April 29, 2015

Having the Birth You Want: Are You Setting Yourself Up For Success?

I recently attended a moving and incredibly supportive workshop for expectant parents and birth workers about VBAC (vaginal birth after cesarean) and cesarean births. Choices in Childbirth, a well respected childbirth advocacy group, gathered a versatile group of speakers including VBAC moms, Sarah Pancake- a veteran doula, Joan Bryson- a home birth midwife and Dr. Jaqueline Worth – a NYC OB/GYN. One by one, the moms told their emotional story of the cesarean births they underwent for their first child, the disappointment for their unplanned cesareans, the healing process and ultimately their decision and preparation to attempt a VBAC. Even though most of the evening’s discussion was based on the VABCs, all the speakers had such valuable insights and advice about preparing for birth.

Most women do not put too much stock into what they may encounter during their birth before they get pregnant. Frequently, the research and decisions about carrying out the mom’s vision for her birth are not done until later in pregnancy. This can leave the mama-to-be in a sticky situation if she later finds out she has chosen a care provider and hospital who firmly hold a different birth philosophy. Joan Bryson candidly said, “The people you choose to be with you during your birth is the one of the most important decisions you will make.” Dr Worth echoed that sentiment by saying, “Find a provider you trust and who believes in you.” Taking the time to find a care provider who supports your birth philosophy can make a huge difference in your experience.

From my own personal experience, I interviewed three different midwives before deciding who best aligned with my needs. I came prepared with some questions as well as the answers I know I needed to hear. One of my biggest concerns was postpartum hemorrhaging. I knew what protocols I wanted the midwife to perform in this event. During the first interview my husband and I attended, I asked the question, “In the event of postpartum hemorrhaging, what do you do?” She started with, “I have some herbs I use…” In my head I heard a loud buzzer, “WRONG ANSWER”. Well, let me clarify- that was the wrong answer for my comfort level. Others may really resonate with this option. I wanted to hear a more medical approach to stopping postpartum hemorrhaging. So even though this particular care provider was really nice, warm and kind, she was not the person I wanted in my birthing posse.

Start to think about what interventions you may be comfortable receiving. I have created a blog, “5 Questions to Ask BEFORE Your Birth“, that may be a good jumping off point. Remember, by becoming a care provider’s patient and working with that practice, you are putting yourself in their care. The care provider has every right to practice how he/she sees safe and appropriate. Make sure you are in agreement with how your doctor practices medicine to help avoid conflict and disappointment.

Another point Dr Worth mentioned was, be aware of your hospital’s protocols. She explained that the hospital she works at has very clear guidelines and protocols and she has to work within them. She likens it to a strict parent, when the boundaries are well defined it is easy to work within the limitations that have been set. Dr Worth made a very good point, if you are looking for a more liberal hospital, do not choose a care provider who works for a very conservative hospital. There is only so much leeway the care provider has to stretch the rules. If you do not want certain routine interventions you know you will encounter at a hospital, like full time External Fetal Monitoring, an IV or hep lock, or certain time constraints, you should consider not using that hospital. She was really blunt and honest in saying, “If you want the freedoms of a home birth, do not come to a hospital. You are setting yourself up for controversy.” Some hospitals are less restrictive than others, and it is a good idea to learn about their policies.

Lastly, do your homework!
1. Educate yourself and take a childbirth education class. You cannot make educated, informed decisions if you do not know the information

2. Get good exercise and nutrition daily. Aim for 30 minutes of exercise and get 50-80 grams of protein and 175 healthy carbs daily. Find some exercise that can build your endurance. Labor is work!

3. Understand everyone’s role. Consider a doula. But realize the doula is your physical, emotional and informational support. She should not be adversarial with your care provider and hospital.

4. Explore all the possibilities that may arise in labor. Not just the one you have pictured in your mind. Discuss these variations and then put it in a box and tuck it away.



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