Giving Birth

A birth plan? You mean you plan how it goes?

Doesn't it just happen? Well, yes, things are going to happen. Your body will do what it does. Trust your body.

And... many things can happen that you have a say-so in.

As a child, I often heard from my parents the 5 P's- Prior Planning Prevents Poor Performance.

In this case, you are not performing per se. But you do expect how things will go, and preparing ahead of time will provide the best outcome, reduce stress and create empowerment.

In our experience talking to our labor and delivery nurse friends, much of what is in birth plans brought to the hospital has become common standards of practice. Present your birth plan to your nurse and discuss it together so you are on the same page.

1. Prepare for many situations - Check out https://www.betterbirthstories.com/. Whether you have an unassisted home birth, home birth with midwife and doula, birthing center birth, hospital birth, or birth along the way in a taxi, it's best to make some decisions ahead of time how you want it to go, ideally, and write that plan down so your partner or support team can best care for you. During the birth, trust us, you will not likely be in the headspace to make a lot of decisions. Clear the way for an empowered birth by making a birth plan A and include what you would like to happen should scenario B or C or D happen.
   
   
2. Have an advocate to make sure your wishes are the main focus - be prepared for ways to say no and stick to your plan. This could be your spouse. And many women also have additional female support, such as a sister, mother, or friend. Keep in mind how this person usually reacts under unsure situations or stress and wants that way of being around you during a difficult time. ?? For this reason, many mothers choose a non-family member and hire a doula and midwife, highly trained for the situation. We suggest searching for a local doula and midwife. It is worth a few hundred dollars to have the support that is solely focused on your care.
   
   
3. Long labor? Specific movement patterns can get the baby in the "ideal" position for delivery. Learn exactly what fetal position is, why it’s so important for labor and delivery, and how to coax baby into the ideal fetal position for labor.
   
   
4. Episiotomy vs. perineal massage. Do you want the OBGYN to cut the perineum (lower portion of the opening of the vagina, between anus and labia) or provide perineal massage (stretch) the opening instead? These days, perineal massage is more common. Episiotomy or lacerations requiring stitches can mean days or weeks of difficult healing. We suggest planning on the perineal massage and asking for hot packs before the perineal massage; they feel so good! Side note, too much perineal massage can cause swelling and great risk of tear during delivery. Passive descent or laboring down can be a great way to naturally and slowly stretch the perineum.
   
   
5. Pitocin will likely be heavily marketed to you or even insisted upon if your cervix does not dilate according to a labor curve. Pitocin is used to speed up the labor, bringing the contractions on much faster and more consistent than naturally produced oxytocin. Some suspect it impacts the baby. (What are you implying by impact? I think we should clarify because that sounds scary.) One risk of Pitocin is that when administered in a high dose over a long period of time, it can cause excessive bleeding after delivery. A natural way to increase your contractions is nipple stimulation which releases a mother's natural oxytocin. You can do the by placing your pointer and middle finger in a v position on the areola (not the nipple, this can make the nipple sore before breastfeeding even begins) and move fingers back and forth. You will be surprised at the body's response! The goal is one contraction every two minutes or 5 in 10 minutes so don't overdo it! Pitocin and the movie Business of Being Born have led many veteran mothers to switch to birthing centers or home births.
   
   
6. Epidurals to ease pain will also be offered in a hospital. These are not an option at a birthing center or during a home birth. During contractions, your spouse or mother/sister/friend may have a challenging time seeing you in that position and may urge you to take the epidural. If you want to, it's your choice! Now, most people want to ease the discomfort. (I don't understand what your meaning is here?) If you do not want to, out of concern for the possible effect on the baby, or you do not want the hormonal disruption (some report it can make you feel spacey and less bonded to the baby initially), make it very clear ahead of time that under no circumstances are they to give it to you. Keep in mind, women have been giving birth for many thousands of years without chemical pain killers. It may feel like you can't do it for a short time, but you can! Long-term history proves it.
   
   
7. Skin-to-skin - Unless there is a complication with mama or baby, the baby will be placed on your chest immediately after delivery and left there for the first hour of life or so. This gives the baby the opportunity to instinctively start displaying "feeding cues" such as drooling, making suction motions with his/her mouth, or "rooting" crawl toward your breast and begin nursing. Birth can be a disruptive experience for baby too and being on your chest helps the baby to transition most effectively. The nurse may use a bulb syringe to remove excess secretions from the nose and mouth as the lungs learn to work for the first time and the amniotic fluid exits the body but many times this is not necessary and the secretions will be expelled or reabsorbed on their own. In extreme cases where the baby is not oxygenating efficiently, it may be taken to the baby warmer in the room and suctioned with a catheter by the nurse. Unless the baby is "too big", "too small" (each hospital will have a slightly different weight cut-off), born before 37 weeks (considered late pre-term) or you are diabetic, there is no rush to weigh the baby. However, the before mentioned situations can cause a baby's blood sugar to drop so having a weight on the baby early may be important.  Be specific in your birth plan about what you want and convey it to your nurse. Unless you are HIV positive or hepatitis B positive, there is no rush to wash your baby. Typically, you will be offered a bath for your baby sometime during your stay in postpartum. This was you get to have time immediately with your marvelous baby that you've waited all these weeks to meet!
   
   
8. The benefits of delayed cord clamping are clear. There are nutrients and many beneficial reasons to delay cord clamping—no need to rush. Enjoy the moment and the process. Click here to find out more.
   
   
9. Vitamin K Shot or Not? A hospital will definitely include a Vitamin K shot in their protocol. A midwife or birth center, not so much. Many hospitals will not perform a circumcision if the baby does not receive vitamin K. Click here to learn more. Vitamin K is given to help the baby with blood clotting. Keep in mind, babies have been born and thrived without the intervention of vitamin k for thousands of years. Just do your own research to decide what makes sense for you and your family.
   
   
10. Sleep - If you give birth in a hospital, several different machines will monitor you. The alarms can be worse than delivery. It is to be expected that this won't be a very relaxing and restful time. Prepare to be awakened if someone needs to mess with your IV or take a temperature or blood pressure or other reasons that seem completely maddening at 2:03 am. This may not work, but we suggest a sign that says, "PLEASE LET MOM SLEEP" or simply express your needs and desires to your nurses. This may help keep the interruptions to a minimum.  Also, another sign, if you wish to breastfeed exclusively, says, "NO FORMULA for BABY. MOM IS BREASTFEEDING."
    
    
11. Placenta - Decide if you want to take your placenta home with you ahead of time. If you do this, you will have to sign a release form at the hospital. You will also have to have a container or cooler to transport the placenta home and the placenta will need to be kept on ice. Typically, if a patient is keeping her placenta, she will have arranged with a doula to pick it up after delivery.
    
    
12. Baby medications - yes or no? Have an idea if you would like your baby to received erythromycin, vitamin k, or hepatitis B injection before you come to the hospital. Often times you are asked before delivery so everyone is on the same page. Be prepared that if you refuse any of the medications, the pediatrician may try to change your mind.

Support for preparation:

Sample Birth Plan from one of our moms who is a registered nurse.

Mom Tips:

Buy ahead of time (may be able to get from the hospital or birth center, but no guarantees):

Big elastic mesh disposable underwear for after the birth.

Ample supply of the jumbo jet-sized sanitary pads for after the birth.

Plastic squirt bottle to clean vaginal opening and/or episiotomy

Example of these three products here.

(Note this is not an endorsement of this brand, as we don't remember the brands of the ones we used, but this is an example only)

Courses:

Hypnobirth and  Birth Courses - Being prepared helps alleviate stress and facilitate birth. It's worth it to take a course with your support partner ahead of time.

The Bradley Method - Childbirth education class preparing a woman for a natural birth (home or in the hospital).

Books:

Gentle Birth, Gentle Mothering - Sarah J. Buckley;

Guide to Childbirth - Ina May

Doing It At Home podcast 

Pathways to Family Wellness

The Other Baby Book 

MUST WATCH MOVIE:

Business of Being Born movie

Don't forget to have a 4th Trimester Plan:

Put a note on the refrigerator with the list of tasks visitors can help with, such as laundry, sweeping, doing dishes, feeding animals, watering plants or gardens, or cleaning bathrooms.

Ask a mother, mother-in-law, sister, aunt, or friend to come to stay with you or at a hotel nearby to help with daily tasks, care for you and help with the baby for 2-3 weeks after the birth. This may seem unnecessary if you have a spouse and maybe even unwanted at this point, but after the birth, you will realize that female support will greatly appreciate it.

Plan out any care or helpers that may need to be hired to take care of work, animals, household chores, or, if you have other children already, driving and homework. Doing this ahead of time will save everyone from situations of stress.

Please note: This resource page is a work in progress. If you have suggestions, referrals, please comment below. If you are an adoptive mom and would like to contribute to support others to navigate that process, please contact us.