Mike and I have been working on our "birth plan" for the past few weeks. We want to try for a "natural" birth if possible, but we also want the security of delivering in a hospital in case any medical emergencies arise. We've both been reading lots of books, with our favorites so far being Hypnobirthing (thanks, Mom!) and Natural Hospital Birth, and I've also been scouring the internet for helpful (not horrifying or sensationalistic!) information.
This blog post a nice seven-point summary of the latter book:
1. Plan it. Absolutely have a dream birth and write it all out if you want to. While so many well-meaning friends, docs, and childbirth educators tell women to “stay open” she says there’s still a place for being very clear about what you want.”To the call for flexibility I say, ‘Let the hospital be flexible!’” Her most important advice: “Make a birth plan, and get attached to it!” She says you don’t have to hand this long document over to everyone you encounter– the headlines will suffice– but for your own process, writing it down can help you.
2. Get a great birth team together. Think about who will be with you to support you in labor. You really want to have a midwife or doctor who supports your wishes. This might mean you need to switch care providers mid-pregnancy (don’t worry, they’ll have plenty of other patients), hiring a labor support doula and taking a childbirth class “Taking charge of creating a positive birth team is a vital step in preparation for a natural birth.”
3. Learn about what happens in labor and what it feels like. Her sections on this topic are outstanding. She describes different kinds of labor but throws in amazingly accurate descriptions of what a woman looks like and acts like (for the partners) and feels like (for the moms who’ve never given birth before). She writes about particularly challenging moments: the car to the hospital, triage, mid-active labor (at around 5-6 centimeters dilation) and transition.
4. Learn lots of coping strategies. Investigate all the ways you can cope without pain medication and practice a bunch of them with a partner beforehand. Gabriel gives a list of ways to help cope (she is a very big fan of getting in the water– a tub or shower) but also describes in detail how these things play out and help at various stages.
5. Wait an hour. When a medication or a medical procedure is proposed ask, “what if we wait an hour?” How this is answered will give you a lot of information. Sometimes you say, “What if we wait an hour” and the doctor says, “Oh, OK.” Now you know this is not an emergency but a suggestion.
6. Stay home in early labor. And while you’re at it? Ignore it! Ignore it until you can’t ignore it anymore.
7. Eat, cry or move. Often if a woman reaches a plateau in labor and it seems to slow down– often eating (for energy), crying (to release stress) or moving (to enable better positioning for the opening of pelvis/descent of baby and/or reducing pain) will likely help!
This blog post was also helpful for suggestions about incorporating home birth practices into the hospital setting:
1. Stay home in early labor.
In first births this is especially important. There’s no reason to rush off to the hospital at the very first sign of labor. Stay home until you’re in active labor (this starts when contractions are 3-5 minutes apart). And do what home birthers do. Dim the lights, keep random people away, get in the bath, get in the shower, moan, groan, get on all fours, rock back and forth, eat and drink lots of water or Gatorade.
2. Think of hospital procedures and medications as “back up” as opposed to essential.
Birth may be difficult or hard or downright painful but most often it works. We are designed to do this. And in the instances where something isn’t working out we have fantastic medical technology to back us up. Home births work on the assumption that, in low-risk pregnancies, all will be fine and in the case that something does come up, you can transfer to a hospital. You can get into the mind-set that hospital care is a “back up” even if you do know you’ll be going there for the actual birth. This can build your confidence both in normal labor and in medical technology. Both have their place.
3. Learn some other ways to cope with pain than the epidural.
If you’re giving birth at home you can’t get an epidural, so you’re forced to really educate yourself about other options for reliving pain in labor. Even if you know you want to get an epidural in labor, you might benefit from learning these other techniques– massage, changing positions, vocalizing, hypnosis, etc– as you may go through some portion of labor without pain medication for any number of reasons. In general, learning lots ways to cope helps build confidence.
4. Get a midwife.
In the US most babies born at home are delivered by home birth midwives. But midwives deliver in birthing centers and hospitals, too! And they are often covered by insurance. There are lots of myths about midwives circulating, but the fact is certified midwives are trained medical professionals who can prescribe tests, sonograms and medications. The only thing they are not trained to do is surgery. But we have doctors for that.
5. And/or a doula.
A doula provides continuous labor support, something not offered by hospital staff or obstetricians or even (some) midwives. This continuous support has been shown to reduce the chance of medical interventions including c-sections and even shorten the length of labor. Doulas are often used in home births as a primary source of comfort and support.
6. Labor in your tub and/or a hospital shower as much as possible.
Women giving birth at home often rent or buy a birthing tub to help with pain in labor. Being fully immersed in warm water can be as effective for coping with pain in labor as an intramuscular shot of narcotics. Birthing centers and a few hospitals have tubs for laboring, if not there will be a shower which is a good runner up.
7. Read about what normal birth is like.
Pick up one of Ina May Gaskin’s books or another book about how normal birth works, and read it. Gaskin’s enthusiasm for the female body can be infectious. It can give you just the reassurance you need.
8. Avoid people and websites and books and movies that make you feel overly anxious about birth *including movies that make you feel anxious about the hospital.
Reality television shows that feature dramatic medical emergencies and terrified pregnant teens get ratings but are they instructive or inspiring when you’re expecting? Maybe not. I’d also caution against watching documentaries or TV shows or reading birth books that highlight things that can go wrong in the hospital. It’s time to be skeptical, sure. But it’s also time to build confidence and minimize fear.
9. Focus on ways to make the hospital birth a more intimate experience.
Labor hormones tend to flow when mom feels safe and protected. Birth, it turns out, is kind of an intimate experience. So have people with you in labor who believe in you and who believe in birth (partners can read positive birth stories, too). Play gentle, repetitive music on headphones if you want to. Turn down the lights when you get into your labor and delivery room. Bring your own pillows. Go to the bathroom and just sit on the toilet for a while. Talk to your partner in advance about how he or she can support you and help buffer you from all the logistical hoo-hah of checking into the hospital and getting settled.
10. Eat and drink AND MOVE in labor.
Some hospitals still have an outdated policy about not eating and drinking in labor. Some don’t. Most hospital staff won’t care of you have sips of Gatorade or water in labor. They’ll also turn a blind eye to snacking. Home birthers tend to eat and drink through labor to help maintain hydration and much needed energy. And they tend to move around a lot. Just because there’s a bed in the middle of the hospital room doesn’t mean you have to lie down on your back. If you’re not being monitored, get up and move! Or squat. Or lean. Or kneel on the bed. All this helps labor progress and it can take the edge off the pain.
We have our all-in-one birth class this Saturday. (Two weeks after my parents took their grandparenting class. They are so much more prepared than we are!) We'll then have a few weeks to practice breathing/relaxation/visualization exercises, to prep our iPods with good music, to re-read the important parts of the above books, to remind myself that my body knows what to do, to pack our hospital bags, and to finalize our "birth plan." We're coming down the home stretch!
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