Our Birth Preferences... and why.

I debated posting this but want to share, partly because it's great to have ideas for your own birth plan. and partly because some people look at me like I'm nuts because we're having a natural birth in a birth center (probably a water birth)... feel free to ask questions, feel free to add a link to yours, enjoy!
*My commentary is in blue italic font*

Our Family Birth Preferences

Support Team for Catharine 

Father- John   

Doula- Deby 

Mother’s mother- Debra 

Birth Photographer- Christine 

Hypnobirth Instructor- Kate 

John is my primary support person. He will be at my side at all times unless the baby and I must be separated in a medical emergency. In this case, my mother, Debra will stay by my side while John accompanies the baby.

We are planning a natural hypnobirth. We anticipate laboring at home prior to admitting to the Connecticut Childbirth & Women’s Center. We understand that unexpected complications may arise and will rely on our midwives’ medical opinions and informed consent for any unplanned interventions. In the event that our situation requires a transfer to the hospital, we have educated ourselves about potential interventions and request the following be respected if deemed safe by our providers;

Labor & Delivery

·         We strongly prefer as little medical intervention as possible one often leads to another... many procedures are done "routinely' in hospitals and aren't medically necessary for every woman

·         No artificial rupture of membranes without specific informed consent and medical reason When the baby's lungs are fully matured and she is ready to be born, she'll excrete a chemical that breaks down the waters, when membranes are ruptured before this occurs, the baby isn't ready to come out

·         Regardless of our location, we will be practicing hypnobirthing techniques and request dim lighting and quiet voices in the birthing room. She's been in the dark in water for her entire life, no need to add light and noise to the shock of this big day and the temperature change. I also read once that the first voices a baby hears should be her parents, and I like that.

       We respectfully decline any offers for pain medication, including narcotic drugs and epidurals. Some hospitals repeatedly offer pain medication, this isn't an issue at the birth center but we are preparing for any scenario. Hospitals need an anesthesiologist on staff 24/7 for true emergencies- they are VERY well paid doctors. On hospital maternity floors where less than 80% of women get an epidural, the hospital is losing money having them on duty... sick, isn't it?!

·         Our preference is intermittent Doppler monitoring, Should constant monitoring become necessary, we request external monitoring. We will need to discuss internal fetal monitoring with our midwife prior to the monitor. External fetal monitoring is inaccurate and has more false positives (panic when there isn't reason) than accurate positives ( a real emergency)... they also limit a woman's ability to move as her body wants her to to shimmy the baby down into place. Regular intermittent doppler readings by someone trained to use a doppler (a nurse, midwife, or doc) are more accurate. Internal fetal monitoring involves screwing a needle into the baby's skull and still shows little benefit... there needs to be a VERY good reason for this to occur.

·         We only consent to vaginal exams by Women’s Health Associates. We request minimal internal examinations. Internal exams are a welcome way to introduce infection- your vagina doesn't just GET an infection in labor, they aren't comfortable, either. Each cervix dilates (and can UN-dilate) at it's own pace, there is no purpose in these examinations, so stay out, thank you.

·         We prefer that an instrumental birth is a last resort to avoid a cesarean section and will attempt to assist the baby by changing positions and moving around the room/wing  A laboring woman's body is very smart if unmedicated- it will give her urges to move and bend and flex as the baby bends and flexes- further, the lithotomy position (laying on your back, legs up) is the SMALLEST, TIGHTEST position for your pelvis- not really helpful when trying to allow a small human to pass through. When upright, gravity is on your side, the pelvis is open and loose (it's multiple bones, not one circle, you know!) and baby has an easier time out. Additionally- forceps carry the risk of crushing the baby's skull and vacuum extraction is much more harsh than many doctors let on. A vacuum extractor exerts 50lbs of force (on the head of a 6-10lb newborn)... at 75lbs of force, the extractor can decapitate- sounds barbaric, doesn't it?

·         We do not plan to push on command or have counted pushing. Please do not instruct me to push unless a medical urgency arises Holding breath and counting to ten while pushing (like you see on A Baby Story) cuts off oxygen to mom AND baby (and can put baby in "distress"). Often doctors want a woman to push as soon as she hits 10 cm... when labor is left to it's own, there is most often a period of rest for mom and baby, up to 30 minutes even, where contractions slow- your body wants you to take a break before the home stretch! There's a phenomenon called the "fetus ejection reflex"... when a woman lets her body and the baby do the work, the uterus will slowly contract in downward waves and slowly push the baby out on its own... kind of like a tube of toothpaste! Letting this happen GREATLY reduces risk of tearing.

·         We prefer to avoid the use of routine IV’s, I plan to drink clear fluids during labor to maintain hydration. IV or hep-loc will be for medical necessity only and will be discussed prior to administration  Filling a woman with saline messes with the baby's hydration as well as mom's, messes with blood pressure, and leaves the woman swollen after the birth- I have also read it can mess with mom's milk coming in.

·         I prefer to wear my own clothing for the labor and delivery I'm not sick, I don't need a hospital gown! I think it contributes to the vulnerable patient image and further separates mom from the rest of the people in the room.

·         I prefer natural methods of promoting dilation, we wish to labor as long as necessary provided the baby does not exhibit signs of distress Most hospitals label a woman "failing to progress," if she dilates less than 1cm/hr... the rate of dilation varies dramatically between women and is directly affected by how safe/comfortable/relaxed a woman is. Natural stimulation methods include kissing the partner, nipple or sexual stimulation, and even intercourse (early in labor, if water hasn't broken yet!!)

·         We plan to be physically active in labor, it is important to me that I be supported in moving as my body needs to and utilizing water for pain relief—unless there is a serious medical contraindication, I do not wish to lie in bed As I mentioned above, the pelvis is made up of multiple bones/joints, the hormone Relaxin has been getting these joints ready to move for months now, the worst thing that can be done is laying on your back!! Women in labor get urges to bend over, sway their hips, lean in certain directions, squat, or submerge in water- the body knows what to do!!

·         We prefer to use perineal massage to an episiotomy if at all possible. Episiotomy incisions permanently damage muscle, if massage doesn't work (which can be very effective!), natural tears are natural injuries, less scar tissue is create and nerve endings are less likely to be severed... quicker recovery time and less permanent damage.

Newborn care

·         We plan to delay cord clamping at least until it stops pulsating and preferably until the placenta is delivered Mom's blood isn't pumping through the placenta like a hose, what's in the placenta is the baby's blood and has great benefits if she can receive it, lower likelihood of jaundice and anemia, important infection-fighting/immunity-boosting blood cells.

·         Unless there is an urgent medical concern, we wish to allow the placenta to deliver naturally Allowing the placenta to break away on it's own continues the ideal labor cocktail of hormones for decreasing risk of hemorrhage and encouraging mom's breastmilk to come in.

·         John plans to cut the umbilical cord  Typical dad thing, worth mentioning though!

·         We wish for the baby to be placed immediately upon my chest. As long as she is breathing on her own, we would like her to be able to crawl to breast on her time  The best way to regulate a newborn's temperature (more effective than a newborn incubator box!) is skin-to-skin contact with mom. This also helps regulate baby's heartrate and breathing quite effectively

·         Please do not roughly towel the baby, we wish to leave the vernix intact We will wait to bathe the baby at home The vernix, the cheesy coating a baby is born with, has antibacterial, antiviral, and antimicrobial properties... it also has vitamin K in it, which is helpful in clotting. This is especially important in a hospital where many staff may handle the baby and she would be exposed to strangers' germs.

·         Please wait to weight and measure baby and  administer Vitamin K until after breastfeeding has occurred The first breastfeeding and how uninterrupted it is can set the stage for great breastfeeding or breastfeeding difficulties, if you google "breast crawl," you will see videos of babies left to find the breast on their own- in the first hour or so of life, a baby on mom's chest has the ability to crawl to the breast, unmedicated babies will find the breast and latch on instinctively... interrupting this and the first moments of bonding for weight and length measurements seems trivial! She won't grow in an hour.

·         We respectfully decline/waive Erythromycin eye ointment administration. We will sign any necessary waivers  This antibiotic eye ointment is given routinely to all babies in CT, I'm unsure about other states, but many women aren't told WHY it's given, so I'll tell you- if a woman has gonorrhea or chlamydia at the time of delivery, the baby can get those bacteria in his/her eyes in the birth canal- they can lead to blindness/infection. If you don't have either of those, the baby doesn't need antibiotics in their eyes at birth. Additionally, c-section babies don't need it either- as they never came into contact with the birth canal! Gooping up baby's eyes interferes with his/her ability to see mom and dad clearly, can create anxiety because they can't see clearly, and can be irritating (the baby is moments old, we don't know if they're allergic!)

·         We respectfully decline the hepatitis B vaccine at this time, our daughter will receive this under the care of her pediatrician at a later date Unless mom or dad are IV drug users that could have bloodborne contact with the baby and open wounds, it isn't urgent to give this vaccine... again- why are we exposing baby to man-made chemicals in the first moments after birth!? We discussed vaccines (that's another blog) and she won't step on any IV needles between birth and coming home... once she's mobile and could in some crazy universe step on a needle at a park or playground, then we'll give her the Hep B series... babies were meant to have colostrum and skin to skin contact in their first day of life, not shots and antibiotics.

Surgical Birth

It is my strong wish that I give birth vaginally. In the event that my midwife and consulting obstetrician feel a cesarean section is absolutely necessary for the safety of my life and that of our baby, we request the following to make the surgery as family-friendly and natural as possible:

·         My husband will accompany me and my doula or mother will be available as a backup support person should John need to leave my side to follow the baby I don't know that my mom want to be in my OR, my doula has attended c-sections...one of them would be with me.

·         ALL IV medications are to be discussed with us prior to administration. Informed consent isn't too much to ask for, right? Sometimes women are given sedatives or other drugs in their anesthesia and not told, not ok.

·         I do not consent to insertion of a urinary catheter until after anesthesia is in place Ouch. A simple courtesy I believe...

·         I would like to request one arm be left free so that after the birth I may hold my baby with assistance  You can still have skin to skin contact in a surgical birth, I feel if I had to have a cesarean it would be that much more important!

·         If the baby is breathing on her own, I would like her placed on my chest immediately with my husband supporting her while my incision is being closed. same idea as the last bullet point

·         If a cesarean section is necessary, I request a surgeon able to complete a double-layer stitch as I plan to have subsequent deliveries vaginally.  Please ensure someone proficient in a double-layer suture is part of our medical team. The uterus is made up of multiple layers of muscle... some contract vertically and others horizontally, it makes sense to sew them up separately so they can work in harmony next pregnancy. Additionally, this double-layer reduces the risk of uterine rupture in subsequent pregnancies

·         I do not consent to the administration of sedatives after delivery. Some women are given a sedative after surgery, I would want to be awake and alert to feed baby as soon as possible.

·         We prefer all routine procedures be delayed until after I have been taken to recovery. Again, no urgent need to weigh or measure the baby, especially if we both went through major surgery.

·         I do not consent to baby being removed from our presence at any time. Taking the baby away for routine testing is not okay with us- one of us will be with her at all times to ensure our wishes are respected and she's appropriately cared for.

·         I would like the IV and catheter removed as soon as possible so I may get out of bed and move around

·         I wish to eat as soon as possible after delivery

Soooooo that's our birth plan thus far!! Anything I forgot?