Writing My Birth Preferences

This is one of those posts that I’ve actually been pretty excited to write about.  Birth preferences!

Writing out my birth preferences this time around is so different from writing my Birth Plan from when Gabi was born. 

The hospital where I had Gabi provided a template, so I based my plan off of that so that I could give them information in a format with which they were already familiar and comfortable. 

With the hospital birth, there was so much more to worry about.  The Birth Plan, while certainly not adversarial, was much more of a defense against unnecessary interventions.  I had to specify things like no episiotomies, no continuous internal monitoring, give the baby to me immediately instead of delaying with newborn procedures, don’t give the baby formula or pacifiers, etc.  Even using the format provided by the hospital, the Birth Plan was very much a defense for Gabi and I against the standard protocol of the hospital.

I don’t have to do that this time and it’s blowing my mind!  All of those things I have to prepare for and defend against?  Those are things that my midwives don’t do anyway.  This notion of having my midwives working with me as a team that I already know and am totally comfortable with as opposed to a nurse I’ve never met who may or may not respect my right to informed consent is just incredible.

I’m not The Patient in Room 326.  I’m me.  They know me, and they respect me as an individual.

Because of all of this, my birth preferences are much shorter than they were the last time around.  I’ll list them here, and include my reasoning for each one.  The preference itself will be bold, and I’ll follow with the reason behind it to make it easier for you to skim.  If there’s something that’s not on this list that you’re curious about, let me know and I can talk more about that item and why I didn’t include it.  I promise I’ll be better about responding to my comments this week.

So, without further ado…

My Birth Preferences

I don’t want to know baby size until after she’s born.  No estimates please.  I know I can birth her “big” or not.  Baby size estimates can be off by more than a pound, and since I’ve already had a baby vaginally, I know that I don’t have a pelvic issue that would prevent my pelvis from opening to allow the baby to pass.  At 8 lbs 6 oz, Gabi came out at a pretty respectable size.  Women have “big” babies all the time.  It’s just not something I want to have to worry about.

I don’t want to have internal checks until I am ready to push.  Last time, knowing that I was walking around for a month at 3 cm weighed on my mind, and when I got to the hospital I found I was “only” at 5 cm.  Knowing this just shattered my belief in myself, so I’d just rather not know.  Realistically, it’s perfectly possible to go from 5 cm to 10 cm in an hour or less.  I know this rationally, but emotionally, those kinds of cold, hard numbers can be disheartening.  If I’m in active labor, I have faith that my body is doing its job in its own time. 

For those of you who may be considering this as a preference, you may encounter a health care provider who just really wants to start doing internal checks once you reach a certain number of weeks.  They may do this just out of habit or they may tell you they need to “establish a baseline.”  This is completely bogus.  The baseline for dilation is… not being dilated at all!  This isn’t a subjective thing.  You’re either dilated or not.  This is a measurement on a ruler.  There is also absolutely nothing you gain from knowing this number as it will give you no indication of when you’ll go into labor.  You could go from 0 cm to 10 cm in the space of 8 hours.  Or you could walk around dilated to 3 or 4 cm for weeks.  There’s no value in knowing this number, and every time someone reaches up in there you deal with risks: introduction of bacteria, accidental rupture of membranes, the temptation to strip your membranes without your consent, etc.

So no thanks on the internal checks for me!

Please feel free to suggest position changes!  I tend to freeze up when I’m in an unfamiliar situation and don’t know precisely how things are going to go.  I know that everyone says your body will tell you what to do when you’re birthing, but I really do tend to freeze up.  I’m so glad to have a great doula and team of midwives who will be willing to make recommendations if they notice me getting stuck.  Last time I felt like I just sat on the bed and didn’t know what to do.  I asked for the epidural so quickly that I didn’t really get the chance to see what my body would tell me.  I’m just not sure what to expect, so I’m very open to suggestions!

Please avoid using the word pain?  Instead, I prefer to talk about things like “intensity” and “pressure.”  This is a Hypnobabies thing.  In so many of the Hypnobabies birth stories, it seems like the mom is doing great until a nurse comes in and asks about pain level.  Then, suddenly, she loses her focus and starts feeling out of control.  Since “pain relief” in the form of medication really isn’t an option, I just prefer not to visit this area at all.  We can use words like “intensity” and “pressure” instead.

Please no AROM.  AROM stands for Artificial Rupture of Membranes.  That’s when they go in and manually break your water.  There are about a gillion reasons why this is not a very good idea, but rather than list it all here, I’ll simply refer you to this article from Midwife Thinking in Australia: In Defense of the Amniotic Sac.

I would like to birth my baby in the water.  That’s right!  We’re planning to have a water birth!  There are many reasons why water birth can be a great option:

  • The warmth from the water serves as a natural way to ease the discomforts of labor.
  • The weightlessness that the water provides allows women to move and change positions easier.
  • The water helps to soften the tissues allowing the perineum to stretch more easily to accommodate the baby.
  • The warmth of the water provides a much more gentle transition for the baby from the womb into the outside world.

I’m just really pleased to have the opportunity to use the birth pool at the birth center to have this baby.  I know this will help me so much during my birthing time to stay comfortable and composed.

GBS+:  I’d like to get the IV line placed and the antibiotics run as fast as possible.  Then I would like to have the line pulled completely.  I just don’t want an IV hanging off me.  They’re distracting and upsetting to me right now.  I don’t know for sure if I am GBS+ (group B strep positive), but I’m operating under the assumption that I am.  This way, if I am, I won’t feel disappointed, and if I’m not I can feel pleased about having one less thing to deal with.  I am also exploring the options of hibicleanse during my birthing time to help with this.  It’s a bit up in the air at this point, but since I don’t know if I have group B strep or not, I think that’s okay.

Please no directed pushing.  I would like to follow the signals of my body and allow it to do its work gently and naturally.  Also please don’t count while I push or have a contraction.  What I’m really trying to avoid here is “purple pushing.”  That’s where you hold your breath and pushpushpushpushpush until they tell you to stop.  This can reduce oxygen flow to the baby, and it’s really exhausting.  On top of that, this kind of hard pushing can cause tearing as the baby moves too fast down the birth canal.  So I just don’t want to do it.  My body will tell me when to push.  We’ll just listen to that and go with the flow.  In Hypnobabies, we learn about “Aaaahing” the baby out.  That’s just what I intend to do.

Please delay cord clamping. Since we donated Gabi’s cord blood, delayed clamping was not an option for us.  This time, however, we won’t donate the blood.  Instead, we’ll be allowing all of our baby’s blood supply time to move from the placenta into her body.  According to this article, around 21% of her blood is in the placenta.  She needs all of that iron- and oxygen-rich blood.  It’s hers.  I often wonder if some of Gabi’s early sleepiness and weakness during nursing would have been helped by delaying the cord clamping.  For this baby, we’ll wait until the cord stops pulsing, and then we’ll clamp and cut the cord.

For the baby, no Vitamin K shots and (if I am not GBS+) no eye drops.  Vitamin K shots are really only needed if your family has a history of blood clotting disorders.  That’s not an issue for us.  Unless the baby comes out with significant bruising, there’s no reason to give this shot.  The eye-drops are only needed if the mom has chlamydia.  They’re also recommended if the mom is GBS+.  I definitely don’t have any sexually transmitted diseases, so as long as I’m not GBS+, there’s no need for the eye goop.

I would like an unmanaged 3rd stage and deliver the placenta on my own.  Would also like to avoid the shot of pitocin unless it’s really and truly necessary.  The 3rd stage of labor is the part where you deliver the placenta.  During a managed 3rd stage, the healthcare providers may tug on the cord or “massage” the mom’s belly to help the placenta come out more quickly.  The “massage” is pretty forceful and brutal, so banish the thought of a comfortable, relaxing belly massage.  Picture instead people shoving against the mom’s belly with all their strength to manually push out the placenta.  Really unpleasant.  The cord pulling and the “massage” can also cause increased bleeding, hemorrhage, and the risk of the placenta breaking up and leaving pieces behind.  Hello infection!  I’ll pass.  The pitocin shot is something to help curtail bleeding.  If I’m not bleeding heavily, I’ll just skip that as well.  As they say, “If it ain’t broke, don’t fix it.”

 

Those are my birth preferences.  It’s a fairly short list.  I’ll be talking about these with my midwife at my 36 week appointment later today.  It’s so refreshing not to have to worry about defending myself against unnecessary hospital policies.  I love that I am included as a member of my own birth team this time around.

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12 thoughts on “Writing My Birth Preferences

  1. That was an awesome set of birth preferences! You go!! :) And I’m so glad you posted them here so that all of your readers can see and learn from all of the research you have done. Good job!

    I’m going to be posting my birth plans pretty soon – working on them right now. Currently have 3 – one for homebirth, one for transport, and one (just for fun) that’s a plain hospital plan.

    • I can’t wait to see them! Sounds like you covered your bases. I’ve only got the one. If I do transfer, I’ll have my midwives with me as doulas so I’ll be relying on them to help “defend” as necessary. Although, if there’s a reason to transfer it would be a medical emergency, so there wouldn’t much to do besides roll with what the situation presents us.

  2. This is great! So glad you’re getting to make these choices in the knowledge that they will be respected.

    My birth “plan” is very short and straight to the point… pretty much says that as it’s my first and I don’t know what to expect I don’t want to specify too much at this point, but that there are some areas I am really not willing to negotiate unless really necessary (ie baby or my health at risk). These things include delayed cord clamping, baby being given straight to me before being cleaned/checked, and my husband being as involved as possible at every stage.

    I spoke to my midwife about being sick during labour (seeing as though my HG has gotten worse lately and I have Emetophobia) and she said to go right ahead and ask them for a strong dose of antiemetic medication as soon as I get to the hospital, explaining why I want that. This is my main fear regarding pregnancy as I know that the more fearful I am the less able I will be to cope with the labour and birth. So it’s good to know we can ask for this. I’m hoping to cope with the pain with my Tens, breathing and movement alone for as long as possible because I know from experience that pain killers, especially opiates like the ones used in labour, make me sick. For me, being sick at that point is far more traumatic than being in pain and although I expect it to be very difficult, I also know what my personal pain threshold is as I have had severe pain with Endometriosis in the past and my mum said that contractions are pretty much the same as what her Endo pains were like (and what I have described my Endo pains to be like). So I’m hoping being mentally prepared for this will help. That being said, I have told my husband to watch me for signs that I’m not coping and to help me reassess whether pain meds would be necessary.

    I’m rather gutted not to be having a homebirth or giving birth in our local midwifery led unit, but the nearest maternity unit able to deal with any complications that might crop up is a good 45 mins drive and I just do not feel comfortable risking something going wrong and having to go by ambulance as 45 minutes is a long time if something unexpected happens. At first we chose this option as I was at a higher risk of pre-eclampsia, but when it looked like I might have avoided that I was considering changing back to our local unit but then discovered baby is lying back-to-back and I’m just worried that with my PGP and the hypermobility of my joints I might end up really struggling to get him out if he gets a bit stuck or my labour goes on for a long time. I know this is a fear-based decision, but I think personally going to the hospital which is actually just around the corner from where my parents live at the beginning of labour would put me at ease knowing we were there *just in case* something happened and I could then focus entirely on the labour.

    We are trying to make it as “homely” as possible though for ourselves (and actually from what I’ve heard, read and seen, labour is much less medicalized here than it is where you are, even when labouring in a hospital). We’ve uploaded our favourite meditation and spiritual music onto the MP3, we’re taking a massage oil and soy wax melts plus an electric oil diffuser (if my husband can get it tested and approved for use in the hospital in time) so we have a soothing scent in the air, we’re planning on packing some crystals and just making the room as personal to us as we can. And with my husband working in a hospital he knows pretty well what we have to accept as hospital policy and what we can refuse.

    Anyway, sorry for the long comment! This is a great post, so thanks for sharing it with us xx

    • You know, Amanda, I think the most important thing with any birth plan, hospital or not, is not what it says. The most important thing is that you are making the right decisions for your family and that those decisions come from a place of knowledge. The keywords are *Informed Consent*.

      It sounds like you’ve done your research and are making the very best decisions for your family, and I think that’s fantastic.

  3. I’m right there with you in not wanting to know how many cm dilated I was. When I was pregnant with my first I had a friend who was further along than me and she walked around at a 3 for weeks too. Seeing how frustrating that was for her and hearing a bunch of other women chime in with their numbers and how long they were that way made me decide not to know the number. My OB laughed and said, “You know, you have a point there. I’ll tell you if there’s something you really need to know.” The second OB was similarly amused in a “not a bad idea” kind of way.

    • What I don’t understand is why they need to check this anyway. It gives them absolutely no usable information. I just don’t understand what they hope to learn. I’m not seeing an OB right now, so I can’t exactly ask, and I’m not sure how I would ask without saying, “What on earth are you thinking by doing this?” And I doubt that would go over well. ;)

      • I don’t know either! The second time around the OB said something about it giving them an idea of what to expect, but it seems like it’s such a vague indicator that it’s pretty much useless. I can see there being certain reasons they’d want to check, like if you’re having a lot of preterm contractions and they want to see if they’re causing you to dilate early which could be worrisome sign, or if you may need and induction and they want to see if your body is even a tiny bit ready. But overall it just seems like busywork, something to make you feel like your doctor is doing something.

        Did your midwives give any indication about why they usually do internal checks at appointments?

      • I’ve got a midwife appointment tomorrow. I will ask them what their take is.

        Starla – I tweeted this weekend at an OB I follow over on twitter. Here was the conversation:

        I wrote:

        @DrJenGunter Curious-Why do so many OBs want to do internal checks on pg women once they hit 36+ weeks? What is the value of that info?

        She Responded

        @KnockedUp_Over routine cervical checks not generally needed, many women ask

  4. Great post! I just had my first child 8 months ago and your birthing plan was similar to mine (although I delivered in a hospital with an OB). Thankfully our hospital is rather birthing center like so there was no extra involvement…even when I had been laboring for almost 18 hours after my water broke. The OB just said, “labor is unpredictable…there is no reason to think you can’t have this baby vaginally.” It’s so helpful to have a supportive team around you!

  5. Pingback: My Current Medicine/Vitamin Regimen and the Finalized Birth Preferences | Knocked Up – Knocked Over

  6. Pingback: What about that Hypnobabies thing? « Knocked Up – Knocked Over

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