Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Sign the Petition! Demand Accurate Reporting of ALL Birth Options!! October 1, 2009

Dear Readers,

 

Choices in Childbirth, a NYC based non-for-profit advocacy group whose mission is to improve maternity care by providing the public, especially childbearing women and their families, with the information necessary to make fully informed decisions relating to how, where, and with whom they will give birth, has recently created a petition in response to NBC’s Today Show segment entitled “The Perils of Midwifery” (later changed to “The Perils of Homebirth” and even later taken off the internet all together!!) speaking out against the segment’s inaccurate, fear mongering, sensationalized, and outrageous portrayal of midwife-attended homebirth, of midwives in general, and of the families who chose this option. 

 

Below is the letter attached to the petition.  If you feel the same way please consider SIGNING.   On October 9th, the last day of National Midwifery week, representatives from Choices in Childbirth will deliver the letter and petition to The Today Show at NBC’s headquarters in NYC.  The goal is to get at least 5,000 signatures by October 9th and as of today, the petition already has 3,653!!!

 

Thank you,

 

NursingBirth

 

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Petition Letter:

 

Dear NBC Producers,

    We, the undersigned, collectively voice our deepest concerns over what we believe has been a gross misrepresentation both of midwife-attended homebirth and of the women who choose this option.

 

While empathizing deeply with the McKenzie family and their loss, we are shocked at the way in which NBC’s “Today Show” chose to portray homebirth as dangerous while choosing to ignore ample medical research that demonstrates its safety in the US and in other developed countries around the world. Not only did the producers of the Today Show ignore journalistic due diligence, they also chose to ignore basic rules of fairness by repeatedly citing doctors and the trade union that represents them while denying midwives and their proponents a voice.   This is simply irresponsible journalism, and misleading to your viewers. We expect more from such a well-respected program.

    We stand in support of families who choose to birth their babies at home with a skilled midwife, not for hedonistic reasons, as the Today Show segment so insultingly suggests, but because they truly believe that it is the best option for themselves and their babies. We support women who choose home birth, who are not following a fad, but who are following their hearts and their informed minds to seek a birth that is both safe and healthy. Far from being a recent trend or fashion, midwifery draws on a continuum of knowledge and experience that goes back many centuries. Midwives are well-trained professionals who specialize in normal birth and provide outcomes that are often superior to obstetrician-attended birth. To suggest otherwise is deeply offensive.
   

The Today Show missed an opportunity to discuss why, despite its near universal reliance on hospital-based, physician-attended obstetric care in birth, America has one of the worst infant mortality rates in the developed world. It missed an opportunity to discuss the reasons why highly educated, thoughtful and responsible women are choosing a home birth with a qualified midwife as an alternative to a hospital birth- an option that other countries have proven again and again costs less money, necessitates fewer c-sections, and provides better outcomes for mothers and babies than our system. The Today Show missed an opportunity to ask why the United States spent $86 billion in 2006 on maternity care that left the US with one of the worst infant mortality rates in the developed world and left women and their families asking for more choices in their maternity care.
   

Although every infant death is a terrible tragedy, the real scandal about birth in the US lies not in the death of the McKenzie’s baby alone, but in the fact that 13.6 African American babies die for every thousand live births; an infant mortality rate that is triple that of Denmark or South Korea. What is truly shocking is not that a fraction of women choose home birth, but that our international infant mortality ranking has worsened from 12th in the world in 1960 to 29th in 2004 during the same period that our rates of medical intervention in birth have gone up exponentially- Cesarean section rates alone have more than tripled. 
   

We are passionate about childbirth issues because we know that, like the rest of the healthcare system in this country, there is much room for improvement.  Drawing battle lines between midwives and doctors and terrorizing the public unnecessarily are hardly constructive means to this end. We call on the Today Show to provide the public with the whole story regarding the evidence and viewpoints supporting the choice of midwife-assisted home birth.

 

We call on the Today Show to choose responsible journalism.

 

 

***SIGN THE PETITION***

 

 

No Doula in the Name of Privacy? Oh Come On! September 26, 2009

This comment was recently left by a reader named Jessica under one of my older posts.  Since I read every comment that is posted on my blog I happened to stumble upon it this morning.  When I read it I couldn’t help but think “I Hear Ya Sister!!!”and felt that it was so well stated that it needed to be its own post!  I know that there are quite a few doulas out there that read my blog and I just wanted to take this opportunity and give a shout out to them all and say thank you for all you try to do to educate women before they get to me on L&D!  Unfortunately, they don’t all listen but I hope you know that there is at least one L&D nurse out there that appreciates your efforts, both before and during labor!!!

 

For all you expecting moms out there please check out DONA’s website to learn a bit more about what a doula is, how you can find one, the effects a doula can have on your birth outcome and experience, and how a doula can advocate for you!

 

And just for the record, there is NOTHING private about a hospital birth experience.  Even in the most well meaning hospitals with the most well meaning birth attendant and the most well meaning nurse(s).  Albeit some women’s hospital births might be more private than others and I personally have had the priviledge to be a part of a few totally amazing hospital births.  But to not hire a doula for your hospital birth (especially at a university hospital!) because you want a “private” experience is a very VERY naive and misguided idea!  I am not saying that to hurt anyone’s feelings and I am certainly not judging anyone out there who decided not to hire a doula for one reason or another.  I am just telling it like it is.  Some food for thought…

 

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Hi NursingBirth!

I am a certifying doula and have recently had an interview with a perspective client. She is 36wks pregnant with her first. She was strongly considering a doula, but everyone else in her family was on the fence, and pushing a “private” birth experience. However, they are planning a delivery at a university hospital, she has yet to see the same health care provider throughout her prenatal care, she has no idea which one will be at the birth, or if it will even be someone she has met. They are planning a natural birth. She assured me that the hospital she is birthing at offers a multitude of birth options, including water birth, birth ball, position changes, etc… and the childbirth education from the hospital has given them confidence in their ability to get what they want from this birth. After much “deliberation” they decided that they were not going to hire a doula, based solely on their confidence in the hospital to give them what they want, and their desire for privacy. While I can completely respect their privacy request, I fail to see how birthing in a university hospital will give her much if any privacy…AND if she doesn’t even know who will be her health care provider at the birth…how is she confident that the hospital will give her what she needs? I wish there was some way to help open her naive eyes to the reality of birth in hospitals today. Her chances of getting to work with a mother friendly doc that understands and respects natural birth have got to be low! Reading your blog was comforting (because I know there are others who struggle with this) and depressing(because we have to struggle with this). I don’t want to have her hire me for her VBAC next time around. I want her to have the birth she desires now. I realize there isn’t much I can do for her at this point, which is why I am here, leaving my frustration with a bunch of like minded individuals. I am hoping things will go well for her and in the mean time, I’ve let her know that I am and will be available until the baby is born. just in case. Thanks for the space to rant.

  

Sincerely,

Jessica

  

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Jessica, you can rant here anytime!!!  I Hear Ya Sister!  Loud and clear!!

 

And now I leave you with one of my FAVORITE Monty Python skits of all time.  I have seen it a million times but it is still as hilarious (and eerily true) each time I see it.  Notice how the doctor invites in an army of people to watch.  It often feels like that where I work no matter what I do!!!

 

 

Seattle Birth Photographer “Honored” To Photograph Birth September 9, 2009

Dear NursingBirth,

 

I came across your blog and I thought you might be interested in seeing the images from the recent home birth I photographed.  I am a professional photographer,  mostly I do portraiture work with mothers and newborns but occasionally I photograph birth.  I love the change of pace and the adrenaline rush : )   I am also a natural birth advocate and gave birth to my son at with a midwife at a free standing birth center.  We are planning to have our next baby at home.  The popularity of birth photography has increased dramatically over the last year – I think signaling a shift in how we think about birth.

 

Here is a link to my blog post about the birth
http://emilyweaverbrownphoto.com/blog/2009/09/birth-photography/home-birth-seattle-birth-photographer/

 

There is a slideshow with all the photos set to music linked at the bottom of the page.  Just scroll down and click the link that says >>The Birth of Waldron Dain Peterson<<.  Take care and happy blogging!

 
Sincerely,

 

Emily Weaver Brown

www.emilyweaverbrownphoto.com

 

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Dear Emily,

 

Your pictures are gorgeous!!!  Makes me want to move to Seattle and have a baby!!  Good luck with your home birth plans and have fun trying for #2!!!  Thank you for the link to your website as I know many of my readers love to read other women’s empowering birth stories and while a photo slideshow isn’t technically a birth story, a picture is worth a thousand words!!

 

While watching Waldron’s birthday slideshow I was so overcome with positive emotions like happiness, awe, empowerment, and especially a deep respect for our strength and abilities as women!  Some of my favorite pictures include:  (1) The one where the mother is bending over in the hallway, her husband is bracing her and her sister is rubbing her back.  I love how you can see the “family picture” in the background because you know that in just a short while they will have a new addition to the family!!,  (2)  The one where the mother is bending at her waist and then looks up with a smile.  She is either in transition or pushing but she still has a smile on her face, knowing what all of this hard work is for!!,  (3)  The “Moment” Shot where mom holds her baby for the first time and looks up at her husband with a face that says “I DID IT!” and “I LOVE YOU!”,  (4)  When “big sister” leans over the tub and is looking up like “Is that my brother!?!”,  and finally (5)  The whole family sitting on the bed together, happy and healthy!!

 

Keep up the good work!!

 

All My Best,

 

NursingBirth

 

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Excerpt from Birth Photography at http://emilyweaverbrownphoto.com/blog/birth-photography/

 

“The birth of a child is one of the most significant and beautiful events in life.  I am always honored when I am invited by families into these very intimate moments to document their memories.  The first moments of life are so precious…the first breath, the first cry, the first time your baby looks into your eyes.  I love documenting these moments for my clients and I know that they will treasure them forever.  The birth of a child is one of the biggest defining moments in your life and you will not regret having it photographed.  Printed images are stronger than memory can ever be and you will be so thankful that you have them to hold onto for your children, your grandchildren, and their children.”

 

In the blog section of her website, photographer Emily Weaver Brown’s writes about why she loves  photographing births, how she met her client Jessica, and why Jessica chose a home birth.  Check out her original post for more information about how Jessica’s labor went!

 

“I loved photographing this birth for many reasons. It’s so difficult to be just an observer, and though I strive to photograph the birth as though I wasn’t even in the room I still get pulled in. Before a birth I meet with my client’s to discuss their wishes and get to know them. (I don’t want to be a complete stranger showing up one of life’s most intimate and raw experiences.) This meeting and the subsequent emails usually leads to friendship and before long I know all about their previous birth stories and all of their hopes and dreams for the birth that I will photograph. So I can’t help but cheer on the moms while they work hard to birth their babies. With Jessica it was no different. Jessica is actually a former client of mine who is now also a professional photographer. I know that she really values photography as an art form and that having the birth of her second child documented in photographs was really important to her.  But even more than that, I knew that the birth of Jessica’s oldest child did not go as she had hoped. She ended up with a healthy baby girl but also a lot of interventions that she didn’t want and it made her feel like she had failed. I had no doubt in my mind that Jessica would be able to birth her second baby at home naturally as she had planed but I so wanted it to go perfectly for her so that she would have a sense of redemption over all that happened during the birth of her daughter.”

 

Please visit http://emilyweaverbrownphoto.com/blog/birth-photography/ and scroll down to the bottom of the page to see two more birth photography slideshows, both of which are hospital births.  Just curious, did any of you feel differently when watching the home birth slideshow vs. the hospital birth slide shows??  Why?

 

The WORST Idea Since Routine Continuous Fetal Monitoring for Low Risk Mothers September 7, 2009

My husband (being the techie cutie that he is) reads CNET news, a website about computers, the Internet, and groundbreaking technology as part of his morning routine.  The other day, while I was enjoying my Kashi cereal and checking out the latest blog posts on my Google Reader, my husband hollered over to me from his office and said,“Hey Melissa, have you heard of LaborPro?”  Until that moment I was having a pretty good Sunday morning.  I mean, I woke up refreshed and smiling, the sun was shining, and I was looking forward to what I felt was going to be a “good” day at work.  But my attitude quickly turned from happy-go-lucky to blinding rage when he uttered those eight little words. 

(Okay, okay, so I think I am being a bit dramatic.  Maybe blinding rage is a bit strong.  But I was pretty upset!!)

So what is LaborPro and why did it put me into such a tizzy you ask?  According to Trig Medical’s website (the Israeli company that is developing and recently won a Frost & Sullivan Technology Innovation of the Year Award for this GARBAGE), LaborPro is “a novel labor monitoring system that using ultrasound imaging measures continuously and objectively fetal position, presentation and station along with cervical dilatation. LaborPro quantitatively assesses and records vital labor parameters in real-time to enable obstetricians to make informed and accurate decisions throughout the labor process to improve both the quality and cost of obstetric care.”

 

 

 

The website lists LaborPro’s capabilities as able to:  

  • Determine continuous station & position of fetal head by ultrasound imaging,
  • Provide radiation-free pelvimetry & birth canal modeling.
  • Perform one-step computerized “non-invasive” trans-vaginal digital examination (I’ll touch on that in moment)
  • Determine intermittent or continuous accurate measurement of cervical dilatation
  • Record comprehensive labor data recording

 

It also toutes its “unique benefits” as the following: 

  • Non-invasive, precise measurement of station & position
  • Improves assessment of non-progressive labor
  • Supports decision-making before operative delivery
  • User friendly, on-screen display of all labor parameters
  • Enhances patient comfort and sense of security

 

Okay okay okay….Just HOW does it do this you ask?  Well it’s EASY!  (*rolling eyes*)  Well according to the website’s one mintute educational video (check it out here, it’s worth it).  FIRST you have to place “just four little electrodes” externally on the mother’s pelvis in order to continuously assess fetal station and position and also enables the user to “recognize CPD early”.  SECOND you just have to clip (or screw) “just a few position sensors” to the woman’s cervix to accurately and continuously measure cervical dilation.  And THIRD you just have to screw “just a small little electrode” into the baby’s head.

Fetal Scalp Electrode  (notice the little corkscrew tip)

Close up of a fetal scalp electrode, or FSE (notice the little corkscrew tip, that screws into the baby's scalp.)

According to Frost & Sullivan, the organization that awarded Trig Medical for the LaborPro technology writes, “The LaborPro is staff and mother-friendly and requires only basic training in ultrasound usage, obviating the need for an obstetric ultrasound expert,” adds Ms. Prabakar. “Moreover, the technology employs non-invasive, radiation-free pelvimetry as well as a single-step computerised digital examination. All labor progress tracking data including the fetal heart rate monitor are integrated in the LaborPro display and automatically recorded by the system, which helps reduce staff workload.”

 

Oh great!  We only need “basic ultrasound skills” to work it!  (*double eye rolling*)  Here’s a novel idea!  How about every hospital (including my own) in the United States that has a L&D floor actually provide labor support training to their nurses instead!  That would go a lot farther for us than freaking ultrasound skills!! 

(Just for the record, my hospital does NOT include labor support training as part of orientation and we are NOT alone.  At my hospital, if you want to learn how to provide labor support you have to seek out other learning opportunites on your own, like I had to.  But we do get extensive training on how to work and interpret the fetal monitor.  Oh and about 1/3 of our three month orientation is dedicated to learning how to care for a patient who is being induced.  In fact, I had to teach myself how to do intermittent auscultation and hence, I am one of the only nurses that I work with that isn’t “scared” of intermittent auscultation and will actually advocate for it!) 

The most terrifying thing is that although at this time LaborPro is not available in the United States (Oh Hallelujah!!!) there is another company called Barnev based out of Andover, MA that has developed an almost identical product they call BirthTrack™ Continuous Labor Monitoring System which they describe as “a revolutionary continuous labor monitoring technology that provides obstetric caregivers invaluable, precise, objective, real-time information about the physical progress of labor. The BirthTrack System provides tools for a more informed decision making process through which hospitals can reduce the risks and costs of childbirth and assure the safety and comfort of mothers-to-be and their babies.”  I remember hearing about this product a couple of years ago when it was still in “development.”  Well guess what?!  Development is over!!  Marketing here we come!!  (GAG me!)

 

So now there are at least TWO companies that are actively marketing this HORRIFIC, INHUMANE, and OUTRAGEOUS product.  Just wait  until LaborPro makes it to the United States (which according to their website they are actively persuing).  Then they will probably start to compete with eachother!  Now now only will labor & delivery wards around the country have to deal with Similac and Enfamil representatives competing for our money and attention in house (which already makes me sick to my stomach), but now I have to worry about this??!!  THIS IS TERRIFYING!!!

 

I’m telling you right now, I will UP AND QUIT my job and never look back if either LaborPro or BirthTrack EVER  appears in even just one, JUST ONE of my hospital’s labor rooms.  QUIT ON THE SPOT!  And I will make a Hollywood exit too!  A HUGE scene!!!  Hooting and hollering!  You just wait!!  LOL!  As if our moms aren’t already strapped down enough with the often unnecessary and sometimes downright harmful technology we already have.  This is just TOO MUCH TO BEAR!

I have taken care of MANY a laboring woman (often as a result of an induction, mind you) who are connected to:

 (1)  an IV line with IV fluids and Pitocin running through,

(2) an electronic fetal monitor to measure fetal heart rate,

(3) a tocodransducer to measure contraction pattern

(OR a fetal scalp electrode to measure fetal heart rate and an intrauterine pressure catheter to measure contraction frequency and strength),

4) an epidural catheter in the back giving a continuous flow of anethetic and narcotic medications into the spinal column,

(5) a foley catheter in the bladder since it is very rare that one can empty their bladder with an epidural,

(6)  a pulse oximeter to continuously measure blood oxygen level (necessitated by the epidural),

(7) a blood pressure cuff to record one’s blood pressure every 15 minutes since an epidural can drop your blood pressure dangerously low, and finally

(8) if the baby has shown any signs of distress, an oxygen mask for your face!

 

Well I have a message for both Trig Medical and Barnev, LABORING WOMEN DO NOT NEED ANY MORE THINGS SHOVED UP THIER VAGINA!!!!  And furthermore,  CLIPING ANYTHING TO A WOMAN’S CERVIX OR SCREWING ANYTHING INTO A BABY’S HEAD DOES NOT COUNT AS “NON-INVASIVE”!!!  LABORING WOMEN AND BABIES ARE NOT ROBOTS THAT DON’T FEEL ANY PAIN OR DISCOMFORT!!!!  RESEARCH HAS SHOWN TIME AND TIME AGAIN THAT LESS IS MORE WHEN IT COMES TO LABOR FOR HEALTHY MOMS AND BABIES!!!  CONTINUITY OF CARE IS MUCH MORE EFFECTIVE, LESS PAINFUL, LESS INVASIVE THAN ANY “COMPUTERIZED FINGER.”

Furthermore, LaborPro and BirthTrack are a slap in the face to every labor and delivery nurse that cares about giving appropriate, effective, competent, physiological, and compassionate care to childbearing families.   Unfortunately I would bet my hard earned money that at least half of the doctors I currently work with would think that this is a good idea. 

Okay, okay, now that I am all riled up again I have to go to work  :(   Please check out Rixa’s post over at Stand and Deliver about BirthTrack.  It was written about a year ago and I stumbled upon it when I was searching for a picture of a fetal scalp electrode!!

Change has GOT to come!  It’s GOT to!  For the health and wellness of our mothers and babies!!  Remember ladies, YOU actually have more power than ME and all the other L&D nurses out there!!  That’s right!  If you do not hire birth attendants that do not support evidenced based medicine and physiological birth and do not patronize hospitals that do not support a family-centered approach to maternity care then and only then will they start to listen.  You know why?  Because when the customers aren’t comin’, it hits them where it hurts… in their WALLET!!

 

NursingBirth makes TOP 50 Best Blogs List!!!

Filed under: In The News,Just For Fun — NursingBirth @ 8:28 AM
Tags: , , , ,

Good news everyone!!!  (Any Futurama fans out there?  Anyone?  Haha!)

 

Last month NursingBirth was included in NursingDegree.net’s 50 Best Blogs for Neonatal Nurses!  I am in good company too as some of my favorite blogs made the list including: At Your Cervix, Stork Stories, Birthing Beautiful Ideas, Stand and Deliver, The Unnecesarean, Our Bodies Our Blog, Pushed Birth, Enjoy Birth Blog, Woman to Woman Childbirth Education, and Science and Sensibility just to name a few!  Check out my blog roll to the right for links to any of these blogs!

 

50 Best Blogs for Neonatal Nurses

 

The cool thing is that while I don’t think the numbers actually mean anything, I was ranked #17 which happens to be my FAVORITE number!  (That’s right, I have a favorite number.  And a favorite color too!  ….it’s purple if you were wondering!!) 

 

Thanks to all my readers for reading!!  I certainly wouldn’t have made the list if it wasn’t for you!!!  Last time I checked I had 84,552 hits to my blog since I started in February.  WOW!!!!  You all amaze me on a daily basis!!

 

All My Best,

 

Melissa

aka “NursingBirth”

 

Believe! A Tear-Jerkin’ Inspirational Midwifery Ad September 4, 2009

The other day I stumbled upon a YouTube video advertisement for a midwife in Albuquerque, New Mexico via a friend’s facebook page.  You’d think that I must get sick of watching videos of births and babies since I am, after all, a labor and delivery nurse but alas, I am a true birth junkie and just can’t get enough!!  I don’t know anything about the midwife in the movie but I have to say that not only do I BELIEVE everything she quotes in the video but I wish that every health care professional that provides care for childbearing familes felt and practiced the same way as she does! 

 

I believe that every mother DESERVES a midwife and that every baby DESERVES to be born into gentle hands!

 

 

 

The following is from Citizens for Midwifery:

 

The Midwives Model of Care

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention

 

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

 

Natural VBAC Hospital Birth: One Reader’s Empowering Experience September 3, 2009

Dear NursingBirth,

  

I wanted to share with you my birth story.  I thought since I did an all natural VBAC, it might be something you would want to share.  Thanks for the posts.  YOUR blog helped me get though my second birth! Your stories of inspiration that you have are amazing, and just your general  tone.  The fact that there are nurses out there like you made me have the confidence to trust the nurse with me, but also not be totally trustworthy. It helped me realize that I am the final decision maker.

 

In preparing for my VBAC I read your Injustice in Maternity Care Series and your story “I Needed to Know My Body Could Do It!”: A VBAC Story over and over.  I also read Active Birth by Janet Balaskas which I think helped me a lot, and with our first daughter (my c-section) we took Bradley classes so we both thought we were so prepared.  This time I had my mom, a friend and my husband as my birth team and we took control, which reading about it from your point of view gave me the courage to do so!!!


Thanks for all you do!  I love the blog!

 

Sincerely,

Katie C.

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Dear Katie C.,

 

I would LOVE to reprint it and am honored that you would even send it to me!  Thank you for reading and THANK YOU for being such an awesome and empowered woman and mother!!  It is women like you that are an inspiration to ME!

 

I just love everything about your birth story!!  First off, CONGRATULATIONS on your VBAC and on the birth of your daughter!!  What a wonderful time for you and your family!  It also must be really nice to NOT have to recover from major abdominal surgery and take care of a newborn and 3 year old!  Second, one HUGE pat on the back to you for choosing to go back home during your initial trip to the hospital when you were found to be 2 centimeters.  That took A LOT of courage and trust in your body and your abilities, especially since the on-call doctor was pressuring you to stay.   And I completely agree with you; choosing to labor at home until you were more “active” most definitely had a significant impact on your successful unmedicated VBAC.  Thirdly, KUDOS to you for being an active participant in your birth!!  It no doubt helped your labor progress to be upright and moving during your labor!  I am so proud of you!!  While it’s true that no one can really “plan” their birth, you did everything you absolutely could to stack the cards in your favor!!  Yay!  Yay!  Yay!!!

 

Thank you again for reading and sharing!

 

All My Best,

NursingBirth

 

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Katie C’s VBAC Birth Story

College Station, TX

 

Starting on Friday, May 22, I started having very mild but consistent contractions at 5 minutes apart at lunch time.  The rest of the day they came and went, some getting farther apart but stronger slowly as the day went on.  I also had a lot of brownish and pinkish spotting.  Figured that maybe I was in very early labor.  Did my usually stuff that day and went to bed about 9:00pm, just in case this was it. Saturday morning I woke up about 1:00am with contractions strong enough that I couldn’t sleep.  I got up and ate some peanut butter toast and drank a bunch of water and tried to go back to sleep.  Contractions were about 7 minutes apart but stronger and enough so that I was having a hard time sleeping.  Likely because I was excited.  Got up and took a bath but that didn’t help.  Tried to go back to sleep.  Got up and ate 2 huge bowls of apple cinnamon cheerios.  Finally fell back asleep about 4:30 am.  Woke up at 7am and was just very tired.  Contractions were completely bearable but figured that we were starting (maybe) and so I had Madison go to Jaxson’s (and George and Amie) house for a few hours while my mom and I stayed home to see if anything would progress.

 

Lamaze International's Tips for a Normal Birth #5:  Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.

Lamaze International's Tips for a Normal Birth #5: Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.

 

As the day went on they got stronger but not really closer.  I called L&D and she said 3-5 minutes apart, not able to talk through them, so I just figured I would wait.  Wasn’t ready to go to the hospital yet anyway.  I called Meredith (a friend), who was working about 2 hours away, to let her know that she might have to come back that night. We decided that she would come back that night instead of waiting for a call at 2:00 am and have to drive then.

 

Lamaze International's Tips for a Normal Birth #6: Think carefully about who you want to give you support during labor and birth. Consider hiring a doula or other professional labor support person to give you, your partner, and any other support person who's with you, continuous emotional and physical support.

Lamaze International's Tips for a Normal Birth #6: Think carefully about who you want to give you support during labor and birth. Consider hiring a doula or other professional labor support person to give you, your partner, and any other support person who's with you, continuous emotional and physical support.

 

My back started hurting and I called another friend of mine who does massage. She wanted me to come to her studio, but I really didn’t want to leave the house, so I decided to stay home. Rob called his mom and went to meet her and take Madison to her house so that we wouldn’t have here with us. By the time Rob got back, about 6:30pm, contractions were 5 minutes apart and getting stronger. I could still talk and walk, but it took effort. I called Meredith back and she said she was on her way to my house. At 7:30pm I started to panic.  The contractions seemed very strong to me, I was concentrating on them and they were consistently 5 minutes apart, so we decided to head to the hospital.  I called Meredith and told her to meet us there.  Once I got there, my contractions stopped pretty much, likely due to my nerves.  They got me into a room and set and checked me and I was 2cm and 80% effaced.  I was devastated!  I told them I wanted to go home.  The doctor on call was leery of that since I was a VBAC and they said they would really like me to stay but I refused and we packed up and came home.  (In hind site, this was the reason it all worked out!! Best Decision!!!)

 

 

I went to bed disappointed and tired, since I had been contracting for nearly 30 hours at this point and I just wanted to either be in labor or not.  I ate a snack and went to bed.  At about 3:00am I was woken by very strong contractions, 7 minutes apart, strong enough that I would flip to hands and knees in bed and rock and moan through them. Rob decided I was in labor, though I was still not sure!  LOL!  I started just sleeping in between them.  (Must have been some natural coping mechanism, since I did it until about 6:30 am!)  We started timing for real at 7:00am.  Meredith came over and she helped my mom.  My mom would time the start to start and Meredith would time the duration. They were about 5 minutes apart with about 30 seconds of what I would call pain.  The actual contraction would last about a min or longer.

 

 

As the morning went on, I could no longer do anything during the contractions except hang onto Rob and moan.  Contractions got stronger and longer.  They were 4-5 minutes apart, and lasting (pain) about 70 seconds.  During one contraction while I was hanging on to Rob I had a huge rushing feeling, almost like a pushing sensation (or so I thought) so I just said, “We have to go NOW!” We packed up and went up to the hospital.  I had 4 contractions in the car, which were the hardest ones!  [At that point I preferred to be standing during them, since sitting or lying down was excruciating.] We got back to the hospital and I was moaning and hanging on Rob and everyone in the ER was looking at me funny.  It made me laugh.  They probably all thought I was crazy!  

 

 

I went back up to L&D and they put me in the same room and got me all set up again.  The nurse said, “We were waiting for you!” I was so nervous that I would only be 3 centimeters and they wouldn’t let me go!  She checked me (about 11:00am) and I was 6cm, fully effaced!!!  I cried when she told me, I was so happy!!  Rob, Mom and Meredith clapped!  LOL!  They told me I had to stay.  I said that was fine!  They put me on the monitors and said I would be able to get off of them, but then the Dr. on call said “NO!” so I was worried I would be stuck in bed.  The nurse said, “You can move as much as you want, so long as the cord is long enough,” so I got out of bed and stood next to it for most of the day.  We said I didn’t want to be checked again except by the doctor or if they thought I was complete (i.e. pushing) so when the doctor got there at 1:00pm she checked me and I was a stretch 8!! I was still concerned that it wasn’t going to happen, but everyone else was excited.

 

Lamaze International's Tip #4 for a Normal Birth: Plan to move around freely during labor. You'll be more comfortable, your labor will progress more quickly, and your baby will move through the birth canal more easily if you stay upright and respond to the pain of your labor by changing positions. Try rocking, straddling a chair, lunging, walking and slow dancing.

Lamaze International's Tip #4 for a Normal Birth: Plan to move around freely during labor. You'll be more comfortable, your labor will progress more quickly, and your baby will move through the birth canal more easily if you stay upright and respond to the pain of your labor by changing positions. Try rocking, straddling a chair, lunging, walking and slow dancing.

 

Transition for me was the second hardest thing I have ever done.  I refused pitocin (which they really didn’t push since I was a VBAC) and did not let them break my water. I stayed at a 9 centimeters for almost 3 hours, then at 9 ½ centimeters for a while until I begged them to stretch my cervix!!  LOL!  I was on the bed with the back raised on my hands and knees and suddenly had a contraction that felt better when I kinda of pushed at it. My mom went to get the nurse and she tried to check me like that but said I really needed to lie down.  I said I didn’t want to push lying down and she said, “Sweetie you can push however you want, but I need to make darn sure you are complete so you don’t swell.” I knew that was true so I got down and she checked me and then had the doctor come in and doctor said, “I’d call that complete!” I was so freaking happy! However I was also exhausted and once I was lying down, though I was hurting, I just couldn’t get back up again.  They broke my water sometime in there.  [I think it was earlier when I was at a 9 ½ centimeters but I can't remember.]

 

 

The first few pushes I really thought I was doing it but I think the contractions were just not strong enough.  I actually asked the doctor how far down Hana had to be to use the vacuum!  I was exhausted!  The doctor said that she wasn’t going to use the vacuum, so I was just going to have to push!  I started pushing about 4:45 pm.  She would come down (once I finally figured out just how freaking hard you have to push!!) and then scoot back in.  They explained to me that a little bit of pitocin would help to bring the contractions a little closer together, so I would be more effective in pushing, since I was having over a minute between them and Hana would just scoot back in.  I finally agreed to it at about 5:45pm.  The started it at about 6pm.  The doctor suggested a pudendal block, in case I needed an episiotomy (which while I wanted a natural tear, I wasn’t against at that point and I never thought I would come through it with no tear or cut).  I even got a mirror to see my progress, and knew right then that something was going to have to give! I made them put the mirror away!

 

 

I started pushing 5-6 times per contraction and the doctor had been with me the whole time.  She had them break the bed and get all the stuff ready and I asked “Is she coming out this way?” and the doctor laughed and said, “I’m not doing a c-section today!” She asked me also if I wanted to feel Hana’s head, but I just couldn’t bear the thought for some reason.  I kept pushing and finally she said, “Ok, this next one you’re going to have your baby!” and so I hauled back and pushed harder than I thought possible and her head popped out and I kept pushing (oops!!) and Hana was born Sunday May 24th at 6:28pm!!!  It was the most amazing thing in my life and no doubt pushing was the hardest thing in the world.

 

Lamaze International's Tips for a Normal Birth #10: Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping the baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

Lamaze International's Tips for a Normal Birth #10: Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping the baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

 

They gave her to me and after a few minutes (she was breathing but a little blue still) they took her over to rub her and clean her up some.  I was shaking so bad at that point that Rob had to hold her. I ended up with a 4th degree tear… not from her head, but her shoulder popped out when I pushed and the doctor wasn’t expecting it, and so that’s that.  But it isn’t so bad!  She stitched me up, and while it is sore, it beats the hell out of a c-section! Right after she was born I said, “I had a baby out of my vagina!” much to the amusement of the nurses and pretty much everyone in the room! But I can’t tell you just how amazing it was for me. I had been waiting 3 years for that.  And now I have it!  Hana was given back to me and she latched on right away and nursed like a champ for 15 minutes on each side (I was STILL being sewn up!) and finally Rob and Hana went off to the nursery.  To our surprise (and the doctor’s too) she was 8lbs 1 oz, 19 inches long.

 

Happy Birthday Hana!!!!

Happy Birthday Hana!!!!

 

 

I am recovering very well and almost feel like new!!

 

For more information on Vaginal Birth After Cesarean (VBAC) check out the International Cesarean Awareness Network's website at http://www.ican-online.org/

For more information on Vaginal Birth After Cesarean (VBAC) check out the International Cesarean Awareness Network's website at http://www.ican-online.org/

 

Top Ten DOs for Writing Your Birth Plan: Tips from an L&D Nurse, PART 2 July 23, 2009

If you haven’t already, please check out PART 1 of this post:  Writing Your Birth Plan: Tips from an L&D Nurse.  Also, at the end of this post check out a birth plan written and sent to me by one of my blog’s readers who is due any day now!

  

#1    DO keep your birth plan short, simple, and easy to understand (1-2 pages max).

 

“Keep [your birth plan] short.  If you need to spell out a long list of points, you may not be with the right caregiver. If most of the things you want aren’t things your caregiver is used to doing (in which case you don’t need to put them in a birth plan!), you are unlikely to get them. For maximum effectiveness, keep your birth plan to a single page.”

Writing a Birth Plan by findadoula.com

 

#2    DO keep the language of your birth plan assertive and clear.

 

“Remember to keep your language assertive – polite but clearly stating what you want. Use phrases like “I am planning” and “I would like” rather than “if it is ok” or “I would prefer.

 

Be specific.  Avoid words and phrases such as “not unless necessary” or “keep to a minimum.” What one person thinks is “necessary” is not what another does. What one person defines as the minimum is not what the next person does. Instead, use numbers or specific situations, for example: “I am happy to have 20 minutes of electronic monitoring and if all is well then intermittent monitoring every hour for five minutes after that”  or  “I am happy to have a vaginal examination on arrival in hospital and after that every four hours or on my request.”

Writing a Birth Plan by findadoula.com

 

 

“Be sure to be assertive, but not aggressive when discussing your options. Do not allow your caregiver to brush off your decisions or suggest that this is unimportant. At the same time, don’t assume your caregiver [or nurses] will be hostile or uninterested in hearing what you have to say.”

How to write a Birth Plan by birthingnaturally.net

 

#3    DO use your birth plan as an impetus for doing your own personal research about your preferences for childbirth. 

 

One great place to start is at MothersAdvocate.com who, in partnership with Lamaze International and Lamaze’s Six Steps to A Healthy Birth, have created a website that offers FREE, evidenced-based, educational video clips and print materials to educate and inform childbearing families on how to have a safe and healthy birth for both you and your baby.  These extremely well reserached and produced materials are a MUST READ for all expecting moms!!!

 

The introduction handout for these video clips and print-outs entitled Introduction: Birth–As Safe and Healthy As It Can Be reads:

 

“While no one can promise you what kind of birth experience you will have, common sense tells us and research confirms that there are two tried-and-true ways to make birth as safe and healthy as possible:

 

• First, make choices that support and assist your natural ability to give birth.

 

• Second, avoid practices that work against your body’s natural ability, unless there is a good medical reason for them.

 

Lamaze International, the leading childbirth education and advocacy organization, has used recommendations from the World Health Organization to develop the Six Lamaze Healthy Birth Practices that support and assist a woman’s ability to give birth. Years of research have proven that each of these practices increases safety for mothers and babies.

 

The Six Lamaze Healthy Birth Practices are:

 1. Let labor begin on its own.

 

2. Walk, move around, and change positions throughout labor.

 

3. Bring a loved one, friend, or doula for continuous support.

 

4. Avoid interventions that are not medically necessary.

 

5. Avoid giving birth on your back, and follow your body’s urges to push.

 

6. Keep your baby with you—it’s best for you, your baby, and breastfeeding.”

 

The topics of the print materials include: 

Choosing a Care Provider,

Changing Your Care Provider,

If You Have Been Induced,

Maintaining Freedom of Movement,

Positions for Labor,

Finding a Doula,

Creating a Support Team,

Tips for Labor Support People

and even a Birth Planning Worksheet!!

 

 

“We cannot know the day or week labor will begin, how long it will last, exactly how it will feel, how we will react, or the health and sizes of our babies.  What we can do, however, is educate ourselves about the vast array of possibilities and learn which are more likely to occur. We can decide what is ideal and what we will strive for, what are the means to creating the most conducive environment for such a birth, and which people can best help us to attain those birth arrangements. Finally, we can prepare our own bodies and hearts for the process.”

Eyes-Open Childbirth: Writing a Meaningful Plan for a Gentle Birth

by Amy Scott

 

#4    DO include your fears, concerns, and helpful things for the nurse to know.

 

If appropriate, a birth plan can also include a few sentences regarding things you just want the nurse to know about and are important enough to make sure that every shift is aware of.  For example, I once had a patient who wrote the following in her birth plan:

 

“My husband is a type I diabetic and at times suffers from episodes of hypoglycemia where he does not have any warning signs or symptoms.  So if my husband starts to act inappropriate or seems ‘out of it’ or ‘drunk’ please offer him some juice!!  I am afraid that if I am in the throws of labor that I will not notice and this is something that I am very concerned about!”

 

Although this information wasn’t necessarily birth related, as a nurse taking care of this family I found this information EXTREMELY helpful to have in the birth plan!!  By putting it in her birth plan, this mother felt more at ease knowing that she did not have to waste any time worrying about forgetting to tell each new nurse that took care of her.  Having this in her birth plan also served as a reminder for me to pass along this important information when I was giving report to the next shift. 

 

#5    DO review your birth plan with your birth attendant and ask him/her to sign off that he/she read and understands it.

 

“Add a line at the bottom of your birth plan for your doctor or midwife, and other caregivers, to sign your plan under the statement ‘I have read this plan and understand it.’  When caregivers sign your plan, they are only acknowledging to you—on the record- that they have read and understood it.  They do not have to sign and say: ‘I agree.’  No matter what you tell them, they are always responsible for offering you their best judgment and skills as different circumstances arise, and then together you and your caregivers can agree on your care.  This benefits you.  Your birth plan will help you take responsibility for your decisions and ask to be fully informed.”

Creating Your Birth Plan, page 219

By Marsden Wagner & Stephanie Gunning

 

#6    DO make your birth plan personal (don’t just copy paste) and DO make sure that you understand and can elaborate on everything in the birth plan if asked.

 

In my humble opinion (regarding birth plans), there is nothing more frustrating for a nurse (and nothing more detrimental to a nurse’s overall attitude and view of birth plans) than to have a patient just copy and paste a general, “all-purpose” birth plan off the internet, check the boxes that “sound good”, and pass it in to a nurse with her name typed in at the top.  Why?  Because when a nurse (like myself) sits down to review the birth plan with the mother and her labor companions in order to start a dialogue about how the nursing staff can assist in adhering to the birth plan, it will most certainly become obvious to the nurse that the patient has done little to no research on any of her choices making it almost impossible to help the patient follow her birth plan when the birth attendant comes in and wants to do things differently.

 

Let me give you a few examples:

 

Example 1:  One time I had a patient who had the following statement on her birth plan:  “Regarding an episiotomy, I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage.”  Now don’t get me wrong, this statement is great and it is one that I personally believe in and try to promote.  So while reviewing the patient’s birth plan with her and her husband I enthusiastically said the following, “Oh, I see here you have been doing perineal massage and Kegel exercises and wish to avoid an episiotomy.  That is great!  How many weeks have you been doing perineal massage for?”  The patient looked blankly at me and said, “What?  Oh I don’t even know what that is!  My sister just told me that I shouldn’t get an episiotomy so I checked that box.” 

 

Ladies, it is really hard for a nurse to advocate for you if you don’t even understand what you are asking for!

 

Example 2:  Almost all the birth plans I have seen make some statement about pain relief and pain medications.  Again, I think that this is a great thing, especially if the mother was inspired to research all of her pain relief options (both pharmacological and non-pharmacological) and make an informed pain relief plan during the writing of her birth plan.  One time I had a patient who had the following statement in her birth plan, “Regarding pain management, I have studied and understand the types of pain medications available. I will ask for them if I need them.”  Again, I was very enthusiastic when I read this and said to the mother, “I see here that you have done some research on pain management.  Wonderful!  Have you taken any childbirth preparation classes or read any books?”  The mother responded, “What do you mean?”  I replied, “Well you know, like any classes or books by Lamaze, Bradley, Birthing From Within, Hypnobabies, etc.”  The mother responded, “No.”  I then said, “Oh, did you do any research on the internet or talk to anyone?”  To which she replied, “No, not really.  I mean, it’s my first time so I don’t know what to expect.  My best friend just said she hated her epidural so I don’t really want one of those.  Unless , of course, I really need it.  We’re just going to wing it.” 

 

Ummmm, huh?!?!  Now again, don’t get me wrong.  I feel that I am very supportive of mothers that are preparing for a natural, or physiological, childbirth and I often write about the risks and benefits of common obstetrical interventions, including pain medication and epidurals.  But ladies, your nurse can’t be the only one who is advocating for your natural childbirth.  YOU have to be on board too and YOU have to understand your reasons for not wanting pain medication or epidural.  Because if you don’t even know why you don’t want an epidural then the next person who walks into that room who feels differently, be it a nurse or your birth attendant, guess what’s going to happen?!  You’re probably going to agree to anything said nurse/birth attendant tells you you should get, because you don’t know any alternatives.

 

I am not trying to say that taking a certain childbirth preparation class or reading certain books is required for a positive and empowering birth experience.  But some type of research and preparation on the part of the mother and her labor companions/partner is EXTREMEMLY IMPORTANT!!   

 

Now here’s one more example to give you the full perspective.

 

Example 3:  One time I was taking care of a patient who had the following statement in her birth plan: “My husband and I have been preparing for and planning a natural childbirth.  I am very interested in using the Jacuzzi tub for pain relief in labor and have been reading about other drug-free ways to cope with pain.  I am not interested in pain medication or an epidural as I had both with my last baby and had a poor experience with both.   I respectfully request that they not be offered to me.  I have done research and feel that the risks outweigh the benefits.”  When I asked her about it we embarked on a really informative discussion about her last delivery, in which she had persistent numbness in her right leg for 2 months after the epidural as well as a debilitating spinal headache that took required two blood patches and made it difficult for her to nurse or care for her baby during her hospital stay.  She also told me that she did not like the way the IV narcotics made her feel, as she was “seeing things” and generally “very out of it.”  After our conversation I felt confident in advocating for her with her doctor (who often insisted his patients get epidurals) because I knew that if I said anything to the doctor that she would, in a sense, back me up and likewise I would back her up!! 

 

It is so hard when a patient has something in her birth plan like “I don’t want an epidural”, and hence I argue with the doctor about how the patient does not want an epidural, but then when he goes into the room to ask the patient himself, the patient says “Oh well, whatever you think is best doctor!”  It really just makes the nurse look like she is trying to “push her own agenda” when in reality the nurse was just trying to follow the patient’s birth plan!! 

 

One more thing…I don’t want anyone to feel like I am implying that a woman has to “prove” anything to me when I ask questions about her birth plan.  That is NOT the case.  I just know from personal experience how important it is for a woman to understand and agree with everything she herself puts in her birth plan!  Remember, mothers, labor companions, and nurses work best when they are all on the same page and work as a team to facilitate a positive and empowering birth experience!!

 

#7    DO look at examples of great birth plans online to get some ideas.

 

The following is a list of some good places to start. Remember, while these websites provide a wealth of ideas, they should not be simply copied and pasted!  The best and most effective birth plans are personal, NOT just a list of things with check marks next to them!!

 

a)      BirthingNaturally.net

b)      Sample Birth Plans from BirthingNaturally.net

c)      ChoicesinChildbirth.com

d)      American Pregnancy Association

e)      BabyCenter.com

f)      MothersAdvocate.com

 

#8    DO run through scenarios in your mind about how labor could unfold and actually talk these scenarios out with your labor companions and doula (or perhaps even your childbirth educator or birth attendant too!) 

 

Think about all the different ways labor could unfold and how you might react if labor was faster or slower than expected; harder or easier than expected. What would you need for comfort, support and information in each of these variations?  Thinking about “worst case scenario” doesn’t mean it’s going to happen.  But if it does, or if any variation does, it will make you more at ease to know that your team has already talked about it and knows your wishes. 

 

“If you knew that something would go wrong or would pose a difficult challenge during a portion of the labor and birth, what would your ideal strategy and scenario for handling that problem be?  How would you want your midwife or doctor to speak with you?  How would you like your spouse or another support system to help?  What alternatives would you like to try, and in what order?  Again, in your mind’s eye permit yourself to have the best.  What would help you relax and be able to continue labor under difficult conditions?”

Creating Your Birth Plan, page 219

By Marsden Wagner & Stephanie Gunning

 

 

#9        DO try to treat researching and birth plan writing as a fun and exciting experience, not a chore! 

 

Enjoy this time!  Don’t be afraid to be creative and fanaticize!  There are so many amazing thing that you can discover and learn about while doing research for your upcoming birth.  It is never too early to start so don’t put it off till the last minute!

 

And finally…

 

#10    DO remember to bring your birth plan to the hospital!! 

 

It won’t do much help to the nursing staff if you forget it at home on your coffee table!  I encounter this very often at work and I always feel so badly because I know that there is usually a lot of work put into writing a birth plan.  It might be best to make sure that you place a copy of your birth plan in the bag you have packed to take with you to the hospital.  I have even had a few mothers put an extra copy in their car’s glove box so that they wouldn’t forget it!

 

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SAMPLE BIRTH PLAN

 

This birth plan was sent to me by a reader of NursingBirth who goes by the name “ContortingMom”.  Contortingmom’s guess date is 7/17/09 and she is still “cooking” with her first baby :)  I really like her birth plan for a variety of reasons.  #1 She was inspired to add some stuff to her birth plan after reading a couple posts of mine (which I think is pretty cool :) and #2 I think it is a perfect example of a personalized birth plan!!  No check boxes here!  Thanks again to ContortingMom for allowing me to post her birth preferences for other moms to read and learn from!!

 

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Birth Preferences:

I understand that labor and birth are unpredictable and ultimately want the health and safety of both the baby and I to take precedence. In all non-emergency situations, all proposed procedures are to be discussed (benefits and risks) so I can direct the decision making with informed consent.    

Your help with these preferences is very much appreciated.

 

Labor:

• I intend to have as natural a labor as possible – including freedom of movement, intermittent monitoring, a saline lock instead of an on-going IV, and clear liquids as tolerated.

• Due to my GBS+ status, I request only very limited vaginal exams and do not want an amniotomy.

• Please accept my request that pain medication not be offered to me. For many reasons – personal and medical, I’m striving for an unmedicated labor and delivery. If I eventually want drugs or an epidural, I’ll be the first to ask for it and understand that options change as labor progresses.

• If augmentation is necessary, I would like to try non-pharmacological methods before resorting to meds. However, if my OB and I agree that pitocin is required, I request that the it be administered following the low dose protocol and increased in intervals no closer than every 30 minutes, allowing my body an appropriate amount of time to adjust and react to each dose increase.

 

Birth:

• Please do not direct my pushing with counting or yelling. I will ask for help if needed.

• I strongly prefer a tear to an episiotomy and do not want a local anesthetic administered to the perineum.

• I plan to be as active during pushing & delivery as possible, including choosing productive positions. They will be probably anything except supine, lithotomy or “sitting squats” that put pressure on my tailbone. It’s been broken several times & currently inflamed. I also have restrictive pain from spinal injury & surgery, so please allow a position suited to my medical needs. I’ll make sure the OB has comfortable access.

• I would like to have the baby brought to my chest immediately for skin-to-skin contact & initial procedures – and to try nursing to see if it works to contract my uterus, delaying pitocin until we know.

 

If Cesarean Is Required:

• Please use double-layer sutures when repairing my uterus. If I have a second child, I hope to attempt a VBAC and understand this is a requirement for many doctors.

• As health permits, I would like to skin-to-skin contact with the baby, to stay together during repair and recovery, and to breastfeed during the initial recovery period.

• If my husband has to leave the operating room with the baby, I would like my doula to take his place.

 

Baby Care:

• We would like to spend as much time as possible with our baby after birth before being taken off for procedures and will be breastfeeding, so please refrain from giving bottles/pacifiers.

 

We Appreciate Your Support. Thank You!

 

Writing Your Birth Plan: Tips from an L&D Nurse, PART 1 July 22, 2009

There have been many a time that I have written about the option of writing a birth plan, especially if one is planning a hospital birth.  And some of my readers have questioned me further, asking things like “I don’t know how to write a birth plan!  How do I begin?” or “There are so many websites about writing a birth plan, how do I know which one is best?”

 

Indeed when you type “birth plan” into Google you get 22,600,000 hits.  Yowzers!!  No wonder why so many expecting moms write to me and tell me how overwhelmed they are!!   And as we all know, not all websites are created equal as some are more helpful (and more accurate) than others. 

 

So since I suggest writing a birth plan so often in my posts and comments I feel that it is only proper that I write a post specifically about birth plans.  I will try to help you navigate through the sea of websites and direct you to the ones that I feel are the most accurate, truthful, easy to understand, and helpful.  I would like to make a disclaimer though:

 

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Disclaimer:  This post is riddled with my own opinion as both a consumer of health care and an L&D nurse.  I feel that this post has something to offer to the world of birth planning articles because in all of my research I found very few birth plan guides written by L&D nurses.  I found them written by mothers, doulas, midwives, and even doctors…but very few, if any, written by L&D nurses.   This is very interesting to me because if you are planning a hospital birth the first person in the hospital that you present your birth plan to is the nurse.  Sure, your doctor or midwife might (wait, scratch that….SHOULD) go over it in the office with you and if you are hiring a doula, then she will most likely review it with you as well.  However when push comes to shove it is the L&D nurse who is your go-between and except for the actual “catching” part, it is going to be the L&D nurse who manages your care throughout your labor.  While I agree that there are probably many L&D nurses who feel differently than I do about how a birth plan should be written (if at all), I can say with confidence that there are surely just as many who do agree with my take on it.

 

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Since the vast majority of women are planning a hospital birth and I am in fact a hospital based L&D nurse, this post is geared almost entirely towards women planning a hospital birth.  Although a birth plan isn’t a bad idea for a home or birth center birth, it is often less crucial.  Why?  As Leah Terhune, a certified nurse-midwife with Midwives Care, Inc. in Cincinnati is quoted in the article Eyes-Open Childbirth: Writing a Meaningful Plan for a Gentle Birth by Amy Scott says:

 

“A birth plan is not a must for out-of-hospital births because there is more self-education done by the mother, and most people come into the situation with the same philosophy: childbirth as a natural process.  In a really good relationship with a midwife, it should be understood by the end of the pregnancy what the expectations are.”

 

 

My goals for this post are the following:

 

1)      To assist you in writing the best birth plan you can by pointing you in the direction of the best resources out there, that I have found, on birth plan writing,

2)      To review the true purpose of a birth plan and to help you write a birth plan for the right reasons, and

3)      To help you navigate through a bureaucratic hospital system often perforated with outdated dogma and run by unofficial “policies” and help you and your labor companions facilitate a positive and empowering birth experience for your whole family!

 

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What Exactly is a Birth Plan?

 

 

According to Penny Simkin, a physical therapist, doula, and author of The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions:

 

 

“The mother’s Birth Plan tells her caregiver and nurses in writing what options are important to her, what her priorities are, any specific concerns she has, and how she would like to be cared for.  The plan should reflect the mother’s awareness that medical needs could require a shift from her choices, and it should include her preferences in case labor stalls or there are problems with her or her baby.”

 

 

I like this definition of “birth plan” because no where in that definition does it state that a birth plan is the mother’s actual plan for her birth.  That is, it acknowledges what those of us who work with mothers in labor know to be absolutely true:  LABOR CANNOT BE PLANNED OR CONTROLLED.  (And likewise, when someone, including the mother, her labor coaches, or her birth attendant tries to control labor, it only spells trouble.)  Writer Lela Davidson quotes professional childbirth educator and doula, Kim Palena James in her article Create a Better Birth Plan: How to Write One and What It Can and Cannot Do For You:

 

 

“Too many parents create birth plans with the expectation that it will be the actual script of their baby’s birth. There is no way! Nature scripts how your child is born into this world: short, long, hard, easy, early, late, etc… The health care providers you choose, and the facility they practice in, will script how you and your labor are treated. The variations are vast. I wish every expectant parent spent less time writing birth plans and more time selectively choosing health care providers that align with their philosophy on health care, match their health status and their needs for bedside manner.”

 

 

In their article Writing a Birth Plan, findadoula.com writes:

 

“It is not possible to use a birth plan to “make” your caregivers agree to things they are not comfortable doing. For instance, if you don’t want an episiotomy but your doctor usually cuts them for most women, it is unlikely a birth plan will make your doctor change his practice.”

 

 

[For more information on choosing a care provider please check out my post: Must Read Blog: “It’s Your Birth Right!!”]

 

Also doula Kim Palena James warns that a birth plan CANNOT:

 

1. Change your health care provider’s style of practice, personality or protocols.

2. Script the nature of your labor.

3. Insure you have a satisfying labor. 

 

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What Types of Birth Plans are UNHELPFUL to Mothers and Nurses?

 

 

Remember how I said that you cannot control labor?  Well you also cannot control your birth attendant or the medical system.  This is why author, certified nurse midwife, and childbirth educator Pam England, CNM, MA warns mothers about “The Birth Plan Trap.”  In her book Birthing From Within she writes:

 

“Writing birth plans is becoming a ritual of modern pregnancy.  This practice began with the positive intention of encouraging parents to take a more active role in birth.  Writing a birth plan motivates parents to learn about their hospital’s routines (usually with the intention of avoiding them).  A birth plan also can be a tool to open dialogue with doctors.  Telling a doctor what you want (and seeing his/her reactions) allows insight into the doctor’s philosophy of practice and willingness to share decision-making.

 

While gaining information is advantageous, the subtle implications of writing a birth plan are more complex than many people realize.  If you look below the surface, you’ll see that birth plans are like a hidden reef on which your efforts towards deeper birth preparations may run aground.

 

In my classes I discourage mothers and fathers from writing a birth plan.  I’ve changed my mind on this issue for several reasons.  I now believe that the need to write a birth plan invariably comes from:

 

  • Anxiety and/or mistrust of the people who will be attending you;
  • A natural fear of the unknown.  Some women attempt to ease that fear, and enhance their sense of control by writing a detailed script of how the birth should happen;
  • Lack of confidence in self and/or birth-partner’s ability to express and assert what is needed in the moment.  (Birth plans may be intended to substitute for face-to-face negotiations with authority figures.) 

 

In writing a birth plan, a woman focuses on fending off outside forces which she fears will shape her birth.  This effort distracts her from trusting herself, her body, and her spirituality.  Rather than planning her own hard work and surrender, her energy is diverted towards controlling the anticipated actions of others.”

(Birthing From Within, pages 96-97)

 

 

Indeed I have met and cared for couples as an L&D nurse where it seemed like they spent the majority of their time preparing for the birth by writing a birth plan that was intended to “ward off the enemy.”  Pam England calls this “fear-based externally directed preparation” (i.e. “I don’t want this,” “I don’t want that”).  And when I work with couples like this I, in turn, spend the majority of my shift trying to convince the couple (and sometimes their doula) that I am actually on their side.   And don’t get me wrong…I completely understand where their fear comes from (they probably experienced or heard about situations like in my “Don’t Let This Happen To You: Injustice in Maternity Care Series”)!  And there are plenty of stories of unsupportive nurses and crazy on-call doctors to where I don’t blame the couple for feeling like they have to gear up to fight me for everything they want.  But all that fear and worry does NOT facilitate an empowering and positive birth experience and sadly, it sometimes becomes a self-fulfilling prophecy; indeed a mother must almost let go of “control” in labor and surrender to the power of her body and of birth.   

 

So we’ve just learned that birth plans intended to control birth or ward off the enemy are not helpful to anyone.  However unlike Pam England, I don’t take the same drastic stance as she does by recommending that couples do not write a birth plan.  Why?  Because when a birth plan is written for the right reasons and contains the right information, it can really be a helpful tool that nurses can use to help facilitate the birth experience that you desire.  So what types of birth plans are helpful to childbearing families and nurses?  What should be included in a birth plan? and, How should a birth plan be written?  Well, I’m glad you asked!!

 

What Types of Birth Plans Are USEFUL and HELPFUL to Mothers and Staff?

 

In her article Lela Davidson writes:

 

“A birth plan is most useful when you use it to:

 

1. Discuss options and choices with your health care provider. Understanding how your care provider thinks and what her normal practices are will help eliminate confusion, debate, and disappointment during labor and birth. You’ll also increase the level of trust between yourself and your care provider: She’ll understand your priorities and you’ll understand her limitations and preferences.

 

2. Communicate your personality and unique physical, emotional, and environmental needs to your labor and delivery nurse. Let her know what works best for you: A quiet environment? Whispered voices? Do you have a fear of needles? Are you worried about too many people in your room? What do you want to do for pain relief? What helps you relax? What does your partner need? What are his or her fears? Do you like to be touched? What did you learn in your childbirth classes that you’d like to try?”

 

Up for Tommorow:  Top Ten DOs for Writing Your Birth Plan

 

“Pit to Distress”: A Disturbing Reality July 8, 2009

Dear NursingBirth,

 

I just saw a couple of posts about “pit to distress” on Unnecessarean and Keyboard Revolutionary’s blogs. Can you comment on that as an L&D nurse?! Is the intent really to distress the baby in order to “induce” a c-section?  I’m distressed that such things may actually happen, and am holding out a little hope that it’s a misunderstanding in terms….

 

Thanks!!!

Alev

 

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Dear Alev,

 

I wish I could put your heart and mind at ease and tell you, from experience, that this type of outrageous activity (i.e. “pit to distress”) does not happen in our country’s maternity wards but unfortunately it does.  I know that it does because:

 

1) I have read and heard stories from other labor and delivery nurses who have worked with birth attendants who practice “pit to distress,”

 

2) I have read and heard stories from women (and their doulas!) who have personally experienced the consequences of “pit to distress,”

 

and, most importantly…

 

3) I personally have worked with attending obstetricians who subscribe to this philosophy. 

  

Before I start my discussion on this topic I would like to quote a blog post I wrote back in April entitled “Don’t Let This Happen To You #25 PART 2 of 2: Sarah & John’s Unnecessary Induction”.  This post is actually the first post I ever wrote for my Injustice in Maternity Care Series.  It is a TRUE story (although all identifying information has been changed to adhere to HIPPA regulations) about a first time mom who was scheduled for a completely unnecessary labor induction and the following excerpt is a good example of how “pit to distress” is ordered by physicians, EVEN IF they don’t actually write it out as an order (although some actually do!)

 

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“…At 1:30pm, right on schedule, Dr. F came into the room.  After some quick small talk he asked Sarah to get into the bed so that he could perform a vaginal exam and break her water. 

 

Sarah: “Umm, I was hoping we could wait a little bit longer to do that, until I am in more active labor.”

 

Dr. F: “Well, if I break your water it is really going to rev things up and put you into active labor.”

  

Sarah: “I’d really rather wait.”

  

Dr. F: (visibly frustrated) “Well I at least have to check you!”

 

(Oh lord, I love the “have to”!)  Dr. F’s exam revealed that Sarah was 4 centimeters!  Yay!

 

After helping Sarah to the bathroom and back to her rocking chair, I stepped out the catch Dr. F at the desk.  “Thanks for holding off on the amniotomy, it was really important to her birth plan,” I said, trying to “smooth things over” and (gently) remind him that the patient was in charge!  “Yeah well I’ll be back around 4:00pm to check her again and if she hasn’t made any progress I am going to break her water,” he said, grudgingly. 

 

He started to walk towards the elevator but then turned around to me and said:

 

Dr. F: “You have the pit at 20 right?”

 

(Note: The way pitocin is administered for induction in my hospital (and many others) is that you start the pitocin at 2mu/min (or 6mL/hr) and increase by 2mu/min every 15-30 min (or more) to a maximum of 20mu/min (or 60mL/hr) until you obtain an adequate contraction pattern (or, 3-5 contractions in 10 minutes).  So what does that mean?  That means that you do NOT just crank the pitocin until you get to “max pit,” rather you TITRATE it until you get 3-5 contractions in 10 minutes that are palpable and are causing cervical change.  However, this is not what many physicians I work with ask you to do.   Bottom line is everyone is different.  I personally could take a whole box of Benadryl and not so much as yawn while my husband can take one tablet and all but hallucinate!  It is no different for pitocin.  Some people are extra sensitive and only need a little bit, and others tolerate “max pit” very well.  I seem to have this same “fight” with physicians all the time at work.  They insist you “keep cranking the pit” when all you are going to do is hyperstimulate the uterus and cause the baby to go into distress.  But I digress….)

 

Me: “No, I have her at 10mu/min.”

 

Dr. F: (sarcastically)  “What!?  What are you waiting for?! 

 

Me: (said while biting my lip so I didn’t say something I would regret)  “She is contracting every 2-3 min and they are palpating moderate to strong.  She has to breathe through them.  And the baby is looking good on the monitor.  I want to keep it that way!”

 

Dr. F:  “But she’s not going anywhere!  You have to keep going up if you want her to progress.”

 

Me: “But she has changed to 4 centimeters…”

 

Dr. F:  “I was being generous!”

 

Me: “So you lied…”

 

Dr. F:  (annoyed) “Listen, keep going up on the pit, even if she is contracting every 2-3 min.  They aren’t strong enough.  Keep going up.  If we hyperstimulate her, we can just turn the pit down.”  (Note: These were his exact words.  I know this because I was so flabbergasted that he said it, I wrote it down in my notebook that very moment!  The fact is sometimes the baby is in so much distress after hyperstimulating the uterus that just turning the pitocin down isn’t enough!  And it really bothers me when doctors start sentences off with “Listen…”  Grrrrr.)

 

Me:  (jaw dropped, completely dumfounded) If I turn the pit up anymore, I am GUARANTEED to hyperstim her.”

 

Dr. F: “We’ll cross that bridge when we get to it.  I’ll be back around 4:00pm.”

 

By this point I was more than annoyed with Dr. F.  I explained the situation to the charge nurse and told her that I would not be cranking the pit on room 11 unless Dr. F wrote me an order that read “Regardless of hyperstimulation or contraction pattern, continue to increase pitocin until the maximum dose is reached.”  (By the way, he wouldn’t’ write me that order).  She basically told me to do what I felt was right because it was my license at stake too.”

 

 

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Ladies and gentleman the account that you have just read is called “Pit to Distress” whether the pitocin order was actually written that way or not.  What Dr. F gave me was a VERBAL ORDER to increase the pitocin, regardless of contraction or fetal heart rate pattern, until I reached “max pit,” which he acknowledged would hyperstimulate her uterus.  This goes against our hospital’s policy and the physical written order that this doctor signed his name under.  However, like some other doctors I work with, none of that mattered to him.  What he wanted was for me to “crank her pit” regardless and from my experience with this doctor, at the first sign of fetal distress we would have been crashing down the hallway for a stat cesarean!

 

Hyperstimulation of the uterus (more appropriately called tachysystole) is harmful and dangerous for both mothers and babies: 

 

“If contractions are persistently more often than 5 contractions in 10 minutes, this is called “tachysystole.” Tachysystole poses a problem for the fetus because it allows very little time for re-supply of the fetus with oxygen and removal of waste products. For a normal fetus, tachysystole can usually be tolerated for a while, but if it goes on long enough, the fetus can be expected to become increasingly hypoxic and acidotic.

 

Tachysystole is most often caused by too much oxytocin stimulation. In these cases, the simplest solution is to reduce or stop the oxytocin to achieve a more normal and better tolerated labor pattern.”

Electronic Fetal Heart Monitoring” by Dr. M. J. Hughey

 

The truth, however, is that many times stopping tachysystole is not as easy as just shutting the pitocin off.  Although the plasma half-life of pitocin is about 6 minutes, it can take up to 1 hour for the effects of pitocin to completely wear off.  And for a baby in distress, one more hour in a hyperstimulated uterus is too much!  So guess what?!  The physician has two choices:

 

#1 Administer yet another drug (like terbutaline) to decrease contractions and wait and see (unlikely to happen), or

 

#2 Administer yet another drug (like terbutaline) to decrease contractions while heading to the OR for an emergency cesarean section (much more likely to happen.) 

 

Because in the end…who wants to “sit” on a compromised baby?!

 

 

What is also unsettling is that my encounter with Dr. F regarding the most appropriate administration of pitocin for that mother was downright pleasant as compared to some of the other encounters I have had with much more intimidating and hot-headed physicians.  Labor and delivery nurses all over this country (including myself) have been bullied, yelled at, cursed out, and down-right humiliated by birth attendants who want you to “keep cranking the pit” regardless of maternal contraction or fetal heart rate patterns or in general, refusing to be a part of or questioning other harmful obstetrical practices.

 

I once had an obstetrician, while in the patient’s room, call me “incompetent” in front of the patient and her entire family because I had not continuously increased the pitocin every 15 minutes until I reached “max pit” and instead, kept the pitocin at half the maximum dose because increasing it anymore caused my patient to scream and cry in pain and her uterus to contract every 1 minute without a break.  Who wants a nurse to take care of them that was just called “incompetent” by their doctor??!? 

 

Another time I had a physician (who via this program called “OBLink” can watch her patient’s monitor strips from her own home or office) call me on the phone from her house to chew me out about not having the pitocin higher.  When I explained that I had to shut the pitocin off an hour earlier and start back up at a slower rate because the baby started to have repetitive and deep variable decelerations despite position changes, IV fluid bolus, and 10 liters of oxygen via face mask, I was told that the decels “weren’t big enough” to warrant such a “drastic measure as shutting of the pitocin” and I was “wasting her time” because “at the rate [I] was going [her] patient wouldn’t deliver until after midnight.”

 

I had yet a third doctor tell me once that he wished that only the “older” nurses on the floor would take care of his patients because they aren’t “as timid” and “are not afraid to turn up the pitocin when a doctor orders them to.”  That younger nurses like me are “too idealistic” and don’t understand “how the world really works.” 

 

And yet another time I had a physician tell me that I needed to “crank the pit to make this baby prove himself either way” and that if I couldn’t do “what needed to be done” for his patient, then he would ask the charge nurse to “replace me with a nurse who could.”

 

And guess what, when I came in the next day and read the birth log, I discovered that 3 out of those 4 patients ended up with cesarean sections after I had left that night for “fetal distress.” 

 

AAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!

 

Although not one of these physicians actually wrote in black and white “Pit to Distress” and they didn’t have to; their words and actions speak to their true intentions.  These physicians are smart in the fact that they know that actually writing “pit to distress” like some practitioners do can land them with a law suit if an adverse outcome happens and they find themselves in court.  So while it is true that one’s medical record might not show “pit to distress” on the order form, it doesn’t mean that it didn’t happen to you!  What these doctors do instead are bully nurses into to doing their dirty work for them.  (And I would like to note that just like Dr. F, I have yet to encounter one physician who will actually physically put their hands on the IV pump and turn up the pitocin themselves when I refuse to do it!…..They know better!)

 

 

As a registered nurse my practice must adhere to the American Nurses Association Code of Ethics for Nurses.  Here is an excerpt:

 

“The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.  The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”

 

What these practitioners don’t realize is that when they work with nurses like me (and there are many out there!!), they are working with someone who values the health and safety of women and babies (as well as their nursing license) much more than a fake cordial kiss-ass relationship with some high-and-mighty doctor!  But let me tell you, its really frigging hard to work like that!  That is, to constantly battle with practitioners who have such a different philosophy about maternity care than you do!  I mean, even the best nurses will start to doubt themselves if they are constantly being bullied and told that they “can’t cut it” or are “incompetent” if they don’t follow the status quo!  Like many other nurses, sometimes I just don’t have the energy to argue and fight.  Sometimes I have down right lied to a doctor over the phone about how high the pitocin really is (telling them it’s running at a much higher rate than it actually is).  Other times I just “forget” to turn up the pitocin for hours at a time.  One time I actually disconnected the pitocin and discretely ran it into the floor!

 

Women of this earth…TAKE BACK YOUR BIRTH!!!  We need YOUR voice!  We need you to choose caregivers that practice evidenced based medicine, and BOYCOTT ones that don’t!  We need you to HIT THEM WHERE IT HURTS….in their WALLET!!  We need you to DEMAND better care!!  We nurses, birth advocates, doulas, childbirth educators, midwives, etc. etc. can’t make change without YOU!!

 

Thank you, Thank you, THANK YOU to Jill at Keyboard Revolutionary and Jill from The Unnecessarean for their blog posts on this issue!  I second their anger, outrage, and voice for change!!!

 

Are you an L&D nurse who has ever been ordered to “pit to distress?”  Are you a mother who has ever experienced the consequences of a birth attendant who followed a “pit to distress” philosophy?    Please share your story with us!! 

 

In closing I would like to say that I am NOT anti pitocin, but like ALL labor & delivery interventions, I speak out and advocate for the appropriate, evidenced-based, and safe use of them!

 

Please check out my next post!  “Pit To Distress” PART 2: Top 7 Ways to Protect Yourself From Unnecessary & Harmful Interventions

 

 
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