So you know you need to write a birth plan, right?  If you’re birthing in hospital (or even if you aren’t) writing a birth plan is an important part of birth preparation, and there aren’t many scenarios I can think of where it’s wise to skip it.  Even so, I know that many of you find this process incredibly overwhelming and time consuming.  Years of guiding clients through this part of their preparation has taught me one thing – we usually fall into one of two camps when it comes to birth plans.  The first camp will spend weeks creating a document that’s the love child of a birth manifesto and a medical journal.  The second camp starts off okay – understanding quite correctly that no one can control every aspect of their birth – but then take this to the extreme.  They become overwhelmed by choice and throw up their hands, declaring they’ll just “go with the flow on the day”.  Neither approach is ideal.  But if you recognise yourself in there, I have some good news for you!  (as well as an awesome free tool to show you how to write a simple birth plan…read on!)

 

 

Most of us don’t need to spend days doing a crash course in midwifery through the University of Google to write a good birth plan.

There are five key areas that really need to be thought about for a hospital birth plan.  These “The Big Five” are most likely to have the biggest impact on your birth- so if the goal is to keep the process simple, they’re a good place to start.

Fetal Heart Monitoring

The Decision:  Doppler vs Continuous Monitoring (CTG) 

If your pregnancy is low risk and remains so throughout labour, you have a choice about how your baby’s wellbeing is monitored during labour.  There are specific risks and benefits associated with the two main methods available – hand held doppler and CTG (the elastic bands with the discs and cords on them).   More than any other issue, women seem to know the least about monitoring options even though this one decision arguably has the most potential to change the course of their birth.  As with any proposed intervention, you’re free to decline monitoring all together – though you might experience resistance to this.

Starting Point Resources:  Evidence Based Fetal Monitoring

 

Pain Relief Options

The Decision: Comfort Measures vs Pharmacological Options (gas, opiates, and epidural)

Planning to birth without drugs?  Signing up for the full enchilada immediately on admission to the labour ward?  Keeping an open mind until the big day?  No matter what your plans, it’s important to understand the risks, benefits and potential knock-on effects of the multitude of options available for managing labour pain.  I can’t promise you anything about how your birth will be for you, but I can absolutely guarantee you that by the time you opt for an epidural in labour, you won’t be even slightly interested in listening to the anaesthetists long disclaimer before he/she gives it to you.  On the opposite side of the coin it’s kind of annoying to realise an hour into your planned hypnobirth that you actually really, really hate that hypnobirthing CD, and will probably stab your ear with a pencil if you have to listen to that woman’s voice One.  More.  Time.  Except you can’t form the words to tell someone.   It’s always better to prepare for these things from an informed place before labour, rather than a panicked one during it.

Starting Point Resources: Childbirth Connection – Options: Labour Pain

 

Induction and Augmentation of Labour

The Decision:  Artificial Rupture of Membranes (Breaking Waters) + Synthetic Oxytocin (syntocinon/pitocin) or not – and under what circumstances.

I know, I know.  This isn’t going to happen to you…right?  Hopefully it won’t, but the reality is that according to Queensland Health, about 40% (no, that is not a typo) of labouring women are being given syntocinon (a synthetic form of oxytocin) to either start labour or at some point during.  For a good proportion of these women, labour will be induced because their pregnancy has lasted beyond their due date.   If you’re birthing in hospital, it’s a good idea to get your head around why so many women are being induced, how inductions are managed, and the risks and benefits of this process.  Also, find out when your hospital or caregiver would put induction on the table – you’d be surprised at just how much this can vary depending on where you’re having your baby.  This puts you in the best position to make the right decision for you and your baby, should that time come.  There’s nothing worse than being pitted against the clock and having to get your head around a huge topic like induction, when you should be just enjoying the last days with your baby in your belly.

Starting Point Resources:  In Defence of the Amniotic Sac, Induction of Labour – Childbirth Connection, Induction – A Step by Step Guide

 

Umbilical Cord and Placenta

The Decision:  Physiological vs Managed Third Stage, Immediate vs Delayed Clamping and Cutting.

When I first began attending births eight years ago, getting delayed cord clamping required negotiation akin to something that might go on at the United Nations.  Fortunately, this is now getting easier to obtain for those women who want it – particularly if a supportive birth place and caregiver is chosen.  There’s growing evidence that leaving the umbilical cord unclamped and uncut for a period after the birth has health benefits for both mum and baby.  Connected to this issue is the option of private cord blood banking.  If this is something you’re considering, do your research on the likelihood of baby needing the blood later against the risks and benefits of him receiving his full quota of cord blood at birth.

Starting Point Resources:  Common Objections to Delayed Cord Clamping – What is the evidence?

The First Hour After Birth

The Decision:  Extended Skin-to-Skin vs Hospital Routines

The first hour after birth is often called the Golden Hour, for good reason.  While it seems the action is all over, for both baby and mother there are some very complex physiological processes going on that get breastfeeding started, facilitate bonding and slow your postpartum bleeding.  Unfortunately for many of us, this first hour will be spent being poked and prodded while bleeding is checked, stitching is done, observations are taken of you and baby, baby is weighed, measured and given shots, and often forced to breastfeed before he/she is ready.
While there are certainly good reasons for some of these things, the execution of them can be lacking in busy birth units.  Time pressures sometimes mean that baby will be strongly encouraged or even forced on to the breast rather than being allowed to self attach, and that critical skin to skin is interrupted for reasons that can be more to do with getting through a to-do list than immediate medical need.  Protect this critical time with your baby by understanding normal hospital procedures in the first hour after birth, knowing what needs to be done right away and what can wait, and listing your preferences for how this is to be handled on your birth plan.

Starting Point Resources:  Evidence for the Vitamin K Shot in Newborns – Evidence Based Birth, A Timeline of A Baby’s First Hour

What Next?

Want to write a simple birth plan, but not sure where to start?  Let me help you! I’ve created The Simple BirthPlan Checklist just for you!  This easy, free tool will take you through your options for each of the five areas described above, giving you a quick outline for your birth plan.  You don’t even need to print this baby off – just tick off your preferences and any extras you need to remember, right on the PDF.  Grab it – it’s absolutely free!

SaveSave

SaveSave

SaveSave

SaveSave

We’ve all seen it – that movie with the pregnant woman minding her own beeswax, perhaps sorting through apples in the fruit aisle, when….plop! She looks at her feet in shock as a mad frenzy ensues to get her to the hospital, because she might just have her baby on the floor of the supermarket, ANY MINUTE.

One of the most common questions I’m asked as women reach the end of their pregnancies is about waters breaking – or in technical terms, spontaneous rupture of membranes.

Did my water just break? How would I know? And most importantly – how can I make sure this doesn’t happen to me in the middle of Woolworths?!

 

It might surprise you to learn that the vast majority of labours don’t begin with waters breaking – in fact, only about one in ten spontaneous labours will start this way. For the other 9 in 10, waters will remain intact until they rupture on their own well into labour, or until consent to rupture them artificially is given. Something else I’ve noticed in my years as a doula, and that many midwives will also atest to, is that waters often break or begin to leak late at night. So even if your labour does begin this way, it’s fairly likely that you’ll be in the privacy of your home rather than the fruit aisle. Phew.

Before I go further, a caveat – if your pregnancy hasn’t yet reached term, is high risk, or you don’t know if your baby is head down in your pelvis, there are special factors to consider and you should contact your caregiver as soon as you can.

How Will I Know If My Water Breaks?

  • For most women, the dramatic gush of Hollywood labours doesn’t happen. Usually, waters breaking before contractions begin is experienced as a trickle of fluid, rather than a flood.
  • Contractions might not begin right away – so don’t assume your water didn’t break just because you aren’t having any yet.
  • If you’re soaking a pad every five minutes, it’s a pretty safe bet that this is not a test run.
  • A trickle or small amounts of fluid can occasionally be confused with urine leaking, or lots of watery vaginal discharge. A good way to check if it’s urine is to clench and try to stop the flow, just as you’d do on the toilet mid-stream. If you can’t stop it, it may be amniotic fluid.

What Should I Do?

    • Pop a pad on, grab your phone and lie down for about 30 minutes. Amniotic fluid pools in the vagina when you’re lying down – so if your waters have broken, when you get up again you’ll probably feel it coming out onto the pad right away. If it was just urine or discharge, you won’t notice anything much when you stand up.
    • Call your careprovider or hospital – some will want to see you, others will ask you a few questions and be happy to watch and wait. You’ll most likely be asked about:
Colour

Is the fluid clear? Is it tinged (pink, yellow or even green/brown)? Clear or light pinkish is normal, other observations need to be discussed with your careprovider.

Smell

Amniotic fluid smells vaguely like semen, or bleach.  There shouldn’t be any sort of nasty smell to it.

Amount

Was it a big gush, or a trickle?

Time

When did you first notice it? Are you still noticing it now?

There are a number of medical tests that can be used to determine whether or not your water has broken. Depending on the policy of your care provider or hospital, these may be offered to you. If you do choose to go into hospital, remember to ask questions to help you decide your best course from there. Some starting points could be:

      • What are my options while I wait for labour?
      • If I remain in hospital, how long before you would recommend further action to begin labour?
      • If I go home, is there anything I should be looking out for?
      • If labour doesn’t begin in the next 12-24 hours, what would you be suggesting we do?
      • What are the risks to my baby and me at this point? What can we do to manage those risks?

In the meantime, no sexy-time for you – if your water has broken, sex increases the risk of an infection. But you SHOULD get cuddly with hubby, and get those oxytocin receptors firing. Remember to rest and stay well hydrated – you have a big task ahead!

SaveSaveSaveSave

SaveSave

SaveSaveSaveSave

SaveSave

SaveSave