Tuesday, July 22, 2014

When natural is not the best…how do I plan?

Often women that desire a natural birth plan the dickens out of their births. Some women keep it simple, and have some perspective, but others hold their birth plan up as the absolute gold standard by which their birth is made.

 I find that often when a client is writing up a birth plan, you should keep it short, to the point, covering the important things, but also realize this is more for you. It is a reminder for you more than anyone to be able to remember your plans and desires.

 But, what if your naturally planned birth doesn't go as planned? Babies and pregnancy is unpredictable, and often little things happen that require an intervention. Does this mean your birth plan is useless? I would answer and say no, if you have following my recommendations.

When you write up your birth plan, most women that are planning a natural birth include that they want a Hep-lock instead of an I.V. What happens if that I.V is needed? Does that mean you throw out the whole plan?

An I.V is needed in the case of an epidural, or a c-section to get enough fluids to prevent your blood pressure from dropping too low and in the case of blood loss at times. However, if you are not to that step yet, it is okay to ask to wait an hour or two, to decide on that, even when you feel you need an intervention.

I believe there is a tendency to try to feel like everything needs to be decided right now. Then when you do decide to go ahead with an intervention,  if it is not an emergency, often hospitals do not move very quickly. You are left with a lot of time to think about your decision.

In the case where you are faced with an unplanned c-section, I would really advise everyone to write out a short plan on c-sections.

For example, if you have a doula, talk to the care provider about having your doula in the c-section with you. It can make a huge difference in your mental recovery if you have support from more than just your husband in a c-section. Often, first it is scary to be taken to a surgical room, treated suddenly like a surgical patient, rather than them listening to your needs and you need someone that is focused on you and not the baby, (which your husband will be focused on the baby).

They can talk you through it, what is happening and stay with you if there is a problem with the baby. Sometimes, when things go awry, it seems like there is a higher likelihood of something happening with the baby, where they need to be separated from you. This can be really scary for a mom that is strapped down to a table, your husband walks across the room to be with the baby and is trying to tell you what is going on, but his mouth is covered by a mask and you don't know what he is saying. The panic sets in and complications can occur.

Many surgeons do not think about this. They are surgeons for a reason. They often like their patients sedated and do not think of their mental health in a surgery. For this reason, you need to plan ahead. Plan for support if you think there is a possibility of surgery, confirm and discuss with the care provider ahead of time that you will be having an extra support person. If they talk about how they only allow one person, there is not room etc. etc. You will need to push a bit. They allow students in surgeries all the time. They are generally concerned about liability if someone passes out. Make sure your support person is skilled and has attended surgery before, and has no history of fainting.

I have worked in different hospitals and found it curious that the one that is touted as the most "natural" has the worst policies as far as doulas and c-sections. It was as if they were naturally minded until you needed intervention and then they threw out all of that, and figured it was all a moot point.

I am going to be working on some education on that for the community benefit, but I am not exactly sure how it will happen.

For you, remember natural birth or not, if you educate yourself on all the options, give yourself the chance to make the decision, you will feel better about your choices. If you feel like you are simple taking their word for it, you will be feeling more out of control with your decisions.

Stay in charge of your birth, interventions or not. If they have a policy against something, educate yourself on those ahead of time.