Saturday, February 26, 2011

a natural birth plan dissected.

Although this hospital birth plan was a moot point after we switched to a homebirth midwife, writing a birth plan really guided me to realize that I wanted to give birth to Liza in a 100% natural intervention-free birth.    *The birth plan bullets are in bold.*

Please do not offer me an epidural or other pain medications.
Even though I knew my resolve for a natural birth was strong, I had read enough about transition to know the allure of numbing drugs would be strongest during the phase immediately prior to pushing and I didn't even want that card on the table at the most difficult stage of labor.

I am happy to have 20 minutes of electronic fetal monitoring upon checking in.  After that, I prefer only 15 minutes of monitoring per hour.
Electronic fetal monitoring is the strap placed across your belly checking baby's heart rate and your contractions.  Research consistently shows constant fetal montitoring does not improve birth outcomes and being strapped to the bed is the last thing you want during a natural labor.

After the initial cervical check, I would like my cervix checked only upon my request.
If you are in labor, you are in labor and the baby is coming.  Knowing your dilation, effacement and station tell you nothing about when your baby will be born.  You might have a short early labor and a long active labor or vice versa.  Emotional signposts are much more effective at letting you know your stage of labor.

I decline all IV fluids.  I will stay hydrated and energized by drinking and eating at my own discretion.
Although they do not address possible risks os IV fluids, even ACOG (which has no concept of 'normal' birth) states women should be allowed to drink clear fluids at their own free will.  Of course, the same release states that a laboring woman wouldn't want to eat.  But, if a woman does want to eat, she should absolutely be allowed food.  Labor is like a marathon, taking every bit of your physical and mental energy.  Would you restrict foods to a runner simply because of the tiniest remotest possibity she might need general anesthesia for an emergency surgery?  I think not.

I would like my bag of waters to remain intact.
My baby is in a bag of water for a good reason.  I prefer not to mess with a good thing to possibly shorten labor by a few hours.  Amniotomy is not medically necessary.  Fact.

Freedom of movement will be important during labor and delivery.  I will not be limited to the lithotomy position as I push.
During labor, movement is important in order to cope with labor pains, to aid gravity in moving baby down into the birth canal and to help baby get in the optimal position for birth.  The lithotomy position during the pushing phase only serves to give the birth attendant a good view of what is happening below.  Pushing flat on your back is not a good idea for a number of reasons, such as it narrows a woman's hips and compresses major blood vessels limiting blood flow to your hardworking baby.  Squatting, kneeling, or hands and knees are much more comfortable and physiologically appropriate for delivering a baby.

I intend to use "mother directed pushing".
If you are not numb from an epidural there is no need to be told when to push.  Your body will let you know when the time is right.

I prefer to tear naturally rather than receive an episiotomy.
Think about this way:  either a doctor can cut you to the point he thinks is necessary or you can allow your perineum to tear to the point which is necessary for your body and your baby.  Also, research shows that episiotomy can do lasting damage unlike a spontaneous tear.  Of course, not tearing at all is the best case scenario and there are plenty of things your provider can do to prevent perineal damage during delivery.

I intend to breastfeed and use kangaroo care immediately after birth.
Why would I want my baby swaddled and  placed in a warmer immediately after delivery when my bare chest is warm and cozy and just right for initiating the very important first breastfeeding session.

Baby's cord is not to be cut until it is finished pulsing.
Baby receives oxygen and blood from the placenta via the umbilical cord until the cord is white and no longer pulsing.  There is no need to clamp and cut the cord until my baby gets every bit of blood and placental goodness that belongs to her.



TheSandersFamily said...

I think this is a good hospital birth plan. Although, you were a little nicer than I would have been :p I would not be happy during those 15-20 minute EFM sessions at all. I requested the fetoscope or a quick listen with the doppler of my midwives and would request the same of a doctor. I think it's good to include that you want no medications to induce or augment labor, no enema and no iv fluids (instead have access to water and food as needed).

I also think it's important to have a baby plan or immediate post-partum type plan to be clear on wishes for your baby and your immediate care afterwards like rooming in, yes or no to the eye ointment, vit K, Hep B shot, whether or not you want to keep your placenta, no artificial nipples for baby, etc

I am so glad that going into the birth of my babies that I didn't have to worry about all this crap (i did have emergency transfer birth/post birth plans). It should be the standard instead of all these requests being the exception.

TheSandersFamily said...

I guess I had a lot to say on this subject ;)

Rebecca said...

So Laura-what are your thoughts on your water breaking naturally, as in you are still home but having a hospital birth????

Laura @ our messy messy life. said...

Okay....I actually left out a few bullets last night because I thought it was getting too long.

My original plan also said no IV fluids -- I'll add that one back to the post because you are right. That is important.

I also left out that I wanted to deliver the placenta naturally, without pitocin or cord tugging and be givenn up to 1.5 hours for placental delivery.

I also had that we did not want eye goop, Vit K (unless WE deemed the birth traumatic) or Hep B shot.

The rooming in, no artificial nipples, and no labor augmentation were not in my plan because I felt those were things that would be verbally stated and did not need to be in the concise plan.

*** 15 minutes/hour of EFM was a a MAJOR concession. My ob and I went back and forth on this one and he said there was absolutely no way I would be allowed to have less than 15 minutes/hour. I was just hoping the nurse would be nice and hold the monitor on me as I freely moved.

I seriously can't imagine a hospital that would allow a fetoscope or doppler during labor. It doesn't provide the all important "strip" for your file.....even though research shows time and time again that EFM DOES NOT IMPROVE OUTCOMES.

Mandi, I have a lot to say on the subject too.

Laura @ our messy messy life. said...

Rebecca, if your water breaks, your water breaks and you can't do anything about it. You want to stay hydrated because amniotic fluid replenishes itself, decline cervical checks because that introduces bacteria into your cervix and keep moving in hopes that labor starts/picks up on its own.

Midwives are fine with ROM (rupture of membrane) unless the woman develops a fever -- sign of infection, or the baby's heartrate does not stay steady.

Kaitlin @ More Like Mary said...

We used your birth plan to help us when writing ours!

One thing that I was pleasantly surprised by was the external monitoring during our labor. We also had agreed to 15 min per hour and I was dreading spending those 15 minutes in bed. BUT the cords were long enough to allow me to walk around the entire room and the belt wasn't uncomfortable at all. The nurses offered to take it off at the end of the 15 minutes and put it back on later, but I just left it on because it didn't bother me. They came in on the hour to turn the machine on and let us turn it off after 15 minutes had passed. No big deal at all!

I agree with Mandi that a baby plan is just as important. Ours was followed to a tee and it made me so relaxed and trusting of the nursery staff.