Tuesday, June 11, 2013

What to CONSIDER when Giving Birth -- Your Options

I don't love writing on issues where people have such strong feelings that it turns into one side being WRONG and the other RIGHT. I feel like issues around birth and how women give birth tends to spur something like that on. And once I started thinking about this I realized there is so much and too much to write about so today all I am gonna do is present you with options when you go to deliver your baby! I am going to write several follow up posts about how to prepare for natural delivery, pregnancy nutrition, choosing care, etc.

Something that has made me want to write this isn't to push my opinion regarding birth or to make women get defensive about the options they've taken, but rather about encouraging urging women to look into all their options before they go into delivery. Don't assume everything will just work out or go to plan and be prepared and educated on what steps you may need to take. You still have the option to make your own choices but I really want to urge you to make yourself at lest knowledgeable about common drugs used, inductions, c-sections, tub deliveries, midwives and doulas, birthing centers, and much more before you give birth. I feel like in any other areas of life when it comes to our health we get second opinions, we research, we prepare. But somehow when it comes to the birth of our child we decide we'll just deal with it when the time comes and do whatever feels right -- which can make for a stressful and scary delivery.

Of course you need to adapt to whatever happens during your delivery. But being prepared can make all the difference for you and your baby when and if the time comes.

If you notice, people often don't describe their birth experience in a pleasant tone. I think what saddens me most is women in the US are buying into this lie that we "can't" do this -- we have somehow come to believe that birth is actually not possible without medical help. Birth for many people is seen as a scary, if not downright traumatizing experience for which they want to forget. Every birth is different, and many don't go as expected and I am SO thankful for medical intervention---BUT most birth's of healthy women with healthy pregnancies are going to go well when not intervened with.

And if prepared for can seriously be the one of the most empowering experience of your life.

Your birth experience will effect your life in some way, so the question is how!? Remember always that the goal and objective is a healthy child and mom, but I also believe that the journey in how you get there is very important.

Ok so this is a helicopter view, very generic "HERE are you options" when delivering your baby!!

Hospital Birth

I am big believer in the making women feel that they are in control of their births and what is happening to them in terms of decisions being made, environment, etc. So it needs to be where they feel most comfortable. For many women, a hospital is that place! And that's great!

Things I like about hospitals for delivery --
1. You are very close to lots of medical intervention if needed/wanted (i.e. high risk pregnancies, premature, baby, complicated pregnancies, etc)
2. You stay several days after delivery for monitoring and...well....clean up! I think this is really nice and I appreciate all the monitoring of my baby where I know some people find it invasive.
3. You have a supportive staff of well trained individuals around you. Please remember doctors and nurses are very well trained and not the enemy, work with them.

Things that I have an issue with in a hospital setting.
1. You are much more likely to have some kind intervention. Whether this is pushed by the Dr. or asked for by you (more on this later :)
2. Many hospitals have policies they must stick by that may or may not work for you. This is simply the way it is due to law suits, safety and so many other issues. One of these would be the 24 hr rule after your water breaks (they need to induce you, admit you, etc) since they can't risk any kind of infection for you they'd rather induce you then have an issue later on. Most hospitals also tend to whisk the baby away right when they come out (because they need to be wiped down and weighed minutes after birth why?!?! LOL) as well as preforming routine tests.
3. Unfortunately most hospitals don't offer midwives or doulas or tubs. I cannot stress how important these things were for me and many others I know. Dr's are wonderful especially if you really like your Dr. But I cannot explain the amazing importance of having that presence of women around you who are walking you through every contraction and step of the way. I was shocked at my need for them and now can't imagine it without that support.
We have to understand that from the Dr's perspective c-sections are full proof. They can have that baby out  and healthy in a matter of minutes whereas "who knows" if they continue to wait on the body's natural course. Again, again, again...I know this is necessary at so many times but I also don't think it's by chance that c-section rates go up near the end of the day and before weekends. And part of me can't blame them -- they are surgeons and can guarantee a healthy baby very quickly. But the full impact of what is being robbed from the mom in that moment is not being understood yet in my opinion. If this is a course your Dr. is wanting to take ask the necessary questions and make sure to look at all other options before consenting.
{So} Things to consider if you are planning to deliver in a hospital by choice or necessity.
Make your birth plan. 
Think about the birth you want IN DETAIL and even if you are high risk you can STILL make a birth plan and be strict about keeping them to it. Make it your space. If you want the lights dimmed or you want to refuse an IV talk with your Dr. about it. Make sure they know you want that baby on your chest immediately and you want to be notified of everything they are doing. You and your spouse need to be the ones constantly reminding them of your wants and wishes because they will most likely revert back to their policy. While they may get frustrated that you are doing your "own thing" and sometimes make you feel like you don't "know" all the important things they do just remember it's your baby and your birth and you can question and ask everything. Refuse to be bullied! This also goes for drugs during delivery....if you are going into a hospital wanting to do a natural birth with no drugs I highly recommend putting that in your birth plan and specifying for them to not offer them to you. Be that annoying person and print out copies of your birth plan for everyone in the room so that you feel comfortable and ready to go :)

Birth Center

It's important to make the distinction between a free-standing birth center and a birth center inside a hospital. So first, a birth center inside a hospital might be a great route for you to go if you find yourself in the middle of these two worlds.
Things to keep in mind with this option:
1. They are a great option for still being "within" a hospital yet having that feel of a birth center. They usually have tubs, midwives, doulas and strongly encourage natural delivery.
2. Because they are still part of a hospital they traditionally need to still remain within their policies. Although at the birth center I delivered in they were slightly altered (i.e. they don't use IV's, they have a 48 hr rule when your water breaks, they let you go FAR longer past your due date, you can leave as soon as 12 hrs postpartum if wanted and cleared, etc). So if you're delivering in one check out their policies and again ASK LOTS OF questions.
For a free-standing birth center they are under no such restrictions. They often use the term "you're having a home birth just at my house." It's a great option if you are considering a home birth but would like to do the actual delivery in a more professional setting with they equipment, tubs, etc.
Things to keep in mind:
1. Remember that midwives are medically trained individuals and are more than capable of giving you the same if not better prenatal and delivery care than traditional OB's.
2. You will be delivering at "their house" but you will often be heading home 3-5 hours postpartum. So make sure to be ready to do your own postpartum care and have supplies for that ready at home. They often come the next day to check on you and baby.
3. Most free-standing birth centers have a relationship with the local hospital in case of a transfer being needed. My only recommendation would be to talk with your midwives and ask about their policies surrounding transfers, when they see a transfer needed, their rate of transfers, etc.

Birth center midwives offer so many things that you are unable to get in a hospital such as more detailed pre-natal care, LOTS of options during delivery to help minimize tearing such as oils, hot clothes, stretching, etc which they simply don't do in hospitals and you are commonly the only patient there delivering so you have their full attention :)
Things to consider is that many (not all!) midwives are very much "their way or the highway". They take great pride in their work as they should but if you find that you have issues with some of their views you need to talk with them. They are confident in their practice and sometimes I believe this can inhibit the need for you to be transferred or have a rare necessary intervention. So make sure you are comfortable with how and what they do.

Home Birth 

Exactly what it sounds like people! You are having your baby IN YOUR HOME! I have always loved the idea of this option but in the end have opted out of it although I have lots of friends who have had wonderful successful home births. In a home birth setting you will commonly go to your midwife for all your prenatal care and then once it's go time she comes to your house with all her equipment and sets up the tub and delivery area. Again what is so wonderful about midwives is they are constantly there with you. They aren't running in and out of the room or making you feel like "It's been too long with no progression". They realize labor takes time and they are with you the whole time but can also tell when intervention may be necessary.
Things to consider when having a home birth:
1. The same as a free-standing birth center -- drugs are NOT an option. They don't even carry them :) This means preparation on your end for pain management that are not drugs....such as water, massage, counter pressure, and other methods.
2. You may or may not be further from a hospital and it could increase your risk if you needed to be transferred.
3. In the rare circumstance where something goes very wrong very fast you are not usually within the time frame or distance of being able to get the medical intervention necessary. Although most midwives are VERY well trained and can sight a problem long before it becomes a medical emergency, it still happens.
Even the most home-birth advocate midwives don't recommend having a vbac at home -- just something to keep in mind :)

Closing thoughts that go in no category :)

I am becoming increasingly passionate about women taking responsibility for their birth experience. You might think that means I'm some natural no drugs nut who thinks nothing can ever go wrong! But seriously, I completely understand that every single birth is different and as a friend recently reminded me of -- women in our country are having babies later, in worse health (overweight being a huge one) and with a wide range of ethnicity and health issues births ARE seeing more interventions because they are necessary. However, I am also seeing a trend and shift towards even the healthiest of pregnant women becoming more distant from any part they should play in preparing for their birth. It is no one's job but yours to learn about birth! While you should and do trust your Dr. when they begin to tell you an intervention is needed if you have no knowledge of when and why it's actually needed you'll have to simply trust them. I can't tell you how many people I know who regret being induced simply because they were a week late and their Dr. said it was time. While in certain circumstances induction is very necessary, a baby being a week late is not uncommon! Remember that dates are all recorded on the traditional 28 day cycle and if you vary from that you really need to hold to that "due date" with a loose grip. When the body is ready and the baby is ready labor happens so well -- rather than things trying to be forced and the baby being essentially taken out before it's ready.

And as much as I'm tempted to write on why I believe a no drug delivery to be best, I will save that along with tips to and methods on natural delivery for a later post :)

So here are lots of options and things to consider as your prepare for a BIG day -- the day you meet your child. You want a healthy delivery and a healthy baby no matter what -- but I hope you'll be a prepared and knowledgeable mommy who is able to have a good birth experience and feel that feeling when you grab your baby onto your chest! The best ever! And no matter what---after all that, YOU DID IT!


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