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Birth Wishes: STEP FIVE: Delivery
Step One:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-ONE-The-Opening/show/1475184
Step Two:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-TWO-Labor-Options/show/1476757
Step Three:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-THREE-Monitoring/show/1476796
Step Four:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-FOUR-Drugs-and-Pain-Relief/show/1479807
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 actual delivery. 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.
The magical moment has finally arrived! You're 10cm dilated and begin bearing down to bring your baby into the world. How do you envision that moment? It is important to note on your birth plan particulars for your delivery because you also have choices in this matter!
First thing you'll want to think about is, "What position will I be in?" Do you envision giving birth like in the movies, on your back with your knees up to your forehead? Or do you envision being in a birth tub, squatting, on your hands-and-knees or laying on your side?
Laying on your back, in the lithotomy position, is likened to be as good as hanging from the ceiling by your toes when trying to deliver a baby. It narrows the pelvis by 25-30% and you're working against gravity. I HATE to compare birth to going poop but it is the only thing I can compare it to that men and women can visualize. When you need to use the restroom the last thing you're going to do is lay down to push your poo out. Toilets are shaped like seats for a reason - so you can sit or squat - and is optimal for pushing something out of your body.
Honestly it is anyone's guess, including yours, on what position will be ideal for the time to push. If you're having a lot of back labor you may naturally turn over to your hands-and-knees to relieve that pressure. Other women may stand up and then squat down.
On your birth plan you may wish to write something to the effect of:
"I prefer to choose a position that is ideal for delivering my baby, such as squatting or side-lying or _____."
Another way to phrase it if you do not wish to give birth on your back:
"I prefer to not push in the lithotomy position and will choose which position is best for delivering my baby."
Other issues you may want to address during delivery is the issue of forceps and vacuum extraction. If baby is truly stuck then forceps or vacuum should be a last ditch effort. Make sure your doctor isn't forcep-happy so you don't end up with an unnecessary forceps extraction. Usually birthing in a position that really opens up the pelvis, like squatting, will prevent the need for the use of forceps or a vacuum anyway.
A big fear women have is the dreaded episiotomy. An episiotomy is a cut the doctor or midwife will make on your perineum (the skin between your vagina and anus). Some do this habitually and others do it as-needed. The debate is ongoing on whether it is better to tear or be cut. Reading the book Pushed, with all the evidence-based information, I personally feel tearing is better than being cut. Again, if you're in an optimal position while pushing you can prevent or reduce tearing significantly.
Other solutions instead of being cut would be to take your time pushing! There's no need to set a world record in the fastest time a baby is pushed out. If you've already had more than one baby this may not be helped (my youngest, Zoë, was out in less than 60 seconds according to my husband and I did not tear; I contribute that to being in a side-lying position and already having given birth before). Otherwise if you're a first-time momma take your time. If you've been pushing for 20 minutes you're not broken! You're actually doing your perineum great favors.
Also perineal massage is a fantastic idea. You can do this before birth and during labor & delivery. Have your partner use EVOO to gently massage your perineum. In the hospital they may use Glycerin or a similar oily product.
And finally you may want to address the issue of "purple pushing". Purple pushing is when the nurse tells you to hold your breath and push while she counts to 10. First, you're losing oxygen and that means baby is losing oxygen as well. Also the likelihood of tearing increases because they are telling you when to push instead of you listening to what your body needs to do. If you end up having an epidural and cannot feel to push then having help pushing is a good idea but don't hold your breath; keep breathing!
And another issue with purple pushing is that you are having to fight your body's natural urge to push. So often a nurse will tell a woman to "NOT PUSH" because the doctor or midwife hasn't arrived yet. My urge to bear down and push was so strong that there was no stopping me whatsoever. If they were to tell me to stop I would've probably had my husband catch baby and tell the nurse to get lost.
Okay so I'm not telling anyone to be irresponsible and order hospital personnel around. But you may want to make it very clear, if this is something that concerns you, that you wish to push as your body wants you to push.
On my birth plan I wrote:
"I wish to employ mother-directed pushing rather than holding my breath for 10 counts. I'd prefer no one yell in my face and would prefer silence so I can concentrate."
The NEXT post will be about IMMEDIATELY following delivery (delayed cord clamping, holding baby, breastfeeding, etc.) and will deal more with the delivery of the placenta and with the care of your new little bundle of joy!
What position(s) did you find helpful while birthing your previous children? Which did you find not helpful? Did you tear or have an episiotomy or which do you think you'd prefer? And finally do you want someone counting in your face while you push?
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-ONE-The-Opening/show/1475184
Step Two:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-TWO-Labor-Options/show/1476757
Step Three:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-THREE-Monitoring/show/1476796
Step Four:
http://www.medhelp.org/posts/GroupTrack-We-Want-a-Natural-Birth/Birth-Wishes-STEP-FOUR-Drugs-and-Pain-Relief/show/1479807
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 actual delivery. 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.
The magical moment has finally arrived! You're 10cm dilated and begin bearing down to bring your baby into the world. How do you envision that moment? It is important to note on your birth plan particulars for your delivery because you also have choices in this matter!
First thing you'll want to think about is, "What position will I be in?" Do you envision giving birth like in the movies, on your back with your knees up to your forehead? Or do you envision being in a birth tub, squatting, on your hands-and-knees or laying on your side?
Laying on your back, in the lithotomy position, is likened to be as good as hanging from the ceiling by your toes when trying to deliver a baby. It narrows the pelvis by 25-30% and you're working against gravity. I HATE to compare birth to going poop but it is the only thing I can compare it to that men and women can visualize. When you need to use the restroom the last thing you're going to do is lay down to push your poo out. Toilets are shaped like seats for a reason - so you can sit or squat - and is optimal for pushing something out of your body.
Honestly it is anyone's guess, including yours, on what position will be ideal for the time to push. If you're having a lot of back labor you may naturally turn over to your hands-and-knees to relieve that pressure. Other women may stand up and then squat down.
On your birth plan you may wish to write something to the effect of:
"I prefer to choose a position that is ideal for delivering my baby, such as squatting or side-lying or _____."
Another way to phrase it if you do not wish to give birth on your back:
"I prefer to not push in the lithotomy position and will choose which position is best for delivering my baby."
Other issues you may want to address during delivery is the issue of forceps and vacuum extraction. If baby is truly stuck then forceps or vacuum should be a last ditch effort. Make sure your doctor isn't forcep-happy so you don't end up with an unnecessary forceps extraction. Usually birthing in a position that really opens up the pelvis, like squatting, will prevent the need for the use of forceps or a vacuum anyway.
A big fear women have is the dreaded episiotomy. An episiotomy is a cut the doctor or midwife will make on your perineum (the skin between your vagina and anus). Some do this habitually and others do it as-needed. The debate is ongoing on whether it is better to tear or be cut. Reading the book Pushed, with all the evidence-based information, I personally feel tearing is better than being cut. Again, if you're in an optimal position while pushing you can prevent or reduce tearing significantly.
Other solutions instead of being cut would be to take your time pushing! There's no need to set a world record in the fastest time a baby is pushed out. If you've already had more than one baby this may not be helped (my youngest, Zoë, was out in less than 60 seconds according to my husband and I did not tear; I contribute that to being in a side-lying position and already having given birth before). Otherwise if you're a first-time momma take your time. If you've been pushing for 20 minutes you're not broken! You're actually doing your perineum great favors.
Also perineal massage is a fantastic idea. You can do this before birth and during labor & delivery. Have your partner use EVOO to gently massage your perineum. In the hospital they may use Glycerin or a similar oily product.
And finally you may want to address the issue of "purple pushing". Purple pushing is when the nurse tells you to hold your breath and push while she counts to 10. First, you're losing oxygen and that means baby is losing oxygen as well. Also the likelihood of tearing increases because they are telling you when to push instead of you listening to what your body needs to do. If you end up having an epidural and cannot feel to push then having help pushing is a good idea but don't hold your breath; keep breathing!
And another issue with purple pushing is that you are having to fight your body's natural urge to push. So often a nurse will tell a woman to "NOT PUSH" because the doctor or midwife hasn't arrived yet. My urge to bear down and push was so strong that there was no stopping me whatsoever. If they were to tell me to stop I would've probably had my husband catch baby and tell the nurse to get lost.
Okay so I'm not telling anyone to be irresponsible and order hospital personnel around. But you may want to make it very clear, if this is something that concerns you, that you wish to push as your body wants you to push.
On my birth plan I wrote:
"I wish to employ mother-directed pushing rather than holding my breath for 10 counts. I'd prefer no one yell in my face and would prefer silence so I can concentrate."
The NEXT post will be about IMMEDIATELY following delivery (delayed cord clamping, holding baby, breastfeeding, etc.) and will deal more with the delivery of the placenta and with the care of your new little bundle of joy!
What position(s) did you find helpful while birthing your previous children? Which did you find not helpful? Did you tear or have an episiotomy or which do you think you'd prefer? And finally do you want someone counting in your face while you push?
Some women feel a little weird pushing on their hands-and-knees so side-lying is a good alternative. You're not on your back compressing oxygen to baby and it actually helps open the pelvis wider, too. I really wanted to get up and squat to push but there was no time for me to move. I was already on my side so my husband grabbed a leg and out she came!
Not all midwives are created equal, that is for sure. I hope your next midwife is sweet and dear and just lets you birth the way you need to birth.
Not all midwives are created equal, that is for sure. I hope your next midwife is sweet and dear and just lets you birth the way you need to birth.
Again a great read.
I had the in your face midwife who told me when to count and i also had a more push when u need to but not when u dont feel a contraction.
I was watching my birthing yesterday ( bad bad move when im only 3 months off delivering again) and i was applaued by the fact the midwife was always telling me to have a break. When i was pushing i was alot like you and noone could stop me. The thought of being able to stop and have a rest was a good idea but there was no way it was happening.
If i felt like pushing when i didnt have a contraction i was going to push.
Im hoping this time ill have a nicer midwife who can coatch me instead of tell me what to do.
Im seriously thinking about birthing on my side from what u said. Sounds interesting
I had the in your face midwife who told me when to count and i also had a more push when u need to but not when u dont feel a contraction.
I was watching my birthing yesterday ( bad bad move when im only 3 months off delivering again) and i was applaued by the fact the midwife was always telling me to have a break. When i was pushing i was alot like you and noone could stop me. The thought of being able to stop and have a rest was a good idea but there was no way it was happening.
If i felt like pushing when i didnt have a contraction i was going to push.
Im hoping this time ill have a nicer midwife who can coatch me instead of tell me what to do.
Im seriously thinking about birthing on my side from what u said. Sounds interesting
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