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

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?


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

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.

 

Six Tips for Gentle but Effective Hospital Negotiations

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.

Birth: To Plan or Not to Plan?

That IS the question that seems to pop up time and again for expectant moms. If you want to see evidence, check out the latest posts about birth plans (and the multitude of comments) from NPR on The Baby Project — here, here and here.

To some, the idea of a “birth plan” sounds silly and unnecessary. “What is my birth plan? Well, I plan to birth a baby!”  Still other moms hinge every other thought in their third trimester on their birth plan. And what about maternity care professionals — how do they feel about a birth plan? Well, it depends. At the hospital where I plan to give birth, nurses, OBs and midwives alike encourage moms to submit a birth plan and bring a few extra copies for everyone attending their birth to review. But I’ve also heard of care providers who scoff at the idea, even calling women who bring in an overly detailed birth plan an “automatic section” (as in, cesarean).

So where’s the middle ground? My personal philosophy, which I was happy to learn aligns with Lamaze educators, is that writing a simple, informed and succint birth plan helps a woman (and her birth parter): consider and research the many choices available surrounding labor and birth; open a discussion with her care provider that can sometimes reveal surprising differences in their “vision” for birth; and provides useful information to a woman’s birth team.

While there’s no “right or wrong” for creating a birth plan, there are some things to consider that will 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 about about birth plans? 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 as short-as-possible (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 will eat and drink as necessary — I just plan to do it, even though I know it is against routine hospital policy. Per Rixa’s advice:

“…don’t worry about including any of the little things that you shouldn’t even be asking permission for. The don’t ask, just do kind of things. Eating and drinking if you’re hungry, moving and changing positions, music, lighting, unhooking yourself from the monitors to move/go to the bathroom/etc (especially if, like most women, you have no specific reason to be on constant monitoring). Just do these things and don’t take any flak from the nursing staff. Make sure your birth partner knows about these things and can buffer you from the nursing staff if you deviate from their policies or routines.”

For more on birth plans, stay tuned for Monday’s post where I will share and discuss my birth plan for my third (and due in about a month!) baby.

What is your personal philosophy on birth plans? If you used one for a previous birth, how did it help you?

 

 

Three Things Nurses Wish Moms Knew About Childbirth

I discovered an article yesterday that lists the top three things labor and delivery nurses wish that women knew about childbirth (compiled from a poll created by the Perinatal Advisory Council). Take a look — this is positive, encouraging advice from the women who work in the trenches!

1. Almost all agree women should take labor and delivery classes (94%)

  • “Usually the more prepared women are the better the experience. The fear factor decreases and with it so does the pain.”
  • “Women think that watching The Baby Story and similar shows on TLC, etc., is preparation for childbirth, and is realistic. This is not the typical birth experience.”
  • “It should be mandatory for women to take classes prior to childbirth for the labor and delivery and baby care/breastfeeding experience.”
  • “I believe it helps the mothers be more informed, realistic and work well with labor and delivery and care of themselves and newborn.”

2. Most believe a pregnant woman should prepare a birth plan (79.8%)

  • “Developing a birth plan takes conscious thought and may assist (especially first time) mothers with being more informed about options.”
  • “A birth plan is good as long as they are aware of the need to be flexible with it and not expect for everything to go exactly as planned.”
  • “I think creating a birth plan can be an educational experience for the patient.  However, I’ve noticed a lot of people use pre-made birth plans from the Internet, which doesn’t really help them to be more knowledgeable about the process of labor of delivery.  I’m not convinced simply having a birth plan will help patient’s to be more knowledgeable or prepared about the process.”
  • “Birth plans must be created with a health care professional who understands the realities of what is available at our particular hospital.”

3. More than half welcome (the right) doulas (63.3%)

  • “It depends on the doula; some are great and some interfere with nursing care.”
  • “A doula can be a great support if a woman is trying to have an unmedicated delivery. A woman really needs one-to-one care when she is laboring without any pain meds.”
  • “Continual labor support from a confident and knowledgeable support person makes a huge difference in outcomes.”
  • “Doulas can be helpful as long as they are supportive, not adversarial with the nursing staff.”

 

You can more about creating a good birth plan here and here.

Natural Birth at a Hospital: Making it Work for You

Last weekend, when discussing childbirth among women at my husband’s firehouse, mostly girlfriends and wives, I was shocked when most of the women discussed wanting a natural birth. It was a pleasant change—one that I have been working so hard toward!

I started doing some research after my discussion and came across a quote on natural childbirth in The Official Lamaze Guide that really struck a chord:

“In spite of evidence, U.S. maternity care continues to sabotage normal birth rather than support it. In 2002, the Listening to Mothers survey learned that among nearly 1,600 new mothers across the U.S., 44% had labor induced, 71% did not move freely during labor, 93% had electronic fetal monitoring, 86% had intravenous lines, 74% gave birth on their backs, and almost 50% of their babies spent the first hours after birth with hospital staff. Only 1% of the women experienced all six care practices that promote normal birth, and none of these women gave birth in a hospital.”

Lots of alarming statistics in there. This first-ever national survey of U.S. women’s childbearing experiences gives us a look into the way women are giving birth today in spite of evidence showing that these practices are outdated, unfounded, or harmful rather than helpful. Let’s take a closer look into each of the statistics listed and learn ways you can try to avoid becoming “one of the statistics” when birthing in a hospital:

44% of women had their labor induced. (!!)
That is a huge number for labor induction, especially since labor should only be induced for necessary medical reasons. Letting labor begin on its own is key for a healthy birth experience for women. It is also the way our bodies are meant to work in the natural stages of pregnancy. Labor induction is not a procedure that is risk free—it can increase the risk of premature birth, cesarean section, abnormal fetal heart rate, fetal distress, shoulder dystocia, and increase the risk of your baby needing to be admitted to the NICU. 

To reduce the incidence of unnecessary induction, find a provider with a low labor induction rate, and research the policies of the facility where you plan to give birth. This may be tricky, as many hospitals do not publicly advertise their rate of induction, cesarean surgery or other interventions. You might be lucky enough to find it on your hospital’s Web site. Or perhaps your hospital’s rating and feedback is listed on The Birth Survey. If not, take a hospital tour and be sure to ask LOTS of questions. Knowing information ahead of time gives you the opportunity to change your place of birth if you’re uncomfortable with their practices.

71% of women did not move freely during labor.
Being confined to a bed while laboring is not ideal by any means. Not only does it decrease the size of your pelvis, but it also can cause lowered blood pressure and fetal distress.  Better positions to give birth in and labor in include:

  • Standing
  • Hands and Knees
  • Side Lying
  • Knees to Chest
  • Squatting
  • The Sitting Position

93% had continuous electronic fetal monitoring.
This is a high number despite the fact that several studies have shown no improved outcome to mothers and babies with continuous electronic fetal monitoring. Also, recently, there has been a number of controversial articles about fetal monitoring and how medical professionals are reading the fetal heart tones.  Many think that the over-analyzing of small decelerations in fetal heart tones is leading to a higher rate of unnecessary cesarean births.  There are situations where monitoring may be a beneficial procedure, but in most birth situations, intermittent monitoring is safe. 

86% had IV Lines.
 Having an IV line in place in a laboring mother means that hospital staff has easier access to administering fluid and medications if needed. However, being attached to an IV line also restricts a laboring mother’s movement, interfering with her ability to change positions. Something that may help is requesting a “hep lock” in place of an IV line. A hep lock is a device that is inserted into a mother’s hand or arm so it is ready in case an IV line needs to be hooked up. Also, drinking and eating during labor will help to eliminate the risk of needing any kind of IV fluids during labor.

74% gave birth on their backs.
Laboring and giving birth on your back is pretty much the worst position. I recently wrote about this in two posts, Positions You Should Be Giving Birth In Part 1 and Part 2. Decreased pelvis size, blood pressure complications, lack of gravity to help with the birth itself are all huge factors in the supine (back-lying) position.

50% of babies spent the first hours of life with hospital staff. (!!)
Many mothers are not familiar with the benefits of skin-to-skin contact with your baby after they are born.  The first few hours are critical for mother-infant bonding. Unless your baby is experiencing complications or needs NICU care, babies should be kept with their mother in the first few hours — baths, weighing and measuring, etc. can all wait. Babies who have skin-to-skin contact after birth:

  • Cry less
  • Have more stable temperatures
  • Have more stable blood sugars (with the lack of skin-to-skin contact with my second son, because of my cesarean, made a change in his blood sugar which resulted in a 30-hour NICU stay)
  • Breastfeed sooner, longer, and more easily
  • Are exposed to normal bacteria on the mother, which can protect them from getting sick from unhealthy, or other types of bacteria, especially if birthing in a hospital
  • Have lower levels of stress hormones

Only 1% of these women experiences all 6 Lamaze Healthy Birth Practices.
Having a birth plan, and being an advocate for yourself and what you want for your birth experience in a hospital is key here. Communicate with your care provider and create a written birth plan to share with your care provider as well as the hospital staff when you arrive for baby’s birth. Make sure your partner knows about your birth preferences so he/she is comfortable talking with and reiterating to your provider and hospital staff on the big day.

When it comes to birthing in a hospital, being an empowered patient is critical to having a healthy and happy birth experience. Read, do research, take a Lamaze class, interview care providers and hospital settings — learn all that you can to be informed and make the best choices for you and your baby.

Photo from Inexplicable Ways

Preparing for Natural Childbirth — First or Second Time

I looked at my second pregnancy as a “do over for the surgical birth of my first. I truly wanted an unmedicated, natural Vaginal Birth after Cesarean, also known as VBAC. I didn’t realized how much research I would put into my second pregnancy. Looking back on all the information I put together, learned, and came across, it would be foolish not to share with others. I think a lot of the efforts and education I put into my second child’s pregnancy and birth has been very helpful in my journey to becoming a childbirth educator.


I worked my own experience into small steps all pregnant women, or women considering trying to conceive, should read before birth.

  1. Interview Providers – Most women I have come across usually choose the OB their sister used, or even a simple referral from their insurance provider. With my first pregnancy, that is exactly what I did. By the end of my pregnancy, and after my birth, I knew the provider choice was a mistake. Providers can make or break your experience. Choose wisely.
  2. Find a Chiropractor – Most women think, “What the heck do I need a Chiropractor for?” without knowing the ins and outs of how your pelvis works!  Not only can Chiropractic Care help with pain, and discomfort, but it can help prepare your pelvis for a successful vaginal birth!
  3. Take a Childbirth Education Class - New studies show women who take a childbirth education course not only are better prepared for class, but they are less likely to be subjected to routine or unnecessary interventions in the hospital. Skip the classes hospitals offer in one day, most teach you how to be a good patient in their facility, rather than anything about childbirth. Lamaze is a great course that is not too long, and provides great education, and positive thinking surrounding birth.
  4. Hire a Doula! – Several North American studies have shown many benefits to having a birth doula. From lowering your chance from a cesarean, to shorter labor times.  There was an amazing difference in my two birth experiences, one including a doula, and one without.
  5. Check Out Your Local Hospital Statistics – Some states such as New York and Massachusetts publish the maternity care statistics by hospital, which is also required by law in these states. Unfortunately for women in other areas of the country, these numbers may not be as easily accessible, but local health departments and The Birth Survey can help you with this.
  6. Do Your Reading! – There are so many great childbirth books that can help you to focus on your journey to a natural childbirth experience.  Some of my favorites, and the most popular books include :        
    • The Thinking Woman’s Guide to a Better Birth – Henci Goer
    • Birthing From Within – Pam England
    • Gentle Birth Choices – Barbara Harper
    • Creating Your Birth Plan – Marsden Wagner
    • Ina May’s Guide to Childbirth – Ina May Gaskin
    • The Official Lamaze Guide – Judith Lothian & Charlotte DeVries
    • The Birth Partner – Penny Simkin
    • Birth The Surprising History of How We are Born – Tina Cassidy
    • Check out the ICAN Recommended Reading List also!

    What are your favorite pregnancy and birth books? Leave a comment to let other moms know about your favorite reading resources.

  7. Go internet shopping!  I get that term from the lovely Feminist Breeder, the term was something her provider hit her with when she discussed her own research she had done regarding VBAC.  Go online, and do your reading, there is so much amazing information on the internet that can help you in the right direction for starting a journey to natural childbirth. Some of my favorite online resources include :

    What are your favorite websites for natural childbirth, or preparing for birth?

These are simple steps that can’t all be done overnight, but they are basic steps in the right direction, many of which you can even start before getting pregnant.  The biggest key in having a successful and positive birth experience starts with education!

Your Questions Answered: Care Providers

Q:

I think I want to have a more natural labor and birth — or at the very least, I want the options available to me in my birth setting. What questions should I ask my care provider to make sure that they’re the right fit for my birth plan?

A:

Choosing the right care provider plays a big role in the health, happiness and safety of your birth experience. It’s a good idea to interview care providers before settling in on the one you want. If you’ve already chosen your care provider, make sure to talk to him/her about your intended birth plan. If they aren’t supportive of what you would like during birth, look into changing your care provider, even if you’re in the middle or late stages of your pregnancy. Here are a few questions to consider when talking to your care provider about their birth practices:

  • What can I expect at routine visits throughout my pregnancy?
  • Do you support natural labor and birth?
  • Can I expect you to attend my birth?
  • Who can be with me during labor and birth?
  • Do you support women who want to labor out of bed?
  • Will I be able to use comfort measures during labor and birth? (example: shower, birth ball, walking)
  • What positions do you recommend for labor and birth?
  • Will I be able to eat and drink when I am in labor?
  • What happens during a normal labor and birth in your care?
  • What do you normally do to help women in labor? Delivery?
  • What do you consider routine interventions for labor? (example: IV fluids, continuous fetal heart monitor, episiotomy, breaking my membranes)
  • Instead of drugs, what would you recommend for pain relief during labor?
  • How would you support me to breastfeed?

Learn more about the recommended Lamaze Healthy Birth Practices for a safe and healthy birth, as well as this tip sheet for considering a care provider.

Lamaze Certified Childbirth Educator Rachel Bohn has been a doula for 9 years and has been teaching Lamaze classes for 3 years. She currently teaches private Lamaze classes in the comfort of clients’ homes. You can learn more about her services by e-mailing her at 1rbohn@optonline.net.