Birth Plans and Birth Realities

I'm was going to get my whole "birth story" up on here some day (my son's now 9 months old, hmmmm).  Meanwhile, however, I was digging through some old files and I found my Birth Plan, and thought this might be a good way to tell it!

I gave birth to David #9 at the birth center of a small community hospital, about an hour from my home.  I picked the hospital very much on purpose - they are the only one in the state that allows water births, they don't have a nursery, they're "baby-friendly", and I absolutely loved my midwife.  I wrote up a plan, and not everything went according to plan.

Overall, I would give my birth experience an 8/10 (the baby gets 11 out of 10, I'm talking about the experience).  I've heard the question asked often - "Does anyone have a birth plan for people who want to birth naturally in the hospital?"  I do....but it's only a plan.  If you want to be guaranteed the best shot at a natural birth, stay home. If, however, you do choose to have a hospital birth, I found this plan to be a pretty good one.

Anyway, without further ado, here's the plan, and how it actually turned out.

 The view from the birthing center at Newport Hospital.  

Not taken by me, but I remember vividly being in labor and watching the sun rise like this over the bridge during a contraction.

Arrival Plan

•    Can I have the room with the tub?  Pretty please?

•    Please assign a nurse who doesn’t think I’m insane for wanting a med-free birth

•    No IV, hep lock if necessary

•    Let Me Eat and Drink (and puke…yeah, I expect it)

•    I’d like to wear my own clothes

•    Intermittent monitoring (via Doppler if possible, please don’t strap me in bed)

What actually happened:
My first sign of labor was my water breaking all over the bed at home at 37 weeks on the dot.  We drove to the hospital, and I got the room with the tub, but never ended up using it.  I was assigned a nurse who didn't think I was nuts.  A saline lock was started 3 hours after I arrived - this was not a big deal.  IV wasn't started until later.  I was allowed to eat and drink whatever I wanted.  I wore my own clothes for 14 hours, until the plan went off track.  Intermittent monitoring was also permitted until pitocin was administered; after that it was continuous. 

Labor Plan:
I would prefer to avoid interventions, but we trust your medical opinion of what may be necessary.  Please discuss any interventions you believe may be necessary with me and my husband.

•    I’m using hypnosis; please don’t try to talk to me during contractions (pressure waves).  Dave or Mom can talk for me if it’s an emergency.

•    In hypnosis I am very susceptible to suggestion.  Please be careful with what you say – avoid words like “pain” and use “pressure”.

•    Ahhh! Bright Light!  I’d like to keep the lights low, if possible.

•    Play that funky music…. I’m bringing my iPod and speakers.

•    I know what my pain relief options are.  I’ll ask for drugs if I want them.  Promise. 

•    Limit the number of internals, and don’t tell me how far I am dilated unless I ask.

•    I would like to birth my baby in the water.

•    If I can’t be in the tub, please let me choose the position that is most comfortable for me.

•    I would like to try “mother-directed pushing” rather than counting to 10.

•    Please let me know how I may reduce tearing.

•    I would prefer to tear rather than have an episiotomy.


 What Actually Happened:
For the first 14 hours, I got everything I asked for.  We had a lovely playlist (5 hours long) going on the iPod, the lights were dim, nobody asked me if  I wanted drugs, I was given a ball to bounce on, a bar to hold, and given free range of the hospital to walk.  My progress wasn't checked (although they did ask).


After 14 hours, I consented to be checked, thinking I would be 7-8cm....but I was 3cm dilated.  My midwife was concerned about infection, given the extended length of time since my water had broken.  She recommended that I be given pitocin - which meant that I was stuck in bed with a monitor on, and that water birth was no longer an option.  After an hour with pitocin, I gave in to the epidural.  The contractions had quickly gone from something I could handle to absolutely miserable, especially since I no longer had the ability to move around.  My "unmedicated" birth was gone, I couldn't use the tub, and in many ways my will was broken.  I know there are moms who can do pitocin without an epidural...I am not one of them.

I will probably always wonder if Pitocin was truly necessary.  In retrospect, I should have asked to use the tub to see if that would help me progress....but when your contractions are 2 minutes apart and you haven't slept in 24 hours, you don't see clearly.  Ultimately, I trusted Kathy - she was the expert, and I trusted her professional opinion and her 20+ years of midwifery, including her own 5 natural births....but still, I question.

When, eventually, I got to 8cm, my midwife turned the pitocin and the epidural off.  I love her for that!  She told me - and the nursing staff - not to push unless I had absolutely no choice, until my body told me "push or die!"  The epidural wore off just as that feeling hit me.  Well,  first I threw up all over my husband, then I had to push like it was the end of the world.

Just as the last of the epidural wore off, I had full feeling in my body and I was able to first sit up during contractions, then squat on the floor, holding the bed.  For the first 40 minutes, all pushing was "mother-directed."  I started to give up a little (it had been 28 hours), and Kathy did have me do 3 massive "count to ten" pushes until she saw David begin to crown.


Then, she had me stop pushing.  Hardest thing I've ever done!  She had me stop pushing and hold, to let my body stretch.  She instructed me to give tiny pushes even though I wanted to give it everything - and David gently wiggled out of me.  I actually had an orgasm.  Seriously.  I laughed out loud, and it was the best feeling ever.  Ten minutes after I gave birth, I asked my husband when we could do it again.

The music was still playing, the lights were still low, and Kathy was wearing cowboy boots and jeans.  No scary medical equipment, no shouting - peaceful and lovely, just how I had envisioned it.    "I Just Haven't Met You Yet" played when David was born, and Rascal Flats "God Bless the Broken Road" was playing when I first held him.  I'll never forget that!

I didn't tear or need an episiotomy.  YAY for stretchy lady-bits!  Oh, and because I know I was concerned, especially with the Ulcerative Colitis....I didn't poop on my midwife.  Heh.

David James IX, 7lbs even.

When the Baby is Born
If mom and baby are healthy….
•    I would prefer that the baby be placed on my stomach immediately for skin-to-skin contact for at least 1 hour after birth.

•    I would like cord clamping to be delayed at least 5 minutes or until the cord stops pulsing.

•    I would like to deliver the placenta without pitocin or traction.

•    If I need stitches, please provide anesthetic (local or otherwise).

•    I would like to delay all newborn procedures – including weight and length checks-  until after we have had the opportunity to breastfeed.

•    I would like to allow the “breast crawl” if possible.

•    Please don’t allow any visitors in until we say we’re ready for them.

•    We plan to exclusively breastfeed.  Please do not offer pacifiers or formula.

•    Our pediatrician will handle the HepB vaccine; please do not administer.

•    Can we use liquid vitamin K instead of the injection?

•    Eye goop (antibiotics) should be delayed until after the first breastfeeding session.

•    Do not circumcise, and do not retract. (Click here for the 50 reasons we didn't)

•    The baby should be with Mom or Dad at all times for any procedure (including first bath).


What actually happened

David came out a little blue, so Kathy delayed clamping and held him below me until he pinked up - no suctioning or toweling.  I'm convinced that delayed cord clamping saved him a trip to the NICU.  He was placed on my stomach, and did the Breast Crawl and self-latched.  It was the most amazing thing I have ever seen.  We were allowed 30 minutes of uninterrupted bonding/breastfeeding time, before any weighing or cleaning was done.


It would have been longer than 30 minutes...but my placenta wasn't moving.  At 30 minutes, the nurses started to massage my stomach (OW), no dice.  At 40 minutes, they started pitocin again....I disliked it as much the second time around!  At 55 minutes, I started to bleed heavily and they called to prep the OR.  At the very last minute, Kathy's partner and ex-husband Doug-the-OB asked me if I wanted him to try a manual removal, rather than a D and C.

I didn't want to be separated from my baby and I didn't want to go under ansethesia, so I said yes.   They cleared the room, my mom and husband were actually escorted out of the maternity ward.  Kathy held my shoulders, and Doug reached up inside me and manually removed my placenta.  My poor husband said he could hear me screaming from across the hospital.  Hurt like hell....but given the choice, I would probably do it again to avoid the operating room.

Wow, that's a terrible picture...but a beautiful baby!!

In the 24 hours that followed (we were released early by request, I felt great), there was never a mention of formula or pacifiers.  We were visited by 3 lactation consultants!  There was no question about the Hep B vaccine, and liquid vitamin K was supplied.  No eye goop either, and no pressure to use it. They did ask us 4 times if we wanted to have David circumcised - but when we said no, our decision was met with relief and respect, depending on who asked.


David was only away from my side for 10 minutes, held lovingly by his midwife while I showered and my husband was on his way back to the hospital with the carseat. 

Summary



Overall, I believe my hospital experience was far superior to what many mainstream hospitals will offer a laboring woman.  I was respected, my wishes were respected, and the hospital waited longer than most would to intervene - 14 hours after my waters released, and almost an hour on a retained placenta.  I have since learned that most hospitals will only allow 4-6 hours of "no progress" and a hard rule of 30 minutes for placental expulsion.


Also, even though not everything went according to "plan", we were still able to get back on track.  I had an orgasmic, medicated birth.  I've still never heard of another.  I thought it was all or nothing, and again the world showed me another shade of gray!  Next time around, I'd like to have a home birth, but I'm not unhappy with the experience I had. 


So, if you choose a hospital birth and things don't go as planned, don't give up on the whole thing!  You can have a beautiful, amazing, mind-blowing experience in spite of it all.   And, at the end of it all, I got to bring home the best (early) birthday present ever, blue eyes and all.