. Always remembering that with so many things in life, it's not about the result or outcome but the journey - it applies with birth planning, too. So, while you want them to receive it well and respect every single part of it, the process of planning and writing it is really the key. Some people feel a little discouraged by that, understandably, because it is a reminder of how much is out of your control. For one, we cannot control nature.  Two, even the toughest, smartest, most determined and informed women will lose some control just by stepping into a hospital system.  A recent client said to me after writing her ‘birth plan’, “I realized how much I just have to hope things go smoothly with my labor so that I don’t need all of the things I just planned not to have.”  UPDATE: Her labor and birth couldn't have went any more smoothly and I think she 'got' everything she hoped for, according to her plan and more. The nurse asked if she had a birth plan as we were settling into her room and when the dad handed it to her she looked it over and said, "This is a great birth plan! I think the best one I've ever seen. Nothing that doesn't need to be on there. I love it, thank you!" And then the midwife said, "I didn't even read it yet but I know I must be following it, haha" There was nothing for her to do! Except offer a birthing stool, smile, and wait ;)

Secondly, about that conversation piece at the end of pregnancy.  It’s best to have it between 37-38 wks because you should have your Group B Strep results by then and that does come into play. A positive result may change when you’ll leave for the hospital in labor, how things may change if your water breaks before labor (PROM - premature rupture of membranes), or what to expect if your baby shows possible signs of infection during labor or after birth or you do not receive the recommended doses of antibiotics within enough time prior to birth, etc. So, after you find out whether you are + or -, have this discussion. You'll get your care provider’s  feedback on any questions you have or what is not to worry about at your specific birth location, what might be an issue there, and if you'd like to compromise or fight for certain things and how to best do that. They SHOULD give you some guidance at that appt where you present it to them.  Remember it’s not so much that you get xyz if this particular care provider says so, it’s more about navigating the system one step at a time based on your individual situation, working with the nurse on staff, and within or against certain hospital protocols. Having a doula to help do all of this really helps. And you may find that after taking a tour of the hospital and talking with the nurse there as well as your care provider during your appt, that most of your wishes are actually the norm for your birth location (such as intermittent monitoring, encouraged to eat and drink freely, being able to use the bathroom freely without placing a catheter - unless you have an epidural, accessing shower, etc). But in some cases, you may find that you would be lucky to get any of your wishes (such as a case of a nurse on a tour at a hospital with a 49% c-section rate scoffing at my client's idea of laboring out of bed and pushing on her hands and knees and said, 'no, we prefer to keep you safe here instead. Our patients stay monitored in bed the whole time and push on their backs with their feet in stirrups, it's non negotiable') If you find yourself getting similar feedback from nurses there or your docs, read an older post Choose Carefully or stories of those who've jumped ship and Changed Care Providers even in later pregnancy. It's never too late until the baby is out! But, ultimately I do think low intervention birth is possible in many hospitals. Again, hiring a doula REALLY HELPS. And if she tells you it might be hard to get what you're hoping for at your planned birth location, consider what she is telling you. Doulas are amazing resources and supports in ways you cannot understand until you experience it. Ask anyone who’s had one!

Ok, so...are you ready to start writing your Birth Plan? My advice is to definitely call it something other than a Birth Plan. Wishes, hopes, preferences. Then, as far as format – pick any of the 3 options:

1) Make three large index cards for each 1. Labor and Delivery, 2. Cesarean Section, and 3. After Birth/Baby Care and simply handwrite about 5 most important specific things you want. I suggest trying to keep language positive when possible - so instead of saying "NO IV", you might say "Hep- Loc" preferred. Sometimes it doesn't always make sense as in really not wanting residents - you kind of have to say "NO residents". But do your best to stay positive and SHORT phrases. No explanations, no philosophy sharing - they don't care. You risk looking like a know it all, inflexible, and idealistic and yes, they are very superstitious. I have enough L & D nurse friends to know what they think - "You silly little woman, you'll be sectioned b/c of this PLAN!" And may treat you accordingly. Not always, of course. But it happens. No one wants their nurse to be in the hallway rolling her eyes and shaking her head while reading the hopes for their child’s birth.

2) A one page write up with a one or two brief sentence statement at the top about how flexible you will be if needed for safety of you or baby and then 3 or 4 categories, all with no more than 5 one line bullet statements. Such as "Want to try pushing on hands and knees" or "intermittent monitoring" or "NO erythromycin" or “Remind me to wear glasses before delivery”

3) Take a piece of blank paper and fold in half and fold again. You now have 4 categories for your birth wishes! Again, keep it 2-5 statements per box and SHORT and sweet. J  - Thank you to Kelly Durbin for sharing this one with me, I love it!

There is so much more I could say and I'm definitely not the only doula/educator with opinions on birth planning, check this out:
    - If you are overwhelmed by creating a birth 'plan',  maybe this plan will make you smile and relax a little so you can focus on the normalcy of this event and remember that with some conviction, you can make the staff adapt to you, not the other way around. Enjoy the simplicity. :)

    **And a few days after I published my blog post on birth plans - Giving Birth With Confidence published theirs - coincidence? HA! No, I love this blog - it's one  of two blogs through Lamaze. (This one is more for parents use, and the other is Science and Sensibility, more for childbirth educators and doulas.)  In addition to touching on many of the same themes I did here, the author presents her informative post in a more organized fashion less narrative than mine and gives a good list of questions to consider when writing down your preferences.

Happy New Year and Happy Birth Planning! :) :) :)