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)

Why NVD is best for baby… (Part 1)

“There is a secret in our culture, and it’s not that birth is painful. It’s that women are strong.” ~ Laura Stavoe Harm

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At about 28weeks gestation our gynecologist completed a slip of paper for us to register at the hospital. What seems like an inconsequential tick on paper can actually be a nightmare-type-decision to make. We had to specify whether I would like to deliver my baby via Normal Vaginal Delivery (NVD) or Caesarian Section (C-section).

I have lived through many very traumatic births during my student and intern-years. I treated multiple babies that barely survived (or did not) the complications of NVD during my pediatric residency years, so this decision was not as easy as I had initially thought.  I knew that a NVD is the best for baby.  I had to make a mind-shift about what the birth of a baby could be like, should be like, and keep my fears trampled underneath the grace and love of God.

“Nothing in life is to be feared; it is only to be understood. Now is the time to understand more so that we may fear less.” – Marie Curie

In South Africa we have one of the highest C-section rates in the world! Nearly 70% of babies are born via C-section. In comparison about 30% of women in the UK and the US have C-sections. I find it so sad! Have we started to make decisions only based on our own comfort?

Before and during my pregnancy journey I had the privilege of talking to multiple strong, passionate women about childbirth. My decision was made: I was so excited to birth this baby the “natural” way. When faced with any mountain in my life I have always stayed positive and motivated by thinking “if others could do this, so can I”. And with childbirth, literally millions of women have done it before me! During my pregnancy I attended ante-natal classes, read books and prayed, and I was SO excited to see how strong my body could be. To live through the pain and be the WOMAN God made me. I had confidence in my body and was ready to embrace this experience.

While studying the physiology of the baby changing from a totally dependent fetus into a self-sufficient baby I realised once again that NVD is the best for baby. I would like to share a few facts with you, get ready to be amazed at how perfect every detail was created to be!

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  • As your pregnancy approaches term, there are many changes in the baby to prepare for survival outside the uterus. This is why it is so traumatic for a baby to be born prematurely. Their brain, heart, lungs, gut and skin are just not ready. It does not mean they cannot survive (I have seen many very tiny preemies who are warriors and who live against all the odds), it is just a much more bumpy road for them and their parents. It is thus vital that you are very certain about your gestation (you do not want to get an induction or c/section too early).
  • A few days before you go into labour a beautiful dance of hormones start that is vital for you and your baby both during labour and in the first few days of baby’s life.  One specific hormone (prostaglandin) prepares the cervix for opening, but will also ensure that the main “shortcut” that the blood was taking between the heart and lungs in-utero will close once baby is born. (Your baby does not use his lungs in-utero as he gets all his oxygen from you, and the blood thus bypasses the lungs through the “Ductus Arteriosus”. It is important that it closes after birth so that more blood will flow through the lungs to collect oxygen).
  • A few hours before labour starts, the Cortisol (stress hormone) levels of the baby increases. In-utero your baby’s lungs are full of fluid (this is important for the stretching and development of the lungs) that is produced and secreted by the lining of the alveoli (the small balloons in the lungs). When Cortisol increases, this production decreases, and the lining actually starts to re-absorb some of the fluid. The baby will also start to exhale some of the fluid. As the baby moves through the birth canal, even more fluid is expelled out of the airways due to the pressure on the chest. The lungs are thus already much drier, which makes it easier for baby to take his first breath! 1
  • Cortisol also helps the liver to produce Glycogen which helps to mobilize glucose during the first days when baby does not feed well yet. The thyroid hormones are activated by Cortisol, which in turn helps to keep your baby warm outside of the womb.2
  • One of the latest buzz words is the “microbiome”, the organisms that live on your skin and in your gut that has recently been found to play a big part in allergies, immunological diseases, obesity, diabetes and cardiac diseases. Your microbiome is formed from birth and how you are born plays a big role. The first organisms to inhabit you can either be the good flora from mom’s birth canal, or the hospital bugs from the theatre surroundings.  The infant’s microbiome is also influenced by antibiotics and formula feeding, all of which your baby has a higher risk for after a C-Section. 3 (I will tell you more about the microbiome in a future post.)
  • Once baby is born via NVD he can be put directly on your chest where he feels safe, stays warm and can look you directly in the eyes. The bonding / breastfeeding can start without any interruptions, and this makes the rest of the journey so much easier.

 

How amazingly did God design us? We really are fearfully and wonderfully made! However, with all of that said, we live in an imperfect world where things go wrong and many moms and babies have died over the centuries during childbirth. So yes, there is definitely a place for Caesarean Sections. It could be planned due to mommy- or baby-issues, or it could be an emergency surgery if things go wrong during labour. If you have to have a C-Section you can still give many of the benefits to your baby by waiting until you go into labour spontaneously.

I hope I could help you with the big decision… it is so important to make a fully informed decision, and not to be pressured into an option because of the comfort of the doctor, or the opinions of your friends, or because of ungrounded fears. You are a woman, your body was built to do this! And if things go wrong, thank goodness for the evolution of medicine to help us!

In my next post I will tell you all about my own birth experience, because we do not always get exactly what we want!

“The birth of a child is the ultimate perfection of human love.” ~Dr. Grantly Dick-Read, 1953

 

* Photo by Desi McCarthy Photographic art

References

  1. Wyllie,J; Applied physiology of newborn resuscitation; Current Paediatrics Volume 16, Issue 6; Nov 2006; 379-385
  2. Liggins GC; The role of cortisol in preparing the fetus for birth. Reprod Fertil Dev.1994;6(2):141-50.
  3. Noel T et al; The infant microbiome development: mom matters; Trends in Molecular Medicine; Volume 21; Issue 2; Febr 2015; 109-117