Our son joyously arrived at 10:08pm on Monday, April 29th.  He came on his due date, which happily is the first of my expectations he decided not to fulfill.  I had told people for months that we would have a May baby, but he had other ideas.  My husband and I were lounging on the couch in the afternoon of the 28th when I felt a sudden desire to rush to the bathroom.  I knew immediately that my water had broken and remembered to note the color, smell, etc. like Lori had told us.  Water continued to seep from me for the next eight hours or so, in varying amounts.  The amount of water surprised me!  Good thing I had a bag of sanitary napkins on hand.  

Dan (the husband, not the baby!) and I frantically packed our bags and called The Birth Center in Wilmington, which is where we were planning on giving birth.  Because I am Group B Strep positive, the midwife (Durenda) requested we come in and start an antibiotic.  I felt high and expectant on the ride to Delaware.  I had not had any contractions yet.   When we arrived  Durenda confirmed that I had experienced premature rupture of membranes (PROM).  I was about 2cm dilated and 60% or so effaced. She suggested that we take a walk and get something to eat at a local restaurant, which we did feeling anxious and gleeful.  After dinner, we considered getting a hotel, which would have meant that we would have to come back to TBC every four hours during the night so the antibiotic could be readministered.  Durenda suggested we sleep there, saving us the hassle.  Very nice!  

During dinner and the walk, I had several slight contractions that felt more like the Braxton-Hicks  variety with little pain.  Things were going slowly so we were reminded that if active labor had not begun within 24 hours of PROM we would be transferred to Christiana Hospital. After we returned to TBC, Durenda suggested taking some homeopathic tablets to help speed the process of labor.  She also presented castor oil as an alternative.  After consulting with Lori, I decided to try to castor oil immediately and try the homeopathy in the morning if it was needed. In hindsight, I should have done everything suggested immediately, but at the time I wanted to sleep a little and thought contractions would begin very soon.  I slept on my left side that night with my belly hanging over the edge of the bed to try to help Baby Danny position himself in the ideal position, with the knowledge that he had been on my right side for the majority of my pregnancy.  The castor oil did not kick in until early the next morning, and I had mild contractions through the night and was able to sleep pretty well.  

The next morning, midwife Sarah gave me the homeopathic herbs and Lori arrived with breakfast foods from Wawa. I was still only about 3 cm dilated and a little more effaced, but satisfactory progress wasn't being made.  I started to feel slightly desperate with the thought that we would be transferred, so after some more castor oil I tried nipple stimulation in the shower, which brought some better contractions.  After about thirty minutes in the shower, we tried taking a walk and doing some pelvis-opening stretches, but another exam revealed that I still wasn't 4cm dilated, which had been our indication that active labor had begun.  Sarah told me that we would need to be transferred, which was heartbreaking to me because I saw a C-section at the end of the ordeal.  I had a good cry, then we packed up and went to the hospital.   

As soon as we arrived, my contractions became more painful.  I was incredibly frustrated with the paperwork in triage, including seemingly irrelevant questions like the name of the county in which I was born.  Apparently, my husband, who took over after I showed clear frustration with the questioning, was also asked three times, "Are you sure she has no Spanish heritage?"  Not sure why this was of interest to them.  Finally, Sarah spoke up and asked if I could go to our room and we were told we could. We arrived in the room about 2:00pm.  As soon as we arrived an IV was started and I was given Pitocin to induce more contractions. The nurses were kind to all of us; I didn't feel any animosity about our wanting to do things as naturally as possible.  The nurses even seemed to respect Sarah and Lori's perspective and knowledge. I think they would agree.   

I found not being able to walk, squat, or move in general very difficult.  I turned to my left and waited between contractions. I experienced very little sensation in the front of my body, but the pain in my back was sharp.  Luckily, Dan never left my side and massaged both sides of my spine during each contraction.  Lori or Sarah stayed in front of my face, while the other stroked my leg or applied pressure on pressure points to help the contractions speed along.  

A habit I developed that Lori later said was unique: during contractions I sang or repeated phrases.  In the beginning, I said things like: "OPEN" in a firm, calm voice; "somos juntos" ("we are together"), a phrase that resonates with me after a trip to Mexico a couple of years ago; "ganbare!" ("go for it!" in Japanese); "there is no bliss like this" (a favorite affirmation from yoga practice); and simply "YES!"  I also told myself to be calm and that what I was feeling was a pain that creates, not that destroys.  As the contractions increased in duration and frequency, I sang long high notes or scales and didn't repeat phrases.   Lori told me I also sang "Somewhere Over the Rainbow." I could not have made it through without this comfort measure, which made me feel powerful and as though I was still in control of something.  At one point, the nurses explained that they were concerned about the baby's heart beat, so they wanted to use an internal monitor.  This device sticks into the baby's head using a piece of wire that looks like a screw.  Lori and Sarah said it was a good idea, and with the idea that a healthy baby was the goal I agreed.  

Around 9:00pm someone asked if I was feeling pressure in my bowel, which I said was true. The pressure increased with each contraction, and Lori was coaching me not to push but to use puff breaths during each contraction to avoid the urge.  During the puff breaths, I began to push uncontrollably.  The pushing felt like a sort of muscle reaction that I could not control, similar to what I imagine a seizure might feel like.  Someone (a doctor?  I never saw her again) said that I was fully effaced and dilated, so everyone agreed with smiles that I could start pushing.  A bar was used across the bed for me to put my feet on and the OBGYN on call arrived.  He said the pushing was going very quickly.  I commented to Lori and Sarah that this part was very satisfying and almost pleasurable because it was empowering to feel I was getting things accomplished.  Several other nurses joined us and everyone was shouting "Go, Sara! Push!" which really helped me stay motivated.  The hospital nurses commented that it was unusual for me to be smiling and seemingly enjoying myself. I think around this time I said to Lori, "I am a warrior" and she heartily agreed with an encouraging smile.  

I expected to be shocked by my baby, so had done a lot of visualizing during pregnancy of the moment when he emerged.  There was no shock involved, he felt like mine and someone I already knew. I don't think the visualizations had anything to do with this feeling; I just think it was the first hormonal reaction of motherhood to know that this creature is mine and no one else's, not even my husband's in the same way as he is mine.  

The placenta came away quickly, though I think the doctor had something to do with that as his arm was somewhere inside me just before it emerged.  The stitching process was not pleasant; I had a third degree tear because our baby was on the larger side (9lbs, 14 ounces) and came out with his arm wrapped around his head. I am disappointed with doctor's performance; he was by far the least caring member of the team and did nothing to keep me informed of what he was doing.  He almost seemed annoyed by my questions.  Our baby spent the next 3 and a half days in the NICU, which is another long story!  If anyone is interested I'd be happy to share.  The end result of all of this is currently asleep on my lap.    :)

Last thing for all you first timers who might come across this: a short list of recommendations.
1.  Hire a doula.  I VERY HIGHLY recommend Lori.  If possible, also have another support person plus your partner for a total of three.  I know that these people's presence there meant that the interventions were kept to an absolute minimum.
2.  Pack a bag in advance and pack as though you'll be gone for several days.  Better to have to much than too little.
3.  Get in shape NOW.  Even if you're already pregnant, find something to do that will keep you fit.
4. I hate to say this, but expect to be disappointed in the doctors you meet.  Find others to trust.   

THE END! Ah, but also a huge beginning for our family!  

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! :) :) :)

Some women find that they get to a certain point in pregnancy and realize they are not totally comfortable with either their care providers or their place of birth, yet do not know what to do about it.  Some women see red flags during an office visit or while asking questions during a hospital tour and they decide to make a change that they become forever happy about.  Some women just completely follow their intuition and go along their journey how they are comfortable.  If you trust where you are and who you are with, that's great! But it's important to Choose Carefully, and here are some stories of women who did.
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Changing Care Providers

1) Mayumi's story 

2) Rupal's story  

3) Angie's story

4) Jess' story 

A collection of birth stories are posted below. Variety is included - medicated and unmedicated births, unplanned cesareans, VBAC's, homebirths, hospital births, birth center births, waterbirths, large babies, midwives, OB's, with and without doulas and more!  From a first birth to a fourth, these are real stories of women's birth experiences, told by the women themselves. Thanks to all who have shared already!  Others learn so much from hearing all the variations of labor and birth.  It is encouraging to read and hear other women's stories of birth - it builds a sense of community that we are sometimes missing in our 'real' lives since most of what we hear and see of birth from other women nowadays is on t.v. or negative, scary, dramatic events people like to share sometimes.  If you'd like to share your birth story on my site, please email me and I'll add it.

***For a collection of stories specifically about changing care providers, read here.***

   
Birth Stories

1) Rory's unmedicated hospital birth (3rd baby)

2) Isaiah's unmedicated hospital birth (1st baby - BIG baby)

3) Jonah's homebirth (4th baby, 2nd homebirth, born in the caul!)

4) Lakshman's birth (first baby, birth center) - Momma Rupal's blog "From Doctor to Mother

5) Nonah's homebirth (first baby, 10 lb baby!)

6) Luke's birth (first baby, hospital, cesarean)

7) Julia's hospital VBAC (Luke's sister!)

8) Gabe's birth (third baby, RCS)

9) Leo's birth (unmedicated hospital birth, 3rd baby, after a traumatic 1st birth and 2nd baby loss)

10) Lilliana's birth (postdates hospital induction after birth center transfer)