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Birth Wishes: STEP TWO: Labor Options
Welcome to the Birth Wishes series where we are working together to write our birth plans. In this step I'll be mentioning some things you may want to consider for your labor. Because the main goal of this group is to have a natural birth those things will be emphasized but I will talk about other options you may want to consider in the event of induction or cesarean.
To read the STEP ONE please go here:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-ONE-The-Opening/show/1475184
Many hospitals have policies in place due to the fear of litigation (being sued if things go wrong). If you are having a birth in a hospital there are still things you can do as a compromise that will allow you the freedoms necessary for a natural birth and give your doctor peace of mind that they're doing things per hospital regulations. As with ANY procedure you have the right of refusal. If at any time they require you do something and it is not medically necessary you may ask for a waiver to release them of any responsibility should something go wrong (such as refusing Pitocin if labor isn't progressing as fast as they want even though baby on the monitor looks fine and is handling labor well). These waivers can always be reversed if you change your mind.
LABOR OPTIONS to consider for your birth plan:
Freedom to Move - The biggest benefit, other than hydrotherapy (getting in a birth tub or shower while in labor) is being able to move around. Sit on a birth ball, sway your hips, lean over a table or the bed, slow dance with your partner, get on your hands-and-knees, walking and much more. Moving while in labor has been studied and proven to decrease labor time for the majority of women. By moving you'll be having more contractions and baby's head will be pushing down on that cervix helping it to dilate and efface.
Likewise if you feel like curling up on the bed, go for it. My natural birth I did get in the tub for several minutes but my room didn't have the whirlpool; it just had a dinky regular old tub that was WAY too small and cramped for my laboring body. So I got back in bed and just laid there curled up on my side. It was a position that felt good to me.
On your Birth Wishes you could write something like:
"I prefer to have the freedom to move around while in labor to get into positions that help baby descend and for labor to progress quickly and efficiently."
Even if you don't end up moving all over the place, like me, you'll at least let them know that interests you.
IV versus HEP-LOCK - Part of being able to freely move about is to refuse an IV unless medically necessary. This is a part that your doctor might want to see some compromise on. When I still had an OB I asked him if it made him more comfortable putting a HEP-LOCK in place in the event they needed to get access to a vein for an IV. My midwife did not make me have an IV or a Hep-Lock and because she was in my room the entire time she was able to monitor me for signs of dehydration. Everyone is different.
A Hep-Lock is the catheter placed in your hand or arm where they can easily and quickly hook up an IV (intravenous method of delivering drugs or fluids through your veins).
http://pregnancy.about.com/od/laborbasics/g/salinelock.htm
If you are becoming dehydrated it is always best to accept the IV. This is probably one thing I would definitely not question if they recommend it at some point in your labor unless you're keeping fluids down by mouth. If they notice you're becoming dehydrated the IV is the a good thing. You'll still be able to move around but will have to cart your IV pole around with you (always have someone, like your partner, help you so you don't trip on it).
FOOD & WATER - Speaking of dehydration did you know that most hospitals DO allow you to have clear fluids while in labor? Next time you visit your healthcare provider ask them if your hospital allows this. Most of the time natural birthers will stay home as long as possible before heading to the hospital to give birth anyway. And in your home before checking in to a hospital you're obviously free to eat and drink as often and as much as you can tolerate. My midwife encouraged food (high protein and fruits) because you need energy for labor. Laboring for hours on an empty stomach my second birth made me so sick thought I was going to pass out a few times. However my midwife did tell me, in her experience, when a woman is so deep into labor that she cannot or will not eat food anymore she is most likely in transition and if birthing at the hospital should be heading there. That was a very interesting tip I had never heard before! Again, ask your healthcare provider what their policies are. If you wish to have food and drink for energy and hydration you may write something like this on your Birth Wishes:
"I understand birth requires a lot of energy. I will have protein bars and apples with me in the event I need nourishment for my labor. I will also drink clear fluids or ice chips by mouth."
HYDROTHERAPY - Another component to being allowed the freedom to move about is water. I have heard it quoted that roughly 80% of women desire to labor or birth in water. Water is a natural anesthetic that can help women cope with pain, though it does not completely diminish it. If you're having a particularly hard time you should have someone fill the tub for you or turn on the shower!
NOISE - One thing women fear when they are in labor is that they will be "too noisy". I have watched many births (on videos, not in real life!) and some women are quiet as church mice. I've also heard other women moan, groan and SING. Yes, SING! Honestly I found the noises to be so beautiful and primal. You must realize that your birth is YOUR birth and if you feel like singing or humming to get through a contraction then do it. If you feel a moan escaping or want to yell a string of curse words go for it. The more you try to contain it the more painful you can make your contractions. Just let it out if you need to let it out! I have a beautiful YouTube video of a woman singing while in labor to share with you:
http://www.youtube.com/watch?v=z3WA9iHz5ww
That video never gets old for me. If you can't view the link you can type in "Woman Sings While in Labor" and it is posted by templetunes75.
You don't really have to put anything on your Birth Wishes about noise unless you want to. I'd just say something to the effect of, "I may sing, groan, moan or yell while in labor to help me through contractions. This will help me cope and doesn't mean I want to be asked for drugs or intervention. If I need pain relief I will ask for it."
FRIENDS, FAMILY, DOULA - You may have certain friends, family or may have even hired a doula to be present. Some families wish to have their children present for the delivery (please note if children are allowed they might have to leave the room for delivery of the placenta, even in a home birth). If there are people you want present first check to see how many people you can allow. Most hospitals have become very doula-friendly.
A doula is a labor coach. They are someone you privately hire to help you cope through labor. They will massage you, help you get into favorable positions for labor, encourage you and be an advocate for you if a certain nurse isn't particularly nice about following your Birth Wishes. Doulas drastically increase the success of a natural birth. For me I did not have a trained doula during my natural birth. Instead I asked my mother-in-law (who *should* be a doula) to be present during the delivery. For the most part she just knitted and prayed across the room. But other times she was getting cool cloths and helping guide my husband in how to help me when he felt helpless or clueless. She was awesome!
To read the STEP ONE please go here:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-ONE-The-Opening/show/1475184
Many hospitals have policies in place due to the fear of litigation (being sued if things go wrong). If you are having a birth in a hospital there are still things you can do as a compromise that will allow you the freedoms necessary for a natural birth and give your doctor peace of mind that they're doing things per hospital regulations. As with ANY procedure you have the right of refusal. If at any time they require you do something and it is not medically necessary you may ask for a waiver to release them of any responsibility should something go wrong (such as refusing Pitocin if labor isn't progressing as fast as they want even though baby on the monitor looks fine and is handling labor well). These waivers can always be reversed if you change your mind.
LABOR OPTIONS to consider for your birth plan:
Freedom to Move - The biggest benefit, other than hydrotherapy (getting in a birth tub or shower while in labor) is being able to move around. Sit on a birth ball, sway your hips, lean over a table or the bed, slow dance with your partner, get on your hands-and-knees, walking and much more. Moving while in labor has been studied and proven to decrease labor time for the majority of women. By moving you'll be having more contractions and baby's head will be pushing down on that cervix helping it to dilate and efface.
Likewise if you feel like curling up on the bed, go for it. My natural birth I did get in the tub for several minutes but my room didn't have the whirlpool; it just had a dinky regular old tub that was WAY too small and cramped for my laboring body. So I got back in bed and just laid there curled up on my side. It was a position that felt good to me.
On your Birth Wishes you could write something like:
"I prefer to have the freedom to move around while in labor to get into positions that help baby descend and for labor to progress quickly and efficiently."
Even if you don't end up moving all over the place, like me, you'll at least let them know that interests you.
IV versus HEP-LOCK - Part of being able to freely move about is to refuse an IV unless medically necessary. This is a part that your doctor might want to see some compromise on. When I still had an OB I asked him if it made him more comfortable putting a HEP-LOCK in place in the event they needed to get access to a vein for an IV. My midwife did not make me have an IV or a Hep-Lock and because she was in my room the entire time she was able to monitor me for signs of dehydration. Everyone is different.
A Hep-Lock is the catheter placed in your hand or arm where they can easily and quickly hook up an IV (intravenous method of delivering drugs or fluids through your veins).
http://pregnancy.about.com/od/laborbasics/g/salinelock.htm
If you are becoming dehydrated it is always best to accept the IV. This is probably one thing I would definitely not question if they recommend it at some point in your labor unless you're keeping fluids down by mouth. If they notice you're becoming dehydrated the IV is the a good thing. You'll still be able to move around but will have to cart your IV pole around with you (always have someone, like your partner, help you so you don't trip on it).
FOOD & WATER - Speaking of dehydration did you know that most hospitals DO allow you to have clear fluids while in labor? Next time you visit your healthcare provider ask them if your hospital allows this. Most of the time natural birthers will stay home as long as possible before heading to the hospital to give birth anyway. And in your home before checking in to a hospital you're obviously free to eat and drink as often and as much as you can tolerate. My midwife encouraged food (high protein and fruits) because you need energy for labor. Laboring for hours on an empty stomach my second birth made me so sick thought I was going to pass out a few times. However my midwife did tell me, in her experience, when a woman is so deep into labor that she cannot or will not eat food anymore she is most likely in transition and if birthing at the hospital should be heading there. That was a very interesting tip I had never heard before! Again, ask your healthcare provider what their policies are. If you wish to have food and drink for energy and hydration you may write something like this on your Birth Wishes:
"I understand birth requires a lot of energy. I will have protein bars and apples with me in the event I need nourishment for my labor. I will also drink clear fluids or ice chips by mouth."
HYDROTHERAPY - Another component to being allowed the freedom to move about is water. I have heard it quoted that roughly 80% of women desire to labor or birth in water. Water is a natural anesthetic that can help women cope with pain, though it does not completely diminish it. If you're having a particularly hard time you should have someone fill the tub for you or turn on the shower!
NOISE - One thing women fear when they are in labor is that they will be "too noisy". I have watched many births (on videos, not in real life!) and some women are quiet as church mice. I've also heard other women moan, groan and SING. Yes, SING! Honestly I found the noises to be so beautiful and primal. You must realize that your birth is YOUR birth and if you feel like singing or humming to get through a contraction then do it. If you feel a moan escaping or want to yell a string of curse words go for it. The more you try to contain it the more painful you can make your contractions. Just let it out if you need to let it out! I have a beautiful YouTube video of a woman singing while in labor to share with you:
http://www.youtube.com/watch?v=z3WA9iHz5ww
That video never gets old for me. If you can't view the link you can type in "Woman Sings While in Labor" and it is posted by templetunes75.
You don't really have to put anything on your Birth Wishes about noise unless you want to. I'd just say something to the effect of, "I may sing, groan, moan or yell while in labor to help me through contractions. This will help me cope and doesn't mean I want to be asked for drugs or intervention. If I need pain relief I will ask for it."
FRIENDS, FAMILY, DOULA - You may have certain friends, family or may have even hired a doula to be present. Some families wish to have their children present for the delivery (please note if children are allowed they might have to leave the room for delivery of the placenta, even in a home birth). If there are people you want present first check to see how many people you can allow. Most hospitals have become very doula-friendly.
A doula is a labor coach. They are someone you privately hire to help you cope through labor. They will massage you, help you get into favorable positions for labor, encourage you and be an advocate for you if a certain nurse isn't particularly nice about following your Birth Wishes. Doulas drastically increase the success of a natural birth. For me I did not have a trained doula during my natural birth. Instead I asked my mother-in-law (who *should* be a doula) to be present during the delivery. For the most part she just knitted and prayed across the room. But other times she was getting cool cloths and helping guide my husband in how to help me when he felt helpless or clueless. She was awesome!
Feel free to ask questions anywhere, on any post! This is just like the main forum so once people reply the post gets bumped up to the top.
You can have a membrane sweep or your water broken but I do not believe you can have Pitocin because it can cause uterine rupture. Most doctors won't give you an epidural either unless you decide at some point to go ahead with a repeat cesarean. I'm NOT 100% on the epidural part but I am sure on the Pitocin because it already has a uterine rupture rate whether it is a VBAC or not.
You can have a membrane sweep or your water broken but I do not believe you can have Pitocin because it can cause uterine rupture. Most doctors won't give you an epidural either unless you decide at some point to go ahead with a repeat cesarean. I'm NOT 100% on the epidural part but I am sure on the Pitocin because it already has a uterine rupture rate whether it is a VBAC or not.
I wish I'd read about options for induction before my baby was born. Good to know for the next time though!
Also, in the labor section of my birth vision I included a comment about fetal monitoring.
The hospital we were at had the regular external wired belts, wireless telemetric monitors, and dopplers so I made sure to note my preference.
Also, in the labor section of my birth vision I included a comment about fetal monitoring.
The hospital we were at had the regular external wired belts, wireless telemetric monitors, and dopplers so I made sure to note my preference.
Joy - I know you have moved on form this question but I only just found this site - I have a few questions which you may answer later in another section but i have not made it there yet and don't want to forget them.
Do you know if you can have a membrain sweep or your waters broken if going for a VBAC? I knwo you can't be induced but does this count?
Thanks.
Do you know if you can have a membrain sweep or your waters broken if going for a VBAC? I knwo you can't be induced but does this count?
Thanks.
Take your time Joy! :) I completely understand!
Chantal, most definitely! Always great to have a backup or "Emergency Plan" which we will talk about in the Cesarean post. I'm a little behind! Being a mom sometimes gets in the way of me getting posts up. I had wanted to get more up by now but will have to work on it tomorrow as it is already 10pm and I'm wiped.
Great information!! When I am in labor and I arrive at my midwife's birth center, she allows me to do whatever I feel like doing. I usually start out by walking which really helps things move along. She also encourages me to eat something high in protein and drink lots of water or recharge. With my first, I got so dehydrated, that even though I had 10 bottles of water during the labor process, it wasn't helping. She put an IV in and wow! After 2 bags of fluid, I felt like a brand new person. IV fluids can be very beneficial and that is definitely not something to refuse.
Being able to eat something helped keep my energy up as well. I was told I could eat protein bars, fruit, or even a turkey and cheese sandwich. I think I only wanted 2 protein bars, just wasn't interested in eating at the time.
My midwife ended up breaking my water to speed things up right around 6-7cm dilated. That made things move very quickly for me and I have no issues with having my water broken. Once that happens, there is no turning back! haha And also, she wants to see the baby come just a few hours after having that done. She won't break my water unless she knows it will help and thankfully with my second, he came within 2 hours of my water breaking.
If I were going to be in a hospital, I would definitely have a more detailed plan. I should probably write something up in case I had to be in the hospital for some reason. Something else to keep in mind IF you choose a birth center or home birth, make sure you know where the closest hospital is and the best route to take at any time during the day or night. This is my husband's job in case something comes up and we need to get there for whatever reason. But more than likely if it's an emergency, I'm sure I would be taken by ambulance.
Being able to eat something helped keep my energy up as well. I was told I could eat protein bars, fruit, or even a turkey and cheese sandwich. I think I only wanted 2 protein bars, just wasn't interested in eating at the time.
My midwife ended up breaking my water to speed things up right around 6-7cm dilated. That made things move very quickly for me and I have no issues with having my water broken. Once that happens, there is no turning back! haha And also, she wants to see the baby come just a few hours after having that done. She won't break my water unless she knows it will help and thankfully with my second, he came within 2 hours of my water breaking.
If I were going to be in a hospital, I would definitely have a more detailed plan. I should probably write something up in case I had to be in the hospital for some reason. Something else to keep in mind IF you choose a birth center or home birth, make sure you know where the closest hospital is and the best route to take at any time during the day or night. This is my husband's job in case something comes up and we need to get there for whatever reason. But more than likely if it's an emergency, I'm sure I would be taken by ambulance.
Thank you for all this information! I actually know what i want to try during labor. Im willing to do anything and everything to cope with the pain. (Besides getting the epidural)
=o)
=o)
One thing I did forget to mention is amniotomy (artificially rupturing your membrane AKA breaking your water for you rather than it breaking on its own). If you prefer to not have your water broken if you're not being induced this is the section you'll want to include it in.
For me, after 39 weeks, amniotomy was not a huge deal. If I was in labor already and they wanted to break my water I'd let them. I really wouldn't mind at all. However some women do not want ANY interference and that is awesome too!
If you do not care if they break your water you may say something like:
"If labor is progressing you may ask permission to break my water. Please ask for my permission before doing it so that I am aware."
If you DO care if they break your water you may say:
"I prefer to not have my water artificially broken. If I change my mind I will let you know."
The water breaking/being broken *can* speed up labor for some (it does for me, which is why I don't mind it). But it can also put you in danger of being put on the clock. Once your water breaks hospitals and doctors may say, "You've got ___ hours to have that baby or we will put you on Pitocin or section you." Sadly this is true. And all that pressure on you can make "performing" impossible or too slow.
If you are uncertain if breaking your water will speed up labor or not it is best to let it break on its own. Most womens' water will break around 5-6cm or more dilated. Mine broke at only 3 or 4cm my natural birth; I was so bummed, ha ha! But I did have her five hours later so it wasn't too bad at all. I tell you this to show you there's always an exception to the rule!
For me, after 39 weeks, amniotomy was not a huge deal. If I was in labor already and they wanted to break my water I'd let them. I really wouldn't mind at all. However some women do not want ANY interference and that is awesome too!
If you do not care if they break your water you may say something like:
"If labor is progressing you may ask permission to break my water. Please ask for my permission before doing it so that I am aware."
If you DO care if they break your water you may say:
"I prefer to not have my water artificially broken. If I change my mind I will let you know."
The water breaking/being broken *can* speed up labor for some (it does for me, which is why I don't mind it). But it can also put you in danger of being put on the clock. Once your water breaks hospitals and doctors may say, "You've got ___ hours to have that baby or we will put you on Pitocin or section you." Sadly this is true. And all that pressure on you can make "performing" impossible or too slow.
If you are uncertain if breaking your water will speed up labor or not it is best to let it break on its own. Most womens' water will break around 5-6cm or more dilated. Mine broke at only 3 or 4cm my natural birth; I was so bummed, ha ha! But I did have her five hours later so it wasn't too bad at all. I tell you this to show you there's always an exception to the rule!
Ha ha ha! Okay I wrote so much I exceeded my word limit.
INDUCTION - You may want to include a little blurp on induction. On my old birth plan with my OB I mentioned that I did not want Pitocin at all as it made me very ill. I asked that if induction was required that they sweep the membranes first, preferably a day or two before induction day. Sweeping the membranes is done during a cervix check. The doctor or midwife will sweep their finger around to help detach the bag of waters from the cervix. This causes a hormonal reaction that can start labor within 24-48 hours for about half the women who have this done.
If labor was not progressing or starting after the sweep I requested that next my water be broken and that I be left alone to go into labor for several hours before they would step in and augment my labor (using synthetic hormones to make it go faster). By having my water broken and not being hooked up to Pitocin (and eventually an epidural most likely) I would have still been able to move around freely.
These are more natural induction methods to get your body into labor and may prevent you from having Pitocin, an epidural and maybe even a cesarean.
As an example I wrote something to the effect:
"I do not wish to have Pitocin to augment my labor. I'd prefer to have a membrane sweep a few days prior to the induction date and if that does not work to then have my water broken. I prefer to be left alone for several hours to see if breaking the bag of waters begins labor. If neither of these methods work I will then follow-up with my doctor on the next course of action."
***I will talk in detail about cesarean options in post #7***
Let's recap the above, shall we? Please note all of this was referenced to hospital birth but if you're having a home birth or birth center birth you can tailor it to fit that setting.
You have a few choices to make to include (or not) in your Birth Wishes and they are:
-The freedom to move as you please (those who are induced may be able to do this as well
-Accepting an IV or requesting a Hep-Lock if they require you to have something in place. This is something you can definitely refuse but compromising with your doctor if a Hep-Lock doesn't bother you is a good idea. Otherwise, if you're like me and don't like anything on you in labor, ask that they not put one in unless you actually need it.
-Food and water by mouth
-Hydrotherapy (ask your doctor if they have this available at your hospital; some do NOT)
-Noise while in labor
-Doula and other friends & family to have present
-Induction
What do you think about the things mentioned above? Is there anything you'd add for the section of labor on your Birth Wishes?
Remember I'll be talking about drugs/pain relief and monitoring in the next two posts so we'll definitely touch on those subjects. And on the final post of this series we'll be piecing together each section and sharing our Birth Wishes (if you desire to share). I will post mine so you can see how it looks written out. I do not copyright my Birth Wishes so if you end up liking most or all of what I write you will have permission to copy and paste and edit as you need.
INDUCTION - You may want to include a little blurp on induction. On my old birth plan with my OB I mentioned that I did not want Pitocin at all as it made me very ill. I asked that if induction was required that they sweep the membranes first, preferably a day or two before induction day. Sweeping the membranes is done during a cervix check. The doctor or midwife will sweep their finger around to help detach the bag of waters from the cervix. This causes a hormonal reaction that can start labor within 24-48 hours for about half the women who have this done.
If labor was not progressing or starting after the sweep I requested that next my water be broken and that I be left alone to go into labor for several hours before they would step in and augment my labor (using synthetic hormones to make it go faster). By having my water broken and not being hooked up to Pitocin (and eventually an epidural most likely) I would have still been able to move around freely.
These are more natural induction methods to get your body into labor and may prevent you from having Pitocin, an epidural and maybe even a cesarean.
As an example I wrote something to the effect:
"I do not wish to have Pitocin to augment my labor. I'd prefer to have a membrane sweep a few days prior to the induction date and if that does not work to then have my water broken. I prefer to be left alone for several hours to see if breaking the bag of waters begins labor. If neither of these methods work I will then follow-up with my doctor on the next course of action."
***I will talk in detail about cesarean options in post #7***
Let's recap the above, shall we? Please note all of this was referenced to hospital birth but if you're having a home birth or birth center birth you can tailor it to fit that setting.
You have a few choices to make to include (or not) in your Birth Wishes and they are:
-The freedom to move as you please (those who are induced may be able to do this as well
-Accepting an IV or requesting a Hep-Lock if they require you to have something in place. This is something you can definitely refuse but compromising with your doctor if a Hep-Lock doesn't bother you is a good idea. Otherwise, if you're like me and don't like anything on you in labor, ask that they not put one in unless you actually need it.
-Food and water by mouth
-Hydrotherapy (ask your doctor if they have this available at your hospital; some do NOT)
-Noise while in labor
-Doula and other friends & family to have present
-Induction
What do you think about the things mentioned above? Is there anything you'd add for the section of labor on your Birth Wishes?
Remember I'll be talking about drugs/pain relief and monitoring in the next two posts so we'll definitely touch on those subjects. And on the final post of this series we'll be piecing together each section and sharing our Birth Wishes (if you desire to share). I will post mine so you can see how it looks written out. I do not copyright my Birth Wishes so if you end up liking most or all of what I write you will have permission to copy and paste and edit as you need.
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