Friday, November 25, 2011

Birth Plan..? Uh...How do I do that?

Creating a birth plan was a very stressful process. One would think that it would be easy, after all women have been having babies since the beginning of time, this isn't brain surgery right...!?

What is a birth plan after all? 

I kept hearing this phrase "birth plan" and wanted to know what it really meant. It means that you have thought about what your ideal birth would be. This means that you have thought about what you want the day to look like, that you have thought about what you interventions the doctor my suggest or insist on and that you feel comfortable with the decisions that you may have to make. In trying to understand what "birth plan" was I had to understand what giving birth would entail. Taking a childbirth class was very helpful in understanding what the birth day would look like and in understanding why the hospital would suggest and do the things that they would do. For me, it didn't matter what my plan was because things did not go as planned at all!

My Journey

I have to admit that before getting pregnant I felt completely comfortable with a C-Section. I even told my doctor on my first visit that was how I wanted my baby to come into the world and I needed to know if she had a problem with that. She didn't and I was relieved. However, something happened in my second trimester and I started thinking about a vaginal birth, and after thinking about it I started to research it...that made me start to think that I could do vaginal birth if I prepared my body, mind, and husband for it. My husband is also an advocate for vaginal birth but is supportive of a C-Section if that is what I choose. In thinking about vaginal birth a little more seriously I started doing a little research...I watched a couple of movies...I talked to a few friends who have had kids and I read a couple of books. I started to feel more comfortable with vaginal birth. I even started taking a prenatal yoga class once a week because studies show that women who yoga do better at giving birth. However, there are still some factors that make me more than a little apprehensive about vaginal birth and make me feel more comfortable with a C-Section.

I feel very strongly that I do not want to deliver my baby at home, I want the safety and security of delivering in a hospital with doctors and all the proper equipment. That being said, when you go to the hospital you are also saying to the medical professionals "I want your help and your interventions" this is the area that begins to make me uncomfortable. I do not like the interventions that they use sometimes. My research has shown that hospitals tend to watch the clock and give milestones in the birth process time lines. When your body does not do things by that time line they want to give you drugs and use interventions to push things along. I understand that they have good reasons for this, they are scientifically trained after all. However, I do not like the side effects and consequences of these drugs and interventions.

There is plenty of research that shows given the right amount of time and the right techniques a women's body handles childbirth just fine without drugs and with out medical interventions. It seems that many medical professionals in the U.S. do not know these techniques or they do not fit into the timeline of when they think things should be happening. For example, laying on your back to give birth is absolutely the wrong way to give birth. It goes against gravity, it goes against the way the muscles function and does damage to the pelvic floor. Yet, this is the way women give birth in American hospitals...Another example: a woman's body naturally creates the hormones needed to make her body dilate but Pitocin, the synthetic version of this hormone, is free given in hospitals which speeds up the contractions and forces them to come faster and stronger. This often results in having to get an epidural because the pain is unbearable. The epidural slows down the dilation process and more of this drug is given...a vicious cycle. How about one more example: Women were not meant to lay in bed while they labor, our bodies need to move in order to make the baby turn and move into the proper birth position (it is the same with our bowels and with circulation). Laying in bed does not allow the body to do its job. Hospitals in the U.S. liberally give epidurals to laboring women which causes them to have to lay in bed. This not only prolongs the labor process and requires Pitocin to keep things going, it means that you are going to have to deliver on your back. Epidurals also cause more damage to the pelvic floor because you cannot feel when something is wrong or you are pushing too forcefully....So far my research on how to healthy and affect (not to mention time tested) methods of giving birth is making me feel justified in being concerned about having a vaginal birth in a hospital.

This led me to look into doula's and birthing centers in my area. I started to feel, and still feel, that if I could labor at a birthing center but be near a hospital then that would be ideal. However, I have come to find out that there are no birthing centers in my area...there are only hospitals...the birthing centers in the LA area are no where near my doctor or my hospital should I need them...this is not ideal!

In the end, labor and delivery did not go has I had planned at all. I was in the latent stage of labor for almost a week without the proper progression. I ended up getting very sick and having to have a C-Section. My C- Section was a beautiful experience, it went smoothly and there were no complications. I was really glad that I had read the book The Essential Guide to C-Sections (See helpful Reading for Mama's). Now that I have been through a C-Section I have no desire to go through a vaginal birth.

Movies that I Watched:

Pregnant in America

This was a very interesting watch. I did not care for this film makers tactics or his style. My personal opinion is that he is the kind of person who is not happy unless he gets exactly what he wants and is not reasonable enough to realize that he is not the center of the universe. That being said I found the information he presented compelling enough to research some of what he was saying on my own. I am still of the opinion that he is incredibly biased and only presenting one side of things...his side. He is incredibly unfair to the medical profession.

The Business of Being Born

I first read the book that was written out of this documentary. I wasn't impressed with the book but I did watch the movie. I found this movie to be a little more balanced than Pregnant in America and it has a much more professional polish to it. I did not feel like they were trying to scare me into believing their side of things or that they were trying to shock me, it seemed that they were simply presenting information and letting the viewer decide.

Natural Childbirth Techniques I Researched:

T.E.N.S Machine during Labor- there is a good chance that they will not know how to use this in the hospital and you will have to bring your own machine. You will also have to take it off for fetal monitoring because it interferes with the equipment. Many doulas know how to use them and can assist you with them should you hire one to help you during labor and delivery. Below is a link to give you more information on using a T.E.N.S unit in labor.

Prenatal Yoga

The day that my son was born I spent about 40 minutes doing yoga. Yoga was an amazing benefit to me during pregnancy and in recovering from my C-Section it helped me with breathing techniques for the painful movements right after surgery. In the childbirth books that I read that movement is the key to a successful birth. Yoga helps with breathing and with birth positions. Here are a couple websites on the benefits of Yoga during Labor and Delivery.

Medical Advance Directive

This was something the I didn't really want to think about but I am glad that I did. I did not have a Medical Advance Directive on file and in thinking about the worst possible outcome I decided to put one together so that my wishes could be known. Even though I didn't need it and my husband would automatically make decisions for me, I felt it was good to cover my bases in case my family wanted to fight with my husband regarding medical decisions. It also gave me a chance to talk about my wishes withe my husband before hand.  I got the document for free online. If you are not married to your spouse or the father of the baby it is even more important that you have an Advance Directive on file and that your family knows what it is that you wish. Be sure to make sure that your doctor and the hospital have one on file as well.

Thursday, November 3, 2011

The Father's Role in Labor & Delivery

Something that I have spent a great deal of time reflecting on is the role of my husband in the labor and delivery process. I have no doubt that he is going to be right there next to me supporting me in anyway that he can. I am also aware that my husband, as well as myself, has no experience with childbirth and that it is important to have realistic expectations for both of us.

I personally believe that understanding your expectations of someone else and being able to verbalize them and discuss them is a healthy way to approach a stressful situation and a relationship. Before my husband I got married we spent many hours discussing our expectations of each other. We also discussed parenting and child rearing in preparation of wanting children. We have continued these discussions throughout our marriage when we have been about to experience something new or we seem to be out of sync with each other. It has helped us both understand when we are expecting to much from each other and allows us to communicate when an expectation is unrealistic or may be difficult for the other person. During pregnancy we have had to make sure to take time and talk about how our expectations of each other have had to change as my body has changed. This process has brought us closer, it has taught us to effectively communicate with each other and I believe that it has kept us from feeling disappointment or resentment with each other.

Below is the original list of expectations that I put together for my husband when I started to think about what I expected him to do while I was in labor...I was shocked at everything I was expecting to need from him...

My Expectations for my Husband during Labor and Delivery- Wow I was expecting a lot!!!
  1. Play soothing music: pre-created play list done in plenty of time, play music on the piano or guitar during the process. Keep the music going during the process.
  2. Be Ready with: Ice Chips, Cold Wash Rags, Prayers and Scriptures.
  3. Meditative Prayer Leader: Keep the call and response prayer meditations going. Change them up to keep me focused on the prayer not on the pain. 
  4. Know the Yoga Poses: be familiar with the Yoga poses that will be helpful during the labor process so that he can assist me in getting into them and remind me of new positions to keep changing things up.
  5. The T.E.N.S Unit: Be familiar with the  T.E.N.S unit, how it works, when it should be used and when to turn it off. Make sure that there are plenty of batteries for the unit.
  6. Prepare the Tub: in plenty of time, make sure that the plumbing on the tub is unclogged and that the stopper will go down all the way. Check the water to heater to make sure it will refill and heat up quickly.
  7. Act as Gate Keeper: communicate with family, friends, and medical staff. Make sure that doctors and nurses are not trying to circumvent the birth plan for their own time line.    
When I read this list to my husband. He took it very well and didn't panic; for which I give him much credit. After reading the list I realized that there was a huge problem, I was expecting my husband to be everywhere and do everything all at once. I realized that he could not physically be and do all the things I was expecting. So how did I come up with realistic expectations for my husband?

A Little Research Can Go a Long Way

I started to do a little research on what the role of fathers has been in labor in other cultures and other religions. I was aware that in many cultures women largely support other women in labor. In our current society many women do not live close to their mothers or in extended family units. I learned that the role of fathers has changed with the westernization of the childbirth process and in inclusion modern medicine in the process. Modern medicine excluded fathers from the process but since the 1970's fathers have been given more rights in the labor and delivery process and are encouraged to be a part an active part of the process. I personally like that fathers are encouraged and expected to be a part of the L & D process. It sets the tone for the relationship between husband and wife and father and child. It says "I am going to be there no matter how rough it gets and I am not going to miss a minute of your life if I can help it."

At the library I came across a great book: Rediscovering Birth by Sheila Kitzinger. This book is a cross cultural look at birth practices over time and the affects of Western medicine on the Labor and Delivery process. It is an amazing book that is very well written. It does not only discuss labor and delivery by culture but also how they have changed over time and even the phychology of the modern hospital room. I found some great info on the role of the father in L & D by cultures.

What Do Other Father's Do?
  • In many cultures the father's role is to build a birthing hut, place stakes in the ground for the mother to grip while suffering a contraction  as in the island of Sarawark or the Great Planes Native Americans (Kitzinger, pg 128). 
  • He may be called to confess to adultery, if the labor is a particularly difficult one as in peasant Greece. It is believed that this confession is needed to remove a "blockage to the birth" (Kitzinger, pg 128).
  • The father may be asked to help the mother physically by holding her up or allowing her to lean on him for support (Kitzinger, pg 128).
  • My personal favorite "Huichol tribe of Mexico" (Kitzinger, pg 128). In this tribe the father of the baby is called on during labor so that a string can be tied around his testicles. The laboring mother can pull on the string during the worst of her contractions... 
  • The father in many religions is considered the spiritual leader of the family. This role does not change in both the Muslim and Jewish faiths. Fathers have the role of praying for the birth to progress and to talk directly to God during the L & D process. 
  • The Sephardic Jewish men gather to pray and recite the following scriptures:
"I lift up my eyes to the hills— from where will my help come?   My help comes from the Lord, who made heaven and earth. He will not let your foot be moved; he who keeps you will not slumber. He who keeps Israel will neither slumber nor sleep. The Lord is your keeper; the Lord is your shade at your right hand. The sun shall not strike you by day, nor the moon by night. The Lord will keep you from all evil; he will keep your life. The Lord will keep your going out and your coming in from this time on and forevermore." (Psalm 121, NKJV

All of Samuel 1: "...She was deeply distressed and prayed to the Lord, and wept bitterly. She made this vow: "O Lord of hosts, if only you will look on the misery of your servant, and remember me, and not forget your servant, but will give to your servant a male child, then I will set him before you as a nazirite until the day of his death. He shall drink neither wine nor intoxicants, and no razor shall touch his head...But Hannah answered, "No, my lord, I am a woman deeply troubled; I have drunk neither wine nor strong drink, but I have been pouring out my soul before the Lord. Do not regard your servant as a worthless woman, for I have been speaking out of my great anxiety and vexation all this time." Eli answered, "Go in peace; the God of Israel grant the petition you have made to him." And she said, "Let your servant find favor in your sight." Then the woman went to her quarters, ate and drank with her husband, and her countenance was sad no longer...And she said, "Oh, my lord! As you live, my lord, I am the woman who was standing here in your presence, praying to the Lord. For this child I prayed; and the Lord has granted me the petition that I made to him. Therefore I have lent him to the Lord; as long as he lives, he is given to the Lord." She left him there for the Lord. 

"The Lord dealt with Sarah as he had said, and the Lord did for Sarah as he had promised. Sarah conceived and bore Abraham a son in his old age, at the time of which God had spoken to him. Abraham gave the name Isaac to his son whom Sarah bore him. And Abraham circumcised his son Isaac when he was eight days old, as God had commanded him. Abraham was a hundred years old when his son Isaac was born to him. Now Sarah said, "God has brought laughter for me; everyone who hears will laugh with me." And she said, "Who would ever have said to Abraham that Sarah would nurse children? Yet I have borne him a son in his old age." The child grew, and was weaned; and Abraham made a great feast on the day that Isaac was weaned." (Genesis 21:1-8)

  • In Germany during the 18th century men would walk back and forth in front of the door reciting the following 3 times: "Sing, O barren one who did not bear; burst into song and shout, you who have not been in labor! For the children of the desolate woman will be more than the children of her that is married, says the Lord. Enlarge the site of your tent, and let the curtains of your habitations be stretched out; do not hold back; lengthen your cords and strengthen your stakes. For you will spread out to the right and to the left, and your descendants will possess the nations and will settle the desolate towns. Do not fear, for you will not be ashamed; do not be discouraged, for you will not suffer disgrace; for you will forget the shame of your youth, and the disgrace of your widowhood you will remember no more. For your Maker is your husband, the Lord of hosts is his name; the Holy One of Israel is your Redeemer, the God of the whole earth he is called. For the Lord has called you like a wife forsaken and grieved in spirit, like the wife of a man's youth when she is cast off, says your God. For a brief moment I abandoned you, but with great compassion I will gather you. In overflowing wrath for a moment I hid my face from you, but with everlasting love I will have compassion on you, says the Lord, your Redeemer. This is like the days of Noah to me: Just as I swore that the waters of Noah would never again go over the earth, so I have sworn that I will not be angry with you and will not rebuke you. For the mountains may depart and the hills be removed, but my steadfast love shall not depart from you, and my covenant of peace shall not be removed, says the Lord, who has compassion on you. O afflicted one, storm-tossed, and not comforted, I am about to set your stones in antimony, and lay your foundations with sapphires. I will make your pinnacles of rubies, your gates of jewels, and all your wall of precious stones. All your children shall be taught by the Lord, and great shall be the prosperity of your children. In righteousness you shall be established; you shall be far from oppression, for you shall not fear; and from terror, for it shall not come near you. If anyone stirs up strife, it is not from me; whoever stirs up strife with you shall fall because of you. See it is I who have created the smith who blows the fire of coals, and produces a weapon fit for its purpose; I have also created the ravager to destroy. No weapon that is fashioned against you shall prosper, and you shall confute every tongue that rises against you in judgment. This is the heritage of the servants of the Lord and their vindication from me, says the Lord." (Isaiah 54, NKJV)  
  • The responsibility of the Orthodox Jewish father is to sit in a room near the laboring mother and read the Psalms out loud.
What Did This Mean For My Expectations?

After much reflection, talking with my husband and with other women who have gone through L & D I was able to hone my expectations for my husband better. I wanted him to be able to support me during the process but I don't want him to be overwhelmed either. This was going to be emotional and stressful for both of us. I realized that if we did a little work ahead of time and we asked a few of our close friends to help support us that we could possibly reduce some of the stress in the situation. I decided to compile a notebook that my husband and I could both add helpful information to and that would aid us during L & D. This was also helpful to the friends that we asked to help us since they were the ones giving my husband breaks. I identified three areas of labor and delivery that were important to me: 

Yoga: Since I planned on using yoga to help me through the laboring process I decided to put together a few pages of yoga stretches with instructions. My husband and I spent some time on yoga together each week so that he could be familiar with the poses and how he could best aid me in them.

Play List: This we decided that we could put together ahead of time so that we simply had to play the music when we arrived. The play list was a huge help and comfort while in the hospital and was a relaxing even after the baby arrived. Don't forget to pack speakers to go with the playing device you are going to use.

Prayers & Scriptures: I planned to use scripture meditatively during labor. We compiled these before hand and put them in the notebook. My husband also had an application on his phone where he could keep these handy. Since we worked on these things ahead of time we were able to memorize a few of these before hand. Since they were in the notebook our support people were able to help with these as well.

One of the biggest changes that we made to the overall birth plan was that we decided not to hire a Monitrice so that we could labor at home for as long as possible. We decided that it would be best for us to rely on the medical professionals at the hospital to help us through the L & D process and that really was the place that we would both feel comfortable. This also eliminated some of the pressure on my husband during the process.

Since we took the time to really talk about the L & D process and what we were expecting from each other we went into our son's birthday calmer and more collected. While I was going through the labor process I felt confident that my husband was on the same page that I was and that he understood what my hopes and fears for the day were. This does not mean that the process was not stressful or even a little scary. It was filled with uncertainty and did not go as planned at all but we didn't have to worry about the basics, we had already worked those out. My husband did an awesome job supporting me the day that our son was born!