Wednesday, March 14, 2012

On birth plans

Another part of the "pregnancy club" is talking about birth. I really have always enjoyed hearing or reading birth stories, and even when I was up to my eyeballs in infertility grief I could barely resist. For some reason birth is simply fascinating to me. Clearly, it is fascinating to a lot of other women, too, because everybody wants to share their stories and advice.

I live in an area where it is very common to create a birth plan and seek to have an unmedicated birth. A birthing center just opened here in the fall and I already know one friend planning to deliver there. Another friend who lives a couple hours away has been filling me on things she has learned in her Bra.dley classes, and I have enjoyed hearing about it. She has a birth plan in place that involves a lot of specific things she wants and does not want.

But despite all of that, I am not going to have a birth plan in the sense that most people talk about it. I DO have a plan, and that is to have an epidural and a healthy baby, Lord willing.

I have had many great conversations with others about their birth plans and shared my own expectations, but I have also had some that made me feel judged. One person told me that I was uneducated about the benefits of natural birth. I saw somebody on a message board call people like me "passive" about giving birth rather being proactive about what I want.

But the thing is, these are proactive choices that I am making...that others simply might not agree with. I have grown up hearing about my own premature birth due to my mom's incompetent cervix as well as my brother's birth defect when he was born that required immediate surgery, and I think those things have highlighted for me the very real risks associated with childbirth. Similarly, my mother in law had three children - two preemies (also an incompetent cervix), one of whom was born breech which resulted in complications, and one full term baby but her placenta separated from the uterus and caused severe hemorrhaging. So out of five children between my husband's and my families, not one normal birth...and you can't say any of those are due to unnecessary medical interventions, epidurals, or C-sections.

Those experiences, as well as my husband's and my belief in the scientific process and research that the medical community uses to determine their practices for labor and delivery, have made us pro-actively decide to have a hospital birth in which we will do things per the doctor's/ hospital's standard methods. I know this is not error proof, as many practices have evolved and changed over the last thirty years, but we believe it will best ensure the safety of our son and myself.

That said, I have full respect for those who choose otherwise. I do believe the vast majority of births are complication-free and the end result would be the same for those who choose, say, a homebirth. Personally, I NEED the assurance that if there was a complication, I am in the best place and already have the expectation that anything necessary will be done to deliver our boy safely. My kind of "birth plan" brings me the most peace and least anxiety about birth, but I can definitely understand that that is not the case for everyone.

I don't have any special reasons for the epidural, and I see that as simple personal preference. I don't think I have a particularly low pain tolerance, but I take Tylenol when I have a headache (and am not pregnant). I just think it would be nice to not be in severe pain, and am thankful for things like epidurals during birth that are options in modern medicine.

At this point in my pregnancy I am kind of excited about giving birth. I am a little nervous about potential complications and the pain I will experience (before the epidural or if I am unable to get one), but I am very thankful to have this experience and love knowing that the end result will be holding my boy in my arms. And then I will have my own birth story to tell. :)

37 comments:

Leah said...

Loved this post. I may have had a more extensive birth plan had it been easier for me to get pregnant. But it wasn't easy, and when I was finally blessed with a pregnancy, one thing mattered at the end of the day. . . that my baby was alive and healthy. I went to midwives throughout my pregnancy, and they really pushed having a birth plan, so I made one, and handed it to the nurse the day I checked into the hospital in labor. My birth plan explained how long I had been trying to get pregnant. All about the failed medical treatments, and that at the end of the day, I want this nurse and the other medical professionals to do anything it took to make sure my baby was healthy. If that meant an unplanned C-Section, fine. As long as my baby was going to be fine, I would be at peace with however she was brought into this world. And you know what, it went perfectly. My expectations were realistic, my baby was healthy, and I was over the moon.

Cadie said...

Good for you! I'm glad you have an idea of what you want and don't go changing it because of what someone else might think is best. I am with you on having a hospital birth- my first two had complications- and even knowing that everything looks good this time around, I still want that assurance that the hospital can bring. Either way, you are going to do great and I am so excited for you and your hubby! Can't wait to see your son! (p.s. I had the epidural and loved it because I was able to actually enjoy the birthing process.)

Jem said...

I am 100% with you on this one. I take Tylenol (pregnant or not) when I have a headache, and am not into the whole 'martyr' thing. I just want a healthy baby, oh, and less pain.

This is not a passive approach at all. Shame on those who try to shame you for your point of view.

Oh, and most people who have birth plans end up throwing them out the window. The last two friends IRL who gave birth had all kinds of complications! And they weren't expected.

Anonymous said...

You are too cute! Do whatever makes you and your hubby comfortable, and there are no explanations needed! I hope you enjoy your birthing process

Amber said...

I think you have a great "plan"! I think the more open you are to rolling with the punches the better! I think I would have been "upset" had I chosen a birth plan that was pretty specific and then have everything go not as planned! I had a surprise breech baby with a surprise epidural that wore off so I was completly knocked out for my c-section. I had so much peace about it cause in the end I just wanted a healthy baby like you! Excited to hear your birth story too!!

Sarah B said...

Good for you, knowing what you want and sticking with it! I also live in a part of the country where cynicism of the health care industry runs high. I got a lot of pitiful looks when I told people I had scheduled a C-section at the advice of my doctor (double footlong breach, low fluids). Honestly, we went through so much intervention to get the baby in that it only seemed fitting we got him out the same way. I could care less how other mothers plan their birth; it bothers me that there is so much judgment about this out there (and that doesn't seem to end with the birth of the baby, BTW). How exciting you are working to firm up these plans!

jeanna said...

Goal is a healthy baby, why do people forget this! I wish the hospitals were able to provide the relax atmosphere that birthing centers do so that women could have the best of both worlds. I have birthed babies in a hospital twice, both were very different experiences. Both times I wanted all the medical advances of modern times at my disposal should anything go wrong.

This post proves that you are already a great mom, making the choices that fit the needs of your family. It is unfortunate that other women/mom's chose to be so judgmental to others.

All that to say: good for you!!

Liz said...

I agree with you 110%! I had my heart set on a medication free birth with my daughter. Long story short, I needed medication and I felt like a huge failure. I was heartbroken about it for a very very long time. The labor was VERY long and VERY painful. When I became pregnant with my son I knew he was going to be our last baby. I wanted a labor that I could enjoy and have happy memories about. I took the medication as soon as I felt I needed it and I had the best labor & delivery I could have ever dreamed of! I wish you the same.

Silya said...

Great post. If I am ever lucky enough to experience giving birth, I would make the same decision, for many of the same reasons you've listed here. I don't know why there has to be so much judgment among women about birth choices, and you've articulated so well why giving birth in a hospital is the right choice for you. I'm bookmarking this for later (hopefully) so I can refer to it when the time comes!

Allyson said...

Hi, from a lurker! I'm 18w preggo and was just asked by a friend if I have a birth plan. My plan is to do whatever I need to do to have a healthy baby. My only strong preference is to not have pitocin, but if the doctor thinks it's necessary, fine. I, too, was a premie, as was my brother (both of us were 2 months early). I was healthy but he was in the hospital for a long time. So, like you, the goal is a healthy baby, regardless of how it gets here.

Jennifer said...

Good for you.

Anyway can't resist sharing my story . . .

I gave birth a few weeks ago, and my attitude was, if I need an epidural, and I probably will, fine. I made a birth plan which we didn't show to anyone at the hospital. I think making it was useful - when would we go to the hospital? What were all the phone numbers we needed? Where would the dog go? When would I ask for pain medication? Making the plan was useful in terms of making sure my husband and I were on the same page. Surprisingly (to me) we actually weren't on a couple of minor things - it was easy to resolve with a quick discussion, but making the plan facilitated the discussion.

Anyway, long story short, I had an epidural. Having it changed my views a bit, as it had two major negative effects.

First, it caused my blood pressure to drop. They had to give me medication to bring it back up, which affected my baby, causing her heart rate to go up 30 bpm, from 130s to 160s and higher at birth. I think this is clearly undesirable, though the nurses told me it was fine.

Second, the doctor was busy, and I had to wait an hour to push my baby out. During this time, she went back up the birth control (b/c I wasn't pushing). If I hadn't had the epidural, I wouldn't have been able to resist pushing. B/c I got it, she basically had to travel the birth canal twice.

Now, I got the epidural late in the game, when i was fully dilated. I remember the pain still - it was extreme. I'm glad I was able to get pain relief.

My conclusion from all this is that it's better to avoid the epidural if possible, but for many or most women, the pain level will be unacceptable. Therefore, I think it's better to wait as long as you can to get the epidural.

I'm not sure what I'd do if I had another baby.

Incidentally, at no time did I feel pressured by the hospital nurses or doctors to get pain relief. I didn't feel like I was going against their wishes or preferences in any way. If they'd wanted me to get an epidural (or other pain relief sooner), I certainly would have. But I never felt that they had a preference one way or the other at any time. If anything, I felt they were encouraging me to get through it without pain relief. I don't think the hospital I was at was particularly progressive either.

I hope you don't think this post is judgy - I don't mean to judge in any way, just to share my experience.

Words Like Swords said...

I think your plan is perfect. I went in with the same plan - epidural and healthy baby. And I'm glad I did. If I'd had some long, drawn-out birth plan I would have been so disappointed. We ended up inducing because my kidneys were failing, but then the induction failed and I ended up with a C-Section and a BP of 220/110. It was a horrid mess, and I'm SO Glad I didn't have the added pressure of feeling like I needed to have a particular birth. One thing you learn about birth and small children pretty quickly (my baby is only 3 weeks old) is that you really have to do what's best for you and your family. EVERYONE has an opinion and life is just easier if you stop worrying about them and do what's right for YOU.

Amanda said...

You have to do what is right for you! Women are so judgmental about everything. Just wait until after you have the baby. Honestly, there are pros and cons to everything. There are certain risks with an epidural, but hospitals are very good at managing these risks and I know bringing home a healthy baby is much more important than having a fabulous birth story to tell, so you go for it. I would just encourage you to listen to your body. If you need an epidural for the pain, you need it. Maybe you find that you don't need it. I was lucky enough to not really experience much pain (except for transition, not fun) and an epidural was unnecessary. All that said, it probably will help you to do some labor prep work just to be prepared for whatever happens. You could have really strong contractions and not have progressed enough to be allowed to have an epidural or you epidural might not be really effective (they don't seem to work for everyone for some reason), so knowing some pain management techniques might be helpful. You'll do fine. Just keep and open mind and your eye on the prize.

Amber said...

Thank goodness for epidurals. My 8 hour labor wasn't too long, but it hurt enough to make me certain I didn't want to experience that pain the whole time. After the epidural, I was able to enjoy the experience so much more. And you are so right about judgement- if you don't choose someone else's way, it must be wrong! That drives me crazy. Your birth plan is exactly what mine was last time and is again.

Single Mom BB said...

I'm so glad you wrote this post! I've been having this conversation a lot lately, and I expect to be having it even more as my pregnancy progresses.

I feel the same way. My goal is a healthy baby. I went through a lot of medical intervention to get this far, I am open to whatever is best for my baby going forward too. And I want to be monitored by medical professionals in a well equipped medical establishment (my hospital is less than 1/2 mile from my house!).

I've watched too many TLC Baby/Birth programs lately (I know, I shouldn't watch them) and the one thing that stands out is how upset women get when things do not follow their plan... and more often than not, they do not.

I interviewed a doula a couple of weeks ago and I felt like I was being judged because I do not plan to be a 'hero' and am open to an epidural and any other necessary intervention. That discussion has turned me off of hiring a doula.

Sorry, this is a long winded way to say I'm right there with you!

A New Beginning said...

I too, love reading birth stories. I find them fasincating.

I love your birth plan. Everyone can "plan" all they want to, but what they don't realize is that the baby is in full control (and always will be!).

Here's to a happy, wonderful, non-complicated birth.

Anonymous said...

As an obstetrician I would like to make one comment. Your baby cannot retreat up the birth canal. Also, please make sure your research is from scholarly sources, and not other peoples experiences. Everyone has a right to view and express their birth story, but it is often misinterpreted. I think your plan is amazing and please stay true to yourself. I also suffered from infertility and was happy to have healthy babies. This is after all the ultimate goal, for everyone involved.

andreajennine said...

I like your plan! After my experience with an emergency C-section at 31 weeks, my birth "plan" this time around was to get as close to full-term as possible and to have the baby by whatever means is needed. We made it to full-term; yippee! I'm hoping for VBAC, but I'm totally fine with another C-section if I need one (can't be induced b/c of higher risks). I was on the fence about epidurals, and I was happy to have the decision made for me when my OB suggested we do an epidural in case I do need a C-section after laboring. Works for me! Infertility and having a preemie have certainly taught me that, when it comes to having babies, we can have preferences, but we really don't have as much control over the "plans" as we'd like to think.

Anonymous said...

I went the same way with my first delivery and it was great. I was able to enjoy the experience and be fully aware and relaxed when she was born. Having a designated birth plan that is so specific can lead to frustration and disappointment as well.

Emry said...

I knew going into both of my births that I'd be having an epidural, and though I struggled with guilt at the time, I'm so glad that I have enjoyable birth experiences. They were happy days, not horrible frightening ones.

Of course I admire women who choose to go natural, but that just wasn't for me. Good for you for expressing your reasons so eloquently!

Anonymous said...

When I was pregnant with my twins over 3 years ago, I remember my ob jokingly telling me that it's those women with every detail planned out who often end up needing emergency c-sections.

I think your birth plan sounds perfect!

Anonymous said...

I am an OB nurse and love your birth plan! It keeps expectations realistic and is flexible to accommodate YOUR birth experience. To be honest with you, the majority of moms that I have helped end up scrapping their elaborate plans for one reason or another. What is sad, is that they then feel guilty that they didn't deliver "correctly". Will continue to pray for you, a safe delivery and a healthy baby boy!

Anonymous said...

I had a c-section with my first pregnancy, epidural with the second and natural with the last. All three births were different and had different reasons for the way they played out. The part that matters is that the baby is healthy. Even when the births aren't what we envisioned, it all fades away once they are in your arms. It will be a wonderful day and a story that is uniquely yours. Don't let anyone make you feel as though your plan isn't the right one. Only you and your husband can know for sure what will work for you.

Amy said...

I love this post! And I'm having such a great time following your pregnancy. You are doing great and you look beautiful!
If I can throw my two cents into the mix, I felt very much like you when I started hearing about writing a birth plan and when I sat down to even think about what I might want, I didn't have a clear picture other than healthy baby and a safe delivery. To me, safe meant in a hospital with my doctor (who I loved) with my husband next to me. Everything else was clogging up my already jam-packed brain.
Both mymom and MIL had epidurals, although my two closest friends didn't, I didn't really feel strongly one way or the other. But when I started really feeling the contractions, I had no problem asking for and getting the epi and then my body relaxed, I could sleep (my water broke around 11pm) and I delivered a healthy baby at 1:30pm the next day.
Being flexible and open to just enjoying and at times just getting through the delivery was enough of a birth plan for me and my piece of paper ended up just having my doctor's phone number and my list of people to call when our son arrived. :)

Anonymous said...

I wonder what nurses and OB's really think of birth plans . . .

I love your attitude and think you will be happy with however your baby boy makes its entrance!

I casually thought I'd try to have my first DS unmedicated but was not opposed to getting an epidural. I had some pressure to live up to since one of my sisters had 3 unmedicated births, but that was her plan, not mine!!!

I ended up getting induced 5 days early since baby boy was big and i had been 3 cm dilated for 2 weeks. I asked to have my water broken first and then observed . . . i started having contractions within a half hour and 4 hours later i was dilated to 6cm and got my epidural. This was the best choice i EVER made!!!! I was in so much pain beforehand, i couldn't even focus on the baby or be happy that my son was going to be born that day. The epidural was amazing and i can't wait to get another one :) I ended up getting pitocin and delivered my son 6 or so hours later on.

Jessica R said...

I did a ton of research on natural birth, took natural childbirth classes, read Ina May... and still chose a hospital birth. I felt, like you, that I wanted to be in that setting in case of any complications. I almost feel like a traitor to the med-free camp saying this, but after laboring without the epidural (and then having a c section), I think I'd do the epidural if I could. I never got to 1cm (at 42wks!), so it was never an option for me, but if I could, I probably would go for it next time... if I dilate at all :)

Choose what's right for you! That is your right. One thing I've found is that the moms judging each other thing starts during pregnancy, and doesn't really end. I'm still working on developing thicker skin about it. Luckily, my girlfriends are incredibly wonderful and non-judgy. Surround yourself with those people - all of this is enough to handle without being judged!

ceecee867 said...

You do what YOU are comfortable with. THAT'S YOUR birth plan !! You have come waaaay too far in your journey to start second guessing yourself. You've "got this" kiddo :)

Rosie said...

I loved your post! As a labor and delivery nurse I know that 90% of people with a birth plan end up with a completely opposite delivery. Alot of these women are uneducated, they think because they clicked a few boxes in an online birth plan that they know what is going to happen. You can't control your labor you can only hope for a healthy baby at the end. The best thing to know about birth is that the baby is in the driver's seat not you. You are so right that anything could happen. There is no shame in getting an epidural and actually enjoying your birth. I'll be praying you have a calm birth but I know it will be one of the most joyous occasions because you are so deserving.

Do I Have to Be a D.I.N.K.? said...

I totally agree with you! That is also my birth plan!

Erin said...

i always say, once the baby is born it doesnt matter how he or she got here, just that they are here and healthy. personally though, i agree with you, who knows what birth will bring and better to be safe and have help all around you. plus... seriously having an epidural is great!! gives you time to enjoy the experience rather than think about pain ;) good luck to you!

Cath said...

Had an epidural and so glad I did!

Cath said...

Had an epidural and so glad I did!

kdactyl said...

My first baby was breech...so my plan was written for me in the form of a consent form and an appointment card for a c-section....and I was THRILLED!!!!! I had long ago lost the desire to suffer throught contractions and then push a watermellon out of my downstairs!!! When I was younger I had all these dreams of natural childbirth and all that bonding and the whole "right of passage" of BECOMING a mother....but what they don't tell you is that you "become a mother" the minute that pee stick turns pink....and for me that was not easy. $40k, 2 years, 2 miscarriages and 5 rounds of fertility pretty much focussed my eye on the prize....I just wanted a healthy baby. So when my Dr. confirmed appt after appt that baby boy was NOT moving...I had no issues...we scheduled his birth and it was the most wonderful day of our lives...and I would not change a thing. Fast forward to baby number 2....perfectly fine...head down....scheduled c-section...why fix it if it isn't broken? I wish for you only what you wish for yourself Hillary....I love how grounded you are in who you are and what is best for you and your family. I loved this post. You were thoughful, articulate and very confident. You are going to be a really great mom. I'm so excited for you. I have followed your blog since your very first IVF and I cried tears of joy when you announced this pregnancy. Enjoy every minute...don't be like too many young women who think happiness is defined by what others think make them happy. Looking forward to hearing about your perfect delivery very soon.
Karaleen

RachieD said...

Just to weigh in with my own thoughts on birth plans.. I had one for my first born. turned out baby had other ideas and when I had to be induced, most of the options on it were completely discounted. This time round, my only plan is to avoid being induced at all costs and get baby out safely.

Pez said...

I loved being in a hospital were there was a Nicu. With our first we needed it. Epidurals were great for me. I just wanted to enjoy everything and that included labor. When my epidural wore off with my first the last few hours were painful.

my thing though is you have to do what is best for your family.
Pez

Sarah said...

This is probably the best article on childbirth I've ever read. I'd say you are VERY well educated to think about your precious baby and what's best for him. All 3 of mine were born in a hospital with an epidural, and it was wonderful, beautiful, and spiritual. Like my labor and delivery nurse friend told me, "there is no trophy at the end for going without an epidural". I didn't feel like I needed to prove anything to anyone. Good job mama!!!

Anonymous said...

I like your plan.

I just wanted to add a few thoughts about the epidural. I certainly wouldn't let people make you feel guilty for going that route, especially if labor is long and painful. There are benefits to letting the body rest from unending pain during labor.

That said, I fully intended to have unmedicated births with my first two children, and I ended up with excruciating back labor that I was unprepared to deal with. I got the epidural with those two deliveries, but it wasn't without side effects. I couldn't stop throwing up, one of my baby's heartrates dropped really low, and I nearly went into shock (possibly from the epidural, possibly not.) With the 3rd child, I succeeded in not having the epidural, and I downed 3 turkey sandwiches immediately after and bonded better with my baby.

My SIL, on the other hand, had her first three children without the epidural and the last 5 with. She decided it was easier on her body with an easier recovery when she had the epidural.

Every woman's body is different. Trust your intuition. You know your body better than anyone else.

Congratulations and best wishes with your pregnancy and birth.