Choices, choices… the Birth Plan (Part 2)

“In the end that was the choice you made, and it doesn’t matter how hard it was to make it. It matters that you did.” Cassandra Clare, City of Glass

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In my previous post I wrote about the advantages of a NVD (Normal Vaginal Delivery) for your baby. I was set on delivering my baby via NVD as I was so excited to give him all of these benefits! In preparation for the birth I attended ante-natal classes at a beautiful Women’s clinic in Bloemfontein. Estherea is run by passionate women who want to give you the best birth experience.

Initially I thought that my husband and I will probably not learn so much at these classes, because we have witnessed and treated so many births and babies. Little did we know that there is another world out there when it comes to pregnancy and delivery! We were introduced to a softer, more natural way that is in such a complete contrast to the medicated ways we were used to. The classes were also good conversation starters at home, and we could work through some issues about raising a child before it turned into a war with a screaming baby in the middle. We met a few other couples at these classes that became friends we could walk this road with, and I am so thankful to have them in my “village”. So in short, if you have the opportunity to attend ante-natal classes, GO! It prepares you in so many ways for the life-changing moments ahead!

The staff at Estherea consists mostly of Midwives, Doulas and Lactation consultants. After reading up on the advantages of having a Doula, we booked one to assist us with the birth of our boy. We met with her a few weeks before and worked through a checklist so that she knew what our “labour-day-preferences” were. All your choices can be summarised and presented to your health care workers as your “Birth Plan”.

“May he give you the desire of your heart and make all your plans succeed.” Ps 20:4

Did you know you have sooo many choices?! It was a bit overwhelming for us, and I was so thankful to our doula for helping us make some of these decisions. Many of these choices are made for you “by default” by the nurses and doctors, but you actually do have a say. Let me look at some of the options with you:
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During your labour do you want to play some music, dim the lights, wear your own clothes, bring your own snacks, have a photographer? Who do you want in the room with you, and who should rather stay away? Do you want to stay mobile for as long as possible, take a bath or a shower? (Ok, now it may become a bit graphic…) Do you want an enema? Do you want your pubic area to be shaved? Do you want a urinary catheter?

The enema has become standard practise in the labour ward for many reasons. It was thought to create maximal space in the pelvis, keep the delivery clean and decrease the duration of labour to a certain extent. However the latest research shows that there is not really a significant advantage and it is thus no longer recommended. But you do have the choice. 1

You can decide whether and how you would like to augment your labour, which pain relief you want (you are not only limited to an epidural, there are many other options to try), in which position you want to labour and deliver, and if you want to see your baby’s head crown with a mirror! Some of these options are a bit unconventional, but I think it is good to at least know about them and make up your own mind.

You can also specify what should happen immediately after baby is born. This part is very important for baby,  bonding and initiation of breastfeeding, and these choices can be made to a certain extent whether baby is born via NVD or C-section.

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Cutting of the umbilical cord – in the fast-paced world we live in, the cutting of the umbilical cord has become just another task to complete before moving on to the next patient and as such is done almost immediately after the baby is delivered. However unless the baby is in need of urgent resuscitation, this procedure should be delayed as much as possible. The umbilical cord is attached to the placenta which contains almost half of the baby’s blood volume as this is where the exchange of nutrients, oxygen and toxins take place. If the cutting of the cord can be delayed, most of this blood is pumped back into the baby’s body. This means that the baby gets more of the precious stem-cells and more red-blood cells (which prevents anemia later on). It can even help to prevent brain bleeds and gastro-intestinal problems in premature babies. The only possible negative effect is that the baby has a higher risk of being jaundiced after a few days. A delay of minimum 30-60seconds is recommended. 2

Do you want to store stem cells? This is a new field that is rapidly evolving. It is still quite expensive to store the cells, and if the cold-chain is broken at all the cells are useless. Currently the stem cells can only be used as treatment for a few rare cancers, but there is a lot of hope that it can be used for a multitude of diseases one day.

The WHO and UNICEF both recommend that all healthy mothers and babies, regardless of feeding preference or method of birth, should have uninterrupted skin-to-skin care from immediately after birth for at least an hour.3 Unfortunately this is not standard practice in all units yet. Usually the baby is taken to a warmed resuscitation-corner just after birth to be dried, weighed and immunized. You can ask for this to be done differently. He can be put on your chest immediately, skin-to-skin. Did you know your chest wall-temperature will regulate according to the temperature your baby needs? Baby can also smell you, hear your heartbeat, and is close enough to see your face and this makes him feel safe. It also stimulates oxytocin production in the mother and the baby, which reduces stress, helps with bonding, breastfeeding and prevents post-partum bleeding in the mother.  All routine procedures can either be done in this position, or can be delayed until after the first feed.  If there is any complications with mom, dad can give some skin-to-skin love to keep baby warm and safe.

You should also communicate your feeding choice and whether you want to bath your baby on the first day. I will elaborate more on these options in a later blog.

Discuss all these options with your healthcare workers. They may not be able to grant all your wishes, but you do have some control. Unfortunately there is still a lot of red tape in both state and private hospitals to get around. Doctors and Sisters have gotten so used to certain ways of doing things that it is sometimes difficult to make births more baby-friendly. Nothing will change if we do not keep on asking and pressing for change, so go ahead… ask!

Wow, what a lot to think about! I will give you some time to contemplate, and then I will share my birth story (and what I ended up choosing / getting) in the final part of this trilogy.  There are many examples of “Birth plans” available on the internet to use as a template, this is the one we worked from : https://www.thebump.com/a/tool-birth-plan

 

 

  1. Reveiz L, Gaitan HG, Cuervo LG; Enemas during labour; Cochrane Pregnancy and Childbirth Group; 31 May 2013
  2. Argyridis S; Delayed cord clamping; Journal of Obstetrics, Gynaecology and Reproductive Medicine; November 2017; Volume 27; Issue 11; Pages 352-353
  3. Crenshaw JT; Healthy Birth Practice #6: Keep Mother and Baby Together – It’s Best for Mother, Baby and Breastfeeding; J Perinat Educ; 2014 Fall; 23(4): 211-217

** Photo credits to Pixabay and Mercury Press (Emma Jean Photography)

2 thoughts on “Choices, choices… the Birth Plan (Part 2)

  1. Thank you for sharing, Nicke 😉 All the choices can be so overwhelming and it helps to know what your options are and give it some thought ahead of time!

    I also think there should be a part 3 😉 would love to hear a bit more of your personal experience – especially being on the receiving side of medical care and what you learned from not getting a NVD as you hoped 😉

    Liked by 1 person

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