Musing on Birth Plans

The following views are expressed on the American maternity system, which is the only one I have personal experience with.

Birth Plans get better known each year, by both moms-to-be and care providers. Pregnant mamas view them as a way to express their desires for the minutiae of birth (getting all those questions we're bombarded with when we're there out of the way early) and care providers see them in a mixed light.

A midwife typically sees them as either quite welcome (as she wants to make her client's birth as easy and comfortable as possible, so knowing what she wants is essential) or unnecessary in a different way than the OB does. Midwives offer natural care in general, so they figure if you're going to choose one, that is the sort of birth you'll want. They tend to ask about vaccination, birth tests, eye goop, etc. beforehand.

OBs tend to see them as either unnecessary (because they have no intention of following them) or dangerous (as this is a woman who is not going to submit to every procedure s/he suggests unquestioningly) because few mothers desiring a medicalized birth submit one. Also, OBs are not involved in birth the way that midwives are, so most of the information is useless to them. A midwife sits through the birth and needs to know that her client wants to be checked only rarely or wants to use a certain type of natural pain relief. In a hospital, the nurses deal with all of this information. Things like pitocin, etc. are like asking a baker not to use a certain spice that they typically overuse. They've learned to work that way and they don't want to deviate.

I had the standard form Birth Plans (my second was never submitted, but to take the 'you can't plan a birth' argument away, I had renamed it "Birth Preferences") for my first two births. In my first, it was partly respected. They did not reduce the number of vaginal checks at all and I was told I could not refuse, that I had no right of consent. So, against my will, basically anyone who walked in the room was allowed to stick their hand inside me (or that's how it felt). I ended up with a cesarean that had none of the elements I had requested (other than photos being taken and my arms were free because I made it clear there would be a fight even if my body was like a dead fish if they tried to strap me down) in my birth plan.

It was so defeating, I never submitted to my second OB (though he was nothing like my first). My VBAC was nothing like I had hoped, other than the end (the baby care was quite well done) in that she came out vaginally and I got to catch her (I had to negotiate for this while pushing). It would have been thrown out due to unforeseen complications, so it wasn't a big deal.

With my third baby, I was seeing a midwife and one day, the subject of birth plans came up. I asked her if she wanted me to give her one, though I wasn't sure what I would put in it since her standard birth policies were all in line with my wishes. She said that she liked birth plans and then, remembering that I fancy myself a writer, she asked for me to deviate from the standard form. She wanted me to write my birth story in advance. My ideal birth story. I joked that there would be little story to that, since I'd just wake up pushing and pop the baby out in bed. We laughed, talking about precipitous birth and I agreed to write one based on my personal birth history. So what followed was a realistic, but desirable birth for me and I'm going to finally share it here.

Beautiful henna art by my friend Nikol on my 9 month belly

My Realistic Ideal Birth Plan for my Third Baby

On October twenty-second, I wake up around 10am, unable to ignore the contraction urging me to adjust myself in bed. I roll onto all fours to stretch out my stiff back and breathe through the pressure, trying to ignore it. When it passes, I check the time and groan. I'm still tired, but 10 is a good time to get up. I roll over and snuggle Naomi and kiss her cheek, then reach over and rub Lilly's fuzzy head.

Naomi peeks open her eyes and grins at me, whispering, "Time to get up! It's morning." I smile at her and nod. She rolls over and snuggles up onto my shoulder, grinning and sighing happily. I'm about to tell Lilly that it's time to wake up when I feel the beginning of tightening and close my eyes, feeling myself breathe in and out as it comes. Naomi is saying happy little things and snuggling me, but I don't really notice much. I'm too busy cursing prodromal labor.

It passes and I tell Lilly it's time to wake up, squishing Naomi a little as I reach past her. She giggles and clings to my arm. Lilly groans at me and I rub her head again. She grabs my hand and opens her eyes to grin at me. I smile at her and she asks Naomi to move so she can cuddle me. Naomi stands up and dances in place while Lilly scoots over and tucks up against me.

After we cuddle, I turn on the television and sit up as another contraction comes. Grumpily, I look at the clock to see they've been coming every three minutes, as I suspected. When it's over, I get up to pee and go out to the computer to complain about how my body likes its little games and catch up with friends on facebook. A few contractions later and I don't want to be at the computer anymore, so I go over and lie on the couch and turn on the living room television.

I turn on the XBox and go to Netflix to see what looks good. I pick a romantic comedy or something equally mindless and absently write down my contractions as they happen. Lilly interrupts me a few minutes into the movie asking for breakfast and I know I don't feel up to cooking with how I'm contracting, so I tell her to go make some cereal and find out if her sister wants some, too.

Realizing that I should probably eat, too, just in case this isn't a fake-out, I follow her into the kitchen and en up having to lean on the counter through a contraction, glad that we have a bigger kitchen than we had in the old house. Our old one made me claustrophobic (no small feat for someone who likes safe little enclosed spaces). When it's over, I poke through the freezer and realize that I want a burger, but we don't have one, so I settle for a turkey and cheddar bratwurst, hoping I won't regret it.

Naomi informs me loudly that she wants a sausage, too, so I grab one for her and toss it on the plate to heat them up while getting out the bread and ketchup. I sway through yet another contraction and then make us our breakfast. I grab my water cup from the fridge, glad that Lilly put it in there the night before. I had been too grumpy from a few hours of contractions to want to do my night time ritual.

I go back out and eat my breakfast and enjoy my movie. The kids don't pester me after I tell them that I need to relax and watch a movie, so no, they can't take over the XBox today. When the movie is over, I get up and restlessly walk around, wondering when it's going to die down and give me a break. I roll over the yoga ball and bounce on that for a while while getting back on the computer.

I post on [my parenting forum] about what's going on in the pregnant chatting thread and make another whiny status update on facebook. I read the replies to my last one and smile at the people sending me labor vibes and laugh at the ones who wonder why I'm not rushing to the hospital over a few contractions. I growl at my mom's usual well-meaning "Is there anything I can do?" I know she just enjoys being a part of my life, but it still irritates me.

I realize I'm getting irritable with the contractions and they're starting to hurt more, so I call a friend to come over and hang out and let our kids play. I text Brandon to let him know how long I've been contracting and how often. He texts back asking if he needs to come home and I text back with "Not yet. I'll call when it's time." I add that my friend is coming over and then she knocks on the door. I toss on some clothes as I let her in. We chat and the kids play and I feel better.

When the contractions continue to build, she smiles at me knowingly and doesn't say anything about it. After a while, she casually asks me how long it's been going on and I realize it's been five hours. She gives me that look that people get when you tell them you've been contracting for five hours and I roll my eyes. "Oh, I've had prodromal labor longer than this," I assure her. "I had it for seven hours the day before Naomi was born. Five hours wasn't too unusual with Lilly. For. Four. Freaking. Weeks."

She tells me that she hopes that I don't have to do this for the next four weeks and I readily agree. Things are starting to get really intense and I tell her that I think I want to take a bath to help and we say good-bye while I go in to draw a bath, hoping it will stop things if it's not real and give me that blessed water relief if it is.

Before I get in, I take a few belly pictures and the kids join in, so I have some cute ones. Then I tell them they can have the XBox while Mommy takes a bath, grab my phone and set it in reach, but far enough away to stay dry, on a little folding stool and refill my water cup before getting into the warm water.

The next contraction is much more manageable and I relax and just enjoy the waves rippling out from my belly as they happen. I can breathe and think again and know that I can do this, be it real or practice, and it will be fine. I just let my mind drift and roll around in the water like a great whale trying to stay comfortable in the too-shallow-for-a-person-my-size tub.

I fold my arms against the side and lie my head in my hands while the contractions continue without slowing down. I have to pee and carefully crawl out of the tub over to the toilet. While I'm peeing, I feel a pop and gush. I freeze. I know what I just felt. Nervously, I wipe and check the paper--it's clear. No meconium!

I stand up and water gushes down my leg, so I climb back into the water and wash my leg off, then stick a towel between them while I go to grab a pair of poise underwear to catch the gushes. I debate what to do while checking the clock. It's 5:30pm and I know I won't be done before Brandon gets off work, but I am still tempted to call him.

I call Brandon and tell him that my water broke and that I'm sure he can finish his shift if he wants, but it's up to him. He decides he'll come home and we say "I love you" and hang up. I call Tara and let her know that it's baby day, then I call Rachel to let her know, too. I assure her that it's still too early to go in, but that my water is broken, so it's going to be soon regardless.

I go out to the living room and pace about for a while, grabbing things to sway through contractions. I'm hungry and still want that burger, so I call Brandon quickly and ask him to grab me one on the way home. No, I don't want fries, just the burger. McDonald's, of course. It's got to be that terrible-for-you-greasy-goodness. Yes, a double, I agree as I pull on a tank top and a skirt.

I turn on Deftones and start dancing around to 'Digital Bath.' Since it's just me and the kids, I am utterly unrestricted and I sing loudly and emotionally with what I've always considered a song about birth, from making the water warm to the cord breaking away. I want things I can dance to, sing to, be loud to, so I cue my sansa playlist and tell Lilly to unlock the door for Tara. I belt out with Seether and Three Day's Grace and grumble about never getting around to making my birth mix, but I don't really care as long as I can sing.

I'm not sure when Tara got there, I'm so lost in the music, but when I look over at the chair, she's sitting there, smiling and Brandon's on the couch. They wave at me and I say hi, feeling a little self-conscious, since I always hide when I sing and dance anymore. They tell me not to let them bother me, but I want to eat the food that's smelling up the room and had permeated my music fugue state.

I ask Tara if she wants anything, but she's already had dinner and Brandon goes to feed the kids, who are delighted to see him home early. Lilly tells him that I'm having a baby, which is what I told her for why I was wearing a "diaper" when Naomi demanded that I explain. Naomi asks me where the baby is and I remind her that the baby hasn't come out yet.

I'm not comfortable sitting on the couch, so I stretch out on it instead and put on Food Network as something easy to watch and either talk through or zone out to. I end up adjusting with every contraction until I end up with my labor ball on the floor. Tara sits near me and is just a comforting presence, since there's not a lot to do except keep me company at this stage. When some of the contractions get more intense, she applies counter pressure and I feel better.

I get to the point where I need to start visualizing to get away from the soreness building from all this work and when the next contraction comes, I'm in mind, floating above an ocean that is the pain and discomfort. I leave the water and float above it. Some pain breaks through and it's a wave lashing against my ankle, but I just breathe and it falls away, not hard to leave behind in the surging ocean.

This has always been my meditation technique for escaping negative feelings and pain in particular. It's effective and has very nerdy roots, which are comforting to me. I'm so worn out and want to take a nap, so I move to the bedroom to try to do just that. Tara brings a chair in and the door to the hall is left open to provide her some light to read or knit or however she usually passes the time in a birth while mama naps.

I lie there in the quiet dark, unable to sleep, as usual, but slowly drift between contractions for a while. When I open my eyes, the kids are sleeping next to me and so is Brandon. Everything is dark and the contraction that woke me up is so intense that I was vocalizing before I even woke up. I need to pee and I roll out of bed, grabbing another pair of poise panties to change into on the way to the toilet.

Sitting on the toilet is very uncomfortable and I find myself whining through it until I'm done, wipe and crawl onto the floor to get away from it. I rock on my hands and knees and moan loudly. The contraction passes and I go to the kids' room, where Tara is sleeping on the spare bed and let her know that I need her.

She stays a calm, comforting presence and helps me get back from the intensity of what labor is becoming. She rubs my back and encourages me while I moan and breathe and occasionally curse my contractions. She asks if I think I need to go in, because it's clear that things are picking up strongly. I ask her what time it is and she tells me that it's 2am. I tell her that I want to let everyone sleep a while longer. She asks me if I want to listen to music again. That sounds good and I tell her so, so we go back out and I cue up my playlist again.

I get up and dance the baby down a bit, feeling intense pressure against my cervix and some rolling around that I interpret as the baby getting into position. My singing woke up Brandon and he comes out to make sure everything's okay. Tara assures him that it is and he sits down and reads on his Nook while I dance and sing.

By 4, I know it's time to go in. I'm having visions of the lovely, big, blue birthing pool at the birth center and I call Rachel, hating to wake her up, but knowing that she was probably expecting it anyway. Brandon gets the kids and puts them in the van while I eat some soup and post on facebook and twitter before we go. Tara grabs the infant bucket for me and my bag and we go out to our vans. She tosses my stuff in ours and follows after us to the birth center.

The drive in the night is intense for me, but I relish the dark, peaceful streets. I love being on a drive at night, even though I'm moaning and whining as quietly as I can through the strong surges pushing the baby further into this world and getting her ready to meet it.

Brandon pulls up to the door without stairs and lets me out while Tara parks. I hobble over to the door and Rachel lets me in. No way I can climb stairs in labor. I have never been a fan of stairs anyway. I see the tub is filling up and I sigh gratefully. I have to go to the bathroom again, so I do and whine through it again. I put on another clean poise panty and am happy to see my water is still clear, even if it's gushing as usual.

I come out and plug the laptop into the speakers I brought from home to play some music. I don't feel like singing right now, so I put in the classical/instrumental/foreign playlist. Brandon and Tara come in, each carrying a sleeping child and put them on the bed in the other room, where they continue to sleep, uninterrupted.

I end up on the floor, leaning against the bed as the next contraction comes on intensely and I moan, wanting very much to get into the water. Sheena listens to the baby briefly with the doppler while I rest on the floor and checks my blood pressure. Everything's fine, of course.

Before too long, the pool is full and I take off the poise underwear and climb in, feeling instant relief. I float a little bit and then roll over to just relax in the water with my cheek lying on the edge of the pool and my arms draped over it. Brandon takes some pictures and then sits by the pool, holding my hand.

I'm able to just meditate through the contractions now, lost in the instrumental music. They're coming fast and strong, but not painful, between the music, water and how relaxed I am. I drink ice water and just feel my baby and body working to bring her into the world.

After an hour or so, I need to pee, so I get out and walk around a little, then I want to nap again, so I change into something dry and lay down in the bed and rest while the contractions take a break for a while. When I wake up, the sun is filtering through the window and the contractions are back, having only let up to let me get the sleep I needed to be ready for the last part of labor and birth.

I have someone turn the music back on and relax to Origa's 'Kawa yo, Watashi no Kawa yo.' Then 'Fukai Mori' comes on and I sing with the Japanese that I know. I cue up 'Ningyo Hime' by Rie Tanaka and then I want Yoko Kanno, so on goes Origa's 'Inner Universe' and then 'Rise' as I get more into singing.

I want back in the water, so I go back in the pool and have the music go back to stuff in English so I can sing more mindlessly. Back to Deftones and 'Digital Bath' again and so forth. The kids wake up and come in to see why they woke up in the birth center. They want to listen to my heart, etc. and then go get some toys to play with while things really pick up for me.

I'm using the singing in place of moaning, so my voice is strained through contractions, but it feels good to get through them that way. But it's getting harder and harder and I am uncomfortable, moving into moaning instead, moving around and trying to get comfortable. Things are getting intense and I'm getting negative, but Tara and Rachel assure me that I'm doing well, it's okay, I can do it, because I am doing it.

I realize I must be in transition and I try to concentrate on breathing and relaxing, but it's hard and I turn the music to something darker that has me use my diaphragm more. Still, during contractions, which are coming fast and furious now, I have trouble keeping it up. I throw up water and feel better, then the urge to push comes over me.

I tell everyone what I'm feeling and Rachel tells me to go ahead if I feel like it, so I do. I get up on my knees and hold onto the side of the tub, one leg up and press my belly against the wall of the pool from the top and let my body do what it wants. Brandon takes pictures and goes around behind me to see if he can see anything and Tara changes the music back to something brighter, turning it down to just be background sound. Brandon tells the girls that the baby's coming and they can come in, but need to be quiet. They come in and watch.

I push and it feels good to work with my body. My abdomen feels better, but I feel increasing pressure in the birth canal and each contraction, I'm able to press lower on my belly. I switch legs and there's a burning feeling, so I reach down and feel the baby's head crowning. Brandon has switched to video and I gush happily and say silly things that I know I'll mute out of the video later.

I push for a little while longer and baby's head comes out. I rest between contractions as Rachel watches and checks, making certain everything looks good. Another contraction comes and I push with it and feel the baby's shoulders slip out, then she's pouring into my hands and I guide her out a bit and move so that I can sit back and pull her up to my chest.

Someone hands me a towel and I wrap the back of her in it and turn her over to look into her face and see her wrinkly, beautiful little self look up at me, a little cheesy with vernix that I wipe off her face a little. I'm laughing and the girls are cheering and wanting to touch the baby. Brandon hands Tara the camera so he can touch his new baby and she switches it to still images and takes pictures.

The cord stops pulsing and Rachel clamps it and asks Lilly if she wants to cut it as I stroke it in amazement, as I love how umbilical cords feel and it shows how we've been connected these last several months. Lilly does and cuts her sister free and beams in delight. Naomi coos over the baby, saying "She's so cute!" over and over. 

I hand her to Brandon and move out of the tub onto the bed, changing into a dry shirt and getting under the blanket as I don't like being wet on land and he hands her back to me. I offer her the breast and she latches on, watching my face as she nurses for the first time on instinct. She pauses and her eyes widen as the colostrum obliges her efforts and she continues to nurse with that new baby amazement over everything.

I push out the placenta and Rachel shows me the mother side and the baby side and explains what I'm looking at, pointing out anything interesting about it and then off it goes. Since I am in a rental property, I can't plant a tree with it and I'm not interested in placentophagy, so it can be disposed of however. Tara gets pictures for me while it's explained, since Brandon doesn't even want to see it. He's not a fan of blood or organs, while I'm fascinated by them.

Baby and I cuddle, nurse and rest while Rachel checks to make sure I haven't torn (which I haven't, just a few skid marks, as I'm not very stretchy, but the water helped prevent tearing like I'd hoped it would) and I still stick an ice pack down there to feel better. I hand baby off to be weighed and measured as someone tells me what time she was born and I relax and watch everyone while Brandon resumes taking pictures of everything for me.

The girls climb up on the bed and hold their baby sister carefully. When it's time to hand her back, Brandon gives them the 'congratulations, big sister' presents from their sister to them that we had prepared ahead of time. Everyone gets a chance to hold the baby and coo as I make phone calls and take a cell phone picture to post on Facebook. I post the baby's stats and name (assuming we've come to an agreement by now) and that we're doing well.

Someone brings me the sandwich I've been waiting 9 flipping months for--turkey with miracle whip and I eat it while looking down at my beautiful little girl and Brandon goes and feeds the kids the breakfast they're whining for. Whenever she feels it's time, Tara goes back home to her family while we rest and recuperate with my new family of five.

And here is my actual birth story to compare: http://musing-mommy.blogspot.com/2011/11/katarinas-birth-story.html

This post was written for inclusion in the Preparation for Birth series at A Little Bit of All of It