At some point during pregnancy, someone or some book or some article tells you to think through your “birth plan” and write it out for your doctors. After having two kids, I can honestly say the best advice I have is this: do not spend a lot of time planning out an event that is by nature entirely unpredictable. I mean, the term itself is an oxymoron, like jumbo shrimp.
Sure, it’s good to have an idea of what you want so you can sign up for the right classes or anesthesiologist, and it’s good to weigh health risks of certain interventions and procedures. But I didn’t understand the ridiculousness of my 3-page (typed!) plan until way after my episiotomy and tear scars had healed. So I learned from my lesson, and with Zach, I told my OB that my birth plan was to get him out (safely).
Thus, I thought it might be fun for my pregnant friends and readers to see some of my birth plan (I wouldn’t dare bore you with the whole thing) compared to how differently things actually went. The best lesson childbirth gives you to prepare you for parenthood is how to deal with unpredictability.
“We would like to do all we can to have a natural delivery while keeping the baby’s health the priority. We will attempt to labor at home until contractions are two minutes apart, but with the knowledge that pain management or other complications might send us to the hospital earlier.” Natural it was not. I don’t think I’d even call it vaginal because my rectum became so involved in the whole process. I distinctly remember calling the OB number about six hours after my water broke and 12 hours into labor. The on-call doctor called me back, and when I told her my contractions were erratic and 3-5 minutes apart but that I wanted to come into the hospital, she said, “that’s not part of your birth plan.” I wanted to say, “It is now!”
“As much as possible, we would like privacy during our birth. Once I’m in stage two of labor, we do not want anyone but us and the doula in the room. Additionally, after the baby is born, we want an hour to ourselves (without the doula) before anyone else interrupts our time (aside from medical personnel when absolutely necessary).” There were probably 6-12 people in-and-out of the delivery room during my nearly two hours of pushing. I almost fainted, so I think there was a team there responsible for me and also a surgical specialist waiting, among others. Once Eliza came out, a bunch of new faces appeared during my 40-minutes of getting sewn up, and I realized later they were interns and residents. If you will deliver at a teaching hospital and don’t want anyone to, ahem, learn about va-jay-jays while staring at yours, there is most likely a way to prevent this if you ask for the right paperwork.
“We would like as much freedom of movement as possible and as much choice in birthing positions as feasible. Thus, having intermittent electronic fetal monitoring and a saline or heparin lock IV are important to us so that we are as free as possible to improvise.” I had lots of freedom until I got drugs. Then I had no freedom. For pushing, I was on my back with my legs up like you see in all the movies and lots of videos. It makes it easy for the doctor to see, and let’s be honest, isn’t that what really matters? (Can you sense the dripping sarcasm?)
Specific interventions:
Epidural – only administered between 5 and 8 cm dilation, and only under circumstances listed above. I had been advised to get the epidural in that window because that would give it the least chance of slowing down my labor. Although I got it at 5 cm, it slowed me down anyway.
Pitosin – only administered if there’s a question about the fetal heart rate, the baby is asynclitic (head turned to the side or posterior), or aphoditic (the baby is no longer getting good circulation from the umbilical cord). I am not interested in having Pitosin administered to speed up stage 3 of labor. I wasn’t interested in it but I got it anyway after I hadn’t made any progress for two hours. We were approaching 20 hours since my water had broken and needed to get things moving. It turned out Eliza was posterior anyway, and she just didn’t manage to turn on her way out.
vaginal exams – only as necessary. Hey, what do you know, I found something else that went as planned. I didn’t have very many of these.
Episiotomy – only if absolutely necessary and we would like to be asked about the decision. I would definitely like to know what the doctor will do to help prepare my perineum. The doctor, who was not my OB, did not ask. I knew he was cutting me because my epidural had been turned off for pushing and I felt him snip me three times.
If you’ve gotten through to this point, I do want to say I hope I am not scaring (or scarring) you. My labor with Zach was everything I could have dreamed of at less than two hours and completely natural. The bottom line is despite my two very different experiences, both of my kids made their ways out of my womb and into this world healthily. So try not to freak out about your “birth plan,” and concern yourself with more important things, like sleeping a lot and thinking through what to eat right now because food will never taste as good as it does when you’re pregnant.
I can't even pee in peace 
You could not be more correct in your advice to know your options and preferences, but don’t bother with a full on plan. Because as you’ve said “The best lesson childbirth gives you to prepare you for parenthood is how to deal with unpredictability”. We will have no birth plan for #2. I know some preferences that I have and my hubby will know those, but that’s as far as it’s going since none of my labor last time went according to plan.
I thought of you when writing this, Dana! What an ordeal. And Sarah Rice, too. The second time around gives so much wisdom … Congratulations, by the way!! 😉
Thanks! And I think of your 2 birthing stories when I think about how much better our second one could be 🙂
timely advice since i’m just beginning to think through my options — thanks christine!
it’s also amazing how much harder your story strikes me now that i’m preparing to give birth myself. before, i *thought* it was horrible but now i feel it. i think maybe i’m a little scarred. but also reassured, because, despite everything, you made it through and eliza made it through and you healed well enough that you were able to have zach. thank goodness! =)
I agree that all that matters is the healthy, safe delivery of your child, but it made me so angry that the doctor cut you for the episiotomy without even asking! Actually, a lot of that made me angry with the doctors and nurses.
I think you were making fun of yourself for having a well thought out birth plan, but reading it made me sad that you don’t think what you wanted was realistic. Or are you just saying that’s not realistic in a hospital? It just sounds to me like you had an awesome birth plan but the odds were stacked against you. Obviously, I wasn’t there, and it sounds like it didn’t scar you for life, but I do wish the hospital model would change to be a little less intervention intensive.
I just wrote a post about birth options the other day (http://namammaste.com/?p=1555) and would love your feedback.
Hey dear,
Thanks for your feedback! I think part of me was angry for a while, wondering if the doctors screwed up, and I think perhaps they could have. But I decided that I’d rather be thankful for what is than dwell on what wasn’t. I’ve read that 85% of the time, when a baby is posterior, during its exit through the birth canal, it will turn, at least 90 degrees. (I was actually concerned about having the same thing happen again with Zach, so I had a sonogram the day before I was to be induced, and he was also posterior. I shed a few tears, worrying, but then prayed and God gave me peace. I ended up going into labor 3 hours before I had to be at the hospital for my induction – which was also awesome because I did NOT want to be induced – and Zach must have turned at some point during the process because he came out the right way.) With Eliza, she just never turned. And that is completely out of their control. I do believe the doctors tried to let me do what I wanted because they left me alone and let me work with the doula and didn’t force an IV, etc. But once I couldn’t go on without the epidural, that changed things. It slowed my progress substantially. They suggested Pitosin and I wanted to wait a couple hours to see if my labor would progress on its own. They allowed me to do that. Two hours later, it hadn’t, so we allowed the Pitosin. Then we turned off the epidural for pushing, but because I had gotten it, I couldn’t then get up and walk around to push her out. Plus, she really was stuck. They probably would have just C-sectioned anyone else, but I think they really were trying to let me do it the way I wanted. And by the time a C-section seemed like the right idea, she was too far into the birth canal to do it, but still too high up to get her out with suctioning or forceps. She really was just sort of “stuck,” and I just had to keep pushing (and keep reshaping her head I guess) to finally get her low enough for suctioning. I know the doctor gave me the episiotomy to make room for her because she was going to come shooting out, and her positioning and her shoulders just messed everything up on the way out.