A Simple Birth Plan

I'll just admit it.  I am a doula and I had no birth plan for either of my births.  I was giving birth at home and I just assumed that "Home Birth" inherently covered all the things I wanted in a birth.  I toyed around with a document with birth preferences, but it was just for the people I imagined would be there ("I have no idea what I'll want or who I'll want around me.  If I ask you to go see a movie please, it isn't that I don't love you!"), and to please not tell me what time it was or how long I had been at it.  I assumed that if I needed to go to the hospital, it would only be because I needed this intervention or that one.  It may have been naive, but it all worked out fine.

But I am in the minority.  The vast majority of women birth in the hospital and if these women want a natural birth, a birth plan is not just a good idea, but essential to making sure they are on the same page as their caregivers.

So what does the doula who has never written a birth plan have to say about writing birth plans?  My recommendations to my clients for birth plans are based on the words of the L&D nurse who attended my doula training workshop.  She said (and I quote): "Oh, I usually read them.  I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page.  If there's any more than that, I just don't generally have time for it."  She also said (and I paraphrase) that she hates the birth plans that have all the little checks of I don't want this or I don't want that, and there is one important point no one ever puts in that she would tell all her doula clients to add.  More on that later.

Keep in mind, this is from a nurse who was at a doula training workshop so she could be as supportive of natural birth as she could.

So let's deconstruct her statement.

"I usually read them."  

Note the word usually.  That means, of course, that sometimes she doesn't.  Is it because she doesn't care? She doesn't want to make sure you get the birth you want?  Of course not - remember, she was at the doula training to learn how to be more supportive of the natural birth process.  Moving on:

"I definitely read the first page, then depending on what's happening on the floor, I'll scan the second page. If there's any more than that, I just don't generally have time for it."

So this shouldn't come as a shock, but hospitals are often sadly understaffed.  And in the DC area, we have a lot of baby-factory hospitals churning out babies by the hundreds every month.  There is a lot going on at any given time and one nurse will often monitor 3 or 4 mamas at once.  She doesn't have time to read a 20 page birth plan.

So based on her statement, this is what I suggest.  And of course, all of this is predicated on the health of the baby and the mother.  I can't emphasize strongly enough that your caregiver must be on board with your plan.  If s/he is not, you may consider switching providers to one more supportive of your choices

Keep it Simple.
There are things that are worth fighting for.  Waiting for labor to begin naturally is a biggie.  It is one of the best ways for you to ensure that you get your natural birth.  But other little details may not be worth fighting about.  This L&D nurse said that a mom agreeing to have a heparin lock in place is viewed as a mom willing to compromise on the little things, and so some of the harder-line nurses are more willing to work with her on the big things.  (This is just an example - if not having a hep lock IS deeply important to you, by all means, mention it).  So keep it simple.  Narrow it down to the things that are really truly deeply important to you.  And see if you can get it all on one page.

Keep it Positive
This goes back to getting the nurses on your side.  In a perfect world, we would have "sides" when it comes to birth.  But sadly, mamas wanting a natural birth in a hospital setting often have to fight the hospital powers that be to get it.  So instead of handing a group of over-worked nurses a list of "I don't wants", try using positive phrases, such as "I know there are pain medications available.  I will ask for them if I need them" instead of "I don't want an epidural."  Or "I would like to use the position that feels most comfortable to me during the pushing stage" instead of "I don't want to push on my back."  I sort of equate this to talking to my kids.  If you use all negatives - Don't run, don't hit, don't throw your brother down the stairs - all they hear is the "don't" and the "no" and miss the actual message.  Make your plan an expansion of the statement "this is what I want from my birth experience" instead of relying so heavily on "This is what I don't want".

Get Attached
This is from NATURAL HOSPITAL BIRTH by Cynthia Gabriel (and GREAT book that I cannot recommend enough!).  Get attached to your plan.  Be willing to fight for it.  Yes, birth is unpredictable, and you have to be willing to shift gears if something goes awry, but be committed to it.  Be dedicated to getting your natural birth.  It is the same in life.  You are not going to get that which you don't set your heart on.  Obviously, if an emergency comes up, you will go with it.  No one - not even us dirty hippie home-birthers - is putting the birth experience ahead of a healthy baby.  But in the absence of an emergency, you need to be attached to the idea of natural birth.  Otherwise it is too easy to be swayed by the "this" and the "that" that the staff could do to make things "easier".  Get attached.  Be passionate.  Be informed.

The One Important Point
This L&D nurse told us at my training that if you are started on Pitocin to help with progress during labor, the nurses will routinely up the level of the drip at regular intervals - REGARDLESS OF HOW YOUR LABOR IS NOW PROGRESSING.  Pitocin makes contractions hard.  I mean HARD.  She said that if the patient requests it, they will not do that.  So consider adding a line that says something to the effect of "If I need Pitocin to augment my labor, please do not routinely increase the level after it has been administered unless absolutely necessary," or "If Pitocin is needed to augment my labor, I would prefer that the initial dose not be raised unless absolutely necessary and only with my knowledge and consent."

So that is my simple guide to a simple birth plan.  Here are some suggestions of what to include:
* A short message to your care provider/nurses a la "I'm really committed to and excited about a natural birth. Anything you can do to help me achieve this would be greatly appreciated!"
* Preferences about letting labor begin on its own
* Who you want in the room
* Whether and/or when you want to be offered pain medication
* Being able to move freely and eat/drink throughout labor
* Avoiding vaginal exams
* Pushing positions
* Preferences on coached pushing
* Whether and how long you want to delay postpartum and newborn procedures (cord clamping, vitamin K shot, eye ointment, weigh/measure, bath, etc) while you bond with the baby
* If you plan on breastfeeding

Heidi Thaden-Pierce (a doula in Texas) has a wonderful resource called Things to Consider.  It is a pretty comprehensive list of things to think about while formulating your birth plan.

Stuff I Learned from Being a Mama #1

I wrote this for my mama blog in 2010, about 9 months after my first child was born.  I think it bears repeating on the doula blog!

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My friend is having her first baby in September.  I had my first baby last September.  She recently asked me if I had any words of wisdom for her.  My immediate reaction was "WISDOM?  What wisdom?  I am making this up as I go!"  Of course, upon further reflection, I realize that IS a sort of wisdom.  It is a trial-by-fire-in-the-trenches-let's-see-if-THIS-works kind of fearless (sometimes) experimentation that has yielded some good results.  It has, admittedly, steered me wildly wrong a few times.  But the path of parenthood seems to me to be an old-dirt-road-looking sort of thing.  Lots of people have passed before me and the path is very well worn, but everyone takes a slightly different course and leaves a slightly different mark in their wake.  Also it's bumpy.

So here it is.  Everything that I have learned in the last 19 months since I conceived my daughter.  Okay, not EVERYTHING, but some little tidbits that I wish someone had told me beforehand.  I am also realizing how long-winded I can be, so this wil be first in a series.   Some of this might qualify as TMI.  You have been warned!

PRENATAL ADVICE FOR MAMAS-TO-BE

You just can't worry about everything.  Everyone has another thing that could be harmful, that will be dangerous, that should be avoided.  And the list is twenty miles long.  You simply can't worry about everything.  I am not saying ignore the list altogether (or the advice of your caregiver), but if you accidentally eat some non-pastuerized cheese or forget to nuke your deli meat till it steams, chances are everything will be fine.

Eat.  Eat.  Eat.  But eat WELL.  Don't be obsessive about the weight you gain.  Your body needs to gain weight to support the pregnancy.  As long as you are not packing on Haagen Daz or donut pounds, you are doing okay!  Lean protein, veggies, fruits, grains, eat the good stuff.  And then don't worry about it!

Don't look at the scale when they weigh you.  It is just better that way.

That being said, there is only one time in your life that eating a pint of Ben and Jerry's in one sitting is cute (and pregnancy is IT), so if your health permits it, don't be a food nazi either. 

Make lots of food beforehand and freeze it in single-serve portions.  Or buy a bunch of microwave dinners (though the "real" food will be nicer - it will be like your mom is there cooking for you:-).  Fill the freezer.  Don't skimp.  You will bless your forward thinking when Baby is 2 weeks old and there is not a scrap of fresh food in the fridge.  And you will bless your forward thinking when Baby is 6 weeks old and there is not a scrap of fresh food in the fridge.  Seriously.  Freeze everything.

Consider your birth options.  Do some research.  Consider using a midwife for a home or birth center birth.  

Studies show that home birth - for healthy, low-risk mother and babies - is as safe or safer than giving birth in a hospital.  The American College of Obstetrics and Gynecology (ACOG) and the insurance industry want people to believe that home birth is at best risky and at worst recklessly engangering the life of mother and baby.  But this is simply not the case.  The midwifery model of care (as opposed to the medical model of maternity care) is based on allowing a woman's body to work naturally.   The link above explains it much better than I would, but midwives allow the process of birth to unfold naturally.  They are well-trained professionals who know, understand, and HAVE WITNESSED the process of birth from beginning to end without intervention and therefore are an excellent judge of when something doesn't look right or when something is perfectly normal.  My labor took 50 hours from onset of contractions to the birth of my daughter.  FIFTY hours.  Contractions were 5-8 minutes apart for more than 30 hours.  I was dilated past the "you shoud go to the hospital" stage for about 24 hours.  If I had been at a hospital, I firmly believe I would have had a c-section.  Lucy's head was tilted up slightly and was therefore not pressing and opening the cervix as effectively as if her chin had been tucked.  But mymidwives knew that everything was fine.  The baby's heartbeat was fine.  I was tired, but not exhausted.  I was eating, I was drinking and labor was progressing, however slowly.  So we let it keep going.  And everything was fine.  She was perfect (Apgar score of 9 at 1 minute).  She was beautiful.  She was born in our family room, among our family, gently, beautifully, naturally.  I also firmly believe that our breastfeeding relationship would have been toast if we had been in a hosptial.  We had so much trouble at the outset that if either of us had been drugged, it would have been a lost cause.  I could go on about this for a long time, so maybe I'll save the rest of it for another post.  That you have a choice.  Know your options, and make an informed decision.  Some books to read:

The Thinking Woman's Guide to a Better Birth by Henci Goer.  Very informative look at hospital vs. birth center vs home birth.

Obstetric Myths vs. Researc Realities by Henci Goer.  Just what it says.

Ina May's Guide to Childbirth by Ina May Gaskin.  Beautiful natural birth stores along with...well...a guide to childbirth written by one of the country's best midwies.  Also includes a CRAZY picture of a baby coming out FACE FIRST!  Not for the faint of heart.

Journey Into Motherhood - Inspirationl Stories of Natural Birth Beautiful, inspiring stories of women giving birth on their own terms.

Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent.  This book clinched my desire to have a home birth.  Wonderful, moving, inspirational, heartbreaking, uplifting.

Spiritual Midwifery by Ina May Gaskin.  More from Ina May Gaskin - wonderful.

Consider breastfeeding.  Do the research.  Best for mamas, best for babies.  Get prepared.  It is natural, but almost never instinctual or easy to begin with. Attend La Leche League meetings - they have them all over the country and the leaders are well informed and very very helpful.

The Nursing Mother's Companion by Kathleen Huggins is a great breastfeeding reference.  I still reference this book from time to time, and it was a lifesaver in the early months.

Ask questions of your caregiver.  Get REAL answers, not the "that's just how we do it" crap I got from my OBs before I switched.  If you don't like the answers, or if you liked what you initially heard and they start to change to something less palatable the closer you get to birth, switch caregivers.  IT IS NEVER TOO LATE TO SWITCH.  My friend switched at 37 weeks when her OB insisted on a scheduled c-section for her breech twins.  37 weeks.  She found an OB willing to let her try a natural vaginal delivery, and that is just what she got.  You are a consumer, not cattle.  You have rights.  Birth is a HUGE business.  HUGE.  A lot of hospitals are baby factories and you will just be another bed they want to empty out as fast as possible.  Doctors want to cover their asses (often with good reason in our overly-litigious society), but it usually comes at the expense of mamas and babies.  KNOW YOUR OPTIONS and YOUR RIGHTS.  Make a decision, make a birth plan.  Be willing to be flexible, but ask questions, ask why, be an active participant.

No matter where you choose to give birth, consider taking a birthing class.  Even if you intend to show up at the hospital and immediately get an epidural, chances are you will be laboring at home for a number of hours before you are permitted to check in.  If you have no relaxation or breathing techniques at your disposal, these are likely to be very long, uncomfortable hours.  I took a Hypnobabies class and my labor - while inordinately long - was generally very comfortable.  I had no pain (only what I would call discomfort), I didn't feel the baby crown (no "Ring of Fire"), and even though I tore, I didn't feel it at all.  People swear by the Bradley Method, and there are many MANY other classes out there.  Just don't think taking the class the hospital offers will be good preparation.  From what I have heard, it is a "here's the epidural needle, who wants to sign up?" and admission procedures.  I am sure this is not the case for every hospital, but everything I have heard from moms who have taken these classes leads me to believe they are not worth the time.

Take some time with your spouse/partner before the baby comes to talk about who you are and how you see yourself as a parent.  It helps to be on the same page.

Spend some time with your spouse, just the two of you.

Unpackage, wash and put away everything you have for the baby.  Nothing is worse than having a poop blowout and a crying baby and all the clean sleepers are on hangers, stapled together with those stupid unbreakable plastic tie thingies.

I liked taking baby bump pictures every week.  Now I have a visual record of my changing body - and it is really cool!  I also had a fun pregnancy journal called The Belly Book.  It is a really cute and sweet keepsake of my pregnancy that I'll give to Lucy one day.

Get a fork lift to help you out of bed in the morning during your third trimester.  Heh.  If only.

Braxton-Hicks contractions can last for a long time.  I walked around with a rock-hard belly for an hour at a time on occasion.  Call your caregiver if they are coming on regularly or they hurt, but your uterus is warming up and conditioning itself for the marathon of birth.  Don't let it freak you out.

Chamomile Tea will calm BH contractions if they are bothersome.  My midwife said that the Amish have been known to keep an antsy baby inside for weeks just using chamomile tea.  I would make an extra-big, extra-strong cup of tea, mix in some honey, pour it over a liter of ice and sip it all day long.  Once again, always call your caregiver if you are concerned, but if she says you are okay and the BHs are irritating, chamomile is a lovely aid.  And it helps you sleep.

Ask for help and accept help when you need it.  Seriously.

More later on what I learned from labor and birth and the postpartum experience.  If any of you other first-time moms have anything you want to add, leave a comment!  I'd love to hear the things you've learned!