what kind of birthing plans do you have?
How many of you will have a doula present?

I am *planning* for an intervention free labour and delivery. We don't have birthing centres in my town and being my first, I didn't want to try homebirthing. We don't even have mid-wives here. My ultimate goal is to avoid being cut anywhere- primarily c-section, secondarily episiotomy. I believe in order to (more likely) acheive that I will not request pain medication and be free to move about and labour in various positions.

We will have a doula there to help us through and help us not be bombarded by medical staff who may be intervention happy.

I am ultimately most curious to find out how it all plays out according to my wishes.

First of all, congratulations on your desire for a natural birth. It sounds like you are really thinking about how to make that a reality. I think that a doula is an excellent idea. If I ever had one in a hospital, I would want a support person like that too.

I was actually surprised that my midwife wanted me to make a birth plan, but she said that she wanted to see my desires on paper. So I basically wrote an essay describing my ideal birth and then wrote a few points at the end, in case I needed to be transported to a hospital.

I can totally empathize with your desire to avoid cutting of any kind. I think that your best bet for that is to find a doctor who seldom does c-sections or episiotomies. My midwife doesn't do episiotomies at all and only has about a 5% transfer rate to the hospital. So I felt comfortable that it was very unlikely that I would wind up with these procedures.

If you have a doctor who routinely does these procedures, it is far more difficult to escape intervention, as he will tend to view your refusal as stubbornness and try to wear you down. Beware of doctors who say that they do episiotomies only "when necessary." I mean, they could feel that episiotomies are necessary 70, 80, or 100% of the time! Midwives are often a good choice for natural childbirth as they tend to be far more oriented toward the natural. To prevent tearing my midwife applied olive oil and hot compresses to my perineum. It was great not to have a tear to recover from on top of everything else.

As far as freedom of movement, you nailed the nail on the head. When my labor stalled my midwife had me get in our bathtub and take a walk around the yard and that got things going really fast!

The other huge recommendation I have when preparing for an intervention free birth is to take a high quality natural childbirth class taught by an independent instructor. My husband and I took Bradley classes and it was well worth the time and money. Bradley has a very high rate of unmedicated births compared to other methods and that's why DH and I chose to study that particular method. We certainly utilized what we learned in the class, so even though we had to drive an hour each way once a week to get to class, it was well worth it.

I wish you the best on your birth. If you have any questions, feel free to PM me.

I have my birth plan floating in my head. I am about ready to write it down in the next day or so. I do plan on a medication free birth. And I do not want cut (c-section or episotomy) I do want to be able to labor in any position I feel comfortable in. I wanted a home birth, but in my state, getting one of those is next to impossible, so I am stuck going to a hospital. Both the hospitals in town have about a one in four c-section rate (way too high, IMO). I did decide to go with a midwife for prenatal and delivery (however, if we are still living here for the next baby, I am going to a different midwife!). I have also decided to include specifications for after the birth. Such as when I think I will want visitors, who can come and when (long story on that, I'm sure if you read a lot on this forum, you'll find it) and stuff like that. I want my bases covered, basically.

I am against most if not all of the interventions used today and want to avoid them. The hospitals around here insist on external fetal monitoring for no less than 20 minutes an hour, if they break your water, they love to do internal monitoring (when my husband saw how they did that in our birthing class a few weeks ago, he said that will not be put on my child.). The nurses love to push pain meds (going to refuse that. The more interventions, the greater risk for a c-section. And I act weird on pain meds of any form anyway....I want a clear head for this. Though, Hubby did make my promise that if needed any, I would ask....)

I would love to chat more. If I get mine done in the next day or so, I'll let you know the details. However, I am the kind of person who when they start to write, can't stop.

My town has interesting circumstances - we have a very young population and a very high birth rate- up to 80 babies a week in a city of 70 000. We only have 2 OB's who have hospital priviledges. None of our GP's deliver anymore. Part of the problem is that we are an isloated northern community in which it is expensive to live- we have a hard time getting gp's to stay longer than 2 years, let alone specialists. We are at least 4 hours to the nearest place with "alternate" birthing options IE: midwife, birth centre, non-procedural ob's etc.
The ob's are knife happy and med happy. That is one of the main reasons for getting a doula- she will help us "interpret" what, if anything is necessary. She and my hubby has strict instructions to watch out for scaples and needles in perinium area- ob's are known to freeze, cut and ask later. I don't like the idea of going into hospital feeling like I have to be ready for war- labour is going to be hard enough, let alone fighting with the folks who are suposed to care for me/baby.

I have requested that sign be posted that no nurse offer me pain relief - I will ask if I need it.

I have also indicated that post-delivery I begin nursing immediately unless the baby is in distress. They can evaluate the baby while on me and wait on the weigh adn measure until I am finished.

Ooh, that makes me so mad!! Why are OB's so knife happy? Danou, I totally understand where you're coming from with your comment about being ready for war. That's why my husband and I felt more comfortable doing a home birth. However, everyone has to choose the option that best fits their situation.

Episiotomies should be done away with forever, in my opinion, unless there is a severe emergency or reason for their use, other than the tired old reasons of "they heal better than a tear" or "they prevent tearing". (Both are bogus in my opinion) The problem is that most OB's don't use alternative measures like perineal support and oils, compresses, etc. and they don't encourage controlled pushing. With those measures, it's rare to get a tear that's as bad as an episiotomy. About 1/3 of my midwife's 1st time moms don't tear at all.

Stay strong with your desires ladies!

Danou - they really can't give you a caesarian unless you sign for one over here (you have to concent)...

Do they have midwife run birthing centres in the US? We have a BIG one in Western Australia which is attached to the main women and childrens hospital built and run for women who desire 100% natural and it's also convenient being right within the main hospital so if there is a REAL need for intervention the women can get there quick smart.
So many mothers prefer this over home births because of that fact.

My friend had her 3rd there and SHE LOVED it, she also had no taring or stitches and went home the same day.

Oh, one other recommendation that my Bradley class gave is to stay away from the hospital for as long as possible. Make sure that you're in hard labor (contractions 3-4 minutes apart and over a minute long) before you go. The reason is that many hospitals impose time limits for labor and if you go over those time limits you end up with unwanted intervention.

Something called "Berman's Law" says that most women should not stay in the hospital if they are under 5 cm dilated. That's a good guideline to follow most of the time. I actually ended up doing that for my home birth, because when my midwife came over, the contractions were 4 minutes apart and 70 seconds long. My daughter was born about 10 hours after we called the midwife, so that was none too late! The bottom line is, hospitals "manage" labor. If you don't want your labor managed on their schedule the best thing is to stay away until you have to go. Also, hospitals tend to restrict food and drink intake so if you stay at home longer you can eat and drink as needed and possibly avoid an IV. I could have never ever made it through my labor without food and drink.

Danou, you sound like me with our first. We considered a midwife at home but if an emergency happened and we had to go to the hospital while the midwife was there, we would have had to pay both. We couldn't afford double at the time.

If you don't want an episiotomy, don't do the stirrups. BTW, If you go into premature labor, you need an episiotomy. The pressure could cause brain hemorraging in the baby, since their blood vessels are so fragile.

You're right to let everyone know ahead of time of your wishes, and make sure the nurses put it in your file. We told the nurse that my first daughter was being breastfed only, so when she unexpectedly was sent to the NICU, they already knew not to give her bottles or pacis. At that time, that was the last thing on our minds!

Not to knock homebirths, which are wonderful, but neither of our daughters would have made it. So, you can at least have that comfort that help is there just in case.

The doula should be great in helping you discern what is actually necessary.

This is our 3rd time. We are planning a natural birth in the hospital. I'm definitely more frightened of the epidural than the pain!
No midwife would take me now, since our 2nd was born at 28 weeks.

Congratulations! You are already being a great mom!!

Crystal, do the nurses really push pain meds over there????
... or do you just mean they persistantly ask or hound?

Would the high rate of intervention have more to do with the current trend of lawsuits against obstetricians than anything?

Thanks ladies for all the input.
According to the book I"m reading (A THinking Woman's GUide to Birthing) and others too... state that the main reason for interventions is the lawsuit factor. So if something happens to mom and/or baby then doc can say - oh but we did this, this and this. Plus OB are taught from day one that pregnancy and childbirth are conditions to be rectified/managed.

You're right about episiotomies for preemies, Kerina. My midwife even told me that. I'm not against ever doing them but I'm against doing them routinely for no medical reason.

Aussie Mum, the nurses love to come in and keep asking if you need anything to manage the pain and stuff like that. I think I am going to make up a sign to post that says I will tell them if I want any, I know what my options are, thanks.

I think the reason that most interventions are pushed so hard and routinely used is the lawsuit factor. Obstetrics is the specialty with the most lawsuits, the highest malpractice insurance and frankly, they want to protect themselves. That is one reason why most family dr's anymore will not do obstetrics. Their malpractice insurance would be too high. I don't think I could handle being one in today's world. I used to consider going to school for it a long time ago, but now with how things are, you couldn't pay me enough for the stress.

And while I do understand that they need to protect themselves, I think it has gone to an extreme. I am more than willing to sign a waiver stating that I do not wish for the interventions to be employed as a standard procedure. However, not quite an option around here. Though, I do plan on being very vocal about what is and isn't done when I'm there.

Crystal - the malpractice suits have reached a great height, but a great number of those suits are legitimate, that's why the obstetricians are so quick to jump to an intervention... whether it's a knee jerk reaction or not :shock:

I myself am glad intervention exists or my twins and I may not be here today!!!

Anyway, this has gone way OFF TRACK (sorry everyone :wink: )

I don't know how things are done in hospitals in the US but I'm guessing it all depends on the hospital or the area you live in...

I had a hospital birth with a midwife and it was great. I didn't have medication forced on me and wasn't constantly asked if I would like any. They said I could have an epidural 1x and I said that I didn't want one (more scared of that huge needle than the pain LOL) and they offered Pethidine which I gladly accepted LOL I was in so much pain. I thought I could do it naturally and I could have... and will this time (because the Pethidine did nothing for me). The gas did nothing either. So now that I know that neither worked for me (and that I won't have an epidural unless I HAVE to) I will just tell them I'm doing it without the drugs.
Anyway, so they offered but they didn't force anything on me. If I had said no to the Pethidine they wouldn't have argued.
My midwife delivered baby (no OB) and I didn't need an episiotomy or anything. I had no tearing because she told me when to push and when to stop and prevented tearing. I was really happy about that... I hate the thought of stitches or anything like that. So basically even though I did have Pethidine and tried the gas for a few seconds LOL my labour was natural. Even though I didn't go into labour by myself... I was disappointed about that. Hopefully this time I will...
I didn't have an epidural, stitches, an episiotomy, ventouse or forceps. So I was happy :D

I would have a homebirth this time.. unfortunately it's too late now to choose to do that. The reason I had Abby in hospital was just incase of complications as my mum didn't have good labours with neither my sister or I. Both of us were forceps deliveries...
And Abby was 8lbs 3ozs.
If we have another (and Sophies birth is like Abbys) then I would have no problem having a homebirth.

I don't think I could ever have my first child at home... I would just be too scared that something would go wrong and we wouldn't get to the hospital in time. I'm not knocking homebirths... 2 of my aunties have had a homebirth and they were fine. However, it wasn't their 1st children. My auntie C had her third at home and my auntie M had her fourth at home.

Anyway, definitely have a birthing plan and just be forceful when you go to the hospital. They can't do anything or give you anything you don't want without your consent. :wink:

I didn't draw up a birth plan with either pregnancy. I am blessed here to have a dr. who is matter of fact and doesn't push anything... oh wait, I think that's the case, he hasn't delivered either of my babies! LOL, always got the dr. on call.

With my first baby, I was offered pain meds but they had to give me either an epidural (scary big needle, no thanks!) or an IV (another needle, no thanks). I hate needles. So I kept begging for pain relief but refusing the needles LOL, likely drove dh crazy! When I finally started to push (yeah, finally, after like 5 hours of labour, it was short actually, in hindsight anyway), the on call dr. wanted to give me an episiotomy. I didn't want one. But he said he would only do it if necessary and wanted to freeze me in case. So he did. I'm so glad he did because I actually did need one. Ds umblilical cord ruptured (it was too short to reach from the placenta to where he was and so it tore, very rare occurance) so just before he was born, his heart rate dropped and they wanted him out ASAP. I was frozen so he sliced me and out came ds, as grey as anything. It was so scary when they had NICU in working on him. But he was okay and none the worse for wear. Still, I do think that it was God getting the dr. ready to do an episiotomy. the dr. told me that he would freeze me in case of an emergency. He didn't tell me that the second time around (Same on call dr. both times!)

The second time around, I thought I was way farther along than I was. My pregnancy classes with the first said that your cervix would be at 3 cm before you went into labour with any subsequent children. Umm, no! I was a fingertip when I went in. So I went home. Then 8 hours later, went back in, only 3 cm I think. I was pretty irritated because I already felt like I had to push. Ds was turned funny and wasn't moving which is why labour was so bad that time. Finally, and I wish that they would tell you this, I hit transition. For some reason, with both, that's when I just want to give up. I'm done. And by this time, I had been in labour for 14 hours and was dead tired (I had woken up at 1 am when my water broke and been awake since then. It was now about 3:30 pm. I was only 5 cm so I asked for an epidural. That was awful. They got it all set up and it took so long. Dh is forbidden to tell me what that needle looks like! He said he felt weak in the knees watching! Well they got it all set and I said, I have to push. I was 8 cm. So I likely hit transition but didn't realize and no one else did either... the nurses are busy and dh was tired too. Maybe next time I can remember that transition is hard on me and I'll get through it. Ds was born at 4:56 pm. About 30 min after they got me ready to start the epidural!!! The dr. was, I'm sure, on the golf course, and took forever to get there so I could start pushing! But I didn't tear so maybe that was good.

My dh didn't like me staying home for much because he doesn't want a baby born in the van LOL. Currently we live about 4 min. from the hospital. However, I strongly believe stay away for as long as you can, or as long as dh will let you!

You're right about transition, Jaylene. That's the time in the labor where most women feel like giving up. My childbirth class taught us about it, so when I was in transition, I knew where I was and I knew that I was almost done. Otherwise it would have been overbearingly frightening because those were the some of the closest contractions of the whole labor and the worst pain of my whole life!

Oh yes when the contractions seem to run into each other LOL That was when I was telling Paul I wanted to die and crying. :lol:

I had a doctor that didn't believe in having c-sections. And would only do it if ABSOLUTELY necessary. Their are many doctors like that and i picked her because i didn't want a c-section. Well i ended up having one. :lol: ( and my pregnancy was normal and everything, it was just totally unexpected). It was absolutely necessary and i'm glad that i was at a hospital since it was an emergency c-section and if i didn't get one i know i would of died and my daughter would of ended up with brain damage or possibly would of died also. So although i didn't want a c-section each time i see my daughter running around healthy as can be i'm so thankful for c-sections! :wink: Maybe you could find a doctor that delievers at a hospital but doesn't believe in c-section unless it's a absolute MUST. So that way like someone had mentioned you will have the advanced technology if needs be.