Birth Experience

Peaceful Birth – Write a Birth Plan

7 Comments 11 March 2010

Birth the Way You Want by Writing a Birth Plan

I am writing this post to help you write a birth plan, specifically to those who are planning on birthing in a hospital.

However, this post is also intended for women who are choosing home birth – it will help you write a transfer plan in case of maternal fatigue or true emergency.

Before you can write a birth plan, you must understand your options. Before you plan for your options, you have to know what your options are.

Talk with your care provider about the choices you have during labor and delivery. If their idea of how you birth is different from yours, you have the option of firing them and hiring someone else whose vision is more closely aligned with yours.

Critics of birth plans would argue that many things during labor and delivery do not go to plan. But you wouldn’t have a wedding without planning!

Why You Should Write a Birth Plan

If you’re choosing to give birth in a hospital, it is important to write a birth plan so all the staff members know of your wishes during labor and delivery.

It is possible that many of the nurses you encounter that day will be unfamiliar, and if you’re there long enough, a whole new round of them will come for the next shift.

In some practices, Nurse Midwives work together in a group.  The midwife on call will deliver your baby. A birth plan comes in handy in this situation, particularly if you aren’t well acquainted with each midwife.

At a home birth, you may feel a birth plan is not be necessary, as you most likely will have discussed the ins and outs of your birth-day with your midwife in great detail.

However, writing a birth plan for your birth team could be highly beneficial. It can be your way to communicate your wants, needs and serve to delegate tasks while you’re in labor so you don’t have to think about communicating, just laboring.

Although I did not write a birth plan, (I talked in length with my fiance, doula, midwife and other support staff) I had a lot of feelings surrounding my birth that I wanted to get out of my system. So I created a lot of birth art and taped them to the walls in my birth room.

Find Your Birth Plan “Style”

There are actually several different ways to write a birth plan.

A birth plan can be written as a formal letter, as a chart, broken down into categories or strictly in a “we do not consent to ______” format.

Examples:

In a formal letter type of birth plan you would introduce yourself and include who will be with you during the birth. Include your major concerns and what is most important, the medical intervention you’re okay with vs. what you’d like to avoid.

  • pain management
  • speeding up/augmenting labor
  • fetal monitoring

You should also include how you might like to push and the different styles or positions you may push in and how you’d prefer to handle hydration.

Talk about your preferences in case of a cesarean and other interventions that may be introduced at time of delivery such as use of forceps/vacuum and episiotomy.

My personal recommendation is to keep the letter style birth plan short and easy to read as it takes time to read and nurses are busy.

A type of birth plan that is easy and quick to read is the chart. Categorize into four subjects and write about each:

Environment                    |                 Pain Management
___________________________________________

In Case of Emergency         |                Newborn Care

You could also categorize the subjects like this, writing a brief description under each:

1. Pain Relief
2. IV Access
3. Fetal Monitoring
4. Antibiotics
5. In Case of Vaginal Birth
6. In Case of Cesarean Delivery
7. Newborn Care
8. Thank You!

Lets make writing your birth plan even easier to tackle!

I’ve found an interactive birth plan outline – simply fill out the answers right on your computer and print it out! How cool is that?!

Home Birth Transfer Plan Due to Fatigue or True Emergency

If you should become fatigued or simply decide you would feel more comfortable or relaxed birthing in a hospital, a birth plan is a very good idea to have pre-written and ready to bring along.

Here is a fantastic example of a home birth transfer plan.

In the case of true emergency.

Many may think if there is a true emergency and hospital transfer is impending, there is no need for a birth plan, but there is. There may be very important ideas you’d like to share with the staff about newborn care.

In this case I recommend a very simply worded form of a birth plan. Clear and direct, like this example:

We Do NOT Consent To

  • Eye ointment
  • Vitamin K
  • Hep. B
  • Formula or glucose water
  • Circumcision
  • Pacifiers

Prepare  in advance!

Whether you are birthing in a hospital, birth center or at home, it’s a good idea to discuss your ideas about birth with your care provider weeks before you go into labor.

Be sure to sign your birth plan and print at least two copies.

I hope this helped!

Birth Experience

Peaceful Birth – Choosing a Care Provider

10 Comments 10 March 2010

You might want to consider firing your doctor.

That’s right. I said it. Fire your doctor.

If the physician you’re seeing has opinions about childbirth that differ from your own, leave. Interview as many care providers as it takes to find your perfect match.

When looking for a specific type of care, one should understand the traditional roles of doctors, ob/gyns, nurse midwives and lay midwives alike.

What do each of these providers  have to offer you?

There will be several questions to ask yourself, and your physician. I’ll be getting to that a little later.

History, Job Duties,  and Standards of Care

An ob/gyn specializes in women’s health and must obtain a 4 year college degree followed by a 4 year Medical Doctorate degree and three to eight years of residency and internship.

As physicians, ob/gyns examine, diagnose and treat a plethora of diseases, illnesses and other health issues that are unique to women.

They specialize in pregnancy, to assist women through childbirth and with their general reproductive health.

Average time spent with mom during prenatal visits: 6 minutes.

Nurse Midwives practice under the supervision of an ob/gyn.

Schooling includes becoming a registered nurse (Bachelor Degree in Nursing). One must then enroll in a nurse-midwifery program accredited by the American College of Nurse-Midwives and pass the written examination before practicing.

Nurse Midwives work in a variety of settings including hospitals, birth centers and home deliveries.

Average time spent with mom during prenatal visits: 15 minutes.

Certified Professional Midwives practice midwifery autonomously and are certified through the North American Registry of Midwives. CPMs are strictly home birth midwives and do not have hospital privileges.

They are trained to provide expert care and to support women through pregnancy, childbirth and the postpartum period.

The midwifery model of care is such that labor and pregnancy are normal life events and believe in minimal technological interventions.

A CPM is however, trained to know when a women would be better suited to be cared for by an ob.

Average time during prenatal visits: 30 minutes-1 hour (or longer)

What Model of Care Best Suits You?

As much as it matters the medicine your care provider practices, something just as important to consider when hiring your physician is aligning your core values and vision of birth.

If you want a hands-off sort of approach, and you’d like to let your labor unfold as nature intends with less medical intervention and more “human” interaction, a Certified Professional Midwife might be right for you.

If the thought of birthing in a hospital turns you off but birthing at home makes you feel uneasy, a birth center could be a great middle option. Nurse Midwives work in birth centers.

If you’ve got a great relationship with your doctor and trust you’ll be taken care of best under their care in a hospital setting, great!

Q & A Time

Have a conversation based around these questions. Feel them out and go with your gut.

  • When do you cut an episiotomy?
  • What is your cesarean section rate?
  • How many of your patients induce or are augmented during labor?
  • What type of prenatal testing do you recommend?
  • Do you allow a doula and/or friends to be present at birth?
  • At what points during labor will you be with me?
  • Do you encourage movement and different positions in labor and delivery?
  • How much fetal monitoring do you recommend during labor?
  • What is the standard procedure right after baby is born?

Discuss your optimal birth scenario and write a birth plan.

Your idea of the “perfect birth,” means a lot. It could be the difference between your dilation being checked every 30 minutes or only twice through your entire labor.

With any provider, no matter how well you know them or how close your friendship may be, it’s a good idea to write a birth plan – for you and the rest of your birth team.

It is my sincere hope that through reading this series, you’ve come to understand the importance of self-advocacy during childbirth. Stay tuned for the next part in the series, Peaceful Birth – Writing a Birth Plan

Birth Experience

Introduction to Creating a Peaceful Birth Experience

9 Comments 08 March 2010

Natural Childbirth Can Be Peaceful

I’d like you to think about what a peaceful labor and birth could look like.

More often than not, the natural process of childbirth is uncomplicated. Labor can be arduous, challenging and long. It can be painful and have stressful moments. But the oh-so-famous saying is true: hard work results in the deepest of rewards.

In the second half of this series, we’ll explore creating a peaceful birth environment- how you can set yourself up to achieve a positive birth experience no matter where you are, or what happens.

Natural childbirth is like a marathon.

Have you ever watched a professional runner? They make running look easy – effortless. Each step is taken in stride. They find their rhythm and get to know it inside and out. They moderate their breathing with training.

You wouldn’t run a marathon without training first or surveying the trek you’re about to embark on. Childbirth should be thought of the same way – as an event to prepare for.

Contractions Are Beautiful

So here’s the scoop about contractions for first time moms:

Some would describe contractions as intense menstrual cramps. I didn’t think of them that way.

Each time I had a contraction, I imagined my uterus as a big muscle that was tightening around my baby, urging her body downward. My stomach got hard and tense, but it was important to remember to keep the rest of my body from getting tense too.

Relax with all of your being between contractions, even at the beginning. Lay down – close your eyes – let go. This will significantly retain your strength for increased stamina. You’re going to need that energy when it comes time to push.

The strength of contractions may feel like the most incredible pain you’ve ever felt, but know this: the pain of contractions is the only time you will ever feel hurt when something ISN’T wrong with you. Contractions are constructive and productive. Each contraction brings your baby closer to you.

Love Hormones

Labor is hard. And natural birth – the delivery part especially, is incredibly challenging. But don’t be afraid. Accept this as part of the process and be one with the experience.

Being fully present with your childbirth (naturally) will deliver such a fantastic reward, and I don’t just mean your baby…

The rewards of natural childbirth are life-long lasting.

The moment you see your child and hold them in your arms is the moment when all recollection of “challenge” or “pain” completely disappears.

You may have heard that before, but it’s true! During labor you could be screaming at your birth team, “I never want to do this again – EVER!” but after you’ve given birth you will gladly admit you’d do it all over again.

This is the rush of the “love hormone,” oxytocin running through your veins. You are in a state of pure elation better than anything you’ve ever lived through or imaged in your wildest dreams. Pure joy. Pure love.

And you just don’t get that exact type of experience with an epidural. It’s the pain and pleasure of natural childbirth to feel everything.

Natural Birth Anywhere

I firmly believe you can have a natural childbirth anywhere. It just so happens certain locations and providers are “easier” to give birth naturally than others.

(I’ll be discussing the types of care providers with whom you’ll have the best chance at achieving a natural, peaceful birth later in this series)

There are pros and cons of birthing in an environment where medical access is immediately available. One of the several reasons why I gave birth at home was to distance myself from the temptation of pain medication.

As a first time expectant mother, I had no idea what I was in for, but I wholeheartedly believed I could birth naturally.

Continue reading and learn about the first step to owning your birth by Choosing a Care Provider Who Cares (sometimes that means firing your current doctor).

Birth Experience

Birth Management & Interventions – Cesarean Section

10 Comments 05 March 2010

“A Cesarean Section Rate Over 15 Percent Does More Harm Than Good.” the World Health Organization

There are times when c-section is absolutely necessary for the safety and health of mom and/or baby.

However, the 30% cesarean section rate in the United States is double what the WHO considers safe. This means half of the cesarean sections that are performed on women today, are actually doing more harm than good – unnecessarily.

When is a Cesarean Section Necessary?

Scenarios present themselves during birth that may be (not an absolute) better resolved by c-section than vaginal birth are:

  • Fetal distress
  • Breech presentation
  • Dystocia (not progressing)
  • Repeat cesareans
  • CPD (pelvic disproportion)

It’s a very, very fine line trying to discern whether a cesarean is the right choice, and most mothers, husbands, family, doctors and nurse midwives alike tend to take caution’s side.

Additional options that could be tried before a cesarean section.

A c-section should not be the first choice remedy for stalled labor.

Some of those options include walking, for a woman who is not progressing or changing positions for a baby who is in fetal distress, depending on the intensity of the situation.

CPD, although it is commonly used as a reason for c-section, is actually very rare. Try changing positions, especially to “all fours” on your hands and knees. This position opens the pelvis more than lying on one’s back.

Another tip: patience. Wait. There is no rush (unless it’s seriously medically necessary).

What Are the Risks of a Cesarean?

Physical risks to mom include infection, risk of blood clots and excessive bleeding.

Mom also needs to stay in the hospital for 2-3 days to heal enough to become mobile and heal for another approximate 6 weeks before “returning to normal.”

Emotional risks include being separated from their partner during the operation (sometimes they can be present in the operating room unless it is truly an emergency situation).

If the mother is unconscious or not “with it” enough to see her newborn, the immediate separation from their baby just after birth which can (usually) turn into hours to let mom rest. The result is the complete loss of the instantaneous hormonal bonding period that takes place just after baby is born.

During those hours that mom is recovering, baby must be fed. Receiving a bottle with formula may result in nipple confusion. The breastfeeding relationship may be permanently compromised, or get it off to a tricky start.

Physical risks to baby include minor injury from the doctor while being pulled out of the uterus, breathing problems due to either early delivery and the lungs not being fully developed or excess fluids not being “squeezed” out while being pushed through the birth canal.

If the cesarean is scheduled, one runs the risk of delivering a premature baby due to inaccurate due dates.

Emotional risks are similar to mother in that the initial window for bonding is missed, as well as immediate breastfeeding to get colostrum, or “first milk,” which is rich in vitamins and provides newborns with immunity to infections.

What is a VBAC and What Are the Risks?

VBAC stands for Vaginal Birth After Cesarean.

VBAC risks:

The one main “risk” of vaginal delivery after c-section is uterine rupture. This is when the cut used to deliver the baby that became a scar breaks open during labor.

This is very rare (1% of all attempted VBACs kind of rare).

Due to the seriousness of uterine rupture, most women who have had previous cesarean section are either (in-hospital):

1. Automatically scheduled for a repeat c-section

2. Scheduled to induce labor that most often leads to c-section due to stalled labor and fetal distress (recall the side-affects of Pitocin).

Smart fact: Physicians don’t like to induce women who have had a previous cesarean because it increases the risk of rupture.

The type of incision also plays a factor in the risk of possible uterine rupture.

A low, side to side incision (transverse) is less likely to rupture. This type of incision is performed low on the stomach and is often called the “bikini cut” due to its placement and shape. It is considered safer than the classic cesarean section incision which resulted in more blood loss and was not as easy to repair (higher on the stomach).

Lastly, the risk of uterine rupture is increased by each additional cesarean section, putting a woman at higher risk for each pregnancy.

It is due to this life threatening risk that some doctors in the United States will not offer VBACs to mothers, but rather schedule for the next or induce labor which usually results in a repeat cesarean. Even if your doctor feels comfortable performing a VBAC, his or her insurance company may not allow it. Their “hands are tied.”

Make sure you discuss this in length with your care provider if you’ve had a previous cesarean.

The Home Birth Option

Midwives who perform home births may accept VBAC moms.

So if you’re dead-set on trying for a vaginal delivery after cesarean and can’t find doctor who will accept you, this could be your perfect option.

However, if you’re not comfortable birthing at home, you can have a VBAC in a hospital.

Even if you have to put up a fight. It might be a big fight. But you can win. For all those needing a little inspiration in this department, check out Gina’s (aka The Feminist Breeder) VBAC Story. Where there’s a will, there’s a way.

Birth Experience

Why Does the Birth Experience Matter?

11 Comments 03 March 2010

Two days ago, I began publishing a series of posts pertaining to the “Birth Experience.”

My intention is to inform women about common, often unnecessary interventions that stray from the belief that as women our bodies are designed to give birth.

I hope to draw attention to the risks associated with specific pieces of the “managed” birth pie including using Pitocin to induce or augment labor, epidural anesthesia and lastly, cesarean sections.

Interesting fact - the rate of cesareans performed are higher amongst those who have been induced or received an epidural.

The first half of this series is about birth management & common medical interventions used during labor.

I hope to provide information so that if induction, edpidural use or cesarean section come up, you feel more educated about these topics and more comfortable discussing your options.

But what, other than the physical risk factors of using Pitocin to induce, an epidural or c-section,  does all of this information have to do with the birth “experience”?

Well, I’ll tell ya. Let’s talk about the emotional risks of overly-managed, medicated labor and delivery and unnecesareans.

Post-Partum Depression Pertaining to Negative or Traumatic Childbirth

Every expectant mother hopes for a safe birth.

Beyond that, we plan for a birth that is not only safe, but hopefully beautiful, challenging and rewarding.

When circumstances arise that inevitably prevent the “perfect birth” from playing out the way we envisioned, it is natural to feel a little let down (or a lot let down).

When this happens, when the birth experience is less than perfect and mom feels upset, she should be treated with care.

Mothers need to be helped and taken care of after pregnancy.

That feeling of being let down or disappointed can turn into sadness and depression remarkably fast.

Perhaps she planned a natural birth and ended up “caving-in” by accepting an epidural. It is common for first time moms to feel unprepared for the level of pain they felt during contractions.

In other scenarios, the ob might tell a mother that her pelvis with too small to birth her baby vaginally and orders an c-section due to CPD (although true CPD is quite rare).

When birth doesn’t go to “plan,” a mother may feel as though she (or her body) failed her and her baby.

There are cases when through research after birth, some discover the various positions or coping mechanisms they could have tried to progress labor.

Thus a disappointing or traumatic birth experience leads to feelings of inadequacy, failure and/or resentment. That can have extreme consequences for mom, baby and their immediate relationship.

Approximately 15% of mothers suffer from some type of post-partum depression.

The symptoms of post-partum depression are lack of interest in your baby and other activities you once enjoyed, feeling overwhelmed and detached, hopelessness.

To me, 15% seems rather low. Perhaps because most mothers wouldn’t be so bold (or brave) as to say what they were feeling was true depression. Rather they might quietly say they felt a little let down.

Which brings us back to a quote I mentioned in the introduction of this series. If a mother births a healthy baby, no matter how she had to birth – whether it was traumatic or manipulative, she often hears, “you should just be happy you have a healthy baby.”

That single phrase touches a real nerve in many mothers. Their response is overwhelming.

And keep this in mind – a mother will remember her birth story for the rest of her life. The birth experience IS important!

Here are some replies by real women with valid feelings:

“I heard those words after my unnecessary cesarean- they cut like a knife. It was like I owed credit to my doctor that my child was alive and well, instead of I had a healthy baby because I did my best to make sure I had a healthy pregnancy. My cesarean was traumatizing, and recovery was tough and I felt guilty enough for being so gullible in letting the c-section happen in the 1st place because it wasn’t a peaceful birth for my daughter either- those words just piled on more guilt.”

“(it makes me feel) like my feelings don’t count…like I am just a baby machine and I should take everything bad that happened and put it in a box and forget it…its something someone that has never experinced birth trauma would say.”

“I was induced for medical reasons on my due date with my middle baby. I still am upset with that birth experience…. I mean I am happy she is healthy but she was not ready to meet the world yet. I feel like I didn’t give her the start in life that she deserved.”

“As a second class citizen. I had all my babies in hospitals, I didn’t know I had a choice. I would have loved to had them all at home. My first three were mostly uneventful, really my second and third daughters. My first daughter was traumatic due to induction, episiotomy . My last was a c-section, it was AWFUL, the recovery was horrible, I had a giant hemotoma under my incision, etc. I only wish I had known I could have a birth at home with a midwife, I would have.”

“I felt like I was put in a box. I felt like I couldn’t possibly rejoice and breathe a sigh of relief that- in spite of all of the trauma my baby was healthy- and at the same time grieve and mourn the very real physical, mental and emotional trauma I had been through.”

We’re talking about one of the LARGEST most incredible moments of a woman’s life! It’s not every day a woman gives birth to a life.

When a woman’s wedding cake tastes like crap, if she didn’t land the part, if a relative passed or is going through a hard break-up, her closest friends and family members don’t say, “tough shit.” At least the good ones don’t.

Rather, a good friend lends a listening ear. A good friend gives hugs, sympathetic cards and flowers, they do not say “get over it.” And the one who is feeling low gets to vent, thus encouraging feelings of acknowledgment, validity and ultimately, relief.

I encourage you to leave your thoughts and comments below.

Birth Experience

Birth Management & Intervention: Epidural

5 Comments 02 March 2010

Epidural Pros and Cons

Photo Copyright ©2011 Patti Ramos Photography

Epidurals are used to relieve the pain of contractions.

Currently, epidurals are taken by 50% of women giving birth in hospitals, requested by name.

Pain medication can be helpful in some situations, specifically and especially when a mother is in so much pain that she is unable to relax her pelvic floor muscles.

This pain medication’s risks include but are not limited to the following:

  • Maternal fever
  • Chronic back pain
  • Longer labor
  • Inadequate analgesia after first dosage
  • Duration of analgesia lasting longer than 6 hours
  • Duration of analgesia lasting shorter than one hour
  • Increased rates of instrument delivery
  • Low 5 minute Apgar scores
  • Overall lower rates of mother dissatisfaction

Physical Risks of Epidural to Mom

One risk of epidurals is the result of a higher temperature or fever in the mother (24% of women get fever as compared to 6% who do not receive epidurals).

Higher body temperature increases the need for more oxygen to the baby – lack of oxygen may lead to fetal distress…and fetal distress may lead to cesarean section. What a vicious cycle!

Fever negatively affects baby because infants of mothers with fever need a diagnostic work up which may include antibiotic treatment, lumbar puncture and possibly a longer stay at the hospital.

A woman who has taken an epidural also needs completely different care than the woman who has not.

  • Lack of feeling below the hips which often results in the use of a catheter.
  • Not able to feel when the urge to spontaneously push arrives, thus having to be told when to push.
  • Limited mobility due to numbness in legs and feet which may last hours after birth.

The side effects of an Epidural

Epidurals increase the rate of other interventions to be used to help labor along such as Pitocin to strengthen contractions, intravenous drip to prevent hypotension, (low blood pressure) continuous fetal monitoring and use of forceps or vacuum to help delivery the baby (9% need assistance compared to 3% without).

Nausea, dizziness, itching, headache, feelings of weakness and drowsiness hinder the moments of maternal bonding. There is also a reduction in the amount of oxytocin (a powerful “love” hormone) released in a burst just after labor. This helps stimulate the “let down” of milk in the breast. Therefore bonding may be decreased.

Epidurals may also affect the baby by passing through the placenta.

This controversial issue was studied in Sweden and published in Birth in 2001. The study concluded that babies whose mothers took epidural medication for pain…

“Spontaneous breast-seeking behavior in newborns is part of the interaction between the mother and her newborn and is based on coordination of body movements, sensory stimuli, and communication behaviors. This study indicates that maternal analgesia during labor might disturb and delay the important aspects of the newborn’s interactive behavior and increase the newborn’s skin temperature and crying.”

A newborn’s first instinct is to move to the mother’s breast to feed. If the baby’s reflexes are compromised, it will have trouble locating the breast and nipple and struggle with latching on.

To read more about epidural safety and risks, visit this page documented by Lewis Mehl-Madrona, M.D. Ph.D., Healing Arts

This article is part 3 of a 9 part series.
Browse the
Chapters of Birth Experience Matters.

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