Wednesday, March 30, 2011

What's What Wednesday: Birth Planning-Part Three

Guest post by Julia of A Little Bit of All of It on the ins and outs of planning for a birth center birth experience.

For the birth of my baby girl my husband and I decided, after much thought and consideration, to use a birth center.Having said that, I still felt it would be beneficial to us as a couple and to our midwives to have a set birth plan. After discussions with the midwives and reading over materials from the birth center, I knew that most of my requests were a matter of course. I determined it was best to go ahead and still have those things in the birth plan (even though they were standard procedure at the birth center) in case of a hospital transfer. That is a good thing to point out; don't feel that just because things are the norm at the center you don't need a birth plan. You never know what may happen that may alter where you end up giving birth or whether an emergency caesarean is required. I made sure to also include my wishes for caesarean in the plan as well.

Once I had a set idea of what was most important to me and reviewed with my husband his expectations for the birth of our child, I started making my list. I used Pregnancy Today to help me compile the list with the items I had already predetermined.

Our detailed birth plan appears below. After the plan, I'll detail how things actually played out and my thoughts for our next birth if we are blessed with another child.

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Birth Preferences - Julia Middle Name Last Name
Due Date: 03/22/2009
Patient of Midwives Names— Name of Birth Center
To those attending my birth:
Thank you so much for being a part of our birth and for helping us have the birth we desire. My support people are my husband and mother and I would like them to be present during labor and delivery.

LABOR

I wish to be able to move around (including walking) and change position at will throughout labor.
I would prefer to keep the number of vaginal exams to a minimum.
I do not want a hep-loc.
I do not wish to have continuous fetal monitoring. Intermittent checks are preferred.
I do not wish to have my membranes ruptured.
I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation, etc.) if the labor seems to stall.
I have been educated on the available pain medications. I'll ask for them if I need them. Please do not offer.
I do not want an episiotomy. I prefer to tear.
I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch and, if possible, would like to use perineal massage to help reduce tearing. DELIVERY

I would like to be allowed to choose the position in which I give birth and would prefer not to birth lying on my back.
I would appreciate having the room lights turned low and having the room as quiet as possible for the actual delivery.
I would like to have the baby placed on my stomach/chest immediately after delivery.

IMMEDIATELY AFTER DELIVERY

My husband does not wish to cut the cord. I would prefer that the umbilical cord stop pulsating before it is cut.
I plan to keep the baby near me following birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
If the baby must be taken from me to receive medical treatment, my husband or my mother will accompany the baby at all times.
I do not want a routine injection of Pitocin.
I do not want eye medication or the Hep B shot administered to my baby.
Please delay the Vitamin K shot until the baby is sleeping.
I would like to hold the baby for at least 1 hour before (he/she) is examined.
In case of emergency, please do not cut the cord during resuscitation.
Please do not bathe the baby. We will take care of that when we get home.
Please do not administer the PKU test. We will have the baby tested at a later time.
I do not wish to be separated from my baby. Please discuss with us first if required for health reasons.

BREASTFEEDING 

I plan to breastfeed the baby and would like to begin nursing very shortly after birth.
I do not want the baby to be given a pacifier.
I do not wish to have any bottles given to the baby (including glucose water or plain water). CESAREAN

If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
I would like my husband present at all times if the baby requires a Cesarean delivery.
If the baby is not in distress, the baby should be placed on my stomach/chest immediately after birth. If this isn’t possible, I would like the baby skin to skin on my husband.
If the baby is in distress, I would like my husband to accompany the baby at all times and my mother be allowed to stay with me.

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Now I'll go through how everything actually happened . I'll preface this by first saying that I had a truly beautiful, wonderful birth experience. I was able to have the water birth I hoped for and was able to use relaxation to cope with the contractions. My support partners (my husband and mom) were fantastic as were the midwives and nurse practitioner that attended my birth at the center. In spite of all that, there were definitely unexpected things that occurred after the birth that I was not prepared for. Without going into all the details because that is not what this post is about, I will say that I required an emergency transport a little over an hour after the birth for postpartum hemorrhage. I ended up needing 2 pints of blood and was not able to leave the hospital until the next day. My daughter was perfectly healthy in every way and never needed to be admitted.

Because of my situation, I can tell you what happens when the birth plan was put to the test so to speak. All of the items under labor and delivery were followed with no problem. Like I said at the beginning, mostly those were standard procedure at the center. Under Immediately After Delivery, I did get Pitocin injections since I did not stop bleeding. It was discussed with the midwives ahead of time that it would be used only in case of emergency, which was my case.

Our baby was taken from us both when I was rushed to the hospital and, to my knowledge, this was not discussed with either of us. (I had a seizure and passed out and the EMT's were called at this point.) Unfortunately my mom had left the center as things were fine when she left so that aspect of the plan could not be carried out. Instead, our baby was given to my in-laws and neither one of us saw her again for an hour or two. In talking to my husband afterwards about the fact that we had listed that he remain with the baby in case of an emergency with me, he said that he was not going to leave my side and would do it the same way again. He felt that our daughter was fine, that I was not, and that she was with family that loved her. I have mixed feelings on this to this day but it is what it is.

Under breastfeeding, we were able to initiate breastfeeding within that first hour. However, we were not able to again for quite awhile as I was separated from my daughter.

Looking back, one thing I wish we had done was to talk over and review our birth plan with my in-laws. I think that would have really been helpful in a lot of ways. This is important no matter where you choose to give birth but especially if the way you plan on giving birth is different from what is traditionally done. I think had we given them time to read through it, we could have discussed things they had questions about and had a chance to explain the reasons. As it was, there were several things they had a hard time with and were upset about, and obviously after the birth/during the birth was not the time to discuss things. Anyone that will be there for the birth or with you during recovery should see your birth plan and have time to discuss it with you to reduce the amount of concerns/questions, etc. at the time of birth and after when emotions are running high.

I hope this was helpful in understanding some of the advantages to having a birth plan and that it highlighted some of the ways that things may go differently than anticipated as well. I know I plan on having some discussions with my midwives and family members after my experience and will now know what to add in my birth plan for the next time.

Julia is mom to Marcella, a just turned 2 year old and blogs at A Little Bit of All of It on a variety of topics. You'll find product reviews and book reviews along with her take on babies, parenting and childbirth. Posts on food, Christianity and daily life round out the blog. Guest writers are regularly featured and there is also the occasional giveaway. She also volunteers at Natural Parents Network. You can find her on Facebook as well. 






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7 comments:

  1. I agree, it's super important to talk and talk with everyone who may be involved about your birth plan, and most importantly, the things in your birth plan that you feel most strong about. I think that the shorter the birth plan, it's also more effective, as sometimes, there just isn't time to read pages about what you want.

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  2. Definitely! I didn't include it, but I made sure mine ran only one page long. No one wants to flip through multiple pages when time is of the essence!

    Julia @ A Little Bit of All of It

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  3. I am so glad that all turned out well! Let's hear it for March 2009 babies! Thanks for sharing your story with us all :)

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  4. Yay! March babies are the best! I am loving this 2 year old stage!

    Julia @ A Little Bit of All of It

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  5. I congratulate you for standing up. Dealing with the in-laws is very stressing and i really feel that no one can understand what little patience a woman has with visitors during labor and 36 hours after being home.

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  6. Thanks for the research. It was very useful. I keep in thoughts. Thanks a lot for discussing such a awe-some details.
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