On Writing a Birth Plan

When I was pregnant with my first, I had an idea of what I wanted and though I had heard of writing a birth plan, I didn't think it was necessary because I knew what I wanted. It turns out I didn't get what I wanted. I'm not sure if that was actually related to not having a written birth plan, but I figured writing it down the second time around was something I wanted to do. After the birth of my first son, I felt I had a pretty good experience, however, I still wanted things a bit different. First, I didn't want medical augmentation of the labor. I really felt I fell victim to a snowball effect and that one intervention lead to another. I wanted the second time around to be different.

I did more research and reading on natural childbirth, focusing most of my time reading "HypnoBirthing" and learning relaxation techniques. The book also covers a decent amount about writing up your "birth preferences," known colloquially as a birth plan. The book offered several suggestions that I found useful and I incorporated some things into my birth plan that I had not even known about prior to reading the book.

I did run into a snag though. When I actually went to put on paper what I wanted, I was a bit unsure of what to add. Sure, there were a few things I knew I wanted, no drugs, rooming in with the baby, etc. There were a few things that I learned about in the book like the benefits of letting the umbilical cord finish pulsing prior to clamping and cutting it. But what I was still confused about was how to write it all up and how to phrase my birth plan. I turned to the internet as we do for many things and tried to look for some templates and while I found some things here and there or forms specific to breastfeeding after the birth, I didn't really find what I was looking for and I couldn't even find much in the way of other birth plans that people had written up (I think I found one). I felt a bit on my own, but taking from the form I found, the book, and the one birth plan I had found online and a few other things here and there, I came up with what I wanted. In discussing with an expectant mom today about labor plans and expectations we came across a few things that she hadn't thought of that she may have wanted to include in her birth plan. I am adding mine below so that perhaps another expectant mom can find some use for it and maybe having one more available online will help other moms to put together their own and possibly identify some things that she may have not thought about previously.

One thing I found disappointing, sort of after the fact, was that one of the nursery nurses mentioned that when they see that a mom has a birth plan, they worry. She said that a birth plan usually means a c-section. I'm not sure why this phenomenon is the case, but in my situation, I got what I wanted. I firmly believe that most moms can get what they want, but having a supportive nurse and staff when in labor is a good way to go about getting what you want. I added that to my birth plan too.

In any case, here is the list of my "birth preferences" for my second son:

Birth Preferences for B. E. (April/May 2011)

Howdy! Thank you for being a part of my birthing experience to welcome my newest little one into the world. I am looking forward to a natural birth with limited to no medical intervention, therefore, if there is a nurse who is partial to natural birth, I would enjoy working with him or her. I have listed several items which are important to me for my baby's birth and I greatly appreciate your cooperation in these matters.

Fluids – I prefer only a heparin block.

I am well aware of the importance of hydration during labor as well as the advantages of having a vein readily accessible should medication need to be administered. I am not anticipating needing medication and I would like the freedom to move around while I labor, therefore, I appreciate being free of a fluid pump and line.

Monitoring – I prefer intermittent monitoring if at all possible.

As mentioned above, because I would like freedom of movement during my labor, I prefer intermittent fetal monitoring if it is available. I am happy to comply with hospital regulations for minimum monitoring times and appreciate the opportunity to have the freedom to move around and change positions at will.

Environment – I would like a calm, quiet, dim environment to labor and birth in.

I understand that nurses and doctors are an integral part in ensuring the safety and health of me and my baby. I believe that a calm, quiet, minimally interrupted environment is also an integral part in ensuring the healthy natural progression of my labor. Therefore, please limit monitoring, checks, and traffic to the minimum. Should visitors arrive, please consult me or my husband before directing them to our room. Please limit lighting if at all possible during the birth as well, so my baby can be born into a welcoming environment.

Pain medication – I would like to avoid medications which can lessen the experience for me and my baby.

I am well aware of the systemic and anesthetic medications that are available to me for labor. I do not wish to be offered any medications. Please do not ask me to rate my pain level as I will respectfully decline to answer. If I feel medication is necessary, I or my husband will request it.

Assistance with labor progression – I do not wish to receive artificial forms of labor assistance.

If for some reason my labor stalls or slows for an unreasonable amount of time, as some pauses are the body's natural way of resting, I would like to try natural ways of helping the labor to progress. I would like to discuss any artificial interventions with my doctor and be allowed adequate time to discuss and decide on a course of action prior to proceeding.

Episiotomy – I do not wish to receive an episiotomy.

My doctor has let me know that this procedure is not typically performed in most cases, however, I want to express my preference again. I prefer a tear to an episiotomy.

After the birth

– I would like to have my baby placed on my stomach or chest immediately following the birth.

• Please allow the cord to stop pulsing before cutting it.
• Please perform initial evaluations, suctioning, only necessary cleaning, etc. with the baby on my chest. Please check weight and other measurements as quickly as possible and return the baby to me.
• I would like to initiate breastfeeding as soon as the baby is ready after birth and holding him skin-to-skin is the best way for me to know when he is ready.

Placenta – I would like to deliver the placenta naturally if possible.

I plan to donate my placenta and have discussed it with my doctor. Because of this, I would like the placenta to be free from damage of artificial delivery if avoidable. All portions of the umbilical cord that are separated from the baby will also be donated with the placenta. Please wrap the placenta and all portions of the detached umbilical cord in a biohazard bag and place it in the freezer bag and cooler I will provide.

Recovery

• I wish the baby to room in with me and only be removed or taken to the nursery for procedures that absolutely can not be performed in my room.
• For the short time(s) that my baby must be separated from me, do not offer him any pacifiers, bottles, or formula as he will be learning to breastfeed.
• I am expecting a boy and will have him circumcised. Again, I do not wish for him to be given a pacifier. Please use a finger or other way to administer the glucose water during the procedure.
• Please allow the room lights to remain dim for any procedures or checks of me or the baby as I would like him to be comfortable.

On Breastfeeding Awareness - The Big Latch On

So today was no ordinary Saturday. Ok, it was a little. Rather than head to our favorite mommy/baby consignment shop for our normal Saturday meeting, we headed there for this year's Big Latch On. The Big Latch On is an event sponsored by Le Leche League to organize record numbers of moms all around the country to breastfeed simultaneously to raise awareness of , well, breastfeeding. While not reaching out for the Guinness record, the aim is to collect as many moms as possible to participate. It just turned out convenient for me since I was going there anyway, but I probably would have attended at another time and place if that's where it was being organized since I tend toward  "lactivist" habits and beliefs.

Our little gathering wasn't impressive by any means, but that's ok. We had 15 moms in attendance. The oldest nursling there was about 20 months. I'm not sure how young the youngest was. It still turned out to be a nice little gathering. We even had a reporter from a local newspaper to come and take a pictures of all the participants (while not necessarily in the act, but that's ok).

This event was a great little one for me to participate in. I'm not they type to crave the attention of other "lactivist" activities that may be louder or draw more attention from on-lookers (ok, maybe, but it really does depend on the situation).

On Co-sleeping, Bed-sharing, and Infant Death

We need some education. That's right, education. It hits the news all the time when a baby passes away in the night. SIDS is mentioned, sleeping in an adult bed is mentioned, etc. It all gets garbled and confused and we are hit with absolutes about sleeping babies. Don't sleep with the baby, never put the baby in an adult bed, etc, etc, etc.

Ok, well, here's the thing, these news reports or stories do a little bit of reporting on the incident and then jumble up all kinds of facts and if you aren't clear on the details, they'd have you believe that SIDS is caused by a family bed. All these things are mentioned in these reports but typically, they forget to differentiate. I want to lay the record straight. No matter how you choose to arrange bed time for you and the baby is your decision, but understand the differences in what they are talking about.

Let's talk SIDS. SIDS stands for Sudden Infant Death Syndrome. What makes it scary is that no one knows the cause. Babies simply pass away in their sleep. Many news reports that talk about babies dying in their sleep mention SIDS, but then go on to talk about how the baby suffocated while sleeping with his or her mother. Well, that cause of death was not SIDS, it was suffocation. Why was SIDS even brought up? Who knows, but they bring it up anyway. If a child truly died of SIDS, it almost assuredly was not sleeping with it's parent(s) - that's not a guarantee, it's just not likely. There are many things that can be done that are suggested to decrease the risk of SIDS such as having a fan on, giving the baby a pacifier when going to sleep, having the baby sleep in the same room with the parents, breastfeeding, lay the baby on his or her back to sleep, etc. Other safe sleeping practices have nothing to do with SIDS and more to do with preventing suffocation such as making sure the crib sheet is tightly fitted to the mattress, keep blankets and stuffed animals out of the crib, etc.

And speaking of suffocation, that is most commonly the cause of death when a death is reported when the baby was sleeping with the parent. You hear many things like the baby rolled into the soft mattress or that the baby suffocated in the pillows. Alternately, you hear the tale of the baby being suffocated while the parent and baby were napping on the couch. Well, yeah, of course that is what you hear - those are all considered unsafe sleeping practices even among the people that encourage sleeping with the baby. Now, I'm not trying to make light of the situation, obviously it's a tragedy and no one wishes that upon any parent. The problem is that most of the news reports make too many generalizations and tend to confuse people and then just make people believe that if your baby sleeps with you, you will suffocate it. Co-sleeping becomes a dirty word. Which is odd considering it's actually encouraged by the AAP.

What? It's encouraged? I must be crazy to say that. Nope, I'm not. The reason it doesn't sound right is because there is a distinction between co-sleeping and bed-sharing that people don't always recognize. Co-sleeping means parents sleeping with the baby in the same room - not necessarily in the same bed. The AAP recommends that babies sleep in the parent's room on a separate surface. The "in the same room" part helps reduce the risk of SIDS since it is believed that the parents breathing patterns help to regulate the breathing of a sleeping baby. The "on a separate surface" part is to reduce the risk of suffocation. Most people that are afraid to sleep in the same bed with a baby are afraid to do so because of suffocation. Many people that do sleep with the baby in the same bed (or unfortunately couch) do not understand the safety measures that need to be taken before setting up this sort of arrangement. So, despite what the news says, co-sleeping is good and encouraged.

Bed-sharing however, is typically looked down upon or at the very least, discouraged. Bed-sharing is a type of co-sleeping, but co-sleeping does not necessarily mean bed-sharing. Bed-sharing has a long history, most notably in tribal communities where mother and baby sleep side by side - not necessarily on a bed though, typically on the ground. Studies have actually been done with mothers and babies sleeping side by side where if there is a change in the baby's breathing, the mother will, in her sleep, nestle the baby closer to her. It is believed that is action will kick-start the baby's regular breathing pattern because they are once again closer to their mother who has a regular breathing pattern. It's just my two cents, but physiologically speaking, presence of carbon dioxide in the lungs is what makes us breathe, not lack of oxygen, so it would make sense that the mother exhaling carbon dioxide near the baby's face would cause inhalation - that's just my personal conclusion - that this has something to do with reduction of SIDS risk along with close proximity of the mom helping to regulate heart rate and breathing. In any case, bed-sharing isn't inherently dangerous, but the blanket discouragement of it is due to lack of appropriate safety measures in place. Safe bed-sharing means that the baby is not near pillows or blankets, the bed is a firm surface (sorry to those of you who like your pillow-top mattresses), the baby sleeps next to the mother only - not another adult (or especially another child) because only the mother is biologically "programmed" to have an altered sleep pattern/habit because of a present baby, neither parent should be under the influence of drugs or alcohol, the parents should not be over-tired, etc. Another point that is not often discussed: breastfeeding is a pre-requisite. Yes, that's right, if you don't breastfeed, the baby shouldn't be sleeping in the bed with you. One reason that was suggested by one expert was because positionally, a breastfeeding baby is safer since they typically sleep lower next to the mother where her arm will typically block upward movement of the baby towards the pillow.

Either way, no matter what you choose for your family, make sure you are educated. SIDS is not suffocation. SIDS is deemed the cause of death when they have eliminated all other causes. Co-sleeping does not always mean bed-sharing - though the news reports would have you believe so. The media jumbles it all up and confuses and scares us (unless you pay close attention to the subtleties of their reporting). This is why we need to be educated.