Birth Dreams vs. Reality: Birth Plans?

Do you need a birth plan? I think it is important to think about and discuss with those who plan to support you in birth, about your birth ideals. But, I think it is not only misleading but unreasonable to even begin to think that a woman can really plan her birth. I believe that we need to think in terms of planning our births in a different way.

Take the online birth plans that are out there on the internet today… considering the ideas that they make will help you to begin to consider your options. How should you consider their usage? The ideas suggested are great if you use it for facilitating communication between you and your birth team prior to labor beginning. But expecting the nursing staff to read a three or four page document prior to supporting you in labor is not something that I believe is reasonable. The ideas you may have for your birth should have been discussed a long time prior to you arriving at the location for your birth. Your doctor or midwife can write orders for you based on your ideals after this conversation occurs. Their written orders have much more clout than a document you bring to the hospital.

Since so many practices have multiple doctors or midwives within the practice, having a birth plan that is approved by one provider does not insure that the next provider will agree. Many women think that if their primary provider signs the document it insures them of their wishes being taken seriously. I hate to say, this does not.

Women should consider leaving their options really open in the area of birth ideals. Since a woman has no firm idea on what will happen or what she will need in labor prior to it occurring, it is difficult to make a plan to hold to later. Who has never made a vacation travel plan only to make a change when some location or scenario makes you deviate? Perhaps this opportunity was not something that you had known about prior to driving by it or picking up a brochure at a rest stop. Does it make your vacation more difficult or not the vacation of dreams? No just different than the one you planned originally.

Pam England in her book, Birthing From Within, teaches doing the Next Best Thing. As your labor unfolds, you are able to make good informed decisions based on what is right for you in that moment. I teach using the acronym of BRAIN. A couple needs to consider the benefits, risks, alternatives, their intuition and what will happen next depending on their decision prior to having a procedure done.

A woman may want to think about her birth ideals like a dream. What does she hope will happen in her labor? I encourage them to think about their birth plan being written in pencil and a large eraser should be packed. When a woman thinks her birth is able to be planned and controlled, when things change, she feels like she somehow failed. A birth ideal is just that. It is something that should be hoped for and worked toward. But being flexible is the key.

If you do desire to have a birth plan of sorts, I would suggest keeping it really short and to the point. Keeping it positive and simple are good ideas. Don’t ask for things that don’t need to be asked for and only put things that are really important to you personally in it. If you want to be seen as an individual, then keep your birth ideals personal and individualized. Let’s look specifically at some of the questions that arel on the online type birth plans. (Pregnancy Today’s plan)

I would prefer to avoid an enema and/or shaving of pubic hair. (Note - this is no longer standard procedure at many hospitals.) They do not even offer this as an option unless the enema is to augment a slow labor or the mom is having difficulty with constipation and desires it.

I would like to be free to walk around during labor. Why would you need to ask to walk around in labor? I am a big proponent of not asking permission but forgiveness. Unless you are being monitored without telemetry, you should have freedom unless you make a decision otherwise- like choosing an epidural.

I wish to be able to move around and change position at will throughout labor. Ditto- see above.

I would like to be able to have fluids by mouth throughout the first stage of labor. Why would you even be in the hospital during the first stage? Ideally the studies show eating and drinking should be controlled by the mom as needed and desired. Again, don’t ask permission- eat and drink unless you decide on medication that may increase the chance of a surgical birth.

I will be bringing my own music to play during labor. Why would they care if you brought your own music? Of course you should do so- you don’t need their permission to do so.

I would like the environment to be kept as quiet as possible. Isn’t it a shame that you need to even make this statement? You should be able to control the environment by lighting and mood by creating it yourself and having them respect your desires.

I would like the lights in the room to be kept low during my labor. See above.

I would prefer to keep the number of vaginal exams to a minimum. You know I have this little rule- stay out of the bed and keep your panties on and vaginal exams won’t occur unless you decide otherwise. Use the BRAIN acronym to help decide when to take your panties off.

I do not want an IV unless I become dehydrated. But wait a minute- if you are eating and drinking as you need to, you will not become dehydrated, unless nausea becomes a problem. Again using BRAIN is a good tool here as well. But there are other reasons for an IV to be used. Being GBS+ and needing antibiotics or desiring medication is a reason to desire an IV.

I would like to wear contact lenses or glasses at all times when conscious. Again, is this a reasonable thing to expect- hmm- I want to be able to see well- so keep your glasses on or contacts in.

I won’t be going through the rest of the birth plan. I think you understand the message I am trying to convey. Think about what you really want. Discuss it with your care provider when you are still dressed, not in labor and not feeling that in labor vulnerability. Use the format of these online type birth plans to help you begin to understand your options. Please realize that you need to make a birth ideal sheet that is just for you. But use is sparingly, understanding that labor is unpredictable. Create a dream for what you want to have happen, but keep your options open.

waiting for the contractions...trust the process

I want to be well now! I want to be done hurting- done being sedentary... done... And then this made me think about women who are pregnant. Seems women anticipate- prepare- read- go to class- talk about- and wait for the contractions to begin. But then we they do they either focus too much attention to the early ones that are not really worth demanding their attention yet, or they get anxious about them not starting and agree to an induction. But it is all a process. And when you try to hurry it up, there are consequences. And we need to understand that being patient and waiting for things to happen as they are supposed to is a virtue.

When we try to rush things, force things, whine about the time it takes, we are fighting the process. I have seen the rushed processes in labor and birth- they are not pretty. They are full of interventions, surgical births and regrets on the part of the parents. So, I am going to try to remember the words I preach as a doula... trust the process. I will wait patiently- trusting that my body is healing just the way it should- at just the right speed.

This process of cancer and the aftermath has taught me so much as a doula and childbirth educator. I just hope I can impress upon my students the need to trust their bodies and the process along the way.

speaking as a concurrent speaker at ICAN

I submitted an outline that Polly Perez and myself worked on entitled "Life is a Journey...no one gets out alive- What to do When Meconium Hits the Fan" - it is about what you do when things that you plan don't happen the way you expected them to. It is about healing- who to turn to and what you personally can do to heal. It is about how you can help those who are going through a tough time to heal- what you can say and do.

It was something we submitted to CAPPA for the next conference- but they wanted me to do a ton more to it to get the outline ready for submission for CEUs and wanted it to be a break out session- with a minimum number signed up for it three months in advance- and with the 3Day walk for Breast Cancer in front of me- the last surgery only being 6 weeks ago and my next breast cancer revision surgery in five weeks- I declined. I need to move forward with some more urgent stuff and they needed it pretty quick- just was not going to happen.

When it appeared they were not going to accept us as speakers- I had gotten an email regarding the ICAN (International Cesarean Awareness Network) conference coming to Atlanta in April and desiring speakers. So, I submitted it to them a month ago. I got word this week that they accepted our speech as a concurrent- or break out session for their conference- Whoo Hoo!

So, now that more meconium has hit my fan- it is time to use it to help others!

how do you know?

Today I received a call from an intelligent woman who has run a marathon before. She read an article I wrote- visited my website and decided she may like to have a doula. I was super excited to hear from her. But then as we talked I was sad about some of the information her doctor had given her. Since she has somehow bought that she has a low tolerance for pain- which I doubt if she is a long distance runner- and would need an epidural. But she was open to considering she may not. I asked her how she would know what she may need in labor since she had never been in labor before. But her doctor had told her that the hospital childbirth class was really geared to women who wanted a natural birth- which I also doubt since most hospital educators are required to teach a certain curriculum that the anesthesia and obs approve. But since she was considering using an epidural, her doctor told her that the class would be useless to attend.

So, now instead of having a full range of options available to make an informed decision- she has been limited to the books she has read. I was delighted she had found a good one- Pregnancy, Birth and the Newborn by Simkin. But it made me sad when she commented that she wanted to choose what was best for her and her baby... and somehow had come to believe that may be an epidural. I discussed that she needed to understand the risks of all of the decisions she would make in labor.

She is considering a private class with me. I do not have a problem with the choice of an epidural, but when it is the only option you have- you have little options. I believe in full informed consent. Women trust their doctors to guide them- in the best interest of the baby and them... when did "learn all you can about all of your options" not become the best way to guide someone in an area that is unknown like birth? When did it not become about helping a woman empower herself?

I hope she attends my private class- I will at least know then that she is making informed decisions that are the right ones for her- instead of the ones the doctor chooses for her.

Interference

I was thinking about my blog regarding my niece's birth and I felt the need to clarify some things. Women need to make informed decisions about their births. Their births will be affecting them the rest of their lives... that experience is paramount according to the studies on how they will mother that infant and see themselves as strong or weak later on.

A woman is not classified in active labor until she is dilated to three centimeters and contracting regularly- stronger, longer and closer together. Usually that means at least an hour of contractions lasting at least a minute for at least an hour. Now I don't know what my niece's labor was like. But I do know that the studies show that when a mom stays at the hospital with her water intact and under 3 centimeters dilated, she increases her chances of a cesarean by 30%. So the intervention train is boarded- after all, you are at the hospital to have the baby. So, their job is to help you get the job done. What? At what cost?

A woman making a decision to have her water broken and have an epidural and get pitocin is her right. But did she know the risks? Did anyone tell her that cord prolapse could occur? That epidurals drop a mom's blood pressure and therefore the babies? Do you realize that when all of a sudden they need to continually monitor you that means there is some risks associated with that procedure? But moms are not told those risks many times. And without a childbirth class to educate her- she is likely to not have understood the options going into labor.

Many times even the childbirth educators are forced when they work for the medical model to teach certain things without telling the whole truth. Their jobs are at risk otherwise. It is a hard choice to work for someone who builds your curriculum for you and makes you hold to it. There are teachers who seem to give homework and encourage folks to find the truth out on their own though.

One bottle of formula may not seem like it is tragic. But if you read this you will understand it is a tragic situation: http://www.drjaygordon.com/development/bf/supplement.asp

My neice was told prior to being discharged after only two days that she did not have enough milk to satisfy her son. Why would a mom have any milk before day three? If a baby needed formula or milk during those first three days then God would have given the mom the ability to make milk quicker. The baby's stomach is only the size of a marble! Colostrum is so wonderful- in and of itself to fill that small void and provide the rich wealth of antibodies that newborn needs. So why is it that a mom instead of getting proper help to breastfeed instead is given totally untrue information? And why is it that most new moms feel they are not the authority and some medical staff member knows best?

Where was the lactation specialist who could teach her to properly latch her baby- to keep him at her breasts skin to skin so to enhance her milk production? But we can not make the whole responsibility the medical staffs. We have to see that women need to take back their births and babies. We spend more time planning our weddings than we do planning our births and newborn experiences. And as a society we must start sharing more truth. The women of the seventies having natural births need to be sharing our experiences with the younger women- letting them know it is a lie that you don't get a prize for natural births- you most certainly do!

The prize is a healthier mom- the recovery is wonderful- the baby is more alert and nurses better. The breasts don't have edema issues from the long use of an IV with fluids- neccessary with epidurals- and the nipples are ready to be nursed from. The labors are more active certainly but that activity helps facilitate a baby's movement down and out- with less episiotomies, forceps, vaccum and most certainly less ceasarean births.



If nursing moms were more accepted in our society... if we saw more moms nursing their babies in public.. then women would see that as natural and normal. The talks amoung women regarding what helped their babies nurse well and the normalcy of the nursling and mom would be discussed. So, we must take some responsibility as well.

It is sad that women don't understand the truth- don't know their options- without knowing their choices they have no choices at all.

instinctive vs compliance

My niece had a baby this weekend. She considered childbirth classes late in the game I am guessing since she told my sister she could not find a class- they were all full... So she went into labor- sorta- lost her plug and her doctor listened to her breathe on the phone and said come in. But she was only 1.5 cm dilated so they had her walk... eventually they put her on the medical roller coaster- not sure what happened when but she had her water broken, had an epidural and got pitocin I am sure. Well thank the dear Lord, she did end up with a vaginal birth. She told my sister she was sure the nurses would help her in her labor. She originally thought she would go natural. She was unprepared and did not.

Nursing was not going smoothly- so since she also did not take any breastfeeding preparation class, she again told my sister that she was sure the nurses would help her. Well- they convinced her on day two after the birth that she did not have enough milk. They encouraged her to give the baby some formula. Then one nurse told her that was a good thing since she obviously was not causing the baby to be full and he had been screaming! So, although her plan was to breastfeed, the formula is something she now sees as the thing that her baby will need due to her deficiency.

She felt this would all come naturally- instinctively. It does when you are around women birthing naturally- you grow up around it- you see your cousin birth naturally- you see your friends do so. But when you have never seen a normal, natural birth- then it is not instinctive any more. The media and medical model has done a great job of redefining normal birth. Indeed she had a normal birth!

She felt breastfeeding would just come naturally- instinctively. It does when you are surrounded by women feeding their nurslings. But I bet she has never seen a woman breastfeed. So, I am sad for her.

I am not judgmental at all. I totally understand the fallacy she fell into. She believed that the medical staff would only offer her things that were best for her and her baby. They failed her. But she also has to take responsibility. Classes that teach you choices are essential if you are to have any choices at all. Seeing women nursing their babies and hearing about how they overcame difficulties is important. That is why I loved La Leche League. Shoot her mother in law- my sister- nursed four babies after giving birth normally and naturally. But she was banned to the waiting room.

We need to help women find the questions they need to ask and then encourage them to find the answers that are right for them. I am afraid this is not what my neice did. She did not know the questions to ask- she did not have any answers and she believed in the medical model protecting her and her baby. Sadly who suffers? We all do. Society suffers since this baby is subject to more illness and possibly a lower IQ than would have been possible- ten points according to the studies. The parents do- they do not realize how rewarding the different choices would have offered them. The mom could have reduced her chances of osteoporosis and breast cancer. And the little man suffers for many reasons.

Could this have been avoided? Yes- but unfortunately the importance of these classes and the preparation needed to help her succeed in her initial choices were not impressed upon her. It makes me sad.

I am sure that this little boy will be great. I am sure his parents will be awesome parents. I am just sad that they will not even understand the things that were missed.

in the morning...

I fly to Dallas to a childbirth professionals conference tomorrow. It is my time to soak up and learn some new concepts and absorb some new ideas. It is my time to also share a bit of what I have learned over the last sixteen years. But mostly it is a time for me to forget that in a week I have surgery again for my disfigured abdomen. It is my time to have fun and let go. I am looking forward to hanging with like minded women... where conversations about birth and breastfeeding are common place! This is my last hooray for a while!

more understanding

When a woman goes into her birth dreaming she allows herself to consider a lot of options. Many of the women I work with are looking for a non interventive, natural birth. One of the things she does not really let herself think about is if the birth ends up being a surgical birth. But it happens sometimes. Less often when she chooses the right location, the right birth team and educates herself to the risks associated with some options she may be given. But it sometimes can not be avoided.

These women sometimes return to her doula or initially contacts a doula in hopes of having a vaginal birth after that previous cesarean. As a doula, I have educated myself in the ways to help her achieve a non surgical birth this next time. I help her to research her options and help her to become empowered with knowledge so she can make the right decision for her. Sometimes women choose to have a repeat cesarean either out of fear or sometimes out of making an informed decision that they feel is right for them. And many times she will fight through her fears, look at the statistics and risks and go for a VBAC.

I have always tried to support women in their decisions. But although I thought I understood what they were feeling- I don't think I ever really understood the disappointment they felt with their first surgical birth and then the fears they had about not achieving the birth they desired the next time. But... my life's journey is helping me to understand this disappointment in ways I am not sure I could have before.

My surgery in November of 2007 was to be a two step process- the second phase being optional (adornment of the new breasts). But due to my infection it was not so much the surgery that caused me the problems as it was the five months following the surgery. I got to go home a day early from the surgery. I had issues in my hospitalizations- a fever caused by a UTI- got to love those catheters! And a night of nausea but other than that I did great. I was not on anything more than extra strength Tylenol after two weeks- and the new grafted breasts did great.

What was unexpected were two things- one I went in to have my breasts removed prophylactially and then found out I had undetected cancer . And something I could never have fathomed being possible was my abdominal infection. And now instead of going in for a small adornment, it is another big surgery. And now a third will be following for scar revisions and adornments. So, the best laid plans dissipate quickly.

I face a second surgery in a few weeks. I have been told I have more of a propensity for an infection again since I had one the first time. This reminds me of the doctors telling women that since they did not have a vaginal birth the first time, their odds of having it this time are limited. This may or may not be true! There are times when doctors inflate risks so that a woman will not even try for a vaginal birth. I don't have the option of not doing this surgery. Nor do I get to make decisions about the type of surgery to have- there are not any options!

I am fighting the fear of that infection risk and the healing after the surgery that means pain as well. If I could avoid this surgery I would in a minute! If I could be assured there would be no complications it would help assuage my fear. I understand how a woman fears the idea of attempting the birth of her child without surgery and being afraid that it would end that way despite her work she has done to prevent it. I am taking supplements to help build my immune system. I am doing the work. And I guess this blog is part of the work I am doing.

This page in my story is helping to make me a more understanding doula. It is not easy working through fear and concerns and anticipated disappointments.

one of the hardest things about being a doula...

... there are so many great things about being a doula- but one of the hardest parts is being on call and not ever knowing when the call will come to be with a mom in labor. It is hard- sometimes you want to stay up late and not pay any attention to the fact that you could be called out in an hour and spend the next 24 hours working without any sleep in view.

It is hard- sometimes thinking that you don't want to be "on" today. You may want to go to that event and not have to be concerned about your phone ringing... hang with those folks and be able to be carefree. But the phone may ring any time- if may not be super great timing each time- but it all falls into place very quickly... you get up, shower, get dressed and grab your gear and go.

Then you are able to be doing what you love to do... being with a mom as she journeys to being a birthing woman... with her partner as they watch the power the woman has within her... and most of all to view the power of birth- the miracle of the first breath... and that is the best part of being a doula!

Introductions of sorts

Seems my grown children feel I may have a legacy of ideas to share...whether it be quips and quotes or anecdotes... so I am going to try to share ideas and thoughts- some random and some specific to my work as a doula, to my life as a cancer survivor and as a woman warrior.

Sometimes our lives seem so normal to us but as we share what is going on in our specific lives they seem to fascinate others... and at the same time sometimes the things that we find exciting and wonderful seem mundane or uninteresting to others. I guess you can take or leave that which interests you.

If my words in any way can inspire or guide you, great. If it causes you to think differently than you did before, that is expansion. And if it causes you to rethink some things that you had not given thought to before, that is growth.

I feel blessed with my given career- which I feel is a calling to serve in such a wonderful way. I am led to be a doula by the life I had lived up to that point and the life that I must have lived in the past somewhere. I feel blessed with having had cancer and being able to view the journey from the side of survivor. I think it is important to listen to our voice that God has given us from within... I will share with you how doing that probably saved my life and indeed kept me from having to have chemo...

I thank my kids- specifically Jami and Brok for encouraging me to make this blog... thanks for believing your mom has something worth sharing!