For a quick peek without the commentary, scroll down to the Table below.
As it seems half of my clients over the next 6 mos are hopeful VBAC mamas, I am constantly reminded that we have to keep these intervention conversations going not just for them but for our first time moms! Let's please get the word out however we can - PREVENT the PRIMARY CESAREAN! You can do this by informing yourself and other pregnant women of these common maternity practices in the US and how they can change a labor, birth, baby, and woman. The biggie - unnecessary inductions. A woman is not OVERdue just because she has passed her due date. Post term pregnancy begins after the 42nd week, and induction is NOT supported before that date, especially for first time moms, because of the risk of cesarean. Spontaneous labor is your friend! A friend worth the wait!
Below is a table created by Rebecca Dekker from Evidence Based Birth. Citations are available by visiting her post which she also shared on Improving Birth.Org :
Encourage anyone hoping to avoid a cesarean birth to choose their birth location and provider CAREFULLY
and hire a doula! It's great to take an out of hospital childbirth prep class, too, but going into the hospital with professional labor support is invaluable in helping women avoid routine interventions that lead to cesarean birth without improving mom and baby safety, according to evidence. So many women don't know! Believe me, I hear the stories from moms during their second pregnancies all the time at consultations. There are way too many women who just don't ever come across this info and don't know what to expect at the hospital during labor and how it can affect their birth, baby, and future! They trust their doctors and that the hospitals wouldn't do anything unnecessary or that could possibly be risky. And while those of us immersed in helping to change things don't believe that many care providers are ill-intentioned, we do know this - standard and routine practices being used in hospital labor and delivery care are not supported by evidence, not even recommended by ACOG! And yet they are still used on women everyday and leading to UNNECESSARY CESAREANS. Take a look at the chart - for you, your sisters, your friends, your daughters. And while you may be uncomfortable offering unsolicited advice, how would you feel wondering if you had gently passed on this information and it having prevented a woman and baby you love from unnecessary harm.
I know we all find ourselves asking...but why? Why do hospitals practice this way? Why would our OB's do these things if not based in evidence? If not backed by their own professional organization? I think the simple answer is that this is just how they are trained. "Managing" every step of the labor process is how they've experienced birth in the hospital setting. Ultimately, it's easier to manage a bunch of women's labors using these routine practices coupled with it being more in their comfort zone. Taking spontaneous labor off the table in the majority of their patients really puts a lot more control in their hands, too, which I believe is a good match for most of their personalities ;) ...and schedules, dare I say. That is, of course, all my opinion. Not based on evidence. ;)
And for local information and support for managing interventions in a "trial of labor after a cesarean" (TOLAC) as a hopeful VBAC mom, please attend the ICAN meeting this Saturday at 10 am at Ohm Chiropractic in Media. It will be a roundtable discussion featuring tips from local doulas, ICAN leaders, and experienced moms! https://www.facebook.com/events/598029813590109/
My husband and I had a baby girl on Sunday, May 26! Overall, it was an amazing experience, and I could not have asked for a better birthing.
I was in the shower at 5 pm on May 25 when my water began leaking. I was 38.5 weeks and feeling huge, but my expectation all pregnancy was that our baby would arrive late. I was kind of shocked when it kept leaking and I started to have irregular contractions. My sister Ellen--my birth partner, in addition to my husband—and her fiancé were already at my house, so we just kind of waited it out knowing we were going to go out to dinner once Garrett got home from work. I threw some things in a bag in case this WAS it and started bouncing on my birthing ball.
I called my doctor at 8:30 as I was leaking more and more. My contractions were all over the place--anywhere from 5-10 mins apart. But they were not painful at all-in fact sometimes I did not even notice them beginning and ending. My OB was on call and asked that I come in immediately so they could confirm whether my membranes had ruptured. I was pretty worried to be going in so early with what felt like such minor contractions, as I anticipated that I would end up on Pitocin immediately. I was admitted to Delaware County Memorial Hospital at around 9:15 and had my first cervical check at 10 pm. My OB confirmed my membranes had ruptured. I was 3 centimeters dilated and 100% effaced (I was 90% effaced at my only cervical check before that at 36 weeks).
My OB said with such erratic contractions she would normally start pitocin, but she knew I really wanted to labor naturally, and agreed to return to check on me in a few hours to see if labor would progress on its own. I moved around a little through the first stage, but my first nurse—who I didn’t really like(!)--really wanted me to stay on the monitor as much as possible, so I spent more time in bed and pacing right next to it, than I would have liked. I also tried resting while my contractions were not painful because I missed dinner and knew I would be up all night. I did eat a couple protein bars and some snacks while I was there, but not much because I knew I was breaking the hospital rule!
I did begin to progress on my own and by around 1 a.m. my contractions were getting more difficult. I used breathing techniques from Lori’s class as well as Hypnobabies tracks. As the contractions got harder, I bounced on a birthing ball for a bit and Garrett or Ellen applied counter pressure on my sacrum. I also drank a LOT of water. My 2 am cervical check revealed I was 4 centimeters dilated.
When the nurse came in to check on me at 4 am, I asked to use the birthing tub. She said no and that because my membranes had ruptured, she didn't "think" it was safe. I was pretty ticked and let her know that! She vowed to "check the policies" but basically did not return until 6 am right before her shift change. I was also checked before shift changes and I was only 5 cm dilated. I honestly thought that was a joke—how had I only progressed 2 centimeters after 8 hours—and a sleepless night of hard work!? :( My contractions were so strong, I felt as though I had to be further along. My OB did inform me I could use the birthing tub though and that my next nurse was going to get it ready for me--that was good because I was feeling a lot of pressure on my back at that point. She also introduced me to the doctor who was taking over her shift.
My new nurse was great and encouraged me to stick to my plan and labor out of bed as much as I wanted to. It was such a relief! I got into the tub around 7am and did not get out until 9. It was great as it relieved the pressure on my back and I think it really helped the baby move down. The only problem is, I continued to drink tons of water and eat lots of ice chips while in the tub...so when I got out, I had to pee a lot! And I couldn't empty my bladder all the way because of the baby's position.
The doctors had wanted me to progress to 7 centimeters dilated after the tub, but I was only at 6. My new doctor recommended Pitocin. We asked for more time to think about it. That's when two unexpected emergency c-sections pulled the doctor away for more than 2 hours. It was really a blessing for me because I was able to labor on my own without a doctor hovering or suggesting I wasn't progressing quickly enough. I stayed out of bed and remained active, laboring in different positions, often using the birthing ball. By 11:30 when she returned, I was 7 centimeters dilated (they wanted me to progress a centimeter an hour at this point). I felt like I needed to pee so badly but I could not.
From around 11 until I started pushing, I was in the most intense pain. My Hyphobabies tracks were no longer helpful. Ellen and Garrett were very supportive, but I could tell they were worried about my pain (and I later found out they were worried about the growing crowd of family and friends in the waiting room). I started talking about getting an epidural and we started weighing the options and asked the nurse about it. I felt like I could handle all the pain, I just couldn't handle the extreme pressure on my bladder and not being able to relieve it by peeing! The thought of "erasing" that with an epidural actually sounded great. I eventually decided against the epidural with my husband's support. I had made it that far and would hopefully be ready to push soon...and I wanted to be able to feel pushing, and get up and walk soon after delivery. And I had prepared for a natural birth for so many months!
I don't remember vividly the time between 11 am and 1:30 pm, except the excruciating pain from having to pee! I got on the toilet so many times but with no luck! At 1:15, I was measured at 9 cm. They suggested a drain catheter to remove some of the urine from my bladder and hopefully get me to 10 cm. Both benefits sounded great to me, so I agreed. It didn't do much to relieve the pressure on my urethra, but it did get me to a 10.
I didn't have an incredible urge to push, but the baby was low enough that I wanted to start pushing. We started around 1:45 pm. I tried several positions for the first few pushes. I ended up laying on my back (which I truly did not expect to like) because that's where the pressure on my bladder was minimal and where I was pushing most effectively (go figure!). I did tilt the bed up slightly so I wasn't completely flat. I was told I was an excellent, controlled pusher, but I attribute some of that to the fact that they normally deal with women who have epidurals and can't feel themselves pushing! The other part I attribute to going in knowing what to expect from Lori’s class!).
The doctor came in at 2:15 -- she offered me an episiotomy, but I declined. I continued pushing while Garrett held my leg and Ellen gave me words of encouragement. I gave birth to our baby girl at 2:55. I had a 2nd degree tear and baby girl came out with her hand up by her face.
She weighed 7lbs 8.5 oz and was 19.5 inches. We wanted to delay cord clamping but compromised with the doctor for about a minute and thirty seconds. (We knew in advance this was something we did not agree on, but they would not allow skin to skin until cord was cut.). She was healthy with 8/9 Apgar scores. We did get skin-to-skin and she latched on right away. She had jaundice in the hospital, but it was on the cusp, so she never needed the light or formula.
Overall, I feel so empowered that I was able to realize my dream for a natural birth. It was so amazing to be able to let my body work just the way it is supposed to without all the interventions that have become the norm in hospital births! Since our baby girl came home, she has been a happy, healthy and thriving baby!
http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf"The percent of US infants who begin breastfeeding is high at 77%. While there is concern that infants are not breastfed for as long as recommended, the National Immunization Survey data show continued progress has been made over the last ten years. Of infants born in 2010, 49% were breastfeeding at 6 months, up from 35% in 2000. The breastfeeding rate at 12 months increased from 16% to 27% during that same time period."Why, you wonder? Well, it is attributed to an increase of Skin-to-Skin contact between mother and baby immediately following birth AND the practice of Rooming- In (23 of 24 hrs spent with mom instead of baby away from her in nursery). These practices are being implemented more and more at area hospitals here in and around Philadelphia, PA and we are seeing great results for moms and babies success with breastfeeding. While we hope to lower the rate of cesarean sections happening, we can also hope to increase these numbers even more. The report demonstrates that as the percentages of hospitals and birthing centers where >90% mothers and babies get skin to skin and rooming in INCREASES, so does the immediate and long term success of breastfeeding. This supports the Healthy People objectives for 2020 while making mothers and babies happier! Let's keep it up, America! Let's keep it up PA! Let's keep it up Philly! Support support support! Hospital procedures effect breastfeeding success so greatly, more than mothers realize, so we need procedures to support moms and babies getting the best start to breastfeeding. Come on nurses, docs, midwives, doulas, lactation consultants, and let's not forget our peer counselors - This week is also World Breastfeeding Week and the theme is focusing on the importance of support from moms in the community, ie peer counselors! ;) And last but definitely not least, let's keep it up, mommies! You can do it!
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!
Yesterday I heard the same exact words that I myself said minutes after I birthed my son in a birthing pool in my bedroom 4 yrs ago...she, standing up to push her baby out, supported by her husband...with a little disbelief in her face..."I DID IT." Yes, mama. Yes you did. :) 3 small but very powerful words that can mean so much to a woman.
She closes her eyes for a long second then opens them - staring off somewhere, she takes a deep breath, licks her lips, untenses her muscles, feels her feet on the ground, and finally hears her midwife asking her to reach down and pull up this new wet baby into her arms. She looks at her baby for just a second. Then she looks around the room at each person's face who witnessed her birth this baby as if to confirm that it really did and really is happening. Her wondering eyes are met with gentle smiles. Her most surreal moment. She is somewhere else and time is suspended. It's like she is almost between this world and another just for few moments. There may not be another time in life that a woman is here in this place. She is slowly brought back to this world, trying to wrap her head around what just took place in and through her physical body and what she overcome mentally to bring her baby earthside. She says it again a few more times over the next 30 minutes or so, believing it a little more each time.
Every time I get to watch another woman experience this, every time I get to be there smiling at her, standing in awe at her amazing power that she wasn't quite sure she had until this very moment, proud of her, happy for her, watching her realize how awesome she is and that she can do ANYTHING after having done THAT, giving her HER moment...well, there is just nothing like it.
How wonderful is this? Right after her cesarean birth, my dear client gets to hold her new precious little boy on her chest, skin to skin. She didn't have to beg, either. Within a couple of minutes of his birth and only after a quick observation and wipe down at the warmer a few feet away, he is back with his mommy. A short time after, they are both in recovery and baby is breastfeeding. This is becoming new standard practice at Pennsylvania Hospital as they are beginning to really take bolder steps toward the "Baby-Friendly" designation.
This is a must read for everyone - but I'm especially thinking those who are just starting out raising little ones. In utero! Newborns! Infants! Yes! This is when their eating habits and tastes are being formed! You can start preventing heart disease and diabetes in your child that early....and the habits could change you and your entire family's lives too. You've gotta read this post. Be inspired today :) What life saving meal have you cooked for your family lately? Please share!http://avivaromm.com/why-cooking-can-save-your-life
How's this for informed consent? First time mom says to her favorite doctor at 38 wk check up,
"I'm getting pretty uncomfortable but I really don't want to be induced because I heard it makes things harder" OB response, "1)The nice thing about inductions is you can not only plan your baby's birth into your schedule without the risk of surprise or something going wrong before you make it to the hospital in labor but you also get to assure I'll be the doctor delivering you. (He also reminds her that she won't have to push out as big of a baby either) and 2) We are only giving you the hormone your body makes itself, so it's not going to be any 'harder'. Labor is hard. We have epidurals for that." Mom is surprised how much the answer eases her mind despite everything she's been reading - and feeling much more in control now, says, "As long as it doesn't increase my risk for having a csection, because I definitely don't want that... when is the soonest we can do it?" Doc responds, "The ones coming in with Birth Plans increase their chance of cesarean. (chuckles) You'll be fine. Let's do next Wednesday, you'll be 39 wks and a few days - policy changes - I have to wait until at least 38 wks now no matter how uncomfortable you are."
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:
The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 107 addresses counseling for induction of labor and specifically addresses elective induction in nulliparous women with unfavorable cervices as to the 2-fold increase in risk of cesarean delivery, length of labor, and the need for a readily available physician capable of performing a cesarean delivery. ACOG also offers a Patient Safety Checklist for induction of labor that includes documentation that risks and benefits were discussed with the patient.
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! :) :) :)
You've just got to visit Dr. Aviva Romm's site, subscribe to her newsletter, and read everything she's just blogged about in the first few weeks of her new blogging endeavor. She is amazing. This mother of 4, midwife, herbalist, and M.D. (yes, ALSO a 'real' doc) comes always with powerful information, creative solutions, and unbelievable insight. I have two of her books (one for pregnancy and another for babies and children) But for now, check out this particularly wonderful superfood packed list.
One for all the ladies, including our pregnant mommies. I love love love this list! Hey, I almost always 5 out of the 10 in my smoothie everyday ;) This list gave my busy self the encouragement I needed this week. Dr. Sears last month, Dr. Aviva this month! And...what other superfoods do you like to add to your diet? For me, chia and brussel sprouts - how about you???