My Birth Plan for an All Natural Labor and Delivery

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It’s relatively common for women to have a birth plan when going into labor these days. This is due to greater education surrounding labor options and the unpredictable assignment of hospital staff. Most women who have a birthing plan typically have specific requests for their labor. A birthing plan does not mean your labor will go exactly as you wish. There are various factors surrounding labor that are out of our control. However, there are MANY factors that can be controlled and can potentially prevent more difficult labor both physically and psychologically on mom and baby.

If you study general labor protocol in the US and the hormone oxytocin that begins labor contractions, you may begin to understand why a birthing plan can help make labor better.  For instance, if you are the type of person that gets stressed out by people who yell, or hate fluorescent lighting, or feel very uncomfortable around your mother-in-law being in the delivery room (true story…this happened to someone I know and she couldn’t say anything at the time), then you may want to put in your birthing plan, “please, no loud voices during my labor, I’d like my room lit dimly and prefer the fluorescent lights off if possible, and would like only my husband and hospital staff in the delivery room.” Of course, there may be cases where the birthing plan is thrown out the window for one reason or another. There are actually facilities and clinics that are anti-birth plans like this crazy place in Utah:

aspen_womens_center_provo_utah

This clinic obviously believes in dominant healthcare, where the doctor is all knowing God and the patient should not have a say in how they are treated. This really ticks me off because from the research that I have done, much of labor is very very emotional and psychological as much as it is physical. A mother may have intuition about what should happen during her own labor that a doctor may not understand. For example, taking a walk or a hot shower can help labor progress faster. Birth is not always numbers and calculations.  A birth contract or birth plan attempts to ensure the patient’s comfort levels are met.  A doula helps mom with any physical or emotional support, and bradley is simply an educational tool!

There are some people that prefer not to think about their healthcare whatsoever. They prefer to freely give themselves at the mercy of whichever doctor they end up with. I, on the other hand, do not trust any old doctor. The M.D. to me does not indicate the kind of morals or care a person has. I work in the medical field and know many others that do as well. Having met many doctors who can be slimy, I just don’t trust every doctor. Actually, I trust a very small minority. I don’t say this to freak women out about their docs, but to say that in every profession, there are good workers and bad. There are people who take pride and care in their work. Then, there are those just looking to get a paycheck. Having a birth plan can help give the doctor a sign that you are not to be toyed with however they wish.

So here was my birth plan. This is not a “how-to” make a birth plan as there are many other links like that out there. I just wanted to share my birth plan and I’ll leave notes on why I put what I put with a little “^” to indicate my notes. Most of my plan is based off of a hypnobabies birth plan. You can download the Word file of my birth plan here: My Birth Preferences. Enjoy!

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Birth Preferences

For: Mindy Song

I would appreciate being assigned a nurse who enjoys working with couples who have prepared for a natural birth. Since I will be in hypnosis and highly suggestible, please never tell me what I will feel. I prefer to have my own experience. Thank you.

I will be using self-hypnosis to manage my birthing time and may not be immediately responsive to questions during pressure waves (commonly known as contractions). Please wait until my pressure wave ends and my eyes open to converse, or speak directly to my Birth Partner, Albert. Because of the high level of concentration, I request low lights and quiet voices.

In the event of an emergency situation with either myself or my baby, I am happy to discuss, however briefly, any measure which may be deemed medically necessary prior to their implementation; and, in the event of a normal birth, as we suspect this will be, we prefer:

  • Please no IV. A Saline-Lock is fine.

^I requested this so I could have free mobility during labor. I also felt comfortable simply drinking water during labor—a laboring mother is not a sick patient and I did not want to be treated like one unnecessarily. Interestingly enough about 6 hours into my labor, I ended up getting an IV with the suggestion of my midwife because my labor was pretty rough. I had the IV at home and everything was fine. I continued to drink water too and ended up peeing 2 liters after I gave birth!!!

  • I prefer intermittent monitoring

^ I did not want constant fetal monitoring as that would require being strapped to the bed, and possibly an incessant, beeping machine. I wanted to be calm and relaxed. I also found no benefit to constant fetal monitoring as in this Cochrane review (Alfirevic, Devane et al. 2006there were no differences between women who received intermittent auscultation and those who received continuous EFM in perinatal mortality, cerebral palsy, Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage. The findings were consistent in both low-risk and high-risk women. The only benefit was lowering the risk of newborn seizures, which is very rare at 0.2%. 

  • Please do not offer pain medication or ask me what level my pain is. I know what my options are, and I will ask for medications if I need them.

^ I did not want to be offered an epidural over and over again if I did not need it. According to Dr. Laura Goetzl, Maternal fever following epidural analgesia complicates up to one-third of nulliparous labors. I did not want to complicate my labor unnecessarily with the chance of a fever which can result in harm to the baby with a lower apgar score or seizure as indicated by a study published by the Academy of Pediatrics. 

  • I would appreciate a minimal amount of vaginal exams and do not want to be informed about my progress in dilation.

^Every vaginal exam increases the risk of infection.  While dilation from 1cm to 10 cm may indicate when mom can push, it does not indicate how fast labor will go. A mom can be “stuck” at 5cm for several hours. Or, a mom can go from 1cm to 10cm in an hour. Vaginal exams give healthcare providers an idea of what’s going on during labor but does not tell everything. During my labor, I wanted to limit checks so I could progress naturally without pressure. At my first check a few hours into my labor I was 9cm already! I was happy to be so fully dilated without a constant pressure to open up. 

  • During second stage, I would appreciate warm, moist compresses and perineal massage to help reduce the risk of tearing/episiotomy. I do not want an episiotomy, but am willing to discuss its medical necessity if one should arise.

^Episiotomy during vaginal delivery was first recommended in 1920 as a way to protect the pelvic floor from lacerations and protect the fetal head from trauma. It was rapidly adopted as a standard practice and has been widely used since then. However, over the last several decades, there has been a growing body of evidence that episiotomy does not provide these purported benefits and may contribute to more severe perineal lacerations and future pelvic floor dysfunction. The most horrifying episiotomy of a young girl can be witnessed in this youtube video.

Regarding this video take from improvingbirth.com: 

Dr. Michael Klein, MD, CCFP, FCFP, FAAP (Neonatal/Perinatal), FCPS, is a pediatrician/neonatologist and family physician researcher and educator based at Children’s & Women’s Hospital and the Centre for Developmental Neurosciences & Child Health of the Child and Family Research Institute in Vancouver, British Columbia, Canada. Dr. Klein pioneered randomized controlled studies on episiotomy in the 1980s and 90s, conducting over ten years of research that reached some groundbreaking conclusions (see articles here, here, and here). Thanks to his work, we have known for over 20 years that while episiotomy can be appropriate in rare circumstances, when applied routinely, it “cause(s) the very trauma that it was supposed to prevent” (see article here).

Of Kelly’s case, Dr. Klein said, “The physician here applied a medio-lateral episiotomy unnecessarily early through thick tissue, but rather than making a single definitive cut, he makes a series of short cuts that cause unnecessary bleeding and will interfere with healing. The episiotomy was done so early that the perineal tissues did not have time to stretch, so that the tissues were thick and bloody, a situation that would not have pertained if the professionals had waited… Having decided in advance to do an episiotomy, the doctor apparently does not even know how to do one–how to time it to minimize trauma. This behavior makes it more likely that severe trauma will occur, including tearing into or through the rectum. Our research and the research of others show that it is episiotomy that is the cause of severe trauma, not the prevention of severe trauma….”

He went on to say that the “doctor and the nurses were simply unwilling to allow time for the perineum to stretch, so that episiotomy would be not needed…. The mother is clear that she does not want an episiotomy. Her wishes are ignored and the clearly planned episiotomy is simply justified in advance so that the professionals can do what they planned to do anyhow…. It was all about the impatience of the professionals who were not remotely interested in the values and needs of the mother. They just wanted the birth expedited. This is a picture that was often routine in the past, but since the early 1980s this approach cannot be justified, if it ever was.” (Emphasis added)

Dr. Klein concluded, “this video shows a woman assaulted by uncaring professionals who ought to be sanctioned.”

Kelly, the woman in the video suffered from severed post partum depression and pelvic floor issues which required rehabilitation. Such a sad story. 

  • We will provide blankets and will dry our baby ourselves. Please allow me time to get to know my baby (2 to 3 hours) before removing him from my chest for newborn procedures.

^Hospitals are increasingly “skin to skin” friendly. Not all are. I wanted time to bond with my new baby and help regulate my baby’s body temperature with my own. I did not want his first moments of life being rubbed down by a stranger and set under a heating lamp like a fastfood hamburger. 

  • Please do not clamp or cut the umbilical cord until it has stopped pulsing.

^Research neither backs or or refutes delayed cord clamping in full term infants. There is a proven benefit for pre-term babies. Many argue that delayed cord clamping will help ensure baby receives more iron. There is debate surrounding this topic and most natural friendly moms desire delayed cord clamping. 

  • I appreciate your patience in waiting for the placenta to detach naturally.

^Again, i wanted the process of the placenta coming out very natural. Mine came out about 15 minutes after my baby arrived. Just slithered on out. 

  • We will be saving the cord blood and placenta.

^Hospitals will typically discard these items unless you request otherwise. My placenta was a gift from heaven. I swear by the pills I had made from them…really helped balance my hormones postpartum!

Personal birth plan notes for my doula:

  •  Aromatherapy candle burning with lavender, and frankincense, neroli.
  • Essential Oil massage between contractions: foot massage, low back massage with 20 drops lavender, 8 drops clary sage in 4 oz carrier oil
  • Changing positions every hour utilizing the birth ball.
  • Drink 16 oz of water every hour (coconut water)
  • Eat carrot sticks and lara bars and nuts

 

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Links referenced:

http://www.natural-motherhood.com/eating-in-labor.html

http://evidencebasedbirth.com/?s=epidural

http://www.ncbi.nlm.nih.gov/pubmed/22473213

http://pediatrics.aappublications.org/content/early/2012/01/25/peds.2010-2301.abstract

http://www.medscape.com/viewarticle/721538

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth

Mindy
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Mindy

Founder at Dymin Collective
Mindy Song is a mother of one, a video artist, and musician from Orange, CA. She is an advocate of social justice with interests in globalization, socio-economics, and the history of women’s rights in developing nations. By day she is a marketing specialist for a dental imaging company, milk pumper, and wannabe supermom. By night she is an asian fusion chef, art critic, and blogger.
Mindy
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