women

18 WEEKS PREGNANT

Think about Your Birth Plans and Preferences

This week, you can

• Research different birth philosophies and techniques
• Read several books to get an idea of how you’d like your ideal birth experience to go
• Start to create a birth plan
Birth plans? But I’m still twenty-two weeks away from my due date!

I HEAR YOU. Finally, you can keep down an entire day’s worth of meals and aren’t falling asleep at random times during the day. Can’t a girl enjoy her newfound energy for a while without thinking about how this rapidly growing baby is going to somehow get out? (Unfortunately, it doesn’t involve getting “beamed out” a la Star Trek. . . .) While you don’t have to have your birth plan set in stone yet, it’s still a good idea to start thinking about your birth options now. For one thing, if you want to labor or deliver a certain way—for example, maybe you want to avoid an IV or hope to have a water birth—your doctor or midwife and the hospital or birth center you deliver in will determine whether or not it’s a possibility.

Researching birth philosophies may lead you to the discovery that the practice you’re currently seeing for prenatal care just isn’t a great fit for you, or that you’d be better off giving birth at a different hospital than you’d planned on. The sooner you know that, the better. When pregnant with her first child, Stacy actually switched care providers at thirty-two weeks of pregnancy after having an enlightening conversation with her obstetrician. When she asked him about avoiding certain interventions, he all but patted her on the head as he told her, condescendingly, “Well, we’ll just see about that when you’re in labor.” Stacy bolted and was able to find a good care provider she liked even at her late state of pregnancy. Still, it would have been much less stressful if she’d asked those questions and made her switch earlier on.

For many women, the best way to learn about the process of labor and birth and figure out what kind of delivery they’d like to have is by taking a series of childbirth classes. These classes most commonly meet weekly, starting in the second trimester, for six to eight sessions or so (though occasionally you can take a singleday workshop or even take your birth classes online).

But before you go around town signing up for classes, I think it’s wise to do some reading. Birth classes can vary wildly in philosophy and scope of information, and they require a commitment of time and money from you. Simply reading a bit more about a specific type of class can give you a sense of whether it could be a good match for your philosophy or comfort level. Alternately, you may learn as much from reading some books as you would from an entire class series of less-comprehensive classes. Here is some information about the most common types of childbirth philosophies and methods you may encounter:
 
Lamaze

Probably the first thing that comes to mind when you think of Lamaze is the exaggerated “Hoo-Hoo-HEE!” breathing style made famous in sitcoms and movies. But Lamaze, the first “active” birth movement and method to attain popularity in the United States, has moved away from its hallmark breathing techniques and now embraces a more holistic view of natural, normal birth. In a Lamaze class you’ll learn about a variety of relaxation and coping techniques to help you have a natural birth. You’ll also learn how to make educated decisions should you want or need to pursue medical intervention during your labor or delivery. Lamaze teachers have a lot of control over how their courses are taught, so you might find a significant difference in curriculum or length of a series from instructor to instructor. Some series may include information on pregnancy exercise and nutrition, postpartum care, and baby care. Visit www.lamaze.com for more information and a directory of teachers near you.
 
Bradley

The Bradley Method focuses on complete relaxation in order to achieve a natural, medication-free birth. Many women find its focus on slow, deep breathing to be very effective at helping them cope with contractions and avoid interventions. You’ll also learn a lot about nutrition and health during pregnancy and after your baby is here, and much of the course is geared toward helping spouses and partners become effective “coaches” during labor and birth. Keep in mind that the Bradley Method is extremely pro-natural birth, and their classes may not feel like the friendliest environment if you aren’t completely sold on the idea. The Bradley series includes twelve classes, which cover early pregnancy, nutrition, exercise, labor and birth, newborn bonding, and breastfeeding. All Bradley instructors must be certified and must recertify each year to be able to continue teaching the classes. Bradleybirth.com is where you can find more information.
 
Birthing From Within

Taught as a series of classes or as a workshop, the Birthing From Within method focuses on helping women conquer fears through a combination of information and spiritual and creative projects like art and visualization. Birthing From Within may appeal to you if you’re artistic or creative, or if you see pregnancy and birth as a spiritual journey. More straightforward women may find the class a bit too touchyfeely for their liking. (If the idea of “caging your birth tiger” makes you cringe, look elsewhere!) While natural birth is definitely supported in the Birthing From Within environment, the classes do not promote any one sort of birth experience and the information is useful no matter what kind of delivery you’re planning. Check out www.birthingfromwithin.com.
 
Birth Hypnosis

Several trademarked brands offer birth hypnosis classes, including Hypnobabies (www.hypnobabies.com) and Hypnobirthing (www.hypnobirthing.com). These classes teach hypnosis techniques specifically tailored to help laboring women remain calm and in control. Birth hypnosis isn’t about being “put out” or not knowing what’s happening during your labor. On the contrary, women who study hypnosis learn to train their minds to interpret pain differently so that they can be active participants in their births without anxiety and fear, and without a need to dull any of the sensations involved. Birth hypnosis will require a lot of practice, but women who devote themselves to it report great success in the way the method helped them experience birth in a relaxed, joyful way—and often, they report, without pain. If you can’t find a birth hypnosis instructor in your area, you can also take a few sessions with a licensed hypnotist, or look into a program on CD.
 
Hospital Birth Classes

The hospital where you will be giving birth most likely offers a class series of its own. Topics covered are likely to run the gamut from which procedures you can expect as part of a typical hospital birth to your postpartum recovery and new-baby care. You will probably also get a tour of the labor and delivery unit and a rundown of the registration and check-in procedure, as well as other details you’ll need to know, like what to pack in your hospital bag, what personal items you may bring to the hospital with you, and hospital policies on visitors and the like. Having all that information is definitely useful, but some hospital classes seem to focus mostly on teaching expecting moms and dads to “be good patients” and aren’t as supportive of choices that challenge hospital protocol. So be sure to supplement the information you get from hospital classes with reading of your own or maybe even by taking a second set of classes.
 
Other Birth Classes

This is just a sampling of the different types of birth classes you might encounter in your region. A variety of certifying bodies train and certify educators to teach birth classes, and while they may all have slightly different philosophies, generally they are geared toward helping you be an active participant in your birth process. There are many machines, drugs, medical procedures, and interventions that have become part of the typical modern birth experience, but it’s important that you see yourself as more than just a patient. Even if you plan on using many or most of these interventions, it’s a good idea to have a full understanding of what each procedure or process is for and any possible drawbacks. Any good birth class will help you go into the hospital with the information you need to make empowered choices. Some organizations that train childbirth educators include the International Childbirth Education Association (www.icea.org), the Childbirth and Postpartum Professional Association (www.cappa.net), and the International Birth and Wellness Project (www.alace.org).

Much of your choice of childbirth class may be limited by what’s available in your region. If you live in an area that doesn’t offer any classes in your preferred method, see if the organization you’re interested in offers any virtual or distance-learning classes. The organization may also be able to connect you with a student who has completed the book-learning portion of her training, but hasn’t yet taught enough hours to be certified. A mother I know, Kara, was lucky enough to connect with a childbirth educator who had completed her training but needed to teach one more class to gain certification. She was also earning “contact points” to receive her doula certification (more on doulas in the box on page 71). The educator was grateful for the opportunity to work with a real, live, pregnant woman to complete the certification process, and she gave Kara an excellent deal on her fees for both education and doula support. Less-experienced teachers can still have a wealth of knowledge and are often the most passionate about their subject. Be open to alternative arrangements if cost or availability are an issue for you!

DO I NEED A DOULA?

Every laboring mom needs someone on her side to advocate for her needs. Unfortunately, against the hectic backdrop of a labor and delivery unit, you can’t always count on getting the information and support you need from your busy nurses and doctors. And while dads-to-be are often great at providing their wives and partners love and comfort, they can’t really be expected to translate complicated “medical-ese” or be true advocates under stressful, new circumstances. That’s where a doula comes in. A trained and knowledgeable professional who knows an “epidural” from an “episiotomy” (and how to help you avoid both if you want), a doula will stay with you throughout your labor and delivery, providing hands-on support and helping you make informed decisions about your care as labor progresses. You can also hire a postpartum doula to help you adjust after your baby is born by providing a listening ear, light housekeeping support, and instruction on caring for your baby.

Studies have shown that women who have support from doulas tend to have shorter labors with fewer complications and are more satisfied with their birth experiences over all. Dona.org and Cappa.net are two places to get more information or start your search for your own doula. You can also ask your doctor, midwife, childbirth educator, or mom friends for recommendations.

No matter what style or method you find yourself gravitating toward, once you’ve done your research, you should call and register for classes now. Though your birth still seems a long way off, you’ll want to give yourself plenty of time in case the classes fill up fast.

Of course, even if you live in an area that offers childbirth classes of every stripe, there’s a lot to be said for educating yourself as well. If you find the offerings in your city lacking or simply want to learn all you can about the birth process, you’ll want to do some reading. See page 325 for a list of trusted resources to check out. Don’t feel like you have to read every single book or Web site listed! Feel free to flip through them at the bookstore, read a few paragraphs, and see if the author’s tone and point of view speak to you. Much of this will depend on your personality—if you’re a “just the facts, ma’am” type and want to see cold data and hard research to help you make decisions, Henci Goer’s The Thinking Woman’s Guide to a Better Birth might satisfy your science-loving mind. On the other hand, if you gain more confidence from reassuring stories and spiritual affirmations, Pam England’s Birthing from Within might be more up your alley.

All this reading could take several weeks (if you’re an information junkie you’ve likely already read some of these and I bet you’ll be reading throughout your pregnancy!). Make time for birth research every day, even if it’s just five minutes. Pour a cup of pregnancy tea or a glass of water, put your feet up, and read! In your pregnancy journal, jot down terms you want to research more fully or quotes you find inspiring. The more educated you become, the more you will likely feel yourself drawn toward certain birth methods or philosophies.

YOUR BIRTH PLAN

Likely your childbirth class will help you create a birth plan—a written document detailing your preferences for labor and birth. Many women give their birth plans to their doctor or midwife and bring copies for nurses and other hospital staff to inform them of their wishes. Others use the birth plan for their own purposes, to help them remember what is most important to them when they are losing focus during labor and to use as a reference tool while in the hospital.

You’ll find lots of boilerplate birth plans online, but I encourage you to avoid going by somebody else’s idea of what a good birth plan looks like. Instead, let your personal birth plan grow organically from what you learn from your readings and how you feel about what you learn. Doctors and nurses are not likely to respond the way you’d like to a long list of demands printed off the Internet. They’ve seen those dime-a-dozen plans a hundred times before.

Instead, dig deeper and prioritize. Think about what really matters to you, and why. Maybe all you need is a simple paragraph stating your overall philosophy of birth and asking hospital staff to check with you before they deviate from it. Then you can consider each possible change or intervention on a case-by-case basis. Or maybe you’ll find that you are OK with most of the interventions that are part of hospital protocol. In that case, you may want to focus more on the postpartum part of your experience than the labor and birth portion. This is your birth, not anyone else’s. Listen to your own gut.

You’ll have plenty of time for creating a formal birth plan. For now, just let the information you’re taking in percolate a bit as you think about how you’d like your own birth experience to go. Here are some questions to keep in mind as you consider this issue:

• Do I plan to have an unmedicated birth, or will I opt for an epidural or other pain relief?
• If I plan to “try” for a natural birth, how important is it to me?
• What are my reasons for wanting medication, or for wanting to avoid medication?
• What coping techniques seem like they’d be most helpful to me?
• Are there any interventions I absolutely want to avoid?
• Are there any procedures or medications I absolutely want as part of my birth?
• Who would I like to have at my birth? (These should be people you are absolutely comfortable around.)
• What would I like my husband or partner’s role to be in the birth?
• What kind of support and attention would I like from the nurses and my doctor or midwife?
• How do I hope to spend the minutes immediately after my birth? Is it important to me that I have time to bond with the baby before he is taken away to be checked out?

Remember, birth is unpredictable. You can’t control how it will go, and no one can guarantee a specific outcome. Letting go of illusions of control over your body or the birth process can be very difficult for some women. This is where meditation can come in very handy. Are you remembering your five minutes a day?

This week, we packed in a lot of information and you may be feeling overwhelmed. That’s okay. You don’t have to commit to any style or birth method right now. In fact, you always have the right to change your mind—even (maybe especially) while in labor. But the more you think about the process of labor and birth in advance, the better a position you’ll be in to make decisions you’re satisfied with.

Of course, the ultimate goal of any birth is a healthy mother and a healthy baby. But
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