Considering the broken state of America’s Maternity Care System, planning your birth should be considered essential. You are going on a journey, and it is not to Disney World. Being uninformed puts you and your baby at risk. You should spend more time planning your birth than your purchase of a house or a family vacation.
However, presenting an L&D nurse with a Birth Plan can backfire. Often nurses mock them when you are out of earshot. The problem, as they have explained to me, is that birth is unpredictable, and it is better to be flexible. Implicit in this is their opinion that you should listen to the staff’s recommendations in the moment, and if you have a Birth Plan, you are going to want to stick to that instead. I read an article recently quoting a nurse admitting to stamping up a Cesarean section chart upon receipt of a birth plan, cynically anticipating a bad outcome just because of a birth plan’s existence. It is a rare nurse that says anything positive about a patient’s birth plan, or the patient who has one.
So, I propose you do Birth Planning instead. This means that you do your homework (see below), and know what the turning points are in labor, learn the pros and cons of each of the decisions made at the turning points, and thus become an informed consumer of your health care. Don’t bring your printed work to the hospital. Don’t tell your nurse you have a specific plan or vision for how this birth is going down. Be fully prepared, aware, informed, and participate as decisions are made. Don’t be a lamb to slaughter, presenting your body for “extraction of human,” as one patient quipped. Discuss your hopes for labor with your health care provider during prenatal visits. If you wish to have some special thing done, such as the Dad announcing the gender, or silence until after Mom says a prayer, definitely tell your team in advance. Most importantly, do come prepared to ask these questions repeatedly:
The Three Power Questions
What are the risks and benefits of this proposed intervention?
What could happen if we don’t do it now?
What are some alternatives to doing it?
Birth Planning Homework
What are the problems with lying in bed during labor? What are the benefits of walking, staying upright, and using shower jets as long as possible?
What are the risks of Pitocin? How does Pitocin work, and what is the difference between oxytocin and Pitocin? If oxytocin is the “love hormone,” why don’t women feel the love with Pitocin? When is the use of Pitocin truly necessary? What are alternatives to Pitocin?
What are the risk of calorie limiting during induction and labor? What are the risks of eating and drinking? What are the benefits? Can hunger lead to Cesarean section?
What are the relative risks of IV pain medication versus epidural? Which one works better? How long does pain relief last with each? What is the worst thing that can happen with each choice? How late in labor can I get each?
What are the risks and benefits of artificially rupturing membranes, i.e., breaking the water? Does doing so increase the risk of Cesarean section?
What is chorioamnionitis? Do repeated vaginal exams increase the risk? Does having water broken make a difference?
What are the downsides of having an IV? Is a “saline lock” a good alternative? What are the risks of not having an IV?
What is Intermittent Monitoring? What are the risks and benefits of Continuous Electronic Monitoring? What is telemetry?
How long is an average first labor? How long can labor go on safely? What about when the membranes rupture first?
What are the pros and cons of having a certified nurse midwife instead of a physician at birth?
How many people can be in the room with a woman in labor at my chosen hospital or birth center?
What is a doula? Does insurance cover doula services? How much do they cost? Why are the benefits of having a doula?
What are the risks and benefits of episiotomy? What type of episiotomy is done by my health care provider? What is his/her episiotomy rate? Under what circumstances does he/she do an episiotomy? What alternatives are there to episiotomy?
Will I be allowed to do self-directed pushing, or will I be urged to count to 10, do 3 pushes with each contraction, and hold my breath while pushing? What is open-glottis pushing?
What positions are available to me for pushing? What effect would an epidural have on position choices? What are the risks of pushing while lying on one’s back?
Does your health care provider do delayed cord clamping? Under what circumstances do they not do so? What if I have a Cesarean section? Would they do delayed cord clamping then?
Can the father of the baby cut the cord? Can he (or another chosen person) assist with the delivery if things are going smoothly?
What are the risks and benefits of immediately giving the baby his/her Vitamin K shot, Hep B shot and eye ointment after delivery? What are the risks and benefits of waiting until after baby’s first feeding? What are the benefits of immediate skin-to-skin contact after birth?
When should the baby be given its first bath? Does every bit of vernix need to be washed off?
What are the risks and benefits of circumcision? What are the risks and benefits of the various methods, and pain relief options? What is the worst thing that can happen from not doing circumcision vs doing circumcision? What are timing options? Why are baby boys born with foreskins?
Under what circumstances will baby be taken away from us after delivery? What are the risks and benefits of having baby room with mom after delivery?
To answer all of these questions adequately would take an entire book. If you would be interested in answers to one or two of them, reply below, and I will try to tackle it in a blog post shortly. I have addressed some of these issues, i.e., intermittent monitoring and the importance of mobility, in previous posts.