During transition in my last labor, I remember being on my hands and knees on the floor of the hospital and moaning, “I can’t do this...I need an epidural...I want an epidural.”
But I wasn’t serious, and even in those moments of intense discomfort I knew I wasn’t serious. I didn’t really want medicine.
Fortunately, my husband and nurse were completely on board with my all-natural birth preferences and didn’t rush to get me drugs when they heard me asking. However, after reflecting on that birth and looking ahead to my next one, I think there’s a lesson to be learned.
I need to be able to complain. I want my pain and strength to be validated when I am in labor. I realize now that when I asked for an epidural, I was really asking for my pain to be validated and for more support through the process of labor. It was a cry for both praise and help, not for pharmacological pain relief.
So this time, going forward, I’ve decided to designate a “code word” to be used if I need pharmacological pain relief. This will enable me to whine and complain, to ask for drugs or an epidural all I want, but without tempting my husband to call for them. Instead, I will use the “code word” if I begin to suffer and an epidural becomes necessary. Something like “code red!” or “bananas!” so that my labor team will know when I’m not kidding around anymore.
If my labor team hadn’t patiently urged me to keep going without drugs, I may well have ended up with an epidural when I asked for one. I don’t want to risk that again. I want easy access if I need medicinal pain relief, but I don’t want to get it unless I really need it. I think a code word will enable me to do just that.
Did you use a code word for your labor? Would you consider doing so? Share your thoughts with me!
When I was working on my birth plan I had a discussion with a coworker about making a plan. Her argument was that you can't plan a birth because there are too many unknowns. I countered that that was the very reason every woman needed a plan.
This is not a birth plan:
I will start labor on my due date at 9AM after ten hours of sleep and a well-balanced breakfast. After four hours of early labor, spent watching TV and receiving a back massage, we will have an uneventful trip to the hospital. Upon arrival at the hospital, I will consent to a vaginal exam determining I am 6 centimeters, 80% effaced, and 0 station. An epidural will be administered promptly because there is a readily available and unoccupied anesthesiologist waiting for me. After four hours I will begin pushing and have my 7 pound, 7 ounce perfect bundle of joy after a mere five pushes. The doctor who attended me throughout pregnancy will be there to deliver my baby. There will be no tearing. We will be discharged by the next morning, only staying a night so that I can have the assistance of the nurses so I can sleep and establish breastfeeding. Before discharge my milk is in and our latch is perfected. While we were at the hospital my mother cleaned my house and has lasagna in the oven.
Okay, I hope with all of my heart that every woman can have a birth like that - simple, easy, painless, textbook (whose textbook?!).
My birth plan included rules like don't eat near me, let me roam freely (I ended up spending about 24 hours laboring on my toilet because it felt like I was trying to poop a railroad tie past three feet of rebar) I only wanted one cervical check, and don't rupture my membranes. I made rules because I didn't want any interruptions - we forgot to unplug our house phone and it rang mid-contraction and now when it rings I am filled with the same rage I was that morning.
I planned a homebirth but had a hospital transfer plan, and a Cesarean Section plan.
It was important to me to labor unmedicated but wanted an epidural in the event of a transfer to the hospital. When we transferred I was glad I had pre-planned an epidural otherwise my birth team and I would have been on different pages: they might have encouraged me to continue unmedicated, oblivious to my wishes. Quite the opposite, a mother might think to herself that she believes she can have all-natural childbirth but fails to let her partner and care provider know - at 3AM she might discover a needle in her back not because she was tired, but because her husband was. Afterwards, she might be left yearning for what she knew she was capable of. With every intervention comes risks and benefits: it is important for every woman to know where she stands prior to entering the delivery room, lest she be faced with a decision when her limbic system has taken over.
Some important items to consider in a birth plan:
What methods of pain relief would you like? A hot shower? Massage from your doula or partner? Epidural? Nitrous oxide? A TENS machine? Be sure to know and understand the risks and benefits of each.
If augmentation of labor is suggested, what will you do? How do you feel about synthetic oxytocin? Do you know and understand the risks?
Who would you like present in your labor?
Do you want to eat and drink freely?
Do you want an IV?
How frequently do you want your baby monitored in labor?
How frequently would you like to be checked for dilation?
Your doctor might offer to rupture your membranes, how will you respond?
Under what circumstances would you consent to a Cesarean? Vacuum or forceps delivery? Know and understand the reasons for each - some are genuine emergencies, sometimes it is simply impatience.
Would you like to be encouraged to labor and push in different positions?
When would you like the umbilical cord clamped and cut? Do you want immediate skin-to-skin?
Erythromycin is often put in the newborn's eyes - is it necessary for your baby?
Oral or injectable Vitamin K? When and where will the baby's first bath be?
Knowing how you feel and letting your birth team know ahead of time will ensure your wishes are known. Things can change in a second, and so can your plan. Planning ahead will help you be more flexible - augmentation may have been off the table, but when someone mentions an impending Cesarean you will be able to weigh the risks and benefits and alter your plan accordingly and with genuine informed consent.
Remember this is your birth, your baby, your body. You have the right to refuse and the right to request. You are the boss.
I recently came across an article about “control” that I think is really relevant to the way that we approach birth in the present highly-medicalized system. We are accustomed to handing over control to our doctors and to the hospital with the (often misguided) notion that they will make the best decision for us.
Anyone who has met me knows that my mantra is: “Women need to take responsibility for their birth.” What does that actually mean, and what does it have to do with control? If you are pregnant and reading this then I suggest that you take some time to think about a few questions related to the way that you view your pregnancy, your choice of care provider, and the way you are preparing for your birth.
Who (if anyone) is in control throughout the birth process?
Birth is personal. You are the only one who can give birth to your baby. Sure, you will be in the hospital, under the care of your chosen provider(doctor or midwife) and nurses, but you will be the one who is experiencing labor and you have ultimate control over what is happening.
Any decisions that need to be made at any time should be done as a team. Have a discussion between yourself, your husband and your doctor – with the best outcome for all as the best possible solution.
How much control can we maintain?
You control your mind. Your mind controls your body. You control your fear (or your ability to confront or move beyond fear). You control how you experience the intensity of the birth experience.
Is letting go a necessary part of the process?
Yes, absolutely. There are certain things that are out of our control. Things like the position of the baby, how long labor may take and certain situations that may arise necessitating a change of plan. Let go of what you cannot control. Hold on to what you can. You can control your attitude, your ability to be flexible in the face of unexpected circumstances. You control how you stay connected to your baby, your body and the process of giving birth. You can control your mind, your thoughts, your beliefs and your expectations.
How is the birth experience affected by our attitudes toward authority and autonomy?
Do you blindly agree to everything your care provider suggests? Do you question decisions and routine procedures and how (or if) they relate to you and your pregnancy? Do you feel comfortable discussing your fears and expectations with your care provider? Would you consider changing providers or even hospitals if you felt that after having several discussions, your wishes are not being respected?
Here is a little acronym that I use in my birth preparation classes to help parents form a framework for opening discussions with their care providers. Think BRAT - Benefits, Risks, Alternatives, Timing
Benefits: What is the problem we are trying to prevent or to fix? Will this procedure fix the problem? If not, what would we do next?
Risks: What are possible risks or side effects?
Alternatives: What are the possible alternatives? What would happen if we did nothing?
Timing: Is the situation urgent, or is it possible to wait?
This is a great way to discuss things with your provider so that you can prepare for and have a no fault, no blame birth. If you confidently participate in all the decisions made during your labor and delivery–even those that were not in your birth plan--you are likely to look upon your birth with no blame and no regrets.
When I got pregnant with our first child, we decided to go the traditional way. I was nervous, scared and had many questions. My husband and I talked about it and decided it was, at that moment, the best choice.
I was curious about midwives and talked to ''hubby'' about maybe, going to see one, but he was too scared: What if something goes wrong?
So we kept the gynecologist and planned to give birth in a hospital in Montreal, Quebec. I did keep informed during my pregnancy, and even almost switched to a midwife, but I was still too nervous to make the switch.
The birth went well, I had two great nurses that took care of me during labor. It did not, however, go exactly the way I wanted. I was not totally satisfied with my experience. I had Pitocin, an epidural, and constant monitoring—none of which were in my birth plan, which no one read. I had wanted a more natural birth without Pitocin, unless needed as a last resort. I didn't want the epidural. I wanted to be able to move around, to use the ball, and to be in the bath. All options that were all available me at the hospital we chose. I did not want to be plugged into a monitor constantly and thus lose my freedom to move. I hated having to call the nurse every time I needed to go to the restroom.
I especially hated our afterbirth experience; it was awful, everything to wash a mother's confidence down the drain.
I wanted to breastfeed, nobody needed to convince me; they just had to help me!
Instead I got mixed information, mixed concerns and in the end, mixed emotions. I only wanted to be treated with respect. I especially wished to get out of there and be in my home, in my bed.
When I got pregnant with our second child, Things were going to be different.
I had a good talk with hubby and he told me: I trust you completely; I should have listened to you the first time. You're the one that gives birth, not me. You know much more on the subject and I trust your judgment.
The decision was easy I wanted a Midwife.
I contacted L'ordre des sages femme du Québec to ask: what should I do?
They replied quickly and suggested I call the closest birth center to my home, as fast as possible. Spots within a birth center are difficult to get your hands on, many women want midwife service, but unfortunately, not all will be able to have it. There are not enough birth centers in the province. In order to be able to get a registered midwife there needs to be an available spot in a birth center. Our new government promises 125 new jobs for midwives and 7 new birth centers, but that remains to be seen. Until then, women have to act fast and call birth centers as soon as they find out they are pregnant.
I called one birth center in Montreal; they put me on a waiting list and told me that I would receive a call if a spot became available.
Lucky for me, I only had to wait two weeks to get the call that told me there was spot for me.
I went to an information session given at the birth center; they gave us a tour, and answered all our questions. I was satisfied, and my husband as well. I knew I had made the best choice, for me.
I got assigned to my midwife team—in Quebec they work in teams of two. A principal midwife who follows the pregnancy, she was the one I would call first, should I have any concerns or emergencies. With a secondary midwife acting as backup to the team, allowing the primary midwife time off. They alternated weekends off, thus making someone available 24/7. Both midwives were amazing. While I knew my primary midwife better, I did meet with the secondary midwife a few times at prenatal visits. We broke the ice and, actually, formed a good bond as well.
My appointments lasted at least 30 minutes, except the first one, which was one hour. They always took the time to explain everything to me, how my body worked, and to tell me how the baby was doing. Told me all the tests that I could get and explained why it was there and what would or could happen if I chose to do it or not. I always had the choice to refuse though, and never would be judged based on acceptance or refusal of a procedure.
I was also empowered. I got to do some of the testing myself. I was in charge of checking my weight, looking for the signs of proteins in my urine, and also able to the test for Strep B by myself.
I learned a great deal. I felt so confident in my body and my abilities, I was not nervous at all with the upcoming birth, which I was set on experiencing naturally, as opposed to the first one.
I decided to give birth at the birth center.
When my water broke at home, I paged my secondary midwife, as she was on call, and she coached me over the phone on what to do. I stayed home for a little while to see how labor would progress, but after two hours of intense contractions, I was ready to leave.
When we arrived she was waiting for me and took us to our room—a beautiful bedroom with all the comforts we could need. The lights were dim, the only sounds were of another mother giving birth in the adjacent room.
My labor was pretty quick and easy, but most importantly; it was all done in an environment of calm and respect.
I was able to ease the pain of some of my contractions in the bath. I moved around freely within the room and the midwife suggested and helped me get into different positions to help things progress.
She called a backup when I was close to pushing.
And there we were, pushing a baby girl into the world.
I was so overjoyed by that experience.
As soon as the baby was born, a plate of fruit was set on the bedside table.
My baby was in my arms the whole time the midwife was stitching me up (only one stitch). She took the breast by herself, and we simply cuddled for one hour.
During the three hours after the birth, the midwife did all the exams and tests needed. Baby was administered the vitamin K shot (which I had chosen to give her), she was weighed in and all her vital signs were checked. The midwife also showed me the placenta, which I had asked to see. It was fascinating.
I was completely relaxed.
My midwife paid us a visit the next morning to examine us again. We left for home that afternoon. Even though it was sooner than my fist birth (where I had spent 36 hours, in the hospital, post birth), I had much more energy.
Two days later, the midwife visited us at home and came back three days later. I had follow up appointments, at the birth center, for six weeks after the birth. They did all the same tests my doctor had done during my first pregnancy, including a pap test. They also verified the baby's weight, reflexes, and general health.
My last appointment was bittersweet; I was going to deeply miss these women who had become so important in my life and the bond we had created.
Of course when I found out that baby number three was on the way (8 months later) my choice was obvious. I wanted a midwife, again. But his time I wanted a home birth, and what an adventure it was.
Throughout pregnancy we are faced by choices, possibly more than any other time in our lives. Which blood tests should I have? Should I have pain relief during labour? If so which ones are right for me? Do I really need that Caesarean?
So what is the difference between regular decision making and informed choice?
Informed choice is a decision based on thorough research; backed up by even more research, scientific studies, and experiences from other mothers. It is not an instant agreement that may leave you feeling disempowered in the future. It is a decision made actively by you, together with any other supporting roles that you may choose to consult such as a doula, doctor, midwife, partner, etc.
It is common to feel regret if you do not achieve the ‘perfect’ birth that you have planned. But this is where informed choice really makes a difference. If you trust your instincts; weigh up all your options and choose the one that feels right, then however your baby is born know that you tried your hardest to have the birth you wanted. Take solace in that; reflect on everything and take what you want from it. Then move on and enjoy your new little life.
Outcomes are never guaranteed- such is life- but we should always be comforted in the knowledge that we made a decision based on what is best for our children and ourselves.
Make an informed choice.
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