birth plan

Value Systems & Birth Choices

A birth plan is important as a decision-making tool in the prenatal period and as a guide for providers at the time of birth. Now, the vast majority of nurses, doctors, and midwives know (and often expect) that a family will enter birth with a piece of paper that details their specific hopes during the different stages of labor and delivery including newborn care. Many hospitals even offer families an easy to use, and hospital specific, birth plan that goes straight into their file before birth. 

This all is wonderful news for birthing families. It means that providers are interested in what families want and need during one of the most vulnerable and intimate times in life. Providers that listen to families needs are able to provide more specific and supportive care.

While I encourage everyone to write a birth plan, it can sometimes create expectations that come with any give "plan". For example, a mother’s highest priority may be to have a vaginal birth. In her Birth Plan she may write that she does not want an epidural, but at the time of labor an epidural may be what she needs to allow a vaginal birth. Both items are important in her plan, but what holds the most value?

I encourage you to take a different approach to writing your Birth Plan by creating another important document, your Birth Values. By writing your Birth Values, you can allow your personal values to play the biggest role in your birth decision-making process.  The Birth Values approach allows a birthing family to ditch a Black and White Birth Plan and the sense of the "right and wrong", "good and bad" and "success and failure" that it can sometimes bring. Exploring your values goes deeper into the internal needs of the birthing woman, her partner, and the evolving family, rather than only looking at the choices available at the time of birth. 

An Example - A mother may have in her Birth Plan “something” that will help her remain calm and in control. This could be a birthing tub, nitrous oxide, or an epidural. But, it isn’t so much the item on her birth plan that is important, but the underlying value- feeling calm and in control during birth.

At the time of her birth to remain calm and in control, that “something” may change. A mama that planned to be in a birthing tub may now prefer the epidural. Or, a mama planning to have nitrous oxide wants to get into a birthing tub.  The item on her Birth Plan may have changed, but it still aligns with her Birth Values of being calm and in control. Her Birth Plan may only point to one of these things, but at the time of birth, another makes her feel calm and in control. Changing something on the Birth Plan shouldn’t make a mama feel like she has failed because she is still making decisions that align with her Birth Values.

Values do not start and end at the hospital. They are at the center of our very being, and they are at the heart of the new and challenging path new mothers embark on. Values are what matter.

So sweet mamas, and dear birthing partners, please do not ditch the Birth Plan. It is important, and it can act as a wonderful source for essential conversation in the prenatal period. It helps guide the mama, partner, and birth team  - keeping them on the same page before labor and delivery. But, I encourage you to dig even deeper and look at your values as you bring forth new life. Write these values down and share them with your birth team, this way you can move through labor and delivery fully wrapped in those values. 

By doing so, you will feel more fully heard, held, supported, honored, empowered and understood. It can also allow you to be super gentle on any decision made during birth. If there is any one thing I want for a birthing mother, it is that she feels held and supported, and that starts with first understanding her most intimate values before she ever steps foot into her place of birth.   

Best to each of you on your birthing journey, 

Brook Holmberg - full-time Birth Doula, a Childbirth Educator, a Lactation Counselor, co-founder of Birth Doula Centering and above all else, a value-drive mother. 

borealbirth.com 

Birth Doula Centering  - Twin Cities

 

The Birth of Gwen - A VBAC Story

In order to better understand the birth of my daughter, Gwen, let me first tell you a few things about the birth of my first-born, Theo, two years prior. I had been planning for an un-medicated birth at a birth center, but at 37.5 weeks, I developed some complications that led to a long induction, hours of pushing, a stuck baby, and ultimately, a cesarean birth.

As they wheeled me in into the operating for the birth of my first child, I began planning a VBAC (Vaginal Birth After Cesarean) for my second.

Of course, the planning became more concrete once I was actually pregnant. This time, I wanted to be at peace with how the birth went, even if it ended in the operating room. I put a lot of care into selecting a provider who, in the event of another surgical birth, would honor my preferences for a family-centered cesarean.

I wanted a clear drape so that I could see my daughter from the moment she emerged. I wanted delayed cord-clamping and skin-to-skin in the OR. But what I really, really wanted, though I didn’t care to admit it, was a VBAC, or Vaginal Birth After Cesarean.

I had a hard time even saying that out loud. I was nervous to write a birth plan, only for it to be completely derailed. I was terrified to try for a VBAC and was worried about how it would end. I didn’t want to re-live that awful moment in my son’s birth when the energy in the room shifted and it became clear that the baby was only coming out one way, and it was not in the way we had hoped.

As my due date loomed nearer, I talked everyone’s ear off about whether or not to try for a VBAC. My grandma was horrified—she thought it sounded way too dangerous. The rest of my family wanted to support me in whatever I decided. But that was the problem: I couldn’t decide. It was too hard to weigh the potential benefits of a VBAC with the idea of enduring a long labor that ended in the OR again.

I came close, so close, to scheduling a planned cesarean at 39 weeks. But I knew that even if it was a beautiful, family-centered cesarean, there would always be a little part of me that would wonder: “What if? What if I had tried?” So I decided to schedule a cesarean for a little over a week after my due date. I would try for a VBAC if my body went into labor naturally.

My pregnancy with Gwen was uneventful, and every day that I made it past 37.5 weeks felt like a gift. I would have a full-term baby! My blood pressure, which had caused so many problems the first time, was still normal! Now I just needed to go into labor.

At 40 weeks and 2 days, I had three mild contractions about 10 minutes apart, and that was the extent of my early labor. I continued to labor at home for another three hours. The contractions were intensifying, but I was still in denial that it was really happening. I tidied up my room and checked a few things off my to-do list, trying not to get too excited. I paid a bill for the pediatrician. I texted with my sisters about my mom’s upcoming birthday. Things were getting more intense and I asked my husband to come home, but told him to bring his computer with him in case this was a false alarm. Then my contractions, which had been coming about 5 minutes apart, were suddenly 1-2 minutes apart. It was time to go.

On the drive to the hospital, my contractions were strong with very short breaks in between. It was just about rush hour and there was a lot of traffic on our route. Only an hour before I hadn’t been willing to admit that I was in labor. Now I wasn’t sure if we would make it to the hospital in time! Thankfully, we did make it, and when the elevator doors opened and I saw my doula’s face, I honestly have never been so thankful to see another human being in my life. Just the simple act of holding her hands and looking into her reassuring eyes was everything. As we went through the motions of intake questions, getting an IV placed and fetal monitors hooked up (both requirements of hospital VBACs), I used nitrous oxide and it felt like a life-saver. It forced me to breathe more deeply and it took the edge off the contractions.

Forty Five minutes after we arrived at the hospital, my body started spontaneously pushing. It was the craziest sensation I have ever felt. Sometimes people call birth an out-of-body experience, but that was the most in my body I have ever felt. In all of my planning, I thought that when I reached the pushing stage, I would be wrought with fears of my baby getting stuck again or my scar rupturing. Instead, all I could think was “GET HER OUT!” I heard someone say I was fully dilated and I started to push again. With the first push, my bag of water exploded, narrowly missing one of the nurses. I felt the pressure of the baby’s head and decided to give it my all. Another push for her head and one more for her body. Out she flew, onto the bed. Nobody even had time to catch her! I had really done it, she was here, and it was over! Two years of wondering if I would ever get to experience this moment, of research, fear, and hope. I was in total disbelief, shouting, “What? What?” over and over again as she was placed in my arms.

Gwen’s arrival was the most shocking, electrifying, triumphant moment of my life. I am forever grateful to each and every person who walked this path with me, whether they lent an ear or asked questions that made me think deeply about my options. Her birth was a cake-walk compared to the choice of whether or not to attempt a VBAC. To anyone out there trying to make a similar decision, my heart goes out to you. The evidence tells us that for most women, a VBAC is a safe option that carries less risks than a surgical birth. But that doesn’t mean that it’s the right decision for everyone. Only you can determine how to best protect your heart. My wish for you is that you are well informed, well supported, and at peace with whatever you decide, and however your babies are born.

Join Mari as she leads the Blooma VBAC Class on October 29th!

Written by Mari Melby, doula and childbirth educator at Blooma. You can read more from her on her website, www.marimelby.com.

Photo credits: Julia Soplop, Mari’s sister. Calm Cradle Photo and Design