3.22.2011

Birth plans

A reader recently asked about my birth plan, and although I don’t think that mine was any spectacular piece of artistry, it was carefully planned, well thought-out and revised time and time again.

I followed the birth plan guide in Penny Simkin’s book Pregnancy, Childbirth and the Newborn. The Mountain Man and I were so lucky to be able to take her 8-week birth class, and even though 8 weeks is a long time and it involved rushing home from work to get in the car and drive an hour to the class and eat dinner on the way, it was so worth it.

Our birth plan was informed by Penny’s classes, her book, and lots of other research from books, websites, talking to people and discussions with medical professionals.

I made a choice to give birth with less intervention but in a hospital-based birthing center with a midwife. Ultimately things did not work out exactly as planned. My experience bringing baby home and coming to terms with my unmet expectations of my birth experience were perhaps more difficult than the birth itself. The adjustment was harder for me than the process.

My birth plan reflected my wishes for how the process played out. I was lucky to be in an environment with fairly progressive birth procedures, allowing me to walk, bounce, and sit in a tub as much as I wanted. When I needed it, interventions were available.

I included information about how I wanted things to happen in the event of an epidural (which I had) a c-section or a stillbirth, or if both my and my baby’s lives were in danger. These were the hardest sections to think about, the hardest to write and the hardest to articulate to caregivers. I am so glad that I thought about these things before hands, because I was clear about what things I was adamant about, regardless of the birth outcomes. I was also prepared mentally for things to not go according to my idea of a perfect plan, and the Mountain Man and I had discussed what we would do if the baby didn’t survive. These are not things that any expectant mom wants to think about, but I was glad I did. After a few tearful conversations, the Mountain Man and I agreed on our desired actions in any outcome.

So here is my birth plan. It’s not for everyone, but it’s what I chose. I accepted the vitamin K shot and the eye antibiotics, but after the Pie and I had been together for a while. She was quickly wiped off (not bathed) and placed on my chest. She was covered with a blanket and a hat and was able to nurse when she wanted. Her Apgar evaluation was conducted while she was in my arms.

 

Thank you!

Thank you for all you are doing to bring our daughter safely into the world! We are excited to be sharing this day with you and hope to create a peaceful, welcoming environment for her to spend her first moments. Your expertise and skill are greatly appreciated, and although we hope to avoid interventions we also trust your judgment about best courses of action for complications or unforeseen events during the birthing process.

Attending the birth

  • The Mountain Man and Megan’s mother will be attending the birth.
  • Other family members may come in for a short time to visit.

First Stage Labor

  • Freedom to change positions to alleviate pain and encourage descent. Use of postural aids.
  • Prefer less-invasive, intermittent or wireless monitoring when possible.

Pain Control/Medical Interventions

  • We have been preparing for a minimally medicated birth. Please offer us any guidance possible to help us to effectively manage pain.
  • Comfort measures including: bath/whirlpool, birth ball, squat bar, breathing techniques.
  • If needed, we will ask about other pain management options.
  • We will accept medications/interventions necessary for our daughter’s or Megan’s safety after they have been explained to us and agreed upon.

Second stage labor

  • Use of gravity-enhancing positions for pushing & birth (guidance would be gladly accepted)
  • Spontaneous bearing down
  • Prefer to be undraped, Megan may touch baby during birth

Tearing/Warm Compresses

  • Use of warm compresses, pressure and controlled pushing to encourage perineal stretching and relaxation.

Immediately After birth

  • Please place the baby skin to skin on Megan’s chest immediately after birth.
  • Please perform Apgar evaluation without removing baby from mother’s chest.
  • Please wait until the cord stops pulsating before clamping/cutting. 
  • Megan will breastfeed at the baby’s demand immediately after birth.

First Hours After birth

  • Please do not remove the baby from the room unless necessary for her health/safety.
  • Please postpone vitamin K shot & eye ointment as long as possible. Please administer while Megan holds baby, if possible.

Unexpected Labor/Delivery Events

  • Epidural- in the event of an epidural, we would prefer to use delayed pushing after full dilation. Please follow the birth plan as closely as possible. 
  • Cesarean - In the case of a cesarean, (if possible considering medical needs of mother & child) please place the baby skin to skin on Megan's chest immediately or as soon after birth as possible; please wait until cord stops pulsating before clamping. 
  • Medical problems, stillbirth or risk to baby's or Megan’s life - If the baby is in need of immediate medical intervention please do everything necessary to care for her. In the event of a stillbirth, please place the baby on Megan’s chest and allow time for welcoming her and saying goodbye. If both lives are in danger, please make Megan the priority patient.

 

I think it’s very important to consider the outcomes that may be less than ideal, and to address them. It’s also important to keep the birth plan short & sweet, and easy to reference for the birth attendants. Thanking the birth team (and then bringing them chocolate the next day) will work wonders to keep them happy!

It’s important to decide how you want things handled and make your opinions known from the beginning, but flexibility is critical as well. Birth is a process that just can’t be completely planned for or controlled. You have to know what your non-negotiables are, and be willing to make necessary compromises on other things.

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