Creating Your Birth Preferences (Not a Birth Plan)

You may have read about creating a birth plan to discuss with your doctor or mid-wife. If you haven’t, it’s a list of preferences for your doctor, nurses, husband/partner or other care givers. It’s important that others know what you want so they can be advocates for you if you’re not able to answer for yourself. I prefer to call this your Birth Preferences vs. a Birth Plan as you never know what type of labor you are going to have. You can’t control how things unfold, all you can control is the decision you make once different options are presented to you.

Here’s a list of all the things you should think about and decide on beforehand. Make sure that you review this with your doctor and anyone else present at the birth. Some of the decisions you make below will affect what type of medicine you can be given or how your doctor will perform the birth, so again, make sure you go over it with them so you can discuss what you want and they can advise on any effects of those decisions.

Labor:

• walking while in labor (yes/no)
• changing positions at will throughout labor (yes/no)
• music (yes/no, type)
• quiet environment (yes/no)
• lighting
• number of vaginal exams
• IV hep lock (yes/no)

Monitoring:

• continuous fetal monitoring (yes/no)
• internal monitor (yes/no)

Labor Augmentation/induction

• Break water artificially (yes/no) If yes, under what circumstances?
• Pitocin (yes/no) If yes, when is it ok?

Pain Medication

• Epidural in Standard / Low Dose / None
• Injection of narcotic (yes/no)

Delivery

• Delivery Positioning
• Mirror to see baby coming out
• Touching baby’s head when crowning
• Delivery room environment
• People allowed in delivery room (relatives, coach, medical students)

Episiotomy

• Episiotomy or natural tearing (your doctor might do an episiotomy if they think you will tear, would you rather tear naturally or have them cut you so that you won’t tear?)
• Perineal massage
• Guidance when pushing
• local anesthetic to repair a tear or an episiotomy

Cesarean

• How do you feel about a cesarean? Avoid at all costs? Indifferent?
• Request cesarean second opinion (yes/no)
• The presence of partner or labor coach in OR
• Screen (lowering to see the baby?)
• If the baby is not in distress, but my labor has slowed then ______

After Delivery

• Cord cutting, who?
• Cord saving?
• Holding baby after delivery for how long before/after examination
• Pitocin post delivery to aid in placenta delivery
• Eye medication
• Hep B shot
• Vitamin K shot
• Placenta, discard or keep (some people keep the placenta and get placenta pills made to take postpartum)

Breastfeeding & Postpartum

• Breastfeeding or bottle
• If bottle is ok, formula, glucose water, water. What is ok.
• Pacifier
• I do or do not plan to breastfeed my baby
• Lactation consultant
• Baby in room or nursery

Circumcision

• Circumcision (yes/no)
• If yes, performed in hospital?

I am sure this seems like a lot, but you probably already know how you feel about most of this stuff. If you aren’t sure what something is on this list, just post a comment and I’ll explain. Here was my birth preference list and what really happened:

Labor:

• walking while in labor – yes
• changing positions at will throughout labor – yes
• music – yes, rythmic or drum beats. Ended up with no music bc labor was so fast, I didn’t miss it!
• quiet environment – yes. This ended up being very important. I couldn’t have anyone talk while I was having a contraction
• lighting – low
• number of vaginal exams – as few as I need.
• IV hep lock – no. I ended up getting one because my doctor strong recommended that I do. I am still annoyed that I was requested to get one. It wasn’t used and hurt!

Monitoring:

• continuous fetal monitoring – yes
• internal monitor – no, unless needed because baby’s vitals can’t be found

Labor Augmentation/induction

• Break water artificially – no, not unless emergency
• Pitocin  – no, only OK if labor slows and a cesarean is being considered.

Pain Medication

• Epidural – none
• Injection of narcotic – no
• If no medication, still offer medication? – no

Delivery

• Delivery Positioning – not sure, how ever I feel at the time
• Mirror to see baby coming out – no
• Touching baby’s head when crowning – no
• Delivery room environment – tranquil
• People allowed in delivery room (relatives, coach, medical students) – husband, mother, doctor, doula, nurses and any medical staff

Episiotomy

• Episiotomy or natural tearing – natural tearing
• Perineal massage – ok
• Guidance when pushing – yes
• local anesthetic to repair a tear or an episiotomy – yes

Cesarean

• How do you feel about a cesarean?  – Avoid at all costs
• Request cesarean second opinion – yes
• The presence of partner or labor coach in OR – partner only
• Screen (lowering to see the baby?) – yes
• If the baby is not in distress, but my labor has slowed then _I want to keep progressing naturally, wait, do not perform cesarean. If we must, I’d take pitocin to help get labor going again.

After Delivery

• Cord cutting, who? – father
• Cord saving? – no
• Holding baby after delivery for how long before/after examination – 1 hour before exam
• Pitocin post delivery to aid in placenta delivery – no, but ended up being given it without my knowledge.
• Eye medication – no
• Hep B shot – no
• Vitamin K shot – yes
• Placenta, discard

Breastfeeding & Postpartum

• Breast feeding – yes, right away
• Pacifier – no
• I do plan to breastfeed my baby
• Lactation consultant – yes
• Baby in room

Circumcision

• Circumcision – no

Hopefully that helps give you an idea of all the things you need to consider and think about beforehand. You will not be in the proper state to think things through when you’re having strong contractions. If you want to try and do a non-medicated birth, have a “secret word” with your partner that you say only when you want pain medication. Ours was cupcake. If I said cupcake 3 times that means give me the pain medication. I never used our secret word or even thought about it really, I was so set on delivering naturally. My labor was pretty smooth but I have many friends who weren’t as lucky — make sure you go in with an open mind and that in the end a healthy baby and healthy mom are most important no matter how you get there.

Lastly, you have the right to say no. Just because you’re in a hospital or at a birthing center with doctors doesn’t mean you have to do what they say. You can refuse any treatment and you can ask for second or third opinions. Don’t let them bully you into doing something you don’t want to do — just know that you have the power over what is done to your body AND your baby’s body. For example, we refused the eye ointment (used to protect the eyes from certain STDs, if you don’t have those STDs then your baby doesn’t need it) and hepatitis B shot (we are delaying this vaccination until Archer is a bit older since neither his father, I nor any of his caregivers have hepatitis B). We had to sign a waiver saying we refused these standard post delivery medications for our baby, but I am so glad we did!

Happy Laboring!!

My Labor & Delivery Story

It was a Friday morning, around 7:30am, and I was getting ready for work. I started to notice some slight cramping in my lower abdomen, like menstrual cramps. I didn’t think anything of it. I had those types of cramps a week earlier and my OB said it was a good sign that my body was getting ready. Archer wasn’t due for another 11 days so I figured more progress was being made toward labor.

I headed into work and throughout the day noticed the cramps getting stronger. They started to wrap around my hips and the cramps became progressively stronger — by 4:30 I couldn’t talk during the cramp so I figured it was time to go home and rest. I was so busy at work I didn’t really realize that they were coming regularly. Once I got in the car to drive home I started timing the craps. They were consistently 4 minutes apart. Still didn’t think anything of it and even stopped to get gas on the way home.

Once home I took a bath and tried to relax hoping the cramps would subside. The cramps kept coming. My Doula advised to rest and if the cramps kept coming regularly to go to the hospital to get checked. I then called the OB on call to get her opinion. Once a cramp came on and I stopped talking, she said, you need to go to the hospital to get checked.

My husband and I gathered our bags (we had everything we needed packed already) and headed out in rush hour Los Angeles traffic to the hospital. For some reason neither he nor I thought we were in labor. I assumed contractions would feel like tightening of the belly. That is what I remember being told in our Labor class. I didn’t have any belly tightening.

Finally after an agonizing drive, we make it to the hospital. We said, “We’re not here to get checked in, I’m just here to get checked.” As they had me sign papers at the front desk they noticed how much I was dancing around and trying to breathe. They decided it was time for me to get checked and my husband stayed behind to fill out paperwork. A few minutes later the nurse checked me and said, “Yup, you’re 4 cm dilated and having contractions every 3 minutes.” I said, “So we’re in labor?” She looked at me confused, “Yes, you’re in labor!”

They moved me right away to the Delivery room. I should say that we wanted an all natural non-medicated birth. I wanted to feel what it was like to have a baby. I didn’t want to be numbed or confined to my bed as you are with an epidural. I wanted to be able to move around and go with what my body wanted.

Long story short… I was in the delivery room at 8:15 and by 10:13 Archer was born. My OB didn’t even make the birth. A mid-wife from down the hall had to come deliver the baby. All the nurses were amazed at what a fast labor I had for my first baby. I am convinced that all the walking and squatting I did while laboring is what helped. I never sat down until it was time to push.

What I learned though this experience is how amazingly equipped and intelligent our bodies are. They will birth a child with your help or not. To feel my uterus pushing the baby out without my help was an amazing feeling (they told me not to push, ya right I told them, the baby is coming whether we’re ready or not). While definitely painful, it was the most exhilarating experience and I’ve never felt a bigger sense of accomplishment. I would do it again in a heartbeat.

While natural non-medicated birth isn’t for everyone, I encourage you to consider it. I read about the benefits of baby mother bonding with natural birth, nut honestly I was more curious than anything on what birth was like. What was I supposed to experience as a pregnant woman?

Any birth plan that ends with a healthy mom and baby is what we want so no matter how your birth ends up, be proud of yourself and amazed at the little joy your body created.

Books: Ina May’s Guide to Childbirth

Whether you are interested in having natural childbirth or not, this is a must read in my opinion for every pregnant woman. The book is full of stories of women’s experiences in labor — each has a different and equally interesting birth. It’s important to read so that you mentally are not afraid but excited and empowered for labor and realize no matter how each labor went in the book all turned out ok, healthy mom and healthy baby. It really helped me understand that if all these woman can do it, so can I. More importantly, if you mentally can get yourself in the right place before labor you are closer to having the birth experience you want than if you walk in anxious or uncertain.

Amazon.com: Ina May’s Guide to Childbirth (9780553381153): Ina May Gaskin: Books.