Birth plans/interventions?

mdwiny · October 2017

Hi, everyone. FTM here. I'm starting to think about my "birth plan" (I know it's likely to change in the moment, but I want to have an "ideal.") I'd really like to hear other moms' thoughts on various interventions, like the epidural and pitocin. I always assumed I'd take whatever pain meds were thrown my way, and follow whatever recommendations my doctor gave me, but a friend recently did an au natural birth and I think Emily Oster makes some good points about the benefits of avoiding intervention. What have you all done in the past, and what are you planning this time?

Image: https://media.giphy.com/media/jRLgmcWVjx99C/giphy.gif

kmalls · October 2017

I think it's a good idea to have a plan in your head, as in: what would your best-case scenario look like? For me, it was to go as long as possible without an epidural, and when/if I felt I needed one, to go for it. If your ideal birth is no interventions at all, great!

That being said, I think the most important part is to understand that circumstances can change VERY quickly when labor hits, and not being able to let go of your birth plan can set you up for a really disappointing experience. For me, I ended up having two unplanned c-sections. It wasn't ideal, but I also knew that getting the baby out safety was paramount. Fortunately I don't carry any guilt or disappointment at all surrounding that, and I chalk that up to going into things being totally ok with change.

lindsye · October 2017

@mdwiny I bumped a past thread that discussed this issue in case it helps you; if not, I'd be happy to discuss mine again.

scuba_chic · October 2017

FTM here too and this subject overwhelms me. I don't want to stress about it, but I also want to be informed and have a reasonable birth plan myself. A friend of mine on Facebook asked this same question and this is a copy of one of the responses...things to consider.
"intermittent fetal monitoring, able to walk, shower, use birthing ball, etc, no artificial rupture of membranes, no excessive vaginal exams, hep lock instead of iv fluids, no pitocin before or after delivery, immediate skin to skin and breastfeeding, delayed cord clamping, no bath. I could probably think of 100 more, those are just off the top of my head"

Then someone else made the comment to have DH watch everything they do to make sure they don't try to sneak in anything you requested against.

Like WTF??? I think I put a lot of faith in doctors/nurses to do what is best for babies, but these comments have me really concerned and feeling like I have a lot of research to do. UGH!!!

mdwiny · October 2017

@lindsye Oh, thank you! Jesus, how did I not see that? I tried various search terms and somehow totally failed. I'll read that and come back here if I'm still asking questions. SORRY FOR DOUBLE-THREADING EVERYONE.

Dumbgurl04 · October 2017

The thread @lindsye bumped is a good one.

A Plan is great to have but also very important to be opened minded. Make sure to set a limit in the process that once you cross that line you move on from your plan and make it more about the safety of you and your child. If you plan to not have any interventions let others know (SO, nurses, DR) so you won't be pressured to early in the process.

Also it is still early so I wouldn't make anything set in stone yet, because you never know about what will happen later in your pregnancy like gestational diabetes, preeclampsia, breech baby. All those could have some kind of affect on laboring. Best example my best friend was all about having a drug free natural birth for most of her pregnancy. Last month of her pregnancy she had preeclampsia and the baby was breech, She ended up having a c-section. She was pretty devastated and she had a hard recovery because she didn't prepare herself for anything but the natural birth.

irenejean · October 2017

I think it’s good to think through a few scenarios. I thought about doing an unmedicated birth, but was open to receiving an epidural. I ended up getting a little pitocin because my water broke, and I also got an epidural. I had a great experience with the epidural and plan to get one again, if I can. I think it’s good to have a plan, but also good to be flexible. The most important thing is to deliver a healthy baby, and there are a lot of things you can’t control for when you’re delivering.

whatabout2ndbreakfast · October 2017

scuba_chic said:

Then someone else made the comment to have DH watch everything they do to make sure they don't try to sneak in anything you requested against.

Like WTF??? I think I put a lot of faith in doctors/nurses to do what is best for babies, but these comments have me really concerned and feeling like I have a lot of research to do. UGH!!!

Sneak in?? What would they be sneaking in? I didn't really have any strong opinions against anything but this time I don't want to be stuck in the monitors so long. I was talking to the midwife about it and she said that's a part of why laboring at home for a little bit is nice. But I'm terrified of having the baby in the car so we'll see how far I actually take that.

klburke88 · October 2017

With my first, I labored at home for over 15 hours before finally heading into the hospital. Being a single, teen mom, I was scared out of my mind and basically let the nurses make all of the decisions for me. This time around, I feel so much more knowledgeable and confident in being able to make decisions for myself. I'm all about getting an epidural as I had a wonderful experience with it the first go around. Took the edge off my pain, but I could still feel all of the pressure and was able to push very easily. However, I would like to avoid pitocin and stripping membranes if at all possible and let my body progress through labor at it's own pace, assuming baby is healthy throughout.

kmalls · October 2017

scuba_chic said:

FTM here too and this subject overwhelms me. I don't want to stress about it, but I also want to be informed and have a reasonable birth plan myself. A friend of mine on Facebook asked this same question and this is a copy of one of the responses...things to consider.
"intermittent fetal monitoring, able to walk, shower, use birthing ball, etc, no artificial rupture of membranes, no excessive vaginal exams, hep lock instead of iv fluids, no pitocin before or after delivery, immediate skin to skin and breastfeeding, delayed cord clamping, no bath. I could probably think of 100 more, those are just off the top of my head"

Then someone else made the comment to have DH watch everything they do to make sure they don't try to sneak in anything you requested against.

Like WTF??? I think I put a lot of faith in doctors/nurses to do what is best for babies, but these comments have me really concerned and feeling like I have a lot of research to do. UGH!!!

So a lot of what that person commented about is pretty standard, like being able to walk around during labor, no stripping of membranes unless you ask for it or consent to it, immediate skin to skin, breastfeeding, etc. The really specific stuff about no pitocin is relative to each birth -- like, there no need for it if you're progressing on your own so it more than likely wouldn't even come up. The fact that she could "think of 100 more" if given time seems WAY overboard to me.

My OB gives us a birth plan that they use for everyone around 34 weeks that outlines all of this and more, and we're able to make additional requests from there if necessary.

To the bolded: if you're afraid your OB will "sneak in" something against your wishes, you need to switch OBs. There are always horror stories, but I can't imagine an OB ever intentionally doing anything against your will as long as your requests are reasonable (i.e.: wont put you or your baby's lives in danger).

Edited because I bolded the wrong paragraph

rmmorris · October 2017

With my first I wanted to follow all the “rules”—no pitocin, wait for an epidural, etc. I ended up being induced a week after my due date and literally all of my plans were for not. And it was perfectly fine. Cervadil overnight, pitocin in the morning, and I got an epidural literally as soon as my ob broke my water. Everything ended up working out, I labored for ~6 hours and pushed for 45 minutes. In general I just tried to trust the nurses and my doctor. So if they recommended something, I went with it. I think it’s a good idea to learn about all the interventions and have a best case scenario plan, but so much is ultimately out of our control. I really like this TV show, one born every minute. It was a reality show following l&d nurses at a busy hospital. It really helped give me more realistic expectations.

danjoly · October 2017

These posts make me have a little corner smile. I think if I learned one thing from my DS's labor is that you pretty much have no control over how your body/baby will react. I would say get yourself informed is the key. It's ok to have preferences but don't overlook informations about csection for example. I ended up with an emergency csection and I was really happy we had a full hour on the subject during our prenatal classes. It wasn't as scary as it could have been because I had read on the subject + DH got the info in the class.
Also, I think unmedicated birth are possible but if it's your wish, I'd say it takes serious preparation like hypnobirth for example and good support from a doula or your partner who really knows what to expect. I've seen so many girls saying "oh I have high pain tolerance, I'll ride the wave..." mmmm I think no life experience or "high tolerance for pain" can really prepare you for the intensity of labor pain (I talk from experience of 15 years of chronic severe pain and surgeries that were extremely painful).
In my previous bmb 2 girls had unmedicated labor and they both had done some serious preparation.
I also second what a bunch of posters said before, not having too many expectations can prevent disappointment. I have absolutely no bad feelings or regrets toward my csection compared to my failed Breastfeeding experience because I really had my heart set on a long BF journey.

klburke88 · October 2017

rmmorris said:

I really like this TV show, one born every minute. It was a reality show following l&d nurses at a busy hospital. It really helped give me more realistic expectations.

GREAT show, and it's available to watch for free on the Lifetime app!

laceymarie3 · October 2017

With my son the only thing on our birth plan was that my husband would announce if we had a girl or boy. Besides that we were open to what could happen. I am really glad we weren't stuck on with one idea of how labor would go, because even the doctors hadn't seen the complication I ended up with. I also had the benefit of being comfortable with the hospital setting, I worked for years in a hospital before having our son. Definitely talk with your ob to find out what is realistic for the place you are delivering and what they are comfortable with. I had no choice to be induced and have pitocin because I had low amniotic level.

scuba_chic · October 2017

@peppersmith22 I guess certain shots that you requested against? Not sure, was just saying the whole comment kind of threw me for a loop.

sweetpeammm13 · October 2017

@mdwiny read Ina Mae Gaskin Guide to Natural Childbirth!! It has a breakdown of the whole birth process and goes through options to consider! Just a good read if you want to go that way!

My hospital already has in practice all of what I wanted so I never wrote one out but I definitely had an idea of what I wanted and I had tools at my disposal to help it happen!!

No induction up to 42 weeks,
no pitocin,
no dilation creams as some are not approved for such use by the FDA,
minimal monitoring and checks,
keep moving the whole time, not be strapped to bed,
not labor on my back at all,
and skin to skin immediately,
BF within hour,
room in with baby!

Everything went to plan except at 24 hours my labor stalled and they gave me a wiff of pitocin, and they had me monitored more than I liked which slowed my labor from not being able to move around!

With what I know now I would avoid the pitocin and use more natural techniques to progress labor! Pitocin is so much more violent painful contractions than regular natural contractions!

sdavis2189 · October 2017

I didn’t have any sort of birth plan with my first and I was glad I didn’t. I didn’t have any expectations and it was all new to me. I also didn’t take any birth classes or anything. This time, I won’t have a specific plan either, though I know I don’t want an epidural. Other than that, whatever happens happens!

ladythrice · October 2017

"able to walk, shower, use birthing ball, etc, no artificial rupture of membranes, no excessive vaginal exams, hep lock instead of iv fluids, no pitocin before or after delivery, immediate skin to skin and breastfeeding."

This is roughly what I hoped for each of my births with the caveat that I didn't mind pitocin but that I wanted to be IN LABOR before it was administered. Once that train gets going, your body's natural processes are in place and kicking and pitocin is a labor augmenter rather than labor inducer. Pitocin failed to sufficiently induce labor with my first so it alone as an a solution for inducing is not something I want for my deliveries. I'd also love to avoid IV fluids but since I will likely get an epi, having my system flush with fluids will expedite the time to getting my epi from when I request to when its working. I hate the puffiness/sweats that come with all the fluids but I do love me some epidural...

ngolimento · October 2017

I think birth plans are more useful as a tool to force you to do your research than it is a "plan". It is good to have things writen down for the nurses to see as well, but don't think of it as a checklist of "must haves". Nature doesn't give the singlest crap what you think you must have when it comes to birth. Think of it as a wishlist instead.

I had the full "natural" caboodle for my daughter's birth. I was horrified by the idea of pitocin, dead set against an epidural, didn't want cervical checks, didn't want induction, was repulsed by the idea of laboring on my back, etc.

Then it was go-time after 42 weeks and my labor stalled for literal days. They had to induce me with meds to open my cervix, and then administer pitocin to make my wildly unorganized contractions turn into a productive rythm. My pain thresh hold was curb-stomped by being in labor and without sleep for so long, and eventually I was just a puke-covered ball on the hospital floor. I had an epiphany then that I was being a frigging moron by being inflexible, and asked for an epi.

Apparently my body was in a traumatized emergency mode at that point and that was the main cause for the labor stalling (maybe my ute thought I was standing next to a lion with how stressed I was?). Once I got the epi, my 70ish hour labor ended within 4 hours.

Letting go of my obsession with a natural birth shockingly turned my birth plan being tossed out of the window into a very positive experience for me. Don't be stubborn or obsessed with how things "should go". There are no ribbons, there are no trophies, and your baby is about to take most of the control you have in your life away from you anyway. So research your tail off, call the delivery center in advance and annoy the staff there with as many questions about how they approach things. Get an OB that makes you feel good, and has a good record (yes, more research). Prepatory research is worth 52 well-craftes birth plans.

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