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.

Korean translation for Natural Birth Plan

This is L's actual birth plan so you may have some differences, but this should get you started if you are planning to give birth at a Korean hospital. I do not read Korean and did not write this (just cut and pasted), so please double check this before you use it.

BIRTH PLAN FOR THE ~ FAMILY
(~ 패밀리를 위한 분만 계획서)

I prefer a natural, vaginal birth. Please help me achieve this in the following ways.
(저는 가능한 한 자연 분만을 원합니다. 아래에 적힌 내용을 참조해 주세요.)

1st stage of labour (분만 1기)

I prefer
1 No males, students or non-essential personnel to be in the room.
(분만실에 꼭 필요한 분이 아닌 인턴이나 실습생, 특히 남자분들을 들여 보내지 말아 주세요.)
2 To avoid internal vaginal examinations unless they are medically necessary or I request them.
(꼭 필요하거니 제가 원할 때에만 내진을 해 주세요.)
3 To avoid having my membranes ruptured unless medically indicated or discussed with us.
(꼭 필요한 상황이 아니면 양수를 인위적으로 터트리지 말아 주세요.)
4 To manage my pain on my own. Please do not offer drugs for pain relief. I will ask for it if I need it.
(진통 경감을 위한 약을 쓰지 말아 주세요. 필요 시엔 제가 말씀 드리겠습니다.)
5 If the baby and I are fine, to be free of time limits.
(저와 아기만 건강하다면 너무 진통 시간에 연연하지 말아 주세요.)

2nd stage of labour (분만 2기)

I prefer
1 Not to lie on my back
(똑바로 눕지 않게 해 주세요.)
2 To adopt whatever position feels right for me at that time (for example, squatting, side lying, on all fours
(진통 중 가능한 한 제가 마음대로 자세를 바꿀 수 있게 해 주세요.)
3 To be allowed to rest and wait if I do not have the urge to push straight away, if the baby and I are fine
(아기와 제가 괜찮다면 힘주기때 너무 급하게 재촉하지 말아 주세요.)
4 To push instinctively rather than be coached or told when to push
(힘주기때 제가 스스로 알아서 할 수 있도록 너무 코치를 하지 말아 주세요.)
5 Measures taken to try and ensure an intact perineum (warm compress, massage with lubricant, gentle pressure on baby’s head to stop it coming too quickly)
(perineum이 제 역할을 잘 할 수 있도록 따뜻한 마사지나 지압을 좀 해 주시고 아기 머리가 너무 빨리 나오는 것을 방지하도록 아기 머리를 부드럽게 눌러 주세요.)
6 To risk a tear rather than have an episiotomy (unless a medical emergency)
(위급한 상황이 아니라면 회음부 절개보다는 자연적인 tearing을 원합니다.)

After birth (분만 이후)

I prefer
1 To wait until the umbilical cord stops pulsating before it is clamped and cut
(탯줄이 스스로 pulsating이 멈출 때까지 자르지 말아 주세요.)
2 Skin to skin contact with my baby
(아기와 제가 스킨십을 바로 할 수 있도록 해 주세요.)
3 Not to have my baby’s nose and mouth suctioned unless it is medically necessary
(응급상황이 아니라면 아기의 코와 입에 suction을 하지 말아 주세요.)
4 Time to allow the placenta to deliver spontaneously
(태반이 자연적으로 배출되도록 기다려 주세요.)
5 To avoid injection to help control bleeding and deliver the placenta, unless medically necessary
(의학적으로 꼭 필요한 경우가 아니라면 지혈이나 태반출산을 돕는 주사나 약물을 사용하지 말아 주세요.)
6 To delay newborn procedures (weighing and measuring, etc) until I have had time to breastfeed my baby
(제가 충분히 아기에게 수유를 한 후에 아기 체중 측정이나 키 측정 같은 신생아 관리를 스케줄대로 해 주세요.)
7 To wait until after I have fed my baby before having stitches, if possible
(스티치(봉합)를 하기 전에 제가 아기에게 먼저 수유할 수 있도록 해 주세요.)

In case of C-section (만약 제왕 절개가 필요시)

I prefer
1 Regional anaesthesia (epidural or spinal block) if possible
(전신 마취가 아닌 경막외 마취를 해 주세요.)
2 To avoid a chest X-ray
(X-ray는 찍지 말아 주세요.)
3 If a chest X-ray is necessary, please cover my baby with a lead apron
(꼭 X-ray가 필요시엔 앞치마나 천으로 제 배를 가려 주세요.)
4 To hold my baby after the C-section, if possible
(가능하면 수술뒤 바로 아기를 제게 안겨 주세요.)
5 To delay newborn procedures (weighing and measuring, etc) until I have had time to breastfeed my baby, if possible
(제가 충분히 아기에게 수유를 한 후에 아기 체중 측정이나 키 측정 같은 신생아 관리를 스케줄대로 해 주세요.)

Other
Breastfeeding support (모유 수유시)
1 I would like a lactation consultant to check the progress of breastfeeding my baby during the days after birth
(분만후 모유 수유 전문가가 일정한 시간마다 저를 방문해서 모유수유를 도와 주시기를 바랍니다.)
2 Please provide a breast pump, if needed
(유축기가 필요 시엔 좀 준비해 주세요.)

Infant vaccination (신생아 예방접종)
1 Please vaccinate our baby against Hepatitis B.
(간염 B 예방 접종을 해 주세요.)

Thank you. (감사 드립니다!)