How Do You Plan a Birth?

I enjoyed Bob Audette’s article (Reformer, 1/28/12) about the birth of his new son. You could tell he and his wife had “done their homework” and chose the right place for them to give birth. When we designed our new birth center at BMH, we worked hard to make the surroundings match our philosophy – that the birth of a baby is the birth of a new family. That moms and dads deserve respectful, excellent care. And that having lots of options – physician care, midwifery care, a volunteer doula, lactation support – in one place is a good thing.

Many years ago Carl Jones, in his book Mind over Labor, suggested that couples should spend as much time and energy planning the birth of their baby as they do planning their wedding. Since I’ve been a part of many weddings – usually as organist, pianist or keyboard player! – this analogy made me laugh. (Umm – that’s another essay!) But there are a couple of truths that come to mind as we consider planning a life event.

  • Know your people
  • Know your place
  • Know yourself
  • There’s always a surprise in the box

Let’s take a look at birth plans in light of what we know about life.

Know Your People

My girlfriend planned an elegant wedding. Her fiancée always described himself as one of the Saxtons River Rats. Do you think he wore a tuxedo? No. He wore a chambray work shirt and new jeans, with a bow tie that we made for him out of fabric he liked. Another one of my friends ran into trouble when she planned a portion of her service around sharing a glass of wine with her beloved: the church where the wedding was held didn’t believe in alcohol consumption (and it’s just not the same with grape juice!).

So as you think about your birth, think about your people. We’re blessed in this area to have many progressive, thoughtful practitioners. But if you are planning a lotus birth (umbilical cord nonseverance) in the hospital, or you’d like a waterbirth, or a VBAC, you’d best be talking now and not later!

There is an upswing in this country of planned inductions, cesarean births, and interventions of various sorts during the birth process. You have the right to call the hospital and find out their cesarean rate (don’t blame the hospital – ask your doctor or midwife what their practice rates are too). While you’re on the phone – are they talking nice to you?
Who will be your support team? Do you plan for your partner’s major responsibility to be advocacy during the birth, protecting you from the doctors and nurses and what “they” may do to you and your baby? There are a couple of challenges with this scenario.

You put your partner into a very difficult situation. Studies show that the worst fear for many dads is that the doctor will come to them and say, “We can save your baby or your wife. Which is it?” It’s probably a way that they wrestle with the life changes they foresee with a baby in the house. Your partner may know you pretty well, but they don’t know much about childbirth. Don’t put them in a situation where they feel they need to protect you but they have no idea how to make good decisions. (You wouldn’t want them saying “She doesn’t want a cesarean” if the fetal heart goes down and stays down.)

Will your sister be there, a girlfriend, your mom? A doula? Unlike a home birth where there are lots of jobs for everyone, and a place for them to unwind a bit, a hospital doesn’t have very many tasks or safety valve escapes for extra people. Talk about what the role will be for each person. Then figure out who should be there, and who should support you later on at home.

Know Your Place

I was at a conference in Burlington, Vermont when a nurse from Fletcher Allen asked me about our epidural rate. At the time, we didn’t have epidurals available in Brattleboro. “That is barbaric” she said. I was so taken aback, I didn’t know what to say. Then another nurse chimed in. “Oh, she works in Brattleboro. They can get up and walk around and take showers and they have one on one labor support. Your nurse will rub your back!”

Later she explained to me, “When you said you didn’t have epidurals, that nurse heard, We do nothing for mothers. If all you know is to get the epidural when the mom is in pain, then of course you’ll think it’s barbaric to have no epidural. Because you don’t know that something else could help.”

So think about what will be a therapeutic milieu for you. What would be the perfect place to have a baby? How close can your chosen hospital come to that dream? Don’t try to have a natural childbirth in a place with a 90% epidural rate, unless you bring your own support team (partner and doula at least!). On the other hand, don’t assume you can get an immediate epidural in a small community hospital where the anesthesiologists come to the birthing floor in-between their other scheduled surgeries! (In a large teaching hospital, there literally will be obstetrical anesthesiology residents looking to drum up business. Epidurals are all they do!) Bring your favorite pillow. Wear your own clothes.

Know yourself.

Instant access to movies about birth – whether it’s The Baby Story or homebirths without an attendant on YouTube – may have given us a lot more information, but it’s not necessarily helpful to make you more confident about birth. Look, listen and learn – and then think about what you know about your doctor or your midwife.

  • Do they listen to you?
  • Can you share your hopes and fears with them?

Write down some topics to discuss at your next appointment. The best way to get the birth you want is to develop a relationship of trust with them, and to look within yourself to know what your strengths and fears are. Talk those fears out now so they don’t stop your labor.

Read some great books about childbirth. (Don’t stick with What to Expect….it’s a very medicalized view of childbirth that they sell, and that’s not what you’re likely to see in the Brattleboro area.) Better? Try…

And check out the Lamaze Birth Blog  for ongoing support and lively articles.

A Birth Plan

A recent journal article noted that doctors and midwives felt that women who had long, involved birth plans were more likely to have cesarean section.

That is not true. But doctors, midwives and nurses alike often groan when they see a downloaded birth plan with lots of bullets. Talk to your childbirth educator or call the hospital where you plan to give birth. Get a tour and ask questions. What is the epidural rate? What percentage of moms have a natural childbirth? What are the doctor’s orders about fetal monitoring? Walking around? Staying home during the first part of labor?

Getting answers to these questions will give you a sense of how you will be treated during your labor and birth. Know that if you want something different, you will need to talk to your doctor or midwife – your care is based on their orders. Don’t try to negotiate when you are in labor.

Come to the birth of your baby with a sense of strength, not fear.

There’s Always a Surprise in the Box

Remember the wedding analogy? It makes me laugh because the thing that most people remember about our wedding was not the poetry or the wine ceremony – but that the candelabra fell over. You have to play the hand you get dealt for your birth. That might include a long labor, or a painful backache, or a baby who pinches its umbilical cord during contractions. It might mean you don’t know you’re in labor until the baby’s head starts to be born. Or you gain so much weight that they have trouble finding a fetal heartbeat unless you are in bed. What if you think you want a waterbirth and then you feel claustrophobic in the tub?

Now – tell me the three things that are the most important to you about the birth of your baby, which will help it be a satisfying birth for you. And that is your birth plan. And we can help you get the birth you plan. We want it to be wonderful!

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