Monday, July 15, 2013

Birth Plan vs. Birth Reality

I was lucky enough to give birth in a facility that was extremely supportive and respectful of a woman's choices for labor and childbirth. They even provided me with a "fill in the blank" style birth plan worksheet. I was so grateful for this because there are a lot of things I may not have thought of and wouldn't have known how to answer had I been put on the spot at the hospital. Having a birth plan or birth wish list puts you in control of your birth experience and forces you to do the research and determine what you want and don't want. I learned so much about various interventions, labor positions, comfort measures during labor and vaccinations while I was making choices for my birth plan.

If you read Baby A's Birth Story, you can compare my birth plan to my actual birth experience. The most important thing to remember when you make a birth plan, though, is that you might have to crumple it up into a ball and throw it out the window. Babies don't always have the same plan that we do and that is okay. Holding a beautiful, healthy baby is all that really matters, regardless of how they come into this world.

In this post, I wanted to share some of my personal choices for my own birth plan to show how they compared to my birth reality. Hopefully, this will spark some ideas for your own birth plan!

Labor Options

Hydration - I request a Saline Lock (IV Port without fluids)
One of my main goals was to be able to move freely in my labor and delivery room so I really didn't want to be hooked up to an IV. Luckily, because my labor was relatively short and I never needed any pain medication, I was able to avoid having any IV fluids.

Labor - I request to allow labor to begin on its own
As much as I was ready to meet my baby, I wanted to avoid the Cascade of Intervention that can often come with inducing labor. As long as mom and baby are healthy, my midwife does not induce until 42 weeks and 1 day. Obviously, if she had recommended an induction, I would have respected her decision, knowing that it was medically necessary. I went into labor on my own shortly after I reached 41 weeks.

Activity in Labor - I request 
  • To walk or stand in labor
  • Upright position in bed or chair
  • Use of a glider style chair
  • Use of a birthing ball.
One of the important lessons I took away from my birth class was that you sometimes don't know what is going to be comfortable until you are actually in labor. Positions or comfort measures that sound relaxing right now may make you want to tear someone's head off when the big day comes. I just checked off ever possible activity - I like to have options! In the end, though, I mostly just walked around the room until I was able to get in the tub. I wanted to use the birthing ball, but it caused the monitors to pick up my heart rate instead of the baby's so no birthing ball for me.

Fetal Monitoring - I request intermittent monitoring and/or wireless monitoring
The American College of Obstetrics and Gynecology (ACOG) recommends intermittent monitoring for low risk pregnancies. This involves listening to the baby once every 30 minutes throughout one contraction and for one minute afterward. A reactive non-stress test is required for intermittent monitoring to begin and must be repeated every 2 hours. Continuous monitoring is required for high risk pregnancies. Wireless monitoring is available allowing the continuous monitoring method while in the tub or walking around.

My nurse was not able to obtain a reactive NST during my labor for a few hours so I wore the continuous wireless monitor. Not until she placed a contraption on my belly that emitted a loud noise (it sounded like a dolphin call) and made the baby jump was I able to remove the wireless monitor and get in the tub. My preference was to have intermittent monitoring so I could move around freely, use the birthing ball and get in the tub sooner, but I was thankful for the freedom allowed by the wireless monitor.

Comfort Measures and Pain Management During Labor

-I request
  • Natural childbirth, without medications
  • Use of labor tub
  • Use of the shower
  • To ask for pain medications. Please do NOT offer.
  • To listen to music during labor
I have known since before I was pregnant that I wanted an unmedicated childbirth. I know there are situations where this is not possible, but I wanted to try everything possible to avoid pain medication. During pregnancy, I found warm baths to be very relaxing and I have heard from many other women that it helped with their pain during labor and also helped labor to progress. I love music so I knew I would want music playing in the room during labor. 

I was able to use all of these comfort measures and pain management techniques and they really did help me through the experience. Other options that I did not use were IV pain medications, epidural anesthesia, doula support, hypnotherapy and accupressure.

Comfort Measures and Pain Management During Childbirth

 - I request
  • Use of a variety of positions for pushing and delivery
  • Immediate skin to skin contact with my baby
  • Allowing the umbilical cord to remain intact until pulsation has ceased
  • For my significant other to cut the umbilical cord
  • For my visitors to wait in the waiting room until we have had time to bond and breastfeed
Most hospital beds allow for a lying down position, side lying, squatting (with the use of a squat bar) or you can be positioned on hands and knees with the bottom of the bed lowered so your practitioner can catch the baby underneath you. Just like in labor, I had no idea which positions would be most comfortable during childbirth so I wanted to have options. I ended up on hands and knees because it felt like I was making the most progress in that position. 

I have read so much about the importance of immediate skin to skin contact with your baby. It promotes bonding and helps to regulate the baby's heart rate and body temperature. It also puts the baby in a good position to root around and find your breast if they are interested in breastfeeding right away. Baby A was happy to just quietly lie on my chest for a while. It was a very sweet time for both of us.

In my childbirth class, I learned the importance of delayed cord clamping. According to ACOG, this can increase the baby's blood supply, which decreases the risk of iron deficiency anemia during the first year of life. There are even more benefits for premature babies.We chose not to clamp the umbilical cord until it had stopped pulsating, which was only a few minutes. I asked Kevin if he wanted to cut the umbilical cord and he did so my midwife showed him where to snip it and he did the honor of cutting the cord.

I was up front with my family that I wanted time alone with Baby A and Kevin before we had visitors. I wanted to give Baby A a chance to establish breastfeeding and just cuddle with him for a while. And, to be honest, I wanted to take a shower and clean up a bit before anyone came busting up in my hospital room with a camera. :) They were all very understanding and we made sure to update them when we arrived at the hospital and when Baby A was born so they would know what was going on. I gave birth in the middle of the night, so having visitors wasn't an issue anyway. I ate breakfast and showered in the morning and visitors started coming by about 11:00am the next morning.

Options that I did not choose were the use of a mirror, touching the baby's head while crowning and for my significant other to assist in delivering the baby. I've seen plenty of birth videos and had no desire to see a closeup view of what was happening. On top of that, the position I was in didn't really facilitate the use of a mirror. I actually did end up touching the baby's head, but it wouldn't have occurred to me if my midwife hadn't asked if I wanted to touch the head. Looking back, I wish I had requested to touch the head because this was hugely motivational during those last few pushes! I really never even asked Kevin if he wanted to help deliver the baby. I just assumed he wanted to leave it to the professionals, but he had a front row seat for the whole thing. He definitely wasn't squeamish about what was happening. I think he wanted to be right there to make sure everything was okay with me and with the baby.

For Baby

 - I request
  • Breastfeeding my baby immediately following birth
  • No pacifier to be given to my baby
  • For me or the baby's father to perform the baby's first bath
  • To be present for routine tests and procedures which occur in the nursery, such as the physician's examination
  • Delaying Vitamin K administration until after skin to skin contact
  • Delaying Erythromycin Opthalmic Ointment until after skin to skin contact
I have already discussed that I wanted to try breastfeeding my baby right away. I wanted to delay any tests or procedures until after I had time to bond with my baby. The facility where I gave birth encourages at least an hour of skin to skin contact with baby immediately after birth so they didn't perform any tests during that first hour. After about an hour, someone from the nursery came in to evaluate the baby and give him a bath. This all happened in our hospital room and I totally forgot that I wanted Kevin to help with the first bath, but since we were present for the whole thing I was happy to just lie back and watch.

They also administered the Erythromycin Opthalmic Ointment. I did not feel my baby was at risk for eye infections that the ointment can prevent, but I did research the ointment and found no negative side effects and decided it was better to be safe. I have read that the ointment can blur the baby's vision, which is why I wanted to wait a while before administering.

I cannot quite remember, but I believe the Vitamin K shot was not given until the next morning when we were in our recovery room. It may have been at the same time as the ointment was given, but it is all a little blurry. I never had a strong enough opinion about the Vitamin K shot to withhold it completely. Vitamin K is given to babies at birth as a preventative measure to ensure they have enough Vitamin K for proper blood clotting.

Kevin and I wanted to try exclusive breastfeeding for at least the first four to six weeks after Baby A's birth. Because of this, we denied any bottles or pacifiers at the hospital.


That about sums it up! I feel so lucky and blessed that I was able to have a birth experience very close to what I planned for and imagined it to be. I know that may not be the case if we have a second child, so I hope I am able to keep the mindset that I had leading up Baby A's birth and know that the end result is what really matters. The stars somehow aligned for me, though, and, along with my planning and preparation, I had an experience that I will always look back on fondly. 


If you would like to learn more about following a Paleo lifestyle during pregnancy, check out my first book, The Everything Paleo Pregnancy Book. I cover everything from which healthy, Paleo foods to focus on to get the most important nutrients for pregnancy, how certain foods can alleviate common pregnancy ailments, how to modify your workout plan during pregnancy and over 100 healthy recipes! The book is available in both paperback and Kindle versions through Amazon and Barnes and Noble.

Did you have a birth plan? Which choices were most important to you?

Image Credits
McBeth / Foter / CC BY-NC-ND
jbhalper / Foter / CC BY-NC-SA
markhillary / Foter / CC BY
Fey Ilyas / Foter / CC BY-SA