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.
Picture your ideal birth, where do you envision it happening? Is it in a tub full of soothing warm water? Maybe it is in the comfort of your own home. Or is it at the hospital, possibly on an operating table?
According to the Center for Disease Control in 2012 98.6% of births occurred in a hospital within the United States. Therefore, if “in the hospital” was your first thought, then you are probably correct—ideal or not. With close to 2050 Free Standing Birthing Centers in the US (up from 170 in 2004) and only 27 of 52 states with legislation allowing for midwives to oversee home birth, birthing options other then the hospital are slim. Regardless of where you would prefer to give birth, if the hospital ends up being where you go, there are many things you can do before your big day to help yourself feel comfortable there.
First off, it’s important to come to terms with why you are birthing in a hospital. Do you believe it is the best place for you to give birth, because your health insurance provider doesn’t cover a birth center or home birth, or that you are considered high-risk? Whatever your reason, getting comfortable with it may be hard, as many people feel intimidated by the hospital setting.
Focusing on the positive attributes of the hospital setting will help you come to peace with the choice. It can be comforting to know that you will have quick access to pain relief or emergency medical care in the rare event something goes wrong. The NICU will be close by if baby should need help. Also many hospitals have lactation consultants on hand.
You are still in charge of your birth. You have the right to refuse tests and procedures you don’t feel are right for you. You can labor at home for a long time before you heading to the hospital—if you so wish. Once you get there, you will probably be so caught up in labor that you won’t care where you are, especially if you prepare yourself to conquer the hospital without fear.
Once you have come to terms with birthing in a hospital it’s time to choose which hospital will harbor you. If you have a few options to choose from you should tour each of them before making your decision. Look at their caesarean section rates as well as their birth policies. Do they set a time limit on how long they permit you to labor? What is their nurse to patient ratio?
If you want to try for a particular type of birth such as a VBAC, water or natural birth, the first thing you should do is ask your healthcare provider about the hospitals in your area. Find out which would be more likely to support your birth wishes. Some hospitals are much more supportive than others and that can make or break your birth experience. Unfortunately, many people choose their hospital based on appearance and amenities, but if you want a certain type of birth experience you need to base your decision on the hospital’s policies, facility, and support system.
After you have chosen which hospital you will give birth in, it’s time to get comfortable in it. Being relaxed at your hospital is integrally important because labor can slow down if you are stressed. You will probably need to take a few tours to familiarize yourself with the labor and delivery unit. Take your partner along and assign him to knowing where to go and how exactly how to get there—guys are great at remembering stuff like that!
Don't hesitate to ask questions while on tour, no matter how small or insignificant they might seem to you, and don’t worry if a couple of tours fails to make you feel at ease. Hospitals can be very intimidating! Most of us associate them with illness or preventative measures, not normal, natural events like birth, so it is no wonder some people have a hard time feeling relaxed there.
If you are having a hard time, wander around the main floor a few times. Spend some time sitting in a lounge and reading or people watching. Make a date of it and bring a girlfriend to the hospital cafeteria for lunch. Calm, gentle persistence is best when trying to familiarize oneself with a hospital. Rushing or trying to force yourself into feeling comfortable will only make you more anxious. Making repeated visits to wander around and spend time there is key if you are worried. With time and patience, you can come to accept and feel comfortable in your hospital.
Once you feel comfortable in the hospital setting, you can start to think about how to make your actual room as cozy as possible. Bring a favorite picture to set up in your room. If your hospital does not have a fragrance-free policy and you are fond of a certain scent, get a diffuser or wall plug-in to take with you (candles are not allowed due to the combination of open flame and combustibles gases present in a hospital). Do you have a sentimental attachment to a particular pillow or blanket? Bring it along! If you want to listen to music while you labour compile a playlist of favorite and soothing songs, don't forget a CD player or iPod if your room doesn't have a sound system. Do you want to wear a certain piece of clothing in labor, rather than a hospital gown? Throw it in your hospital bag along with your favorite pair of socks or slippers! Surround yourself with things that will make you feel relaxed and at home, whatever they are. No detail (i.e. laptop, tablet, certain movies, etc.) is too small when it comes to making yourself feel relaxed at the hospital on your big day.
Choosing which hospital you birth in is an important decision. Just as important is familiarizing yourself with “your” hospital and getting comfortable in it. Even if the hospital setting seems intimidating and uncomfortable there are many things you can do to lessen your fears. Have faith, be patient, and keep trying. You will feel relaxed in a hospital and will have a wonderful birth there, too.
Did you give birth in a hospital? What was your experience? How did you familiarize yourself with the environment? Share your thoughts and stories in the comments below!
It's a fact that saddens me to this day, but I put more effort into planning my first child's first birthday than I did planning his actual birthday. The truth is that birth overwhelmed me. My pregnancy continued despite me being in denial about just how important and transformative his birth would be. This post is all about providing others that might feel the same way I did with some guidance.
You've reached that magical 20 week stage, seen your little bub wiggle around at your 20 week scan, and maybe even been told your little miracles gender. Its an exciting time, you might start to think about nursery furniture, baby names, those oh so gorgeous teeny-tiny baby outfits.
Its also time to start thinking about how you are going to welcome this little person into the world. How do you plan to meet your child for the first time? This will be their first chance to see the world, what will their first impression be? Each birth is unique, but one thing is for sure, this is a moment that will be etched in your memory like no other. While the 10000 onesies and those gorgeous cot sheets are important, are you spending more time on the things that are fleeting and less time on that which will be everlasting?
Preparing for birth can be overwhelming, so I have put together my tips on how to get started.
Step 1 - Plan
What do you want for this birth? What would your baby want? What does your partner want? Start with a conversation, and see where it takes you. In the ideal world, how would you like to give birth? What is important to you, and what do you think is important to your baby? Write a list, draw a picture, or take some time to relax and visualize your perfect birth. Now spend some time writing a list of how you can achieve this.
Most of the significant achievements that we experience during our lives involve some sort of plan. Whether is be a sporting achievement, wedding, party, or celebration, the first step is to plan. Traditionally, the birth plan is something put together at the end of a pregnancy, and is sometimes seen in a negative light. I recommend that families start planning early on. A birth plan is not just a piece of paper that you have in your hand at the end of your pregnancy, a birth plan is also the steps that you will take leading up to the end of your pregnancy. Are there fears that you need to work through? Does your partner have fears that they need to discuss? Is your caregiver supportive of your choices? All these questions are best answered early on in your pregnancy so that you can address them. I was told during my first pregnancy that planning would only set me up for disappointment. Now, as a birth worker, it is one of the most common questions I get asked - If I plan for my birth, will I be disappointed if things don't go as planned? My answer is that a birth plan is a way for a family to be in control of the choices that they make. Studies show that the key to a positive birth experience is a sense of mastery of the experience. A birth plan is a way for families to discuss their preferences, list their choices, and to be in control of how decisions are made during this most momentous event. Birth plans or preferences are not about sticking doggedly to a set of pre-determined events, its about putting families in the drivers seat so that they do not become passengers in their own birth. Most people have a plan when they go to the supermarket, so don't be afraid to plan for what will be one of the most significant moments of your life.
Step 2 - Prepare
Read, read, read. Books, positive birth stories, and blogs. Start building your library. Look back through your plan, and pick out 3 things that you would like to learn more about, and find some recommendations for articles or books to read. (I have created a list at the end of this article). Whether it be birth, breastfeeding or parenting, there are a plethora of wonderful resources out there for you. Reading positive birth stories is also a great way to feel inspired and help you prepare. Join a prenatal yoga or exercise class. These are wonderful way to prepare your body for birth. Its also a great way to start to build you village, and meet like minded women. Start thinking of some positive birth affirmations. Positive affirmations start with words like “I will” or “I trust” “I am”. Look at the list that you created in step 1, and create your affirmations from this. For example, if you have written that you would like to birth by using your own instincts, a great affirmation would be “I trust my instincts to birth my baby the way I want.” Relaxation and meditation are other great ways to prepare for birth, and a wonderful way to enjoy your pregnancy.
One of the best investments you could make in your birth is independent childbirth education. There are many opportunities in the community for childbirth education. You could try checking local hospitals or birthing centers for classes.
Step 3 Create your village
Becoming a parent starts to moment you become pregnant. There is a famous saying that it takes a village to raise a child, so why not start creating your village while pregnant? A family that has a strong support system in place before your birth, which stays in place after birth, is more likely to have a positive birth and postnatal experience. Education and support can come in so many variations, but there is an army of dedicated birth professionals out there who feel it is a privilege to support families during this life changing time. Your village might be a group of like minded women (either online or in person), Doulas (both birth and post natal), childbirth educators, midwives, supportive caregivers, and postnatal support professionals such as health nurses, Doulas and breastfeeding counselors. Some of you might have a large village, and others a smaller village. Surround yourself with people who support your goals, and your preparations will flourish.
Lastly, if you need help, start researching birth professionals in your area. Ask at your local council or mothers group, breastfeeding groups or midwife clinic. The birthing community is a wonderful network of professionals who are well trained and perfectly suited to support you during your pregnancy, birth, and parenting.
<Remember, this is the only chance that you will have to meet your baby, and the only chance that they will have to be born. Don't be afraid to explore options, and don't be a passenger in your birthing experience. So, how will you and your baby meet?
“Birth Matters” Ina May Gaskin
“ina Mays Guide to Childbirth” - Ina May Gaskin
“Birthing From Within” - Pam England and Rob Horowitz
“New Active Birth” - Janet Balaskas
“The Thinking Women Guide to a Better Birth” - Henci Goeer
birthwithoutfearblog.com - great inspiring birth stories
documentingdelight.com.au - some wonderful positive birth images and stories
Creating a Birth Plan is a great idea regardless of where you are birthing. This makes sure that you and your care provider are on the same page in terms of what you want for and from your birth. When you're in labour you will not want to spend a lot of time explaining your wishes. It's nice to have people just know their role and what's expected of them, this makes for no suprises with conflict in your wishes.
Some considerations of things to include:
To learn more about birth plans visit this site or any other resources you can find online.
This birth plan article may also provide you with additional things to consider in your birth plan.
Go back to: Step #5: Tests and Ultrasounds
Go ahead to: Step #7: Gathering Birthing Supplies
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Creating a birth plan is, in my opinion, an essential step towards planning the hospital birth you want. As I’ve previously discussed, there are many options and considerations regarding birth that you should familiarize yourself with so that you can feel confident that you have made the choices you want prior to going into labor. A birth plan can help you identify aspects of labor, delivery, and newborn care that you still need to explore, as well as help you communicate your wishes to your provider and the hospital staff ahead of time. While creating a birth plan is not necessarily a guarantee that events will unfold exactly as you wish, it will enable you and your support team (partner, doula, friends,) to make choices on the fly, when the last thing you want to do is make decisions.
There are a number of ways you can start building a birth plan. There are many sites that discuss different components of a birth plan, and others that actually give you a template. You don’t have to use any of these, or you can pick and choose which parts you want to include in yours. This link is to a worksheet on the Earth Mama Angel Baby website that you can fill in the blanks and check off boxes that pertain to your wishes. It includes many obvious options such as labor positions, who you do and don’t want to be present, circumcision, and induction options. There are also as others that I had no idea were even options to consider like enemas, pubic shaving, and frequency of vaginal exams.
Another consideration is how you word your birth plan. This article was a great help for me and can help to give you perspective on how your plan may be viewed by others. While our wishes are important, the way we communicate those wishes can make all the difference in the world. When you write your birth plan, discuss your preferences rather than listing your demands. Nurses and doctors in hospitals are quick to push for interventions and pain medications because it often makes their jobs more predictable and easier to manage. If you do not want interventions and pain medications, you should say so, but try to do it with the same respect and understanding that you would like them to treat you with while you are in labor. I’m not saying that you should kiss their behinds to get what you want, but outlining your wishes in a way that acknowledges the hospital staff’s challenging work may elicit a greater willingness by them to work hard to respect your wishes.
This template is also a great one for mama’s planning a natural birth in the hospital. It has many natural birth and newborn care options that other templates don’t include such as Vitamin K options, and delayed cord clamping. Reading through this one may also give you ideas about what you want to look in to before creating your own birth plan, even if you are not sure about your desires for a completely natural birth.
I could give you a list of all the things to consider, but the list would be long and you will likely learn more from your own investigation of birth plan options. Take your time developing your birth plan and reading up on all the options available. Your desires may change as you progress through pregnancy, but starting the plan now will allow you time to make informed decisions before you’re thrown into labor and don’t have the option to Google something.
Once you have finalized your birth plan, (I would suggest not doing so until you are about 6 weeks from your EDD, but don’t wait too long,) print out multiple copies. Bring one with you to your next prenatal appointment with your provider, mail one to the hospital with your insurance paperwork, give one to each of your support people, and put an extra copy or two in your hospital bag. Discuss your birth plan with your provider, and evaluate his or her reaction to your choices. If you find that your provider is not receptive to your plan or your wishes, try to find out why, and if you are met with a great deal of resistance, you may want to consider switching providers. Also, discuss your plan with your support team so they have the opportunity to clarify any questions they have.
Building a birth plan can be an empowering experience and bring you closer to feeling confident in your ability to birth your baby how you would like. When I was in the nitty-gritty of labor, I was not capable of listening to my options with a critical ear, much less making decisions. I felt a sense of confidence knowing that I wouldn’t have to articulate my wishes, because they were already laid out on paper for anyone with questions to reference. A birth plan may not be an insurance policy or guarantee that your labor and delivery will go exactly as you envision, but it will help you focus on your task at hand: birthing your baby!
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There are many logistical reasons for choosing to deliver your baby in the hospital, all of which are valid. Even if you would have preferred to deliver at home or in a birth center but are required (by insurance, care provider privileges, legal implications or distance challenges), you can still have a beautiful birth the way you would like. The key is to educate yourself about your choices as a mother and a patient. Regardless of where you birth, the experience is in your hands! Planning and preparation is the key to a positive experience that ends in a healthy and happy mother and baby.
The writings in this series will consist of information from my two hospital births, conversations with mothers who have had births in a variety of settings, as well as reading and research from a variety of sources. I will include embedded links within articles to my sources, as well as list my sources at the end of each article. If I am speaking from my own experience, or the experience of others I will indicate this as well. I hope that through my experience and research that I may provide you with the tools you need to plan your birth the way you would like it to be. There is no set way to birth that is foolproof or that works for everyone. I had no idea how much I didn’t know until I stumbled upon various websites and Facebook pages that aimed to educate and inform women of their choices about birth. It is my hope that through these writings, I may help you to better understand your options, especially those options you didn’t even know you had!
Birthing in a hospital can provide a sense of security for both the mother and her partner by knowing that medical professionals are there to assist if complications arise. However, it is important to remember that giving birth in a hospital comes with risks as well, including the risk that interventions may be encouraged by hospital staff. Knowing the benefits, risks, and circumstances that would necessitate interventions beforehand will help you make informed choices if the time comes. Knowledge is power, and a mother’s intuition is not to be discounted!
Birthing in a hospital provides the opportunity for elected pain management (epidurals, spinal block, IV medications,) fetal monitoring, newborn screenings and immunizations, and nurses to cater to your needs so your birth partner can focus on supporting you. Also, in the event of maternal or fetal distress, birthing in a hospital allows medical professionals to quickly react accordingly such as performing a c-section or an instrumental delivery. The availability of a hospital nursery may allow a new mom to rest and recover while her newborn is being cared for by the nurses. Meals are delivered bedside and help is just a push of a button away. Most hospitals also have a registered lactation consultant on staff that is available to aid in the initiation of breastfeeding.
Delivering in the hospital can also be a challenge. Many mothers report pressure from the hospital staff to consent to fetal monitoring, IV’s, pain medication, and cervical checks against their wishes. Mothers who intend to birth naturally and free of interventions often feel as though they are forced to allow monitoring, cervical checks, and feel pressured to consent to pain medications. Mothers who delivered in a hospital also sometimes feel that the frequent vital signs checks are disruptive to post partum recovery.
It is important for every pregnant mother considering a hospital birth to find out what the hospital’s general policies and procedures are, as well as make decisions about all aspects of her care prior to and during labor. Developing a birth plan can aid in this process and further empower the mother and her partner to communicate their wishes to their care provider and the hospital staff.
Birthing in a hospital can be a beautiful and empowering experience with the right knowledge and support! Information is power, and the key to having the birth experience you desire!
Go ahead to:
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This is important as it documents what your wishes are, ensures your birthing attendess know what you want and is important in the event you need to transfer to the hospital.
In your birthing/back up plan:
Be ready for any possibilities, so that you don't find yourself panicking when your baby begins to emerge in a breech position or his shoulders get stuck, or if the cord is wrapped around the neck (which is common). Most "complications" do not require medical assistance, especially for the possibility that you might feel you need to transfer to the hospital.
Here is the story my unassisted birth with my twin girls.
Go to the next step Step #9: Gathering Supplies
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