Tuesday, July 5, 2011

Birth Plan

Pregnant ladies Janine, Aurora and I.  With Alice who paved the trail!

Just talking to my friends the other day whom are also pregnant (with their first) and I told them about my birth plan of delivering vaginally; drug free.  Much to my surprise, they laughed at me and scoffed at my idea of analgesia-free birth! Bah! To a nicer extent, they said I was- CRAZY! And that I should at least be "open to it" and that "I can be too tired from the pain to even push the baby out."

Am I being naive?   If other's can do it, why can't I?

I don't even know what contractions feel like!  LOL!  Nor have I had any form of prenatal class that convince me that this isn't a ludacris idea.  However, I do know that if this weren't possible, the human race would be pretty extinct.  Way back when before such advanced analgesia were discovered, women have been doing this for many many years.  Moreover, i'm sure women are doing this NOW as I type, in countries varying from first world to third world. 

I also know that in general, i'm not one to pop some meds- but i've also never been in a lot of pain that would require analgesia. Maybe I have a high pain tolerance?  I think it's definitely possible if I had staff that supported this idea, a labor partner that supported the idea and think objectively for me in times of heightened discomfort, and a clear vision for myself.

I sought some advice from a baby forum and I got some very insightful and empowering responses:

  • I think its great to have a plan and to want to be drug free. I don't think one birth makes any other birth less natural and no one wins a medal at the end if they endured the pain rather then got the epi. I think you should keep an open mind - and not saying that you feel pain rush for the epi, but that if things don't go according to plan your not going to get a huge feeling of dissapointment.
    Its great to have plans, sometimes babies have other plans
  • If it's what you want - go for it! I've had two un-medicated births and am planning a third one. I don't think it's crazy, I think it's a personal choice.
  • I think it is good to have a plan that is open to change. You never know what you want until you go thru it.
  • I think it's great to be open-minded. There's just so, so much that's beyond your control when it comes to birth. That being said, if you want a drug-free labour and birth then you should definitely AIM for that. Just try not to get too fixated on it (I know, that's easier said than done!) in case things don't go your way.

    As a start, I'd recommend reading The Birth Partner, by Penny Simkin. If I can find my birth plan at home I'll send it to you. I had some stipulations in there to help me avoid drugs, and I did manage to go drug-free until I was 10 cms and then felt like I needed some assistance, so I asked for Entonox. For example, I noted that nobody was to offer me drugs. Ever. If I wanted them I had to ask for them. Also, I stipulated that my request was to be denied if I asked for them at the height of a contraction, and they were only to give me drugs if I requested them between contractions. My reasoning was that if I still felt like I needed them during a rest phase between contractions, then I probably really needed the help.

    That being said, I had a fairly easy labour. My contractions didn't get bad until the very end, and it was only 9.5 hours from start to finish. I had a supportive partner, a great medical team, and all the things just went in my favour.

    I think a drug-free birth is definitely possible and you should prepare yourself for one if you really want one! Just try to be open to last-minute game changes if baby (or your body) has other plans!
  • With my first, I had plans to do it pain med free and I received a lot of the same responses you did. And it pissed me off. I was open to using pain meds if I thought it was too hard to handle, but my goal was to go without.

    I've done it twice now. Granted my L&Ds are relatively short, 7 hours for the first and 9 for the second, but you can do it.

    If you haven't already, I suggest reading some books. Birthing from Within and Ina May's Guide to Childbirth were helpful to me. I found the real birth stories in Ina May's book REALLY motivating.

    Also discuss your plans with whoever will be your birth support(DH, mother, sister) so that they are on board and prepared to help you through it.

    Don't rely solely on the nurses. My first L&D nurse was great, and she was with us the majority of the time, but when I first arrived there was another nurse in the room, who scoffed when I mentioned wanting to go without drugs. The second time around, the nurse was much more supportive because she knew I had already succeeded. In my experience, and from talking to friends, who delivered in hospitals, most are not very supportive of drug free births, especially with first time moms.

    Think about hiring a doula, I regret not hiring one. DH was great, but it would have been nice to have that extra support, especially with my second birth.

    It is doable! Don't let others discourage you and good luck!
  • Similar to you, this is my first child, and at this point I would like to do a natural birth. Sure things could go beyond my control, and might require a emergancy c-section, etc. But my goal at this point is to go med-free for as long as possible.

    As long as you are open to the requirement of medication if necessary you'll be fine. I think it also depends on attitude as well!
  • I don't think you're crazy or naive, but I probably would not use the word "easy" to describe labour especially if you haven't done it before. wink That alone will get some women's backs up!! smile It's called labour for a reason!

    I had an unmedicated birth which was my plan hope, but I was open to using meds if I needed it at the time. I think that it's a good idea to be open minded if for no other reason to prevent yourself feeling let down if you really want things to go a certain way and they don't - I know that having a birth go differently than they wanted is a major source of stress for many new moms and an unnecessary one IMO.

    Good luck! It's do-able for many women but with labour & birth I think it's always a good idea to be open to the many curveballs that can be thrown your way.
  • It's definitely not crazy, people do it all the time and live to tell the tale! You don't have to be open to drugs if you don't want to be either, no matter what anyone says. Some people like to take a wait and see approach and others prefer to not have drugs be an option at all. No one can know ahead of time what will work best for you.

    But, but, but if a first time mom told me that it would be "easy," I might not be able to prevent myself from laughing either smile. Childbirth - drug free, drug heavy, vaginal, surgical - is many things, but "easy" it generally is not.
  • I don't think it's crazy. I am hoping to avoid drugs if I can as well but I think it's really important to not get too attached to a particular birth plan because a lot can happen and there are a lot of unknowns. I know a woman who was so attached to a home water birth that having to have a c section was perhaps more traumatic than it would have been. I'm reminding myself that the goal is the baby, not the birth.
  • I've been reading Hypnobirthing. My plan is to go in with drug-free intentions wink
    Basically, if I can deal, I'll go without, but I will always allow myself the option of pain relief just because you never really know what to expect, especially with the first baby.
  • One of my pet peeves is people saying I can't do it. It's also my birth preference to have it go drug free. Obviously things could change, you always have to go into labour knowing that, but ideally, that's what I'd like.

    My mom is the same as your friends, thinks I'm crazy. And it sucks since she is my number 1 support for most things. Anyway I've found going with midwives, having a doula, and reading books on natural birth (my fave being Ina May's Guide to Childbirth) to be really great tools in helping me believe that it's certainly possible. Keep in mind that there was a time when drugs for L&D didn't exist and I'm pretty sure if it was THAT bad, then humans wouldn't have made it to be much of a species wink

    Hypnobirthing is another book I'm reading. It's not really 100% my cup of tea, they talk about how childbirth would be painless if not for the fear that is ingrained in our minds from us hearing terrifying birth stories. The rationalle being that fear causes more pain. I think there will be pain no matter what my mindset is but learning to accept what is actually going on with my muscles and cervix in labour instead of fighting it and getting all tense I think can certainly help there be LESS pain.
  • I second Ina May's book. It was a great motivator for me to go drug free. I also ended up with an unplanned home biirth so I really didn't have any choice but to go med free.

    That said, even if we had gotten to the hospital in time, I still wouldn't have chosen the epi. I know Barkles mentioned above not using the word 'easy' to describe labour, because it's certainly not easy, but I do believe some labors can be much easier than others. I was lucky in that my labour was very fast, and (in all honesty) not that painful. It was a wonderful experience.

    If you have a desire to go drug free, definitely aim for that as a goal. But, just remember that you may run into a situation where drugs are inevitable, like a c section. You do have to be open minded.
  • I had a drug free labour, and everyone told me I was naive too. Days before the birth my BIL was calling to tell DH that his wife too wanted to go without drugs, but she had no idea what it really felt like. Well I've had two drug-free births now, so I guess I wasn't so naive.

    In my birth plan I had things like: I don't want to be offered drugs at all (assuming labour is progressing normally); I want to be encouraged if I start faltering. I gave birth at home, so it was actually pretty easy. I discusses these topics with my caregivers and DH before the birth, because once you are in labour you're unlikely to be going through the birth plan bullets. Still, putting it together was a very useful exercise.

    As to the "open-minded" comments, I think there's a fine, but important distinction between saying: "I'm going to stay open-minded" and saying "I really want to go drug-free, but if an emergency happens or things go in a really unexpected direction, I'll reconsider." Yes, there's an element of luck. But there's also an element of forethought and planning if you want a drug-free labour.

    I don't know anyone who planned a drug-free labour and was determined to do so who was disappointed when it didn't turn out; but I know a lot of women who were disappointed that they didn't speak up for their preferences during birth.

    Two things crucial for my own experience of going drug free:

    #1. Having taken a prenatal class that focusses on this element; I knew far better what to expect and learned some useful pain-relief techniques.

    #2. A doula or midwife; I had a doula at my first birth and midwives at both births. If you are going to be a in a hospital setting where they may be offering drugs, a doula is a great resource; if you're at home, same thing because there won't be any nurses around. Studies show women with doulas are less likely to need or want drugs. If you have midwives, you may not need a doula, but you might it, particularly if your midwife only comes once labour is pretty far along - definitely something to discuss with your midwife.

    Anyway, your girlfriends don't know anything more than you at this point. Once they give birth they may think they do know more, but they still don't. They'll only know how THEIR births went and felt, not how yours will go or feel. So don't let them intimidate you!
  • There is also the doc. The business of being born. I found it very informative. It is mostly an American slant but it shows that many interventions lead to a cascade of other interventions. Having a doula or midwife will help to achieve your goal. Well at least that's what I'm hoping for for me.
  • It was my experience with my last pregnancy/ birth that people thought it was crazy to attempt a vaginal drug-free birth. In a normal group of moms I was often the only one who was willing to attempt it or the only one who had actually done it.

    It did really get my back up after the birth when people said it was "easy". It was definitely not easy. My sister came to meet the baby and said "oh you're lucky it was so easy" and I almost punched her tongue

    My approach was to go into the birth experience with an open mind. I kept telling myself that birth is a natural human function, that my body would know what to do and that I had nothing to lose by trying it naturally. I had also done the consultation with the anesthesiologist at the hospital just in case I needed an epidural and I had researched thing like gas for pain management in case I needed it. I am slightly embarrassed to say that I was kind of inspired by "The Business of Being Born" (video).

    I brought a whole whack of pain management stuff to the hospital that I didn't end up using: exercise ball, heating pad etc... I was prepared to use the shower, the labour tub, to move around, get on all fours, essentially do whatever my body told me to do to get relief and comfort.

    In terms of "pain", it was painful when they were jabbing my hand trying to get an IV line in, but I would not describe the rest of the experience as "painful", it was more "intense discomfort". I didn't feel the "ring of fire". They were telling me I was only 8-9 cm dilated and you usually need to wait to push until 10cm but I felt a definite drop and change in the pressure and I just said "I NEED to push now, I'm sorry!" and they said go ahead. After DD came out, I thought everything was just fine and I was good to go. In actuality, I needed 10 stitches. That just proves to you that your body produces a natural analgesic to the pain smile (TMI.. I was very ripped up apparently...)

    My final word on the matter is that my birth was relatively quick (5-6 hours). And maybe your friends are right when they say that you might get too tired to push if you have a long labour-- but you'll never know unless you give it a try. If you want to do it, go for it. Just listen to your body bye
  • You aren't being naive whatsoever! After our prenatal classes we knew I really wanted to try without drugs. Who knew how many risks were involved with epidurals? The list was literally 2 pages long. And while I would never look down on someone if they chose the epidural - I just knew that it wasn't something I wanted. I went into labour wanting to avoid drugs at all costs and I was successful at delivering my daughter without medication. I dont think I deserve a medal for it but it is definitely something I am proud of because it was by far the hardest most painful thing I have ever done.

    I think there are lots of women who go into labour with the intention of refusing drugs and they are successful. Others bail on their plan and get the drugs so it's hard to say 100% certain but there is nothing wrong with having the intentions of trying it drug-free. Don't listen to your friends smile
  • I had my mind set on a natural birth. The things I thought about/ said to myself were: that no person has ever died from the pain of childbirth, my grandmother had her babies at home with no pain meds, and my great grandmother did it 11 times- I thought of them during contractions as well as all the millions of women around the world that had been through a natural labor. I felt very connected to women throughout history that had shared this experience.
    I had midwives who supported natural births so i knew if they reccommended a medial intervention, then it really was needed. I didn't have to carry any fear because I knew they had it all under control- they were my angels. They knew me, what was normal for me, and what I wanted.
    I did hypnobirthing which i found helpful. I had a 17 hour labor and pushed my 8 pound 5 oz baby out with his hand in a fist beside his head. I tore badly. I did not have an easy labour, but I would do it again in a heartbeat. I felt so empowered and really enjoyed giving birth.
    I understand not everyone feels this way or has the desire to experience this and that is fine. We are all different. I would never in a million years desire to run a marathon, but for some reason people do this smile We are all different.
  • I had the same plan and was able to deliver my DD entirely drug-free and with no interventions. I think what helped was that I felt adament that's how I wanted things to go beforehand, and my DH was totally on board too. I was offered laughing gas at some point, but DH was able to step in and say, "I don't think we need that at this point" and because I had our plan in mind so strongly, I just said ok.

    Good luck!! It can be done
  • I didn't have any pain medication while delivering my DD. I definitely had an idea of how I would like my birth to go from the start but was willing to roll with whatever was thrown at me since labour and delivery is not exactly something you can plan. I found having people who supported me to be a huge factor as well as labouring at home (I found it a lot more calming). After having gone through labour once I would have no problem with being ready for a home birth should we decide to have another baby. Good luck and it definitely is possible to have a med-free vaginal birth!
  • The only reason I made it med free with my first birth was because it was quick. I'd done some reading but I didn't really spend any time really planning or preparing and, while I managed to go without meds, I wasn't really happy with my birth overall and the support I received during labor and birth or how hard it was to disallow interventions (to 'deal' at all!) in a really uncomplicated and healthy birth. Interventions were suggested and encouraged throughout my labor (which was only 3 hours when I got to the hospital) and were totally unwarranted. If I didn't know the little I did going in I'd have likely just 'gone with it' and was thoroughly annoyed at having to advocate so strongly for myself in the midst of labor.

    I went with midwives and had homebirths for my 2nd and 3rd. I watched LOTS of videos of med free births, talked to others who's had them, read tons and tons and tons of positive birth stories (mothering.com has zillions of them on their forums!), several books on having med free births and had a great support team (DH and my midwives, primarily). The experience was like night and day for me. I certainly don't think you need a midwife or to birth at home to have a positive and med free birth but I do think you need to be aware of the specific challenges to whatever you choose so you can mitigate them and prepare for them so you're more likely to reach your goal.

    I'm another that couldn't go in 'with an open mind'. Truth be told, if I hadn't had vaginal and med free births I'd have been disappointed regardless. I also know myself well enough to know that if I'm in a great deal of pain, a pain I couldn't REALLY totally prepare myself for, and meds are RIGHT there...I might have a hard time not taking them if I didn't have other tools to deal with the pain of labor and birth. I also knew I couldn't prepare for interventions (and didn't want any unless absolutely necessary) so it seemed silly to me to do anything other than prepare to the best of my ability for a healthy pregnancy, labor and birth because that I could control. More than anything I just wanted it all to be as positive an experience as I could make it, leaving me with as little to recoup from as possible, and that required lots of planning and preparation for me...so leaving that to chance...just wouldn't have worked for me, personally. Without the support, preparation and planning I just wouldn't have had the births I did. I know this 100%.
  • When it comes to labour and delivery I think it's best to have an open mind. Personally I wouldn't corner myself by saying, "I WILL have a drug-free birth!" because you just don't know what might happen. You might labour for hours and hours and hours and be so exhausted from the pain that you are unable to push. Or you might do just fine and have a drug-free birth! My birth plan was not a birth plan at all - I just told me doctor, "get the baby out and make sure mommy and baby are both safe."

    I also went in with the idea that I'd try it without drugs for a bit but would most definitely take the epidural when it became too much for me. I'm glad I did, it made for an enjoyable birth of my daughter and I was relatively pain-free the entire time (the epi doesn't block out all pain - there is still pressure and other weird feelings).

    Don't beat yourself up if you change your mind about drugs at some point - you will not have let anyone down by doing something for the pain. It's your body, you do what you want. smile
  • A med-free birth definitely can be done, as shown here. I've had two, and I also got the "Are you crazy" comments. People also thought I was crazy for using cloth diapers. But neither were that big a deal for me.

    Definitely keep an open mind, do plenty of reading, plenty of prep work to get you and your DH comfortable with different birthing options. Fear is the greatest thing to overcome, and when contractions start coming on hard, it can be difficult to get through them. And as others have said, make it an aim, but also be gentle on yourself. Sometimes things happen and we have our medical system for a reason, it's ok to use it if it's necessary. Sometimes it can be tough to figure out that line between necessary and not.

    Things that were a big part in getting me through my med-free births:
    - midwives: they are in the business of med-free births and have plenty of experience and support to provide you with
    - doulas if you can't get a midwife or want the extra support: they will help you and your hubby work through contractions as well as any considerations that you need to work through during labour and delivery
    - a med-free focused prenatal class: often the hospital classes focus on how things work at the hospital and little on getting through your labour. I took a class that was run by doulas, very informative. It was at that point were I decided to go for the med-free birth. I had never really questioned the epidural and it opened my eyes to the risks associated with the different drugs.
    - get comfortable with med-free births: read Ina May's Guide to Childbirth, watch "The Business of Being Born". Ina May's book is a little crunchy-granola, but so empowering. The movie is quite US based, and a little doctor/hospital bashy, but it is still has a great deal of information to gleam from it.
    - stay home as long as possible: it keeps you in your comfortable environment, you don't notice the minutes ticking by, and you aren't as handy to drugs. When it starts to get hard and you want the drugs, you are probably almost there, and with some time, you will probably be able to get through it.

    I also had very quick births (6hrs and 1hr) but I was overdue (13days and 7days) and I was able to allow my body to go into labour on it's own and was comfortable with going with the flow. I think all of that helped keep things as short as they could be.
  • I've had 4 med free births. I got the same reaction you did and it was frustrating. Instead of support people told me I was crazy.

    Everybody's labour is different and you aren't guaranteed to be "to tired from the pain to push the baby out". Pain isn't even a word that I use when talking about labour. Labour is very much about the mind as it is the body. Labour is work with a purpose. It can be helpful to change the way you think about the process of labour.Let go and trusting the process. Clear your mind of any fears. Fear creates tension. Some other things that are helpful are to let your body go into labour naturally, keep moving for as long as possible during labour, use the bath or shower during the last part of labour, birth in an upright position to make birth easier and faster, let your body decide when to push not a nurse or doctor, use positive birth affirmations, use visualization, play music and be surrounded only by people you feel supported by and who are supportive of drug free birth.

    Have you considered a home birth? Being at home and being free to move around, play music, light candles and anything else that gives you comfort. If you don't feel that home birth is the right option for you, you may consider staying home as long as possible in your labour
  • I found the Hypnobirthing and the Ina May books very helpful. I ended up with a c-section, but laboured naturally until then. I had a plan to go natural and wanted to try hard to stick with it even though my mind kept wandering to an epidural. After next contraction I'd say... and then 10 contractions later I'd say ok... maybe next one... haha I highly recommend hiring a doula to help you through. Mine used some hypnobirthing techniques with me and her calm soothing voice helped with each contraction. It also helped to not think of them as contractions, but tightenings. I could feel the pain (I don't believe the idea that you can totally block it out), BUT by the end of each one I was so relaxed I was practically sleeping. Pain is natural and is part of the whole cycle, but it is temporary. You CAN get through it. And if you really can't go on and it's totally ruining your experience, just get the epidural and not think twice about it. You tried, and it's not "failing" if you can't follow through on your natural plan.

    A natural birth shouldn't be something you use to identify yourself as a mother, just like baby-wearing, breastfeeding, co-sleeping, and others. These are just choices you make.(in my opinion) So do your best, and don't let anyone tell you you're crazy for going natural. People have been doing it for years! But be prepared to want an epidural, gas, other drugs, or maybe even need a c-section. All that matters in the end is that you deliver your baby safely.
  • Hire a Doula for the greatest success of natural childbirth in a hospital setting. Really, it can make ALL the difference in the world. And if money is an issue, there are always newer doula's able to work for free or low cost.

    I had my kids without drugs *knowing* from the beginning that I would not chose them (and my first birth was 32 hours, ending however in an unnecessary cesarean though. Next was totally natural though because I wouldn't let any medical staff near me. 16 hours long).

    I have another book and movie recommendation: check out Orgasmic Birth - there's a movie and a book. The interesting thing is that there's great debate as to whether birth is inherently painful. Pain arises out of our cultural expectation and out of fear responses. The hormone that mediates labour is oxytocin, the hormone of love - the same one involved in falling in love and experiencing sexual pleasure. Your body is working on relaxing and opening. But as soon as we introduce fear and adrenaline into the picture, we essentially start fighting our own bodies and it hurts like hell. Ina May Gaskin mentions her "Sphincter Law" too. The cervix is a sphincter like any other; it doesn't operate so well when in uncomfortable surroundings and under observation (try moving your bowels in a bucket in the hospital surrounded with nurses and doctors watching intently and you might get the idea). That's why when woman homebirth, they often will sequester themselves, quite naturally, in bathrooms or other isolated places. You see the same thing with other animals.
    Bottom line is there are plenty of women who have mentioned that they didn't experience their labour as painful. Some even go so far as say it was pleasurable or orgasmic. There are wonderful you-tube videos out there showing beautiful, natural births, not only without pain medications, but without pain. They're real; you can watch them in action. It's much more difficult to accomplish in the hospital however, but I have had clients in a hospital setting that had virtually painfree ones.

    There's a time and a place for everything, even pain medication in labour, but as a Doula myself, I completely see a direct correlation with my clients expectation heading into birth and what they wind up experiencing. And I also see a huge difference with the overall satisfaction and joy a mom who's done it naturally experiences versus one who's been drugged. Everyone needs to make the decision for themselves - and there's no right or wrong one - but there definitely is a natural high and euphoria, not to mention a sense of triumph, that a mother feels for having accomplished it naturally.
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ok what have I learned:
  1. it can be done
  2. get that Ina May book
  3. Watch that documentary "The Business of Being Born"
  4. i'm kind of a private person, and I don't really want a Doula/Midwife ..but someone who is more nurturing yet can deliver the baby at a hospital setting
  5. listen to the body
  6. absolutely no forceps, episiotomy, vaccuum- but a c-section is ok if it had to come to that
  7. tell your nurse, not necessarily just your doctor about the plan
  8. no analgesia, but should be open to meds that help things get further along if need be (Pitocin?)
  9. stay at home for as long as you can
  10. educate yourself

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