BIRTH CHOICES
We’ve had a chance to look at what to expect during a typical labour and birth and how to prepare for the birth that YOU want. But what about all those little decisions? The phrase “If you don’t know your options, you don’t have any” is all too true when it comes to the perinatal period. Below I’d like to take a look at some of these common choices and options as well as some of the interventions that may be offered to you.
First though, to understand your choices, I want you to fully understand informed consent. At the baseline of every single birth should be your ability to understand what is going on and make choices that are the best for YOU and your family. That may change at different parts of your labour, but the choices should still be yours to make. It is easy especially during hospital births especially to get caught up in ‘the way things are done’. Just because something is standard procedure, does not mean that it is evidence based OR the best decision for you. I include the following to give you some tools for making the right decisions for you in the moment, and also to remind you that even in birth, you do not lose your body autonomy.
So how do you decide which options are the best for you? The “BRAIN” tool is often used to help with birth and postpartum decision making. It encourages us to look at the option offered and examine both benefits and risks, as well as what your other options may be. Sometimes it’s the right choice, sometimes it’s the wrong choice, sometimes you’re just not ready to make a choice. Those are all valid.
Birth Preferences and Planning
Now that you have some tools to help you with decision making, let’s take a peek at what some of those choices will be. Knowledge truly is power when it comes to a satisfying birth experience. YOU are in charge of your labour decisions. Consider me your guide, cruise director, coach; supporting you along the way after you have decided how you want to get there. As your doula, I support whichever preferences you have—after all, this is about you, not me.
I recommend looking at samples of birth plans during your pregnancy, not because you need a written birth plan but because looking into what the options are can help you to think about how you want your labour and birth to go. Unfortunately, in labour many procedures are presented as mandatory when in fact they may be ‘typical’, but not necessarily required.
I encourage you to speak with your provider about standard procedures and take a look at the research behind them to decide which options will make a difference in your positive birth experience. You may decide that you are totally ok with all the standard procedures, or you may find that some or several do not resonate with the birth you envision or the research you have read. We can talk about all of these and I can help you find more information about anything that interests you.
While I’m not a huge fan of a birth “plan” in terms of a rigid statement of how your birth will go, I am absolutely on board with discovering your birth preferences ahead of time- and then choosing the important ones to make known to your birth team.
To get you started, over the remainder of this section we will examine many of the standard choices and interventions that may be offered to you.
As you follow along, you can make notes for things you would like to include in your preferences, or perhaps want to learn more about. Baby’s Nectar has a sample of a quick birth preference form found here. And Bundoo provides this extended version.
When completing your birth preferences, I am to make them concise and easy to read, and also consider the environment you will be in. When I wrote out my first birth ‘plan’ for my daughter’s hospital birth, it was long and filled with things I later realized were already standard procedure. When I wrote up my future birth plans I chose to leave off things that I knew I was just going to do anyways (ie no requesting that I be allowed to eat and drink during labour). You can read an updated sample version of my last birth preferences below.
Sample Birth Preferences
My wish is to have a hands off, uninterrupted labour and birth provided baby and I are both doing well. These preferences have been carefully chosen in order to facilitate this.
Please do not focus on the length of my labour as long as baby and I are coping well.
Please do not offer me pain medications. If I would like something, I will request it.
I would like to limit time spent in bed- please monitor baby via Doppler only.
I wish to labour down baby as much as possible to decrease pushing time.
I hope to use mother directed pushing. Do not count or direct pushing unless I ask for help.
Please tell me before adding support or stretching during delivery.
Please let me know if you think I am going to tear, and I would prefer to try position changes, perineum support, and then to tear naturally if needed.
After the Birth:
I do not consent to a pitocin shot after birth.
We would like delayed cord clamping of at least 5 minutes or until the cord is white.
We will do a Vitamin K shot but will NOT be giving baby erythromycin eye ointment.
Please:
Remind me to eat and drink
Remind me to use the toilet
Provide counterpressure on my back
Put music on in the background for me
Leave the lights down low
Remind me to change positions if I am getting frustrated or use the tub or shower
Remind {partner} to take self care breaks periodically
Suggest distraction ideas- movies, games, facebook etc!
This section is still heavily under revision. In the meantime, I want to provide you with a list of considerations as you start to look at your birth preferences.
Birth Preferences Starting Thoughts
Are there any health concerns you have that need to be taken into account during the birth?
What is your vision of a ‘perfect birth’? Look at some of those components.
What things are you most worried about in a birth? How can you alleviate those worries?
Do you have any spiritual beliefs that your supporters should know about?
Would you like to go to your birth place early to settle in, or stay home as long as possible?
What is your plan on coping with labour pains?
Are there any medications you absolutely do not want? Any you would like to learn more about?
Would you like pain medications to be offered to you, or wait until you request them?
What do you currently gravitate towards when coping with stress and pain?
What do you want most from your partner during birth? Your doula? Your nurses or midwife?
Do you have any music or scents that you would find comforting and encouraging during labour?
How do you feel about having your waters ruptured to speed up labour?
How do you feel about having your labour augmented with syntocin?
What is your comfort level with cervical checks during labour?
Do you want to move around during labour?
Do you want the curtains open and the sun shining in, or prefer the soothing darkness?
Will your partner have any needs during labour that you want to make sure are met?
How much monitoring of the baby would you like during labour? Intermittent, continuous, doppler only?
Do you have any mantras or focal points you want your support people to remind you of during labour?
Do you want to eat and drink during labour?
Are there any positions you would like to try pushing in?
Have you thought about directed pushing or mother led pushing?
Do you or your partner want to catch or help catch the baby?
Do you know about delayed cord clamping?
If you do not know the sex, do you or your partner want to announce baby’s sex after delivery?
Are you comfortable with the standard shot of pitocin post birth to speed up placenta delivery?
Would you like baby to come direct to your chest after birth, or be wiped off a bit first?
What is your preference for feeding your baby?
Birth Choices and Interventions
Stay Tuned!
