Saturday, July 16, 2011

The Birth Plan

What kind of birthing experience do you want? Do you plan on giving birth at a birthing center with a doula and midwife? Do you plan on giving birth at home? Do you want to deliver at a hospital? Do you want an epidural or do you plan on a drug free birth?  What about a water birth? Who do you want in the delivery room with you? These are all important questions you need to think about before giving birth.

If you already have an OBGYN then you will most likely have to go where they deliver. If you would like to use a midwife or doula, ask around in your community for what your options are. Not every city has a birthing center, but you can have your midwife or doula with you at the hospital.

There are a lot of options out there and it is important that you are well educated on all of them.  This is YOUR birth…not your doctors. Just because your doctor tells you something, does not always mean you have to do it that way. Ask questions. Find answers. Have a plan!

As important as it is to have a birth plan, it is equally important to remember that there can be unforeseen complications, and the birth plan you put so much thought and work into, can go out the window in seconds!!

Let me share my birth experiences:

With Eli I knew that we would give birth at a hospital and that I wanted an epidural.  I consider myself a pretty strong and tough person, but I was fully aware that giving birth to a child was going to hurt. My personal opinion was why go through all of that pain when the doctors can relieve some of it without affecting the baby?  So when my water broke and we arrived at the hospital and the nurse asked, “Do you plan on getting an epidural? “ I did not hesitate to say YES! The epidural did not hurt at all. The anesthesiologist described it as a bee sting, which is exactly what it felt like. It did not take long at all and was not a big deal. Was I nervous? You better believe it, but I knew that it was going to help BIG time, and that it did!! People who haven't had a baby or who have gone natural always ask "did it hurt?" And I always say that getting the epidural was by far the easiest part of the whole process! 

Because I had tested positive for group b strep (GBS), I had to go to the hospital as soon as my water broke. I would have liked to labor at home longer, but that was not possible. With GBS, you have to be put on an antibiotic right away. The longer you receive the antibiotic, the better chance your baby has of being born healthy.  I was 3 cm when I was checked in triage and dilated another cm within an hour I was there, so they admitted me (around 9:00 pm). I was progressing as normal and at 7 am was 8 cm.  When I was checked again at 10 am, I was still at 8 so they administered some pitocin. (Pitocin is a drug given though an IV to increase contractions.) Pitocin is not your best friend like the epidural is. Pitocin can bring on the contractions FAST and STRONG and H.U.R.T! After a few more hours I was at 10 cm and ready to push. This is where I wish I would have known to ask if the baby was low enough to start pushing. It wasn’t like on tv or in the movies and I was feeling a “need” to push the baby out. Just because I was finally at 10 cm, didn’t necessarily mean my body was ready to delivery the baby. (mistake #1)
The nurse raised my bed almost as high as the ceiling and explained what to do. I was ready… let’s get this baby out! After 2 hours of pushing, the baby was still not close to being delivered. My doctor was not on call and therefore I had another doctor coming in to check on me. She would check to see how things were progressing and then mumble something to the nurse and then leave. The nurse would have me start pushing all over again. I wish I would have known to ask the nurse if I could change positions. (mistake #2) Instead of being on my back, could I turn on my side? What about holding on to something to help push? I remained in the same position the entire time I pushed and I believe that I could have done better if I had been moved. Finally, my doctor arrived, and did not bring the news I wanted. I had been pushing just over 3 hours when he walked in and said that he didn’t think I was going to be able to deliver this baby on my own. It was looking like a c-section. I wish I would have known to ask more questions at this point. (mistake #3) Truthfully, I was exhausted beyond words and did not feel as if I had any strength left in my body. I said “okay” and away to the OR we went. As I was sobbing away, I kept thinking, “This was not how I imagined the birth of our first child to go at all!” In the end, a healthy baby boy was delivered, and even though he had the biggest cone head ever (for being lodged in my pelvis for 3.5 hours) he was still perfect in every way. Did I forget about the whole experience in that second? Heck, no! Would I do it all over again just to have a baby, you better believe it!

With Miles, I knew I wanted to attempt a V-BAC (vaginal birth after cesarean). I researched and researched and knew that it was a safe option because I had fully dilated with Eli.  I also asked my doctor a million questions and knew that my chance of uterine rupture was less than 1%. Many years ago, v-bacs were considered risky, but today, v-bacs are considered safer than a repeat c-section. Near the end of my pregnancy though I could sense my doctors attitude changing. Around week 38, he said he didn’t feel like my chances of having a successful vbac were very high. Why, I asked. His response was because the baby hadn’t dropped. I left that appointment very disappointed, but when I started talking to other women and researching online, the baby doesn’t usually drop until right before birth. So the next week, when he said the same thing, I asked him. He said that he feared I would be going through the same ordeal as with Eli and didn’t want me to endure the same pain. This fear made me agree to schedule a c-section. He wanted to schedule it at week 39, but I didn’t want to, so we came to a compromise. We scheduled the c-section for a few days after my due date. If the baby came before, I would labor on my own. If he didn’t then we would do the planned c-section. I prayed and prayed and thankfully, 1 day before my due date, my water broke!

With this birth, I had again tested positive for group B so we had to head to the hospital early on. When I arrived I was 5 cm and scared to death if I was going to be able to push him out. I did not want to have a repeat experience of last time!  I had to sign some consent forms and the doctor on call (in triage) did some type of test (more like questionnaire) which gave me results of having a 60% successful vbac. I had read online that if you received an epidural too early that it could stall labor, and I did not want to have a repeat of delivery #1. The nurse in triage told me that it would on stall it, if any, by 30 minutes. After I was admitted and taken to the delivery room, my contractions were getting really, really strong. I asked to walk around, but because I had the IV in me, hospital policy will not allow a laboring patient to walk around. I could hear my sister in laws voice inside saying “walk, walk, walk…get that baby moving!” I asked if I could speak with the anesthesiologist and about 20 minutes later she arrived. (Good choice #1) In speaking with her, she informed me the same thing the nurse did, in that it would only stall labor by 30 minutes, and in fact, since I was attempting a vbac, she would recommend going ahead and getting the epidural now, in case of an emergency c-section. She went ahead and administered the epidural and finally I had some relief. Next, I met the doctor on call, who later on would become my hero! I fell in love with her seconds after speaking with her, because she was so supportive of my wanting to do a vbac. She asked so many questions about my last experience and could not believe that they let me push for over 3 hours. She said that her limit was 2 hours. (insert angels singing here)

This time I dilated to 10 fairly quick and thankfully, without any pitocin. The Doctor explained that even when I got to 10 cm, she was not going to have me start pushing because she wanted the baby to naturally lower himself. (HELLO!!! THANK YOU!!) She said to me “Why would I have you do all that work and waste all of that energy, when your body can do it naturally?” (Good choice #2)  After several hours, the nurse said it was time, and she set everything up. This nurse had much more experience than my nurse with Eli and immediately had me changing positions every half hour or so. She would ask my input along the way. This time around, I was not afraid to speak up. (Good choice #3) If the position didn’t feel like it was working, I would tell her and we would find one that did. I loved her! After almost 2 hours, I was making good progress, but the baby was not on its way out. The Doctor came in and said she was going to sit with me and stretch my cervix while I pushed. (Good choice #4)

For the next 1.5 hours, this woman, who I’d never met, sat and worked with me. She never left my side and continued to encourage me along the way. Finally, the head was through my pelvis, and I knew I was going to be able to deliver him naturally. Words cannot express how happy I was. Miles was 1 pound larger than Eli. My Dr’s reasoning for me not to be able to deliver Eli was that he was too big. Well, there you go Doc! I was so thankful that I did not give in to my doctor’s wishes and go with a c-section simply because it was what he wanted to do. Sure, it would have been a whole heck of a lot easier and faster, but that wasn’t what I wanted.

I am so thankful that I listened to my body and that I stuck to my guns. I asked questions and didn’t make any quick decisions based on my emotions. I believed in myself and I did it!

I couldn’t and still can’t help but think about how differently my birth could have gone with Eli if I had only known the things I know now. That’s how life goes and I learned a lot of lessons from that experience.

The point is to have a birth plan and to remember that your plan can change within seconds. The most important thing is the end result, which is a healthy baby. If you end up getting an epidural even though you wanted to go natural, you are no less of a woman. Nobody is going to think less of you because you had one. If you end up having to have a c-section even though the thought never crossed your mind that is okay too! Again, just because you didn’t “push” him out, does not make you any less of a woman!

So, be prepared!! Be prepared for ANYTHING!! No two births are exactly the same. Your body has never done anything like this before so neither you nor the medical experts have any idea how your body will respond.  Know what you want, but be flexible. If you have to do something that wasn’t in the plan, but is required to get your baby out healthy, then do it. That’s the beginning of your life as a mom. Making sacrifices!

5 comments:

  1. Thank you so much for posting your birth stories, Sarah. I'd wondered about how the details. I think your post is very helpful for new moms and veteran mothers to remember that we have agency over our bodies, we can ask questions, make assertions and learn to listen to our bodies...for we are fearfully and wonderfully made. Thanks, again!

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  2. ***Jeremiah Ware is Kim Ware...I don't have a google account and I couldn't figure out how to post....sorry about a typo or two...I had kids tugging on me :p

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  3. My birth experience was a little different than most....
    I really wanted to have a natural vaginal delivery without medication and preferably without being in a hospital. I am constantly asked WHY! There were three major reasons...1) I really believed in my body and God that I was able to do this. 2) I knew the difference in recovery from natural birth to a medicated hospital birth. 3) I didn't think that a hospital was a relaxing place for me to have a baby. I wouldn't be able to focus with random people coming into the room.
    My delivery was so much better than i hoped for! I had gone over my (detailed) birth plan with my midwife (who I loved) several weeks prior and it was almost picture perfect. I went into labor at 1:30 and since my water hadn't broke I had time to take a nap knowing I would need rest for the hard part. At 2:45 I woke up to consistent contraction minutes apart and labored with my mom for about an hour and 15 minutes until my husband got home. Then we called the midwife and I went to the birthing center so she could check my progress. She said I was 5-6cm and the contractions were back to back. At this time my response was to ask for tylenol to take the edge off! Needless to say the midwife explained that tylenol wasn't going to do anything for me. So she gave me a choice (WHICH I LOVED) to stay or to go home and labor since we lived 1 mile from the birth center. I asked her when she thought I would deliver and she didn't seem to think it would be until early morning. I decided to go back home and get in the tub for a while. It was 5:30pm and I didn't want to be hanging around until early morning when I could be at home. well, after an hour I was calling back to the midwife and she told me to come back cause she thought I was needing some additional support and she wanted to check me again. When I arrived it was 7pm I was 8cm and still hadn't broken my water. I was now in the kind of pain everyone dreads and I was asking for drugs but my birth team knew my real wishes. The midwife broke my water at 8pm. My husband put on a CD of relaxation music he made for me and knew I really needed it. I was talking with God and I knew he would get me through all my pains has he had so many times before. My wonderful husband was coaching me and gave me the one thing that put my mind in focus which was a 3D ultrasound picture of our daughter. He said "there she is and now she really wants to meet you!" After a lot of concentration and a few tears I was told to stop pushing. My little girl was coming into this world! I was told to look down to see her but I couldn't move and just wanted to take a few pain free breaths. After a couple minutes I was euphoric. The endorphines kicked in and I was pain free and holding my daughter.
    the only regrets were that I didn't see my husband cut the cord because I was taking a couple minutes to deep breath. Also, I didn't see my daughter while she was being delivered (although I felt everything!). She was born with the cord around her neck which sounded really scary to me but the midwife said since she wasn't having decelerations in her heart rate that we couldn't have known so my husband wasn't able to catch her when she came out. The midwife had to step in and unwrap the cord to assure she was getting enough oxygen. I had wanted to try the water birth as well but with the pain at 9cm your legs don't move quite well!
    We stayed the night at the birth center and the breast feeding went great. We went home 14 hours after my daughter was born and I was feeling great!
    I would like to close this very long blog post by saying I truly do believe that each woman knows what is right for her. It isn't worth making baby stressed and mom completely uncomfortable just to say you had a drug free delivery. Sometimes not getting drugs can hold up delivery just as much as getting drugs. Each woman is different and each birth is different.

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  4. I would recommend my experience to anyone who has a wish to try an alternative. Now living in Louisville,KY with my second child due in Nov. it is a total different story. The only midwife in the area is Elizabeth Bary who practices in New Albany and delivers at Clark Memorial Hospital because it is "illegal" for midwifes to practice in Kentucky. although there are 4 midwifes whom offer home births in Louisville. The only glitch for me is that she doesn't accept my insurance.
    SO I AM HAVING A HOSPITAL BIRTH. I am scared out of my mind already. I love my OB/GYN Dr. Walsh because she is always willing to answer questions and not rush out of the exam room and she is really down to earth. Some might even call her a hippy of sorts. I just hope that my wishes for a drug free vaginal delivery are respected this time. I will be going over a birth plan with her as well. Any advice on how to make a hospital birth relaxing? How did the staff treat you when you during your delivery?

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