Birth Plans

One of the things I regretted about my last birth experience, is that I didn't have a birth plan. I knew I was going to have a c/s, and so I figured I didn't need one. I never put any thought into what options I still had with a cesarean birth.

Since then, I have learned that whether a mom has a cesarean or vaginal birth, a birth plan can definitely be a great help. As many people will point out, a birth plan doesn't *guarantee* anything. It doesn't mean that everything will go as you had hoped and planned, because nothing in life ever goes that way. Even so, a birth plan is a way of setting goals, and preparing for them which can definitely pay off.

Some Benefits of a Birth Plan:

*They lead you to ask the question "what do I want/not want for my birth?" I doubt your run of the mill provider will ever ask you that question, plus it's nice to have it all on paper.

*Because they cause you to ask questions as to what you want/don't want, the natural next step would be for you to become more educated about your choices and the risks/benefits involved with each decision you make. This is a very good thing.

* They can be given to your husband/doula/midwife/OB/ nurse so that they can better understand what it is that you want.

Recently, I read this blog post about birth plans, written by a home birth midwife here in AZ. She makes some really great points about birth plans, and what they should really be about. I think the main point is that if we want our birth plans and preferences to be respected and supported, then we need to FIRST find a provider and birth environment that already offers and supports exactly what we what we want. Getting the kind of birth you want shouldn't be a tug of war between you and your provider. This is why it's so important to go into your provider interview with your birth plan in mind, instead of waiting until you are 36 + weeks to discuss what it is that you want. Trying to convince a provider to do something that they don't normally support is risky and could really backfire on you. Your provider should be 100% supportive of what you want, and you should know this before you hire them.

After many interviews and lots of pondering and prayer, we decided to go with the Bethany Midwives for this birth. During my interview with them, I found that they genuinely wanted what I wanted for myself, even before mentioning what it was that I wanted. There was no convincing needing to be done because they already offer the kind of support I was looking for. Although I'm not excited to be in a hospital environment, I know that I am going to have 100% support from my provider, doula and husband. My written birth plan is really for the nurses and hospital staff, as they will not know what it is that I want, and are used to following hospital protocols, unless asked otherwise.

Kevin & Melissa’s Birth Plan

We have chosen the Hypnobabies method for a relaxed natural birth. We have given careful consideration to each specific request in our plan. We realize that as labor ensues, special circumstances may arise that cause us to deviate from our plan. We trust that you will provide us with a clear explanation of special circumstances, the medical need for any procedures you may anticipate, and what options may be available. Thank you for your cooperation and support.

For hospital admission, we request:
• To be assigned a nurse who is partial to natural birthing.
• To self-hydrate and decline routine IV and or heplock upon admission.
• To be able to eat light foods and drink clear fluids to maintain hydration and energy.
• To have a quiet labor and birthing room with a Jacuzzi tub, subdued lighting, and hushed tones. • To have intermittent monitoring after 20 minute required strip at admission.
• To respectfully decline to participate in the taking of pain scale information.

During first stage of labor, we request:
• Freedom to walk, move, change positions and assume labor positions of choice as well as having full use of the Jacuzzi tub. Privacy when requested.
• Minimal number of vaginal exams, with permission.
• Natural means of inducement, moving to minimal doses of artificial induction, only if medically urgent.

• To be fully apprised and consulted before the introduction of any medical procedure – augmentation, amniotomy, membrane stripping, internal fetal monitoring ect.
• Husband (Kevin) and doula (Kimberly) to be present at all times.
• Please refrain from offering pain medications and or an epidural to Mother.

During birthing, we request:
• To be allowed choice of positions for pushing – avoid stirrups and breaking down the bed.
• Mother directed pushing with quiet guidance when needed. Guidance on when to stop pushing in order to avoid tearing.
• Perineal massage with oil as well as perineal support to avoid tearing. Episiotomy only if necessary and after discussion and expressed permission of Mother.
• Baby to be placed immediately on mother’s chest, skin to skin, and breastfed.
• Allow 20 minutes for delivery of placenta, and please refrain from using pitocin post partum unless there is an emergency situation.
• Placenta to be placed in cooler that we will provide.
• Umbilical cord to be cut by husband after pulsing has stopped.

For baby, we request:
• That baby stay with parents at all times. Father to accompany baby if special care is required.
• To allow vernix to be absorbed into the skin, gentle rubbing with towels instead of bathing.
• Delay newborn procedures until baby has breastfed and has had a few hours to bond with Mother and Father.
• To allow baby to remain with Mother while performing newborn procedures
• To respectfully decline the hep b shot and eye gel.
Breastfeeding only – no bottles, formula or artificial nipples

Cesarean Birth Plan

Should the situation arise where a cesarean is medically necessary, I would appreciate your support and assistance in making it the best experience possible for my baby and I. Thank you for respecting my following wishes.

• Unless it is an emergency situation, I would like to be given a spinal/epidural so that I can be awake and alert.
• I would like my arms to be kept free during surgery
• I would like my husband (Kevin) to accompany me in the OR.

• I would prefer to choose the type of music that is being played during my surgery, if there is going to be music playing.
• I would like the atmosphere in the OR to be kept light and peaceful, and I would like it if the doctor could lower the drape temporarily so that I can see my baby right when he is born (before he is wrapped up).
• I would appreciate it if my husband could hold our baby next to my face after he is born, and while I am being sutured.
• Unless it is an emergency situation, I would like to have a low transverse incision that is closed with double sutures.
• Placenta to be placed in cooler that we will provide.
• I would like to respectfully decline the use of eye gel for my baby and the hep b shot.
• I would like the vernix to be left to absorb into my baby’s skin, and to do light rubbing with towels instead of a bath.
• Delay newborn procedures until baby has breastfed and has had a few hours to bond with Mother and Father.
• To allow baby to remain with Mother while performing newborn procedures
• I would like to breastfeed and have skin to skin contact with my baby as soon as possible.
Breastfeeding only for my baby-no bottles, formula, or artificial nipples please.

Some tips on creating a birth plan are:

*Keep it to one page if possible

* Bullet point each item so it is easy to read

*Try to use wording that isn't really negative or defensive,
for example: "DON'T YOU DARE GIVE MY BABY A BOTTLE!!" probably isn't the best way to get your point across.

* Some things that you plan on doing may not need to be included in your birth plan depending on the situation. For example- I'm planning on wearing my own clothing when I get to the hospital, but instead of putting it in my birth plan I will just say "no thanks" when they offer the hospital gown. Also- I plan on laboring mostly at home before going to the hospital, but there is no need to put this on my birth plan, I just go to the hospital once I feel ready and that is that.

Good, Better, Best

A couple weeks ago, I was messaging a friend who had just decided to change providers half way through her pregnancy. She wasn't going to settle for less then what she wanted, and I was so happy to hear it. Included in my comments and advice to her I wrote: "Even if the drive is long, if it means finding the right provider, then it's worth it." After typing that, I realized that I wasn't taking my own advice. To not settle, to explore every option, and not get stuck in this *comfortable* state, which in my case comes from not wanting to put forth any more effort. I am grateful for her example, because it challenged me to do the same.

This past Thursday I drove across town, and interviewed a group of midwives who have privileges at a hospital in Phoenix. I had originally thought that they were not an option for me due to insurance issues. When I found out that wasn't true a month or so ago, I had already chosen a provider, and I felt somewhat *comfortable.* So I made them my "Plan B", and I brushed it aside. I told myself there was no *need* to change, so why should I waste my time interviewing them? The practice was further away then my current provider, and anyone who knows me well, knows that I HATE driving in Phoenix or anywhere unfamiliar. It was a little stretch for me.

I found that the midwives were much more on my side when it came to my birth plans, and I could tell that they genuinely believed that I could VBAC successfully. They made me feel like a healthy pregnant mom, and not a liability or big risk they were taking. Talking with them was really refreshing. I also toured the hospital which had a few amenities that I felt would provide me with a better birth experience then the current hospital choice.

It was good news overall, but I had been expecting to feel some overwhelming sense that this was where I needed to go, and that feeling wasn't there. This is a feeling I have been praying for ever since I found out I was pregnant. To know without doubt where I need to be for this pregnancy and delivery. To know what was *best* for my baby and myself.

I left puzzled as to what I should do next, and as I drove away a general conference message given a few years ago came to my mind. It was entitled: "Good, Better, Best," and was given by Elder Dallin H. Oaks. The talk was about attaining our spiritual and personal best, by not settling for those practices and habits that are just *good* or *better*. It was about going that extra mile to attain what we considered our personal *best*.

Suddenly I couldn't help but feel that staying with my current provider was

*good*

that transferring to the midwife practice I had just interviewed was

*better*

but that I had yet to find the

*best.*

When I got home, I read my scriptures and said a prayer asking for help. I couldn't help but feel so confused as to what step I needed to take next. Immediately a thought came to my mind, and I decided to make a phone call. It was one that I had thought about making in the past, but was told that it probably wouldn't amount to anything.

I called a Naturopathic Doctor/Certified Professional Midwife that can legally do home births after cesareans in Arizona. As I have mentioned in previous posts, it is illegal for a midwife to assist in a HBAC in Arizona, although it is legal to do so in several surrounding states. This ND/CPM is one of the two that I have heard of that have done HBACS before. After being told by others for the last year that she probably wouldn't consider me as a client because I didn't have a previous vaginal birth, I had pushed this option to the back of my mind. Suddenly, I had a feeling that I needed to at least ask.

I left her a message.

She called me back right away.

We have an interview this week.

I can't tell you how excited I was when she told me that she would take me as a home birth client. For me to have another option, and one that I had previously thought could never become a reality felt so wonderful and exciting. I don't know how things are going to pan out, or if a home birth or this provider is going to be right for us, but I know that I'm getting closer to the *best* that I've been searching for. If anything else, at least I will know that I tried. I will be able to come to a decision knowing that I explored every option and that I did find what was *best*, whether it has us in the hospital or not.

I'm sharing this experience because I think that sometimes it's easy to get comfortable with a certain provider, or a certain way of doing things that might seem good enough at the time. It's harder to pull yourself out of this *comfortable* rut, and put forth the effort to find something better, or to look into options that seem foreign or unfamiliar. Sometimes you don't know if there will be anything better out there, and that alone can keep you from searching. Sometimes what you are doing is already the *best* and you just need to confirm it within yourself. Even if it seems too late in the game, it's not (as long as the baby hasn't been born yet). At almost 6 months along, I still have time and choices as limited as they might seem. Ultimately, no one can know what that *best* is but yourself, and it will be different for every mom and every pregnancy.

Hopefully after exploring each option available, I will be able to find what is *best* for my baby, and myself, and I can move forward knowing that there was no rock left unturned.

Half Way There {Progress and Goals}

16 weeks (semi-profile)

18.5 weeks

20 weeks

I'm officially half way there (give or take a few weeks), and I've got the belly to prove it:)

Here's what I've been doing in the last 5 months to prepare myself, along with some of my goals for the near future.


Progress:

*I've interviewed and chosen a supportive health care provider

*Established a "plan B" in case my provider is not on call when I go into labor

*I've interviewed two doulas

*Had our 18wk. ultrasound which gave us the news that we are expecting our first baby boy

*I'm working out at least twice a week at the gym and trying to stay active the other days

*Started using bountiful baskets in order to up my vegetable intake and improve my overall nutrition

*Purchased some Red Raspberry Leaf Tea to help tone my uterus and keep me hydrated during the summer months

*Continue to go to monthly Birth Circle meetings as well as local ICAN meetings


Goals:

*Find a food based, high quality prenatal that has magnesium in it, and make a habit of taking it every day

* Interview more doulas and hire one

*Prepare a birth plan

*Take a childbirth prep class

*Educate myself about the typical hospital protocols and procedures done to babies, and find out what I want/don't want for our child

*Order Hypnobabies Home Study Course and begin the program at around 28wks.

* Read "The Thinking Woman's Guide to a Better Birth" and any other books that I feel will help prepare me

*Continue to work out several times a week and eat well

*Take a tour of the hospital I am delivering at/register

*Continue attending Birth Circle/ICAN meetings

*Stay really hydrated

*Pass the glucose test with flying colors

*Possibly purchase an inflatable pool to labor in at home as well as a birthing ball

*Review my birth plan with my provider

*Pack my hospital bag

*Have maternity photos done

*Come to an agreement with my husband in regards to circumcision (we are on opposite ends currently)

*Talk to/hire a placenta lady for placenta encapsulation

*Have a healthy baby boy and a successful and empowering VBAC

I still feel like I have a LOT of time before this baby comes, but there's plenty for me to be doing until then.

Wish me luck:)

Interviewing Health Care Providers

At my first ICAN meeting the topic was interviewing health care providers. I personally had never interviewed a health care provider, or knew anyone who had, and so it made me a little nervous. Me asking the wise and all knowing doctors questions before I hire them? Do they even let you do that?

Gulp.

Now that I have experience interviewing health care providers, I understand why it is so important. I think that it is essential not only for vbac moms, but any mom who is wanting to find the right match for their pregnancy and delivery. In addition to interviewing, talking to moms and or doulas who have had experiences with the doctor/midwife can also be helpful.

With a vbac things can become more complicated with finding the right provider. Unfortunately many are limited by the medical community. In Arizona there are vbac bans at certain hospitals, a lot of doctors who don't offer vbac, and laws prohibiting midwives from assisting in a home birth after cesarean. With the c-section rate at about 30%, and the vbac rate at about 8%, you really want to do your research to make sure you are finding someone who is going to be on your side come delivery day.

There are a lot of questions to potentially ask a health care provider, and it is important to ask about the things that are most important to you.

Some of your questions/discussions might include:

-their c-section rate

-whether they do vbacs or not/if so how many do they have in a month/how many are successful?

-their protocol for going post dates(past 40wks)

-their protocol on ruptured membranes (when your water breaks) past 24 hours

-their protocol on induction/induction rate, and what they feel are reasons to induce

-how often they are on call/any scheduled vacations

-who the providers are that take over when they are not on call/what are their practices?

-their episiotomy rate

-their protocol on cord cutting, and thoughts on delayed cord cutting

-what positions they will "catch" a baby in (do you have to deliver flat on your back in bed?)

- their vbac rate

-what their orders will be like in the hospital (monitoring/IV/eating/drinking/movement/pain management options)

-what kind of support they can offer to prevent tearing

- with a vbac/vaginal/c-section delivery, ideally how would they like things to go?

and the list could go on and on...

I was also taught that the best way to get a good answer is to pose an open ended question that will allow that doctor or midwife to do a lot of talking. If your questions give obvious clues as to what you are looking for, it could easily sway their answers to something that might not be completely true.

So instead of saying:

" I REALLY don't want an episiotomy, would I have to have one?"

you could ask

"In what situations would you find it necessary to perform an episiotomy/ how often do you perform episiotomies?"

to get a better idea of what to expect

When I was interviewing, I also paid a lot of attention to their tone of voice and general presence. If they wouldn't even take the time to let me interview them via phone or in person, they weren't worth my time and money. On the opposite end, if they were welcoming and willing to answer all of my questions, it told me a lot about them.

Another important thing is not to make assumptions before interviewing the provider. For example, assuming that because they are a midwife they will not try to use a lot of interventions during labor and will automatically follow through with your birth plans. Or that because your best friend loved this doctor, that you will love them too.

Going from hiring my last provider just based on my insurance coverage, and a tip from a charge nurse, to hiring a provider based on a personal interview and lots of referrals has made me feel so much more confident that I will actually get the support I need.

The Perfectly Passive Patient

{if you looked it up in the dictionary you would see this picture next to it}

I am a very passive person, and it has always been part of my nature. So when someone cuts in front of me at the grocery store, or if the Mary Kay lady blatantly lies to me about "winning a so called prize" just so she can get into my house and get me to buy stuff, I turn the other cheek. I avoid confrontation at all costs, and I magically transform into a doormat. Call me nice, a little too nice, and too afraid to be anything but that.

My nature wasn't any different in the hospital, and lucky for them it transformed me into the perfect patient. I rarely asked any questions and just did what they told me to do when they told me to do it. I agreed to do things even when it felt wrong or didn't make any sense.

I complied to the IV and having to lay in bed during contractions.

I complied to being starved for 21 hours because they weren't ready to define what was happening as "real" labor or not.

I complied to staying the night, even though they had promised to decide whether I was in active labor my midnight and never did.

I complied when the nurses came in every 30 minutes throughout the night to adjust the three monitors that were digging into my 38wk pregnant with twins belly, leaving me with little to no sleep.

And all of this happened while I wasn't even in real labor, although I didn't realize it at the time.

And this was just the beginning.

The bottom line is that a LOT of things that happened to me and my children at the hospital felt VERY WRONG, and I didn't do anything about it. Blame it on me being a first time mom and not knowing what to expect, or blame it on the respect I have for medical professionals. Blame it on my fear of confrontation or my want to be a good patient and to be like able.

I like to think that I've come a long way since then, and I have tried to convince myself that I will never be that passive patient again. I've learned so much in the last year and half, and I look at things so differently now. I'm done with having things done to me or my children without my consent, or without any information. I'm done with being the doormat.

Unfortunately my first appointment for this pregnancy had me repeating these same patterns. The nurse practitioner told me they needed to do a "swab" even though I had a current pap. They proceeded without even telling me why they were doing it, or asking me if I wanted to do it. I didn't realize the error I had made until my drive home. I just started crying and at the time I couldn't figure out exactly why it made me so upset. It was just a stupid swab...right?

When I got home I did some research on the Internet to find out why they did what they did. Knowing the purpose didn't really help, because although I was mad at them for not discussing the purpose of it first (aka informed consent), I was really mad at myself for just letting them do it without asking why or whether it was necessary or not. I couldn't help but feel like a failure all over again.

Coming out of my passive shell is a work in progress, and to be honest I still worry about how I will fare in the hospital setting again. While I have a lot of control over who my immediate birth team will be, I have no control over the nurses and other hospital workers that will also be there. Will they be supportive of my wishes? Will they try the same things they tried last time? Will I be the same passive patient I was last time and end up losing all control? I don't know...

So I'm arming myself

with

research

childbirth prep classes

hynobabies

a supportive health care provider

a great doula

a husband (who is also birth educated)

and faith

that Heavenly Father can make

the seemingly impossible possible

because in the end

He is in control.

Why Choose a Midwife?

So now it's time for me to get serious about finding a health care provider that is truly supportive of my wish to vbac, along with my other birth plans. It's easier said than done. With my last pregnancy and delivery, I used an OB/GYN, but after meeting midwives and learning about the midwifery model of care, I am really hoping to find a midwife this time.

The Midwives Model of Care

(from the citizens for midwifery website)

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

•Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
•Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
•Minimizing technological interventions
•Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

With this birth, I feel that it would be best for me to have a health care provider that:

-views pregnancy and birth as a natural process

-believes in a woman's ability to give birth naturally

-doesn't use unnecessary interventions during labor or delivery

-offers plenty of one on one time with their patient during pregnancy as well as support during delivery.

-tries to minimize the risks that can arise in pregnancy and birth by providing information to the mother on how she can be healthy during her pregnancy and prepare for a healthy delivery.

-views vbac as a safe option for mom and baby, but can also make quick decisions if complications do arise.

-respects the mom's wishes and offers support

-gives the mom real informed consent when it comes to all of her options and the risks involved.

-isn't afraid of "big babies" or a mom going past 40wks.

-allows the baby to come when they are ready.

-genuinely cares about the mom and baby's health as well as their birth experience.

Here is a great video from YouTube that talks about some of the benefits of choosing a midwife.

We're on our way...

( Charting showed we were pregnant 4 days before my expected period)

We are expecting baby #3 in September!

VBAC here we come!