Monday, June 1, 2009

Planning Your First Birth: Planning Your Best Birth

Just finished a chat with my friend, Aja in Mexico. Aja had her beautiful baby girl at home in the water on Friday with her husband, mom, sister and midwife in attendance. It was magical and everything she hoped for and in her words, the baby is perfect. Of course, all parents feel that their babies are perfect but not all moms feel that great about the birth experience.

Aja really did her homework. She found a homebirth midwife in a foreign country, but researched options in the US as well in case she couldn't find what she wanted in Mexico. She kept the responsibility for her birthing and did not leave it up to fate or turn it over to a medical professional. She was attended by a midwife and a Physician's Assistant (her sister) so she had medical help available of she needed it, but they were back up. She birthed her baby. She did it. That is how I feel about Eva's birth, even though I was in the hospital, I birthed her. My midwife attended us.

Now, things happen and c-sections are sometimes necessary. Medical interventions can sometimes help. You can't prevent all bad things from happening. You can't prevent all complications.

But you can prevent a lot of them.

How? How to you "get it right the first time"?

Well, maybe, "get it best" is more accurate. Keep in mind, that I had a scheduled c-section due to breech for my first birth. Though, it was a great experience: easy process, easy recovery (well, easy for major surgery), it was not what I wanted and I didn't try to have an External Cephalic Version. I was talked out of trying. Looking at my records, I had an anterior placenta and a placental hematoma (earlier in pregnancy) and an ECV might not have worked, but I didn't try. I did the best I could with the information I had and no one could tell me who in town (or reasonably out of town) would do it confidently. I didn't realize how a c-section would limit my options for subsequent births. With VBAC bans in hospitals, restrictions for labor or when you have to go into labor by, or whether doctors will perform versions on a scarred uterus, I didn't realize it would be so difficult to have a VBAC.

Right now, I need to publicly thank my friend, Maggie. It was her experience in a VBAC attempt, which ultimately resulted in a repeat c-section, that caused me to work so hard to find a truly supportive VBAC provider and not just settle for the convenience of others. She thought her doctor was pro-VBAC. He said he was, until she got towards the end when his true colors came out and he was pressuring for a repeat c-section if she went over her due date. He would not even try to induce her. (Induction should be avoided for VBAC, if possible, and treated differently than other inductions, but there are methods that can be used for VBAC).

During my first pregnancy, my doula and my childbirth educator both tried to tell me that the practice I had chosen (in retrospect, based on many recommendations from people that saw the doctors for GYN issues, not OB) was very "medical" in their approach and not known for being supportive of natural childbirth. However, my doctor seemed so nice and said all the right things so I just thought that they didn't know my doctor and were mistaken. Also, they couldn't really offer up an alternative that was really better. Now there are more homebirth midwives in the area and as a SAHM, I was able to drive out-of-town for care, but back then (just three years ago), the homebirth option was much more mysterious in that area.

On to my general point:

1. Educate yourself: Read books like Henci Goer's Thinking Woman's Guide to a Better Birth to find out the true cost of interventions an the true benefits of natural childbirth so that when you are making your decisions, you are informed.

2. Write a Birth Plan: A lot of people think this is unnecessary or even setting yourself up for failure because you can't control labor, however, a birth plan should cover your wishes for everything from the ideal natural birth to your wishes in the event that a c-section becomes necessary. On Momversations about birth plans, Nancy O'Dell, author of the book, Full of Life: Mom Tips I Wish Someone Had Told Me When I Was Pregnant, dismissed the need for a birth plan saying that she had a verbal birth plan with her doctor that was,"I was a vaginal birth with drugs asap and a c-section if medically necessary."

Women out there, that is not enough. That is not enough research on the drugs, and there are so many things to decide between vaginal birth and c-section. You have options, even with a c-section. Don't assume that because "most doctors/midwives do it this way" that yours will. Don't assume that because you have a certain type of provider who seems a certain way that you are on the same page. Write it out before the birth and discuss things. Discuss them while there is still time to change providers or negotiate or do more research. You are not in the best position to negotiate when you are in labor.

Even if you are having a homebirth, you should write a birth plan that covers your expectations for homebirth and your wishes in case of transfer.

3. Get a second opinion: "Medically necessary" is a gray area. Providers are often very conservative due to legal fears. Find someone who will support you in what you want. There is a woman that I know who had two vaginal births and with her third, the doctors wanted to do a c-section because the fetus had tumors on her kidney. She didn't want a c-section and she pushed the issue. She contacted a neonatal specialist who said that the baby would not need immediate surgery and could be born vaginally. After the the baby was born vaginally, she underwent further evaluation and it turns out that she will most likely not need ANY surgery, that the one affected kidney will probably be reabsorbed into the body and the other kidney is working fine. Some people thought she was reckless to challenge the doctors. I think she was both smart and brave to get more information and another opinion.

4. Take a Childbirth Education/Labor Prep class and Practice! I did Hypnobabies, but whatever method you choose, you should practice, especially if you want a natural birth.

You don't have to choose a home water birth to have "your best birth", you just have to choose and prepare. Understand your options and make your choices. Understand that complications may occur and though you might not have your ideal birth, if you've made your choices and vetted your provider so that you can be reasonable sure your provider will be supportive, you can have the best birth possible for you and your baby.

If you are reading this and did not have the birth you wanted the first time, you can have a next birth. It may be harder, especially if you want to VBAC, but it is possible and definitely worth going the extra mile(s) to make it happen.


Catherine said...

Great post! I also recommend "Birthing from Within" by Pam England, which is relevant for home or hospital births.

Mama Seoul said...

I read Birthing from Within with my first pregnancy and I really liked it, but I think the attitude/strategy towards pain is better in Hypnobabies. But, BFW took the fear of birthing away from me and is a great counterpoint to more conventional books like the horrific What to Expect that give you the laundry list of things that can go wrong.

Sarah said...

I like this post. I was guilty of not looking at all my options when it came to my birth. I would recommend women to look at ALL options available, even if they don't seem to suit you. My hypnobirthing instructor urged to get me to look into other options, like a birth centre or home birth after I told her of my fear of hospitals. I thought no, no, I'LL BE so many others think. My birth was OK, but it wasn't my 'best birth.' You're right...there's always next time. I'm going to interview so many doctors and look into so many birthing styles!

Also, women should know that their husbands may not be the best birth companion, even if they're amazing husbands! Look into doulas! (I thought I wouldn't need one, but now I wish I would have had one!).
Sorry for the long comment ;)

Mama Seoul said...

I totally believe in doulas as well. I think that 99% of the time, a doula will help your partner be more included and helpful than your partner otherwise would have been. Even in the cases where the partner wants to stand back and watch or take pictures and leave most of the support to the doula, everyone is more comfortable.

Amynf said...

You are awesome, very well said.

Mama Seoul said...

Thanks, Amy.

Catherine, I just remembered that Pam England was a cesarean/VBAC mom as well!

I gave the book to a friend so I don't have it any more.

Angela said...

Gotta love doulas. Wanted to say hi, I am Angela and met you in yoga classes in PA, when you were pregnant of Ian. Then again at Carol's (doula) reunion. When I met Carol again in late 08 for the birth of my second child, I was trying to make baby do a simple turn from her posterior position, and she mentioned you were pregnant and trying to get the baby to rotate from her breached pose. I have been visiting your spot since then, finally today took the time to say Hi. Your baby girl is a doll and Ian is such a cute big brother. Congratulations!!

Mama Seoul said...

Hi Angela,

Great to hear from you! Hope you got your baby to turn and had a good birth!