As a side note, the following is all advice I would have given myself prior to my first birth had I known then what I know now. This advice may not be valuable for someone else, but if one person finds value in it as well, then it’s worth sharing.
Don’t feel like reading this long post? Then take this advice and run with it: Educate yourself. Educate yourself. Educate yourself. Learning about the labor process and the many interventions done in the hospital will give you a better idea of what the consequences are and will also help solidify your own goals for what you want out of the experience.
1. Find an OB that backs up midwives. I was a lost little soul when I first found out we were pregnant. I chose my first OB based solely on a recommendation from a friend that had delivered two babies from him vaginally. I went to 5 or so appointments before I switched over to the care of the midwives. There were many reasons for this that aren’t pertinent to this post, but I will say that when we informed him of our change in delivery plan to a home birth we got nothing but a ill response from his office staff. In my very humble opinion, I think it says something about an OB that refuses to look at the research and support a woman’s right to chose. And since there are OB’s out there that see the larger picture and support alternative care, I would personally feel safer in their care.
2. Take a birthing class with your partner. And then go home and reiterate things gone over in the class. If your partner has any sense of anxiety, like mine, it is even more essential to go over what to expect. Even with all the education we did beforehand, the bloody show still freaked Willy out. So yeah, discuss things like transitional labor vs. active labor and the progression of each stage. It’s helpful for your partner to know that transitional labor is longer and really more grueling than active labor. You’d think things would just keep getting worse and worse, but in reality it’s that long transition that is the most grueling. Once you get to active labor it’s like a roller coaster ride that you have no ability to stop. The most support is needed in the middle, during transition. Especially if you are planning an un-medicated birth. Also discuss things like the rupture of membranes (water breaking), cervical dilation, back labor (god forbid), episiotomies, perineal massage, cord clamping, signs of labor, contractions vs. braxton hicks, what newborns look like, etc etc.
3. Discuss with your significant other who you want in the delivery room. It’s whatever you want, whatever you envision. As a footnote to that, I had a friend that ultimately opted for a home birth in her last few weeks of pregnancy because the hospital would not allow her 4 year old in the delivery room. She was due in december when H1N1 was running amuck. It was important to have her whole family present, so she delivered her 11 pound baby in 3 hours at home. Amy, you’re still my hero.
4. Educate your partner about your desires and hand him the role as your advocate as you are relatively helpless when in active labor. Discuss amongst yourself, for example, how often you want to be examined vaginally. Some hospitals may check a laboring woman every hour. It can be very heart breaking, especially in early labor and transition to endure a couple hours of pain only to find that you haven’t dilated any further and could even persuade a woman to believe she needs a c-section. Personally, I would request to be vaginally examined very seldom and would even put it off, if possible, until I knew I was in active labor. As you are lying in tremendous pain wondering when it will all go away and how much longer it is going to take, this would be a good time for your partner to step in and refuse that vaginal exam.
5. Hire a doula. Rates of un-necessary intervention and c-sections decrease greatly by having a doula. Having my midwives present at our hospital birth was absolutely priceless. Their knowledge of the hospital environment and of the labor process is an incredible asset. Your partner will thank you for the added support as well.
6. Discuss with your partner what requires a discussion and what just isn’t that important. Some woman’s birth plans get into each and every detail and other’s stick to just the things that are really important to them. It just depends on what’s important to you and how much control you feel comfortable having. You can discuss things like having an IV or fluids, for example. I’ve heard some woman protest that having a needle in their arm is uncomfortable. As a nurse, I don’t think it’s really that big of deal. It’s a little plastic cannula anyway, not a needle. And in the event that they do need to give you something through the IV, it’s nice to have the IV line already established. My blood pressure, for example, runs low. After I gave birth, I inevitably lost a lot of blood and the room became a wee bit fuzzy. I was quickly given a bolus, or a large amount of fluid quickly. And I was fine. In fact, having an IV placed beforehand is something I have already discussed with my midwives because I already know I don’t have a huge reserve as far as blood pressure is concerned. I’m not opposed to fluids after the birth. With that said, I’ve also read a research article that linked fluids during labor to inflated birth weights. Because I was given pitocin, I was also given fluids during my entire labor. Hooper weighed an ounce shy of 9 pounds. While it’s expected for newborns weight to drop within the first few days, it should not drop past a certain amount. Hooper’s weight was an issue from the beginning because he dropped more than what was expected. I wonder how much of that unexpected weight loss was actually due to an inflated weight immediately following birth due to the fluids given to me. Whatever the case may be, the article suggested that newborns be weighed 24 hours post birth for a more accurate reading. I think, forget the fluids instead and weigh that baby right away. But, again, this should be something discussed with your OB or midwife as the decision to give a woman fluids during labor ought to be based on individual circumstances.
7. Many doctors require their laboring patients to be “NPO”. In the nursing world, this means nothing by mouth, which means nothing to eat or drink. The nurse will try to explain that you’re getting everything you need through the fluids in your arm… the fluids that we just discussed you may not want. So again, you ought to discuss this with your OB beforehand. For the longer labors, it’s really important to stay hydrated and energized. I was not allowed to eat or drink, but when my nurse left the room, my midwife suggested eating an energy bar. And I did. Again, hire a doula. I would do this again if placed in the same position.
8. Research different forms of labor induction in the event you need to be induced. As a side note, disucss with your OB beforehand when induction is necessary and do your own research as well. Some methods of induction are more invasive than others and the side effects of each method vary. There is a cervical gel, for example, that’s worth researching further. I had a very strong reaction to pitocin and would refuse it if placed in that position a second time.
9. Remember you are a patient, not a prisoner. You have the right to refuse whatever treatment you want. I would suggest, however, that your refusal be based on your own personal research and your own personal goals. I would also discuss your wishes with your OB beforehand so he or she knows your wishes and a plan is somewhat in place before your arrival to the hospital.
10. If you must be on a monitor, request for a battery packed monitor. These allow for you move about the room or the hallway while still being monitored. If there is no reason whatsoever that you need to be on a monitor, request to be taken off. If they are not able to grant this request, negotiate to have it on for 30 minutes and off for 30 minutes. Yes, being a patient on a labor and delivery unit is like being a tourist in Mexico, it’s all negotiable. All the more reason I want a home birth, honestly. I’d rather concentrate on myself and the baby than be in a hospital gown, strapped to a bed, bargaining with some woman that I just met who in turn has to leave to go negotiate my wishes with my doctor over the phone. How exhausting.
11. Check out the hospitals birthing unit. If your OB has privlidges at mroe than one hospital, see if one of the hospitals has a birthing room. These are much larger and mimic the home environment.
12. If you are adamant about having a natural birth, discuss this with your doctor beforehand. When you get to the hospital and meet your nurse, tell her your plan as well. I instructed my nurse not to even offer me an epidural so the temptation was not even there. If you’re undecided, but don’t want an epidural pushed on you, per say, request that an epidural only be given upon your own request. In other words, don’t offer it, instead, I’ll let you know when and if i need it.
13. Ask if they have a shower chair. Sometimes it is nice to sit under the warm water. It beats having to get up to pee and it beats having the bloody show run all down your leg. Am I getting too graphic now? My apologies.
14. Have a rough copy of your birth plan printed and in addition to discussing it with your nurse upon admission, give them a copy. I’m hesitant to advice to plan too much. There is only so much that is in your control as your baby will dictate much of the course of labor. Having a birth plan kind of gives you a false sense of control. At some point in labor, you’re just going with it… riding the wave. All the more reason why it is important to educate your partner to advocate for you and your desires as predetermined and discussed prior to labor. In any case, for those who like lists and find comfort in planning, writing down a birth plan may be helpful but you ought to keep in mind it’s a plan, not a contract.
15. If you plan on breastfeeding, research kangaroo care. Unless it is discussed beforehand, many newborns are taken immediately post birth and weighed, bathed, wrapped, etc. The skin to skin contact immediately after delivery, with the amniotic fluid still on the baby, is shown to increase breastfeeding success. It’s also great bonding time. Newborns are wide awake for something like 2 hours and then they conk out and are sleeping beauties for the next 24 hours. I remember spending this awake, alert time with some of the newborns during my OB rounds in nursing school. It felt wrong, like I was stealing some special time away from their mother. And I was. The newborn should be with their mother, as long as possible. Request for newborn procedures to be delayed, on your terms, if this bonding time and breastfeeding initiation is important to you as well. Hooper was taken from me immediately and I didn’t see him for 4 hours. And though they were initially worried about him before he actually arrived, don’t forget I delivered vaginally on the operating room table, in the end nothing above and beyond the standard care was needed. They watched him in the nursery for their own security, but really they could have monitored him on me all the same. Regret isn’t the right word, because it’s nearly impossible to look back on the birth of your child and say you regret any part of it, but I will say Willy and I should have discussed the possibility of a transfer to the hospital and discussed further what we would want and not want under those circumstances.
16. If all of this sounds as overwhelming to you as it does to me and what you are seeking is a low-intervention natural birth, look into a birth at home. Much of the things mentioned in this post are not up for debate. Whereas lots of different things can go in a hospital, a home birth comes sort of pre-packaged. No meds, no continuous monitoring, no bed (unless you chose), no foley catheter, you get the idea. It just depends what you want and what you’re comfortable with. It’s an individual decision, but I urge those who frown upon home birth solely due to fear of what could happen to research further. Feel free to drop me a message too, I would love to discuss home birth further with anyone trying to conquer those fears. And that’s my two cents. Down from my pedestal I will now step.