February 16, 2016

Planning Your Birth BEFORE You Are Pregnant

I am going to throw out an idea that may sound completely crazy to many people;  Start to think about your birth BEFORE you are even pregnant!  I know for many people there is enough anxiety and anticipation around getting pregnant and then the trials and tribulations of the first 12 weeks- nausea, fatigue, fear of miscarriage.  Yes, all this is true, and still I am asking you to think 40 plus weeks ahead as to how you may want to birth.  Just to get the ball rolling here are some ideas to ponder:

  • Are you high or low risk?
  • What kind of setting do you want, hospital, birth center, home?
  • What kind of care provider do you want, Midwife or Obstetrician?
  • Are you interested in minimal interventions or does that not really matter to you?
  • How aggressively do you want your care managed?
  • Do you want to be with a large practice of care providers, a solo practice or a practice with just 2 or 3 care providers?
  • How much personal attention do you expect in your care?
  • How long do you envision your appointments being?

Unless you have an unexpected pregnancy, there can be a bit of a planning process to becoming pregnant.  A lot women start to track their cycles to see when they are ovulating and start to prepare their body for pregnancy.  Personally, I started with some acupuncture treatments, started on prenatal vitamins and modified my diet a bit- did you know caffeine can change the pH balance of vaginal fluids?!

So here you are, already putting effort into charting your cycle, skipping the extra latte and now I am asking you to start to educate yourself about the childbirth process.  Here is why I am doing this.  Who you decide to have as your care provider will have a serious impact on your pregnancy and birth.  If you take the time before you are pregnant to make some big decisions, you will not feel pressed for time to find the right care provider once you become pregnant.  Imagine the time and effort researching the right care provider will take during your first trimester when all you want to do at that time is take a nap and hope the nausea will pass.

The typical unraveling of events goes something like this, woman gets pregnant (YAY!)- waits until 12 weeks to reveal new pregnancy, becomes happy 1st trimester miseries have passed, cruises through 2nd trimester, enrolls in childbirth education class, takes childbirth education class somewhere around week 32-35, then starts to inquire about hospital and care provider protocols, may realize she has some different ideas than care provider and hospital, panics and rushes to find doula for extra support.  I have even had some students explain, that when they try to have a conversation with their care provider earlier in their pregnancy, their request gets dismissed.  This is not surprising since the national average for face to face time with an OB for a prenatal appointment run between 5-7 minutes.  Given this very small window of time, I recommend to the students, set up a separate office visit for such conversation.

I still think a full childbirth education class in the third trimester is vital to a woman’s sense of satisfaction with her birth, but not having a foundation of education prior to this time can be detrimental.  Most care providers will not take new clients after 23 weeks pregnant.   A few may, but for the most, the amount insurance pays out to the OB after 23 weeks does not financially incentivize them to take new clients mid-second trimester.  Some women even find themselves shut out of options by only 10 weeks.  Because of the shortage of home birth midwives, some women start calling around and realize that their due month is already all booked up.  (This just speaks to the fact we do not have enough home birth midwives here in NYC!)

If the expectant woman aligns herself with a care provider she trusts and shares a similar birth philosophy with, she will save herself a lot of time and stress by not having to create a birth plan, discus birth preferences or enter her birth on the defensive.  This would have already been discussed and the woman knows how her care provider practices. For example, I chose to have a midwife for both my births, so I did not have to sit down and discus my desire for as little intervention as possible, because that was a given.  I knew if she started to bring up interventions, it was not out of protocol or just implementing routine interventions, it would have been because I truly needed them.

The research you put in ahead time can allow you to enjoy your pregnancy more as it unfolds.  Happy birthing!






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