Baby Bean Update & Birth Preferences with Explanation

I thought it was time for a little pregnancy update along with a few belly shots. At 38 weeks (yesterday), things are still going well. I feel good and can't believe that in 3 weeks (Eliza was a week late, so I'm being realistic) or less we will get to meet Bean (and give him a different name)! My friends have been asking if I am ready to have 2 little ones at home and I had to admit that lately I have been thinking more about the actual birth, than the day to day adventures of having an infant and toddler at home. So ready or not, here I come!

35 weeks

In our preparation for Eliza's birth, we wrote a list of our preferences for medical treatments and interventions. We went over it beforehand with our doctor and shared copies of it with the nursing staff at the hospital. Everything went pretty smoothly and nearly all of our expectations were met. It was nice to have everything researched, decided, discussed, and written down ahead of time.

38 weeks

The only difference this time is the opportunity for a water birth. The hospital that I will deliver at has birthing tubs available and all the midwives are experienced in water deliveries. If the circumstances allow, I would like to do a water birth. The complicated issue is that they want to break your water before allowing a water birth because they want to be sure there isn't meconium. If meconium is present (which sometimes indicates distress of the baby), they will not allow a water delivery. I don't want my water broken artificially, as it leads to stronger contractions faster and puts you on a timer to deliver the baby (making a c-section more likely). It also doesn't guarantee that you'll be able to do a water birth, since the fluid may have meconium. With Eliza my water didn't break until 8cm and there was meconium present, so with her I wouldn't have been a water birth candidate. So we aren't setting our hearts on a water birth, but just leaving it as a bonus possibility if it happens to work out.

Since I've had friends ask about my plan for Bean's birth, I decided to post our "Birth Preferences." I will also post a little commentary on each one in red that explains why these are our preferences. The commentary in red, of course, is not included in the printed version of the birth plan. You are welcome to copy or adapt all or parts of our birth plan to use for yourself. We've already shared it with a few others, who used it successfully!

Birth Preferences for Stephanie and Michael

We’re so excited to be here and welcome our little boy into the world. Thanks for your preparation and help as we enjoy this wonderful day.

Above all, our objective is to have a healthy mom and baby. If there is no medical urgency that would require a different procedure, we appreciate your consideration of our preferences on the following:

• Pain Management: We have prepared for a natural, un-medicated birth without an epidural or other pain medication. We would also like to opt out of the pain management questions. The idea of having a large needle in my spine scares me way more than some hours of pain. I don't want to risk any sort of paralysis or weird side-effects of strong drugs. I want to be a part of my labor and even feel its discomforts, as crazy as that may sound. We have prepared using both Hypnobirthing and Lamaze tecniques. The techniques help to remove fear, relax the body and ease tension, which greatly reduces the pain. Having someone constantly ask me to rate my pain on a scale of 1-10 is distracting and would focus me on the pain rather than take my focus away from it.

• Mobility: Stephanie would like to be free to walk around, labor in the tub, and assume different positions during labor. We would prefer intermittent monitoring or telemetry monitoring if possible. Although I never ended up using the tub when I was in labor with Eliza (I just didn't feel like it), I wanted to keep my options open. I didn't want to be tied down to the bed. I am fine with monitoring, I just want options in case I feel like walking around or doing other things (playing tennis, etc). I laid on my side for most of my labor with Eliza, except for the actual delivery when I was in more of a squatting position.

• Induction: We prefer to let labor take its natural course rather than having a Pitocin induction or artificial rupture of membranes. I feel that many interventions are done in an effort to "speed things up" and "move things along" and are not always in the best interest of the mom and baby (I know there are exceptions, so don't hate me). My desire to have a natural birth, etc, etc, is stronger than my desire to get it over quickly (yes, even when I'm in labor). I would like to take my time and let my body and baby do what they instinctively know how to do. I don't want my water broken to speed things up. Contractions get much stronger once the water breaks, so I would like to let it break on its own. Because of the risk of infection, hospitals usually want the baby delivered within 24 hours of the water breaking. Once the water is broken, your chances of having a c-section greatly increase. You are also more likely to be given Pitocin to keep your labor moving to avoid a c-section.With each intervention, you increase your chances of more interventions. I'd like to put a stop to them before they start.

• Water Birth: If circumstances allow, Stephanie would like to deliver the baby in the birthing tub. When I was younger, I thought the idea of having a baby in water was silly and weird. Those who have experienced it testify to the amazing pain relief that water gives.

• Episiotomy: Stephanie prefers to risk a tear rather than have an episiotomy. It seems like episiotomies are pretty standard procedure nowadays. If there is even the remotest chance that you may need one, you will get one. I figure that if I opt out of the complimentary episiotomy, there is a chance I will walk away unscathed. Also, I believe that a tear heals better. Mike's favorite analogy is that it's cutting lettuce versus tearing lettuce. When you tear lettuce, it tears where it wants to tear, which is between the cells. When you cut lettuce, you cut right through the cells, which injures it and makes it brown. Because a tear is natural it goes around the muscle fibers, making the healing simpler. A cut goes right through the muscle, which takes longer for the body to repair. The case where an episiotomy may be better would be to avoid a level 3 or 4 tear (look it up if you're interested). Either way, tears and episiotomies are not nice, which leads me to the next preference.

• Pushing: We have prepared for mother-directed pushing. We would like to do so in a calm, quiet environment without being urged to push. In labor with Eliza, the doctor kind of gave us a hard time about this one. It was one of those "if you just push the way I (the doctor) want you to, we can hurry up and get this baby out" sort of things. They had given me oxygen a little before the pushing part because the baby's heartrate was dropping, supposedly due to lack of oxygen. For those of you who have never given birth, the norm is for the mom to hold her breath and push hard while the nurse counts to ten, often termed "purple pushing." When the doctor was asking what I had against pushing the "normal" way, Mike jumped in like a champ and said "If the baby isn't getting enough oxygen as it is, doesn't it seem a little silly to tell Stephanie to hold her breath?" The doctor said "You've got a good point there" and laid off. Anyway, I believe that my body knows what it is doing and is capable of giving birth on its own. I want to push in a calm manner and as I feel the need to, without a cheering section. Taking it slowly allows more time for the perineum to stretch, which will prevent tears and the need for an episiotomy.

• Cord Clamping: We would like to wait about three minutes before the umbilical cord is clamped. We would also like the baby placed directly on Stephanie’s abdomen immediately after birth. When the cord is cut, the baby is cut off from his source of oxygenated blood. Leaving the cord unclamped allows the baby to receive oxygen while his lungs adjust to breathing. Three minutes is considered sufficient time for the transition to take place. Because the placenta is connected to the baby, clamping the cord cuts the baby off from part of his blood volume, which can leave his system lacking up to 50% of his blood volume. When left attached, the cord vessels naturally "clamp" themselves when the child is crying and pink. The placental blood transfuses into the baby and the circulation pattern changes. There are risks associated with immediate cord clamping (especially in premies) such as cerebral palsy and respiratory distress syndrome. There is no medical need to cut the cord immediately, it just makes it so that the baby can be whisked away from the mom more easily.
  

As circumstances arise that may require a change to our plans, we appreciate your willingness to discuss them with us before a decision is made.

Thanks for your care on our special day. We appreciate all your help.

Well I'm pretty certain that was more information than most of you were looking for, but for the few of you who wanted to know, I hope it all at least made sense, even if you think we're (I'm) crazy!