You are here: Home / Birth / Birth plans

Cesarean Awareness Month: Evidence-based, Practical Cesarean Resources

April 15, 2013 By Cara Terreri 1 Comment

April is Cesarean Awareness Month. While it can be a life-saving procedure for mom and baby, a cesarean is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to comment with your experience as well as any questions. For more information be sure to check out the International Cesarean Awareness Network Blog.

Knowing what happens before, during, and after a cesarean birth is helpful for moms who are scheduled to have a cesarean, but also for any mom approaching birth. It’s common not to want to learn about something you so desperately want to avoid, but educating yourself about a cesarean — even just a little — will help prepare you for all possibilities in birth, which could help ease your fears about the process should you need one.

There are several resources on cesarean around the web. About.com/pregnancy, however, seems to have the most complete, succinct, and practical resources. The author of About.com’s pregnancy resources is Robin Weiss, a Lamaze Certified Childbirth Educator, a doula and doula trainer (DONA), a childbirth educator trainer, author of several maternal/child care books, and mom to eight children.

Moms who plan to have a vaginal birth, but want to know more about a cesarean, may want to read:

 

Moms who have a scheduled cesarean may want to read:

 

All expectant moms can benefit from reading the following:

Filed Under Birth, Birth plans, Cesarean, Featured Story Tagged With cesarean, Cesarean Awareness Month

Thoughts on Birth the Second Time Around

February 8, 2013 By admin 1 Comment

By Caitlin Tucker

I knew right away this time around — I started to feel those familiar signs of pregnancy, cramps, tiredness and nausea. I took a test the first day of my missed period this time and those two little lines came up. My husband and I were very excited! Of course, I have the usually worries throughout the first trimester and the excitement to hear that little heart beat for the first time. For my daughter, who is now 15 months old, we took the typical route of care. We went to my family doctor to confirm that the home test was right, I stayed in their care until I was 28 weeks along and then I transferred care to an obstetrician for the remainder of my pregnancy. I felt confident with both my family doctor and obstetrician, and in spite of the quick visits  and long waits in the waiting room, I was satisfied overall.

We also took the typical labour and delivery classes through our local hospital. I remember only learning what to do once we got to the hospital and how to be admitted,  but not much about how to cope during labour. I figured, since I wanted a natural birth, it would just happen that way. I read a lot of books and spoke to a few of my friends that had already had babies. I wanted a non-medicated, natural and healthy birth. At 38 ½ weeks pregnant I felt my first contraction. After a few that were about 15 minutes apart, I let my husband know I thought early labour was starting. We arrived at the hospital when they were 1-3 minutes apart after about 5 hours of early labour. After about 7 hours more at the hospital, our little girl arrived at 5:43 a.m., weighing 6 pounds 15 ounces. We were relieved and so excited she had finally arrived! I think we were both just so happy she was healthy that it took a few months to come to the realization that my labour  did not go  the way I had hoped and planned. After I arrived at the hospital, I was set up on the fetal monitor and was continually monitored throughout my labour and wasn’t allowed off the hospital bed. In hindsight, I came to understand that being on one’s back during labour is one of the least comfortable positions in order to achieve a successful natural birth. I  laboured for 3 hours on the bed without medication, but as labour  got more intense and I wasn’t able to move around, the contractions became very difficult to cope with. My nurse was very nice, but didn’t offer any labour support and just kept her eyes on the baby monitor. My OB was also very nice, but as usual, she was on-call and was in and out of the room and also offered no support during labour other then medication options. Throughout my labour I was asked several times if I wanted an epidural and I kept saying “no” but after 3 hours and not knowing when it was going to end, I gave in and signed the form for the epidural. After taking the medication, I was relieved the pain was finally over. Two hours later, I was fully dilated.  After 2 more hours of directed pushing, our little one arrived.

Initially, we were satisfied with how things went and didn’t think too much about the disappointment that our natural birth plan didn’t happen. When I started to think about having more children, I realized how important it was to me to have a natural, healthy and safe birth. I started to read more books on natural births, watch documentaries, and educate myself. I spoke to my friends who had natural births and talked about what they did differently than myself. One major point that differed from my experience was that they prepared themselves by taking classes on how to cope with labour and had professional support with them during labour who encouraged and supported natural birth under safe situations. I continued my education on natural birth and it lead me to look into other care professionals that promote natural birth as a healthy part of life, instead of viewing the pain and experiences of natural childbirth as a burden.  When we found out that baby number two was on his/her way, I knew this was my opportunity to be as prepared as I could for labour this time around. I am now seeing a supportive midwife, enjoying their peaceful office with minimal wait times, and receiving encouragement to have a natural birth and continual support throughout labour and postpartum home visits. I believe that our bodies were designed to give birth that is inherently safe, and under most circumstances, women have the ability to give birth without medication, to move freely throughout labour. I believe that women need support from their friends, family, care givers and society as a whole to give birth naturally. It should be celebrated by women. Even though I’ve given birth once, I truly want to experience birth and have the support of my husband and midwife as they help me labour through the discomfort and bring another life into this world. I’m choosing not to be simply satisfied with my birth story – I want to be in awe of it.

 

Caitlin lives in Toronto, Canada, and is a wife and stay-at-home mother to one little girl and baby number two on the way. She and her husband are involved in their church and Caitlin helps run a mothers group on a bi-weekly basis. She recently enrolled in the Douglas College Lamaze Childbirth Educator Program and hopes to bring knowledge, empowerment, and encouragement to other women throughout their pregnancy and birth.

Filed Under Birth, Birth plans, Childbirth education, Featured Story

Don’t Just Hope for the Best — Plan for it: How to Write a Good Birth Plan

January 7, 2013 By Cara Terreri 6 Comments

If writing a birth plan seems like a frivolous step to birthing your baby, you may want to reconsider. It is true that your baby will come whether or not you “plan” (or write a plan) for his entrance, but the act of writing about your upcoming birth can help you learn more about the care you’ll receive and the needs you may have during labor and birth. Writing a simple, informed and succinct birth plan helps you: consider and research the many choices available surrounding labor and birth; open a discussion with your care provider that can sometimes reveal surprising differences in your “vision” for birth; and provides useful information to your birth team.

While there’s no right or wrong in creating a birth plan, there are some things to consider to help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and short (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I wanted to eat and drink as necessary — I just did it.

The Specifics

To help you get started, use the following questions as a prompt for writing your birth plan.

What message would you like for your care providers to read first? Here’s a sample of an opening message:

Thank you for taking the time in advance to read our birth preferences. We realize that unexpected circumstances do arise and do not intend this as a “script” for our birth. We hope you will be able to keep us informed and aware of our options. Thank you!

What would you like for pain relief during labor (narcotic or non-narcotic)?

What routine interventions do you want to avoid (IV, continuous fetal monitoring, etc.)

How would you like to be able to push? As you feel the urge? In a position that feels most comfortable to you?

Who would you like to announce baby’s gender (if you don’t already know)?

Would you like baby’s cord to stop pulsing before being cut? Who would you like to cut the cord?

Unless there is an emergency situation, would you like immediate, uninterrupted skin-to-skin contact with your baby?

Would you like the staff to delay routine newborn procedures (weighing, washing) until after your baby has breastfed?

What routine newborn procedures would you like to avoid or include (eye ointment, Hep B vaccine, vitamin K shot, baby bath)?

How will you feed your baby? Do you wish to avoid bottles or pacifiers?

Even if you don’t “plan” on a cesarean, it’s important to include cesarean preferences, just in case. The following are examples of those preferences:

  • Please allow partner/dad to be present at all times.
  • Please allow doula to be present. (This is sometimes against hospital policy, but it doesn’t hurt to ask.)
  • Please allow dad to announce baby’s gender.
  • Please allow baby’s cord to stop pulsing before cutting. Dad would like to cut cord.
  • Please allow mom to have skin-to-skin contact with the baby in the OR. (Skin-to-skin in the operating room after a cesarean surgery is not standard, though it is starting to happen in a few locations across the United States. When mom is not under general anesthesia for a cesarean, this should be a reasonable request and will help with the initial mother-baby bonding that might have otherwise been missed.)

 

If you’ve written a birth plan, what tips can you offer? How did your birth plan help you?


Filed Under Birth, Birth plans, Featured Story Tagged With birth plan

Questions to Ask During Labor and Birth

November 19, 2012 By admin 1 Comment

Labor and birth can be unpredictable. It’s smart to be prepared with questions to ask to decide if what your provider is recommending is needed and right for you. Keep the following questions in mind, especially when you hear words like “induction,” “fetal monitoring,” “episiotomy” and “C-section.” Also keep in mind that it can be helpful to have a support person with you who can help you navigate the important choices and decisions you will be making.

  1. Is my baby in any danger? Am I in any danger?
    Asking about the safety and health of you and your baby can steer you to the safest, healthiest outcome. If the answer is “no” to both questions, it’s more than likely that the intervention your provider is recommending is not needed.
  2. What happens if I go through with this intervention? What are the risks and benefits?
    Most health care providers want a laboring woman to feel comfortable, so there’s a tendency to answer questions like this with, “It’s really safe,” or “I don’t usually see a problem with this.” But, all interventions have pros and cons. If you know what they are, you can weigh your options and make the best, most informed choices.
  3. What does the research say?
    Not all medical practices are based on the best research. In fact, the majority of interventions are shown to be overused and often unnecessary. As your care provider, he or she should know whether the intervention is backed by science.
  4. Is there another alternative?
    There are plenty of alternatives to common interventions. For example, epidurals are not the only option for pain management; movement during labor, pressure points and breathing exercises are natural ways to help with pain relief. Consider the alternatives first, so you can get the care that’s right for you and your baby. Lamaze childbirth education classes can help you identify very practical, effective alternatives to ease the pain.
Filed Under Birth, Birth plans, Featured Story, Labor

Communicating with Your Care Provider: Are You on the Same Page?

April 25, 2012 By admin Leave a Comment

By Anna Deligio, MSW, Labor Doula, LCCE, Reiki Master

 

First, do no harm.

This instructional value statement is often attributed to different versions of the Hippocratic oath medical doctors take as they embark on their healing careers.  It seems simple enough and certainly it would be easy enough to assume that its interpretation is universal.

We all know what happens to you and me when we assume, though, and to do so within conversations with your medical practitioner can often lead to more than just a need for clarification. Ensuring that a shared understanding exists of the language being used is critical to ensuring that you receive the care that is best for you.

Take the idea of “doing no harm.” Let’s say you’re in active labor and have been going strong for some time without any medicated pain management. You are working through your contractions well but are tired, overwhelmed, and lacking good support. You are starting to feel like you may not be able to continue without medication. The next time your nurse comes in, you say that you’d like to talk about getting an epidural. The nurse alerts anesthesia and soon you are talking with that person about the potential of getting an epidural.

Drawing on what you learned during your pregnancy from your own research and your childbirth preparation class, you know that epidurals can come with increased risks. You ask the anesthesiologist if the epidural will harm your baby. The anesthesiologist gives you a quick and confidant “absolutely not.”

Does that mean that you move forward with the procedure? Not necessarily. First it is important to make sure both of you are operating from the same understanding of “harm.” You might be thinking that “harm” includes the potential for a sleepy baby after the birth and one who may struggle to establish good breast-feeding. The anesthesiologist may be thinking that “harm” means the epidural would kill or permanently damage your baby.  Without clarifying follow-up questions such as “What impact will it have on the baby?” and “How long can I expect that impact to last after the birth?” you are risking approving a procedure that is not in line with your values of birth.

An online search for “tips on communicating with doctors” reveals a theme of writing down questions before the appointment, remembering that you are the consumer, bringing someone with you to appointments, and writing down the answers you get. Added to this needs to be, “ask clarifying questions until you are confident that you and your provider are using the same definitions for words.”

In many childbirth preparation classes, the acronym BRAIN is used to teach participants what questions to ask when faced with a decision. The letters cover the Benefits, Risks, Alternatives, your Intuition, and the potential of doing Nothing and are a way to remember which questions to ask in order to ensure that the procedure undertaken is the one you want.  This model is a wonderful first step, but can still lead to miscommunication if clarification of terms is not established through follow-up questions.

This can be a laborious process and not one you necessarily want to step into during your labor. More the reason to have these conversations during your prenatal visits, write a succinct and clear birth plan, and make sure that you have a support person with you during labor who understands your intent during the birth and can support you in communicating that intent to your medical staff.

Language is wonderful in its ability to convey specific ideas and still leave room for interpretation. While it may be fun to explore the intended meaning behind words when reading a piece of creative writing, it is critical to explore the intended meaning when discussing your care with your medical provider.

Insurance and funding permitting, the ability to pick a provider from the start that shares your values will go a long way in making sure language meaning is shared. That said, you will likely interact with many medical providers during your labor and, like us, each brings his/her own lens, values, histories, and definitions to the conversation.

Practicing asking clarifying questions during your appointments will give you the confidence needed to draw on that tool during your labor with each provider with whom you interact. Each question will get you closer to creating a shared understanding with your providers and build your confidence in your ability to participate actively in the labor you intend to have.

 

Anna Deligio is a Lamaze Certified Childbirth Educator and Labor Doula through her business Nourishing Roots, work that is greatly informed by her previous experiences as an MSW working with families in crisis and babies in foster care, a Special Education teacher of high school students with learning and emotional challenges, a marketing writer, and a waitress at a French restaurant. She loves working with pregnant people and their support people during the transformative time that is pregnancy and birth. When not enjoying the company of pregnant people, she enjoys relaxing with her partner Cathy at their home in Salem, OR.

 

Filed Under Birth, Birth plans, Choosing a care provider, Featured Story, Pregnancy Tagged With birth plan, care provider

Cesarean Awareness Month: Making Your Cesarean Mother-Baby Friendly

April 18, 2012 By admin 4 Comments

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

Making Your Cesarean Mother-Baby Friendly

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

You may find yourself headed for a cesarean birth, even when that was not what you planned.  A cesarean might have been in the cards all along for a variety of reasons, or  this change in plans might occur before labor begins, or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.

As a long time birth doula and Lamaze certified CBE, I always encourage my clients and students to plan for a potential cesarean, even though many mothers feel like that outcome is unlikely.  Current cesarean rates in theUnited States tell us that more than 1 in 3 women will give birth by cesarean this year.  Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.

Here are my top tips to make your cesarean birth as mother-baby friendly as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.

1. If you know you are going to have a cesarean, without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start.  There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor.  There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.

2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby.  Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.

3. Walk into the operating room if possible.  It is very empowering to move to the OR under your own steam, if you and the baby are stable.  If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.

4. Ask for two support people in the operating room with you.  Your partner can be one, of course, and then your doula, family or friend may also be included.  Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.

5. Bring in music of your choice that can be played during the birth.  A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.

6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins.  There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked.  It can feel a little more personal to hear the staff introduce themselves and state their job…”I am Mary and I am the baby nurse…” can help you to feel like it is not such an impersonal procedure.

7. If you were waiting to discover the sex of the baby at birth, you can still do that.  The staff and surgeons do not need to announce “boy or girl” but leave that to be discovered by you and your partner.

8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable.  Even 30 seconds of continued pulsing can provide benefit to your baby.

9. Sometimes, women may feel a bit nauseous during the surgery.  It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells.  Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag.  Peppermint oil can reduced the nauseous feeling and help you to not vomit.  There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.

10. Talk to your baby after s/he has been born.  Ask your partner to tell you what is going on, and what your baby looks like; “Oh, honey, he has the same long fingers as you do…” Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world.  When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.

11. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed.  Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.

12. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed.  Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby.  While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles.  You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety.  If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you.  Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.

13. Ask that your uterus not be exteriorized during the procedure.  Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair.  Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair “in situ” (in position).

14. Ask that your uterus be double-layer sutured.  While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.

15. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside.  This time is precious and the fewer distractions the better, to help you and your baby connect and bond.

A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby.  It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula, doula trainer and Lamaze certified childbirth educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information or need some support in planning your birth.

Filed Under Birth, Birth plans, Cesarean, Complications and high risk pregnancies, Featured Story, Pregnancy, Preparing for VBAC Tagged With cesarean, Cesarean Awareness Month

22 Ways to Make Your Birth Easier

February 3, 2012 By admin 2 Comments

By Lyn Dee Rankin, LCCE, CLS

21 ways to make your birth easier? It is all in the birthing bag that every pregnant woman should assemble in her last trimester. This is the bag that goes with you for birth — different from the suitcase you pack for the hospital stay after the baby is born. Wherever you choose to birth, you and your labor support people can be well prepared for the potential use of many items to make labor easier. The image of the Mary Poppins bag comes to mind. Different items serve specific purposes, but may simply serve as a distraction or a much needed change to support relaxation, focus, confidence and resolve so as to move through intensifying uterine waves (contractions). Consider the following:

  1. Written birth plan/preferences: It is helpful for all involved to have a reminder handy of what your preferences are. A mother-led birth helps result in a satisfying birth.
  2. Clothing to maximize freedom of movement in labor in and out of a birthing room (light shirt, sweater or robe and slippers or warm socks); anything to replace or cover a typical hospital gown.
  3. Focal Point: Many women practice relaxation using both internal and external focal points. Use one you can take with you.
  4. Favorite music or relaxation narrative on a portable device: Several compilations from smooth, relaxation, to motivating, movement music may be chosen during different times in labor for calming “zoning out” or rocking and dancing to encourage baby’s descent.
  5. Lollipop: Especially sour candy on a stick promotes salivation to keep mouth moist and deliver sugar for energy. The stick allows taking out to breathe.
  6. Breath spray or mouthwash: If support partners are breathing closely with birthing mom….
  7. Juice: A small can of sweet juice or energy drink to add to ice chips.
  8. Washcloth for cooling moisture. Colored so it can be distinguished from facility’s white ones.
  9. Lotion/oil for massage.
  10. Lip balm: It just feels good.
  11. Distractions: Cards, portable game for prolonged labor and distraction
  12. Back massage devises: Commercially designed rollers or just tennis balls in a can. (The balls alone are useful for easing back labor and the entire can rolled in a towel works well too.)
  13. Aromatherapy
  14. Mood lighting if birthing room has limited light control.
  15. Birth ball if not provided at facility.
  16. Hair accessories to pull hair from face.
  17. Labor log to record timing of uterine waves and other sign posts of labor (don’t forget a pencil/pen).
  18. Timing Device to track progress through length of uterine waves — stop watch, watch with a second hand, etc.  Reminding a laboring woman of her progress through each uterine wave builds confidence and resolve, one wave at a time.
  19. Labor positions on a list or a set of cards of each position to post around the labor room. It is essential that labor support partners promote movement and changes in positioning throughout labor.
  20. Support partners’ notes for reference. Childbirth educators usually provide summaries of labor signs and suggested appropriate coping techniques. Written narratives for relaxation and mediation will ease labor. No one is expected to remember it all!
  21. Support partners’ snacks: A well-nourished, comfortable support partner will be your best advocate.
  22. Support partners’ trunks or bathing suit for joining you in the shower or tub.

AND DON’T FORGET…

Key phone numbers: Birthing facility, doctor, support persons and family.

Last minute additions:  Wallet and insurance documents, glasses and contacts and respective cases, camera and phone.

Lyn Dee Rankin is an experienced educator, having taught children and adults since 1976 in multiple areas of Health Education and served on educational boards. As an independent, non-hospital Lamaze Certified Childbirth Educator, she has prepared hundreds of couples for safe and healthy births, and has had both a vaginal and cesarean birth, and breastfed both of her children. 

 

Filed Under Birth, Birth plans, Coping with pain, Featured Story Tagged With birth bag, Hospital Bag, pain relief strategies

Birth Choices: Are You Informed?

January 23, 2012 By Cara Terreri 8 Comments

In a recent Canadian study that was reviewed in The Journal of Perinatal Education, researcher Michael Klein, MD, reports that women are inadequately informed and care providers are not delivering evidence-based information when it comes to birth practices. (1) This dangerous combination makes it hard, if not impossible, for women to make informed decisions. A truly informed decision comes when a person has been given complete and unbiased information on which to base her action.  Among the study’s findings:

The women’s lack of evidence-based knowledge about epidural analgesia included failure to appreciate that it interfered with labor and was associated with an increase in the use of forceps and vacuum. Many were unaware of the benefits and risks of cesarean surgery, including whether it was associated with urinary incontinence or sexual issues. The women’s knowledge was also insufficient about the benefits and risks of episiotomy, the role of doulas in improving outcomes for mother and baby, and the place and mode of birth, including a birth center or home birth.

Further compounding the search for evidence-based information in birth is the diverse and conflicting information that is published in mainstream media. Earlier this month, articles from two different large media outlets questioned the true dangers of epidurals and whether they were overstated. (2,3) The articles provide both anecdotal information about each authors’ birth experiences and point to scientific studies. After presenting and debating the science, author Melinda Wenner Moyer says, “Women shouldn’t cave to pressure from either side. They should make informed decisions based on their goals and priorities.” The problem is — once again — how can a woman develop her goals and priorities if she is not truly informed?

At the end of her piece, Moyer sums it up by saying, “My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted.” It’s great that she achieved the birth she wanted! Unfortunately, however, her description negatively influences other mothers’ perception of birth. My unmedicated (aka, “natural”) third birth was painful, yes, but it was not “intolerable.” When mothers believe that the pain of birth is intolerable (as many moms do in the United States), they are driven to choose an epidural without considering alternatives that can make birth just as enjoyable, not to mention healthy!

So with all the obstacles to becoming truly informed, how do you navigate the jungle of mass-misinformation-overload? Lamaze childbirth educator (and Giving Birth with Confidence contributor) Ami Burns responded aptly on the Lamaze Facebook page, “Yet another reason why comprehensive childbirth education is needed. Moms need the information — even when research may be inconclusive — so they can decide for themselves.” Childbirth education, when chosen wisely, helps women look at all of the options by providing pros and cons, risks and rewards to the many decisions a woman can make during labor and birth. Contrary to what some may believe, a good childbirth class doesn’t deliver the “natural birth or bust!” philosophy. A good childbirth class provides evidence-based information to help women be as prepared as possible to make the best decision for her and her baby.


How did you seek information on birth? What helped in your decision-making process? What hindered it?

 

References:

(1) Klein, Michael C. Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About Birth. The Journal of Perinatal Education, Volume 20, Number 4, 2011 , pp. 185-187(3).

(2) Moyer, Melinda W. The Truth About Epidurals. Slate. January 11, 2012.

(3) Dell’Antonia, KJ. Are the Dangers of Epidurals Overstated? The New York Times. January 23, 2012.

Filed Under Birth, Birth plans, Childbirth education, Featured Story, Pregnancy Tagged With childbirth class, informed choice

Six Tips for Gentle but Effective Hospital Negotiations

August 15, 2011 By admin 11 Comments

By Jessica English, CD(DONA), LCCE

Is the hospital you’ve chosen totally supportive of the six Lamaze Healthy Birth Practices?  Once you educate yourself on the elements of a healthy birth, there may be times you need to advocate for yourself and your baby. Hopefully you’re able to choose a birthplace that largely supports your goals for birth, but if that’s not possible, here are some suggestions that might make negotiating easier.

1. Talk it out beforehand, and get it in writing. If something is particularly important to you, talk it over with your midwife or doctor at an office visit. For example, if you know it’s standard for women to get a routine IV in labor, explain your concerns to your provider ahead of time. If you can agree that you will not have a routine IV for a healthy, normal birth, ask your provider to write that in your chart and either put it in writing on a prescription pad, or sign your birth plan. That way, if your doctor or midwife isn’t in the building when you arrive in labor, you’ll have that piece of paper to back you up. Individual midwives or doctors usually have the power to override routine policies for their own patients.

2. You’ll catch more flies with honey than vinegar. It’s great when moms and dads are passionate about healthy birth. Unfortunately, sometimes that passion can leave them feeling confrontational. You don’t need to start off with guns blazing. I suggest to my students that they are firm but very polite when working with the staff. Is continuous monitoring the policy at this hospital? You might say to the nurse, “Our midwife OK’d intermittent monitoring. We’d be so grateful if you could help us with that.” And if her answer is no, try again. “This is so important to us. I know it’s not the standard, but we really appreciate your understanding. We did OK it ahead of time.” Nurses, midwives and doctors are just people. A gentle approach is usually received much better than angry demands, and you’re more likely to get what you want. Be likeable.

3. Brainstorm. If you can get your nurse or provider working with you, they may start to take ownership of your ideas. Try asking for their help to brainstorm a problem. For example, a dad or other support person might say to the nurse between contractions, “We really want the baby to stay skin-to-skin after birth. Can you help us think about how that might work? Can some of the routine things be done while the baby is on her chest? What if we waited to weigh and measure him?” Or maybe continuous electronic monitoring is required because of a medical complication, and you’ve been asked to stay lying down in bed. Ask your nurse or provider to help you think through other options, such as laboring with continuous monitoring on the birth ball, on hands and knees or sitting upright. If they respond with reasons why something won’t work, you can always throw out a phrase like, “Let’s try together.” When people are part of the process they generally respond better than if you simply list your demands.

4. Bring a doula. An experienced doula has usually seen other families successfully negotiate in the hospital environment. She probably knows what’s possible and may have some techniques for helping you “get to yes.”  For example, hospitals in our area require 30-40 minutes of continuous monitoring when a woman first arrives, with intermittent monitoring as an option after that time. The mom is usually asked to lay on her side in the bed for this monitoring, which is hard for most women to do when they are in active labor. Sometimes the nurse will stay and hold the monitor device on her belly, so that she can still move with her contractions without losing the baby’s heart tones on the monitor. Once one of my doula clients had a nurse who was not willing or maybe not able to stay. The nurse kept insisting that the mom lay on her side, and the mom kept insisting that she couldn’t do that because it would make the contractions too intense. I asked if it might be possible for the dad to hold the device on her belly. The nurse happily agreed. She was able to leave and still get the monitoring she needed, the mom was able to continue standing and leaning with her contractions, and the dad was happy to help.

5. Don’t stop at the first “no.” If you’re asking for something outside routine hospital policy, the first answer you receive will probably be no. Expect that first no, and be pleasantly persistent, using all the techniques mentioned above. I know one woman whose nurse kept telling her there was no way she could have the special requests she’d made for her planned cesarean, such as having both her husband and her doula in the operating room and having her baby skin-to-skin on her chest while the doctor finished the surgery. The mother just kept nodding and smiling and saying, “I understand, but this is what I want. How can we make it happen?” Her negotiations were successful, and her doula and husband were both at her side when that beautiful baby was laid on her chest almost immediately after his cesarean birth. Had she accepted that first no, her birth experience would have been much different.

6. Remember, it’s your body, your birth and your baby. If it comes down to the line, remember that no one can force you to do anything or accept any intervention that you do not want. Shared decision making requires your consent. I remember my client who was pushing on hands and knees with a nurse, only to have a midwife come in at the last minute and tell her to turn over on her back. She asked why, and the midwife replied, “I don’t deliver babies this way.” Between strong pushes, the mom simply said, “No.” The midwife told her again to turn over, and again the woman said, “No.” The midwife successfully caught the baby while she stayed on her hands and knees. It was a beautiful birth! It can be intimidating to have professionals in scrubs and white coats telling you to do something, but if there is no clear safety reason for the request, it is always your right to say simply and clearly, “No.” After all, it is your body, your birth and your baby.

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

Filed Under All Recent Articles, Birth, Birth plans, Dads, Healthy Birth Practice, Hospital Birth, Working with a doula Tagged With birth plan, doula, Healthy Birth Practices, hospital birth, natural birth

10 Tips for Avoiding a First-Time Cesarean

July 27, 2011 By admin 11 Comments

By Jessica English, CD(DONA), LCCE

More and more women in the United States (and around the world) are having cesarean births. A recent study from the Yale University of Medicine showed two main reasons for the rise: more c-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).

For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We’ve identified 10 areas where you can be proactive and stack the deck in your favor.

1) Hire your provider wisely. This point is number one for a reason – it’s critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It’s helpful to know your practice’s cesarean rates. The labels “obstetrician,” “family doctor” and “midwife” don’t necessarily tell you what you need to know about your provider’s philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tool to help you if your labor is complex? If you’re not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner.  If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.

2) Hire a doula. Simply put, doulas make birth better, and there’s research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits. Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review. What exactly is the doula magic? The research hasn’t pinpointed the magic, but I think the unique combination of physical, emotional and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn’t really promote natural birth.

3) Take an independent natural childbirth class. It’s not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process. An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.

4) Avoid induction unless there’s a serious medical problem. As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Doubles it. That’s huge! Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula (remember them?) to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you’ll need great support on the journey.

5) If having your baby in the hospital, stay home at least until strong, active labor. Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to “come in when contractions are five minutes apart, at least a minute long, for at least an hour,” most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean). In her book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block tells the story of a hospital in Florida that lost power after a major hurricane. A generator kept the essentials running, but there was not enough power for air conditioning. They wanted to save resources and keep laboring women cool, so for a full week they turned away any woman who was not in full-blown, active labor. Their emergency cesarean rates during that week dropped dramatically.

6) Avoid an epidural, at least in early labor. Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals. There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn’t have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won’t even need the drugs. Most women don’t.

7) Read only the best childbirth books. Get these books, and read them cover-to-cover. Seriously, throw away “What to Expect When You’re Expecting,” and dive into these wonderful books instead.

• “The Official Lamaze Guide: Giving Birth with Confidence,” by Judith Lothian and Charlotte Devries (the book that inspired this blog!)

• “Ina May’s Guide to Childbirth,” by Ina May Gaskin

• “The Thinking Woman’s Guide to a Better Birth,” by Henci Goer (Written in 1999, this book is due for a revision, but it’s still excellent information and routine procedures and hospital technology have not changed much since that time. Henci also runs a helpful Q&A forum on the Lamaze International web site, so you can ask the expert yourself.)

• “Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience,” by Ricki Lake and Abby Epstein (they also offer a great web site and community)

And while you’re at it, buy the DVDs “The Business of Being Born” and “Orgasmic Birth” – they’re even on Netflix. That’s right, I’m recommending “Orgasmic Birth.” Stretch yourself a little!

8) Get your partner on board. It’s hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin’s book “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions” is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.

9) Consider an out-of-hospital birth. It’s possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. As a doula I see them fairly often, and you should definitely choose the hospital if that’s where you feel safest and most comfortable. But the best research is pretty clear that your odds of a vaginal birth are better outside of the hospital: at home or in a birth center. In 2005 the British Medical Journal published a large study that looked at home births in the United States attended by Certified Professional Midwives. The women who gave birth at home had similar outcomes to low-risk women who had hospital births in terms of safety for moms and babies. But just 3.7 percent of the women who had their babies at home transferred to the hospital for a cesarean, while 19 percent of the low-risk women who had their babies in the hospital ended up with c-sections. The current cesarean rate in the United States is 32.9 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.

10) Believe in your body! The cesarean rate for women who birth at The Farm in Tennessee is less than 2 percent. Many industrialized countries around the world have cesarean rates of 15 percent or less. Women have been doing this for millions of years! Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly… trust your body. Trust birth.

 

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

 

Filed Under All Recent Articles, Birth, Birth plans, Choosing a care provider, Healthy Birth Practice, Homebirth, Induction, Pregnancy, Working with a doula Tagged With cesarean, childbirth class, doula, home birth, hospital birth, labor induction, Lamaze Certified Childbirth Educator, natural birth
« Older Posts