A birth plan has a few real purposes. It can act as a values clarification exercise for you and your partner. Then it is a vehicle to open communication with your care provider about your needs, desires, wants for labor, birth and postpartum.  What you want and need matters.

 A brief one page plan with an opening paragraph with bullet point information specific to individualized care and desires not usually within your care provider’s standing orders or usual protocols of the birth location.

I advise you take the written birth plan to a prenatal visit at least a month prior to your given estimated due date. This gives time for conversation, to have a clear understanding of expectation and agreement.

If it becomes apparent that you and your provider are not on the same page, you then have time to seek out another provider that fits you and you fit with.

Remember it is not a legal document that your location of delivery or care provider must adhere to.

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Birth Needs and Desires for: _______________________. 

Care Provider:_________________.

Estimated Due Date: _________________.

I am planning on a no to low-intervention labor and delivery.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

• I plan on wearing my own clothing. I will ask for a gown if I change my mind.
• I would like a saline lock in lieu of a running IV.
• Limited vaginal exams after initial assessment.
• In the event an induction and/or augmentation is medically necessitated-
  • Ripening – Foley Catheter instead of Cytotec (misoprostol), Cervadil or Prepadil
  • Pitocin – A very gentle and slowly administered dosage increase.
  • AROM – will only consent to if an internal fetal monitor is a must.
• Spontaneous pushing and delivery in any position I am most comfortable with.
• External pressure and/or compresses instead of any perineal or vaginal stretching.
• No cord traction or aggressive placental detachment, including deep uterine massage.
• Delayed cord clamping for at least 10 minutes or until my placenta spontaneously detaches (baby can receive oxygen or other assistance while still attached to me).

Postpartum and Baby Care

• Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
• Delayed bathing
• Delaying vaccinations including eye ointment and vitamin k.
• Exclusive breastfeeding, no pacifiers, sugar water, or formula. I will hand express if necessary. I will hand express if needed to syringe feed my baby.
• No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

• Only essential conversation related to the surgery and delivery
• Lower sterile drape or have a mirror present so I may see my baby emerge
• Only one arm strapped down so I may touch my baby
• Pictures
• Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
• Baby to stay with me continuously in OR and recovery
• If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
• Breastfeed in OR and/or recovery
• Delayed immunizations
• Delayed washing and dressing of baby
• No separation from me except what is absolutely medically necessary
• I am willing to hand express if baby cannot get to breast right away.

This “plan” may be copied, pasted and edited  for use by others.

For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

• Vaginal Discharge:

• Loss of mucous plug (after 38 weeks);
• Steady mucousy output;
• Thin and watery mucous;
• Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
• Contraction Characteristics:
• Longer and more intense contractions that most often find a pattern;
• They do not stop or even increase with activity change;
• Sudden increase or onset of regular Braxton-Hicks;
• Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
• Other symptoms
• Increased nesting;
• Insomnia or excessive tiredness;
•  Flu-like symptoms;
• Intuition/Instinct;
• Loose bowels;
• Weight Loss in the last week.

• Testing out contractions for possible labor:
• Change activity level – if resting get up and move, if moving sit down and rest;
• Drink a large glass of water;
•  Eat a snack, preferably higher protein;
• Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

• Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
• Use your favorite search engine and type in your city or area name with the keyword doula
• Search training and certifying organizations such as CAPPA, DONA, ICEA,  ToLabor , Birth Works and Birth Arts International
• Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any websites; phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your initial phone conversation or in your email be sure to include:

• Full name
• Contact information
• Estimated Due Date
• General location where you live
• Care Provider
• Birth Location
• Top needs and desires for birth
• If referred, by whom
• Any financial considerations

Step 3:  Setting up the Interview

I encourage after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

• Unless the doula you are meeting has her own office, interviews are usually held in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is never expected.
• Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
• Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional offerings.

Suggested Interview Questions:

• Why are you a doula?
• What is your philosophy of childbirth?
• Where did you get your training?
• Are you certified? Why or why not?
• How long have you been a doula?
• What is your scope of practice?
• What types of births have you participated in?
• What types of birth locations have you been to?
• How many births per month on average do you attend?
• How many clients would max you out in a month?
• Have you ever missed a birth? Please explain why.
• Do you specialize in working with a specific type of clientele or birth plan?
• What has been the most challenging birth you have attended? Why?
• How do you work with my husband/partner/other support?
• Have you worked with my provider before? If yes, please describe the experience.
• How many prenatal visits would there be?
• In general, what is covered in the prenatal visits?
• Will you help me make a birth plan?
• Please explain how your fee is structured.
• Do you accept barter?
• Do you have a back-up and do I meet her ahead of time?
• When do you go on-call?
• Do you labor at home with me?
• What do you do if I am induced or need to schedule a cesarean?
• When will you see me postpartum and what does it include?
• What are your expectations of me as a client?
• How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

• Sign and return the agreement/contract she gave you at the interview (if applicable).
• Return any intake paperwork by mail or email.
• Payment  – First portion of fee is usually paid upon hiring a doula.
• Ask her usual business hours and contact preference for non-emergencies or labor related needs.
• Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
• Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.
• Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!

Blessing the mother ease the period at the end of pregnancy and ease the transition into postpartum.

Ideas that bless before and after birth:

• Freezer Meals
• Organizing Fresh Meals for end of pregnancy through first month post birth.
• Buy baby wearing gear for her.
• Organize a Blessingway
• Write down encouraging and affirming words in a beautiful card.
• Listen to her.
• Buy her a baby wearing, cloth diapering, breastfeeding class, etc. to her desires as a surprise.
• Organize housecleaning party for end of pregnancy and once or twice postpartum.
• If she has other children, have them over to give her a rest.
• Donate toward her doula, midwife or doctor.
• When she is postpartum, visit her and prepare a variety of snacks so she is never without food.
• Offer to run errands after the baby is born.
• Offer to give her time to shower.
• Buy her a reusable water bottle so she drinks enough fluids.
• Give her permission to phone you during odd hours after the birth if she needs support, advice.
• Offer to dog sit or take care of any pets as needed after the birth.
• Check in on her about 3 weeks after birth to see how she is doing emotionally and physically.

What other ideas do you have to add? Please leave me a comment.

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins -  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

The below post is written by a mother of 3 wee ones. She graciously accepted my request to share her journey to placental encapsulation. I have personally witnessed a significant in Kailah’s postpartum between baby 2 and three overall along with her milk supply increase. I am truly amazed by the differences.

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My Experience With Placenta Encapsulation by Kailah Brost

Not all crunchy people are born that way. In fact, the more blogs I read the more I realize that that becoming “crunchy” is a process for most people.

Since my first birth I have considered myself to be “semi-crunchy”, but I think that my last birth experience officially graduated me into full fledged crunchiness. I mean, not only did I have a homebirth, but I (gasp!) had my placenta encapsulated so I could ingest it!

I had heard about placenta encapsulation some here and there, but hadn’t thought about it as something I would do. The first time I gave it consideration was when I lost my milk supply with my second baby at 5 months – just like it had happened with my first baby. I worked with a Lactation Consultant with both, and tried just about everything, but we couldn’t get it back up and had no idea why it had gone in the first place.

So when I found out I was pregnant with baby number 3, I knew I was going to give placenta encapsulation a chance. Couldn’t hurt right? And as fate would have it, the new leader of our local ICAN chapter was a Placenta Encapsulation Specialist. One of our meetings I was the only one who showed up, so I got to pick her brain. She also sent me to www.PlacentaBenefits.info and gave me a study on the placenta and hormones and I was amazed at the what the research had to say.

We all know that with the birth of a baby our hormones come crashing down around us. Well, all those hormones we lose – thyroid, progesterone, prolactin, etc – are in the placenta and ingesting it gives us doses of those hormones that help keep us from crashing so hard. Thus Postpartum Mood Disorders are much less likely, milk supply is boosted and can come in faster, and energy is increased. After looking at that, I was sold. Who wouldn’t want all that while introducing a baby into the family, especially with 2 other very small children?

Right after my son was born, one of my first calls was to the Placenta Encapsulation Specialist. The baby was born at 5pm, so she came up the next morning and started on the 2 day process. Day one was preparing, cutting it up and putting it on a dehydrator. Day 2 was grinding it up and putting into capsules for me. I had an average sized placenta and ended up with 117 capsules.

We had decided I would take enough for just a couple weeks so I could save some for the time when my supply traditionally decreased. I took 2 3x/day for 2 days, 2x/day for a week, and 1x per day for a week. I could not believe how I felt! I wasn’t sleeping continually, I didn’t mind getting up in the night with the baby, and I felt so calm and at peace with the world. The night I started taking them, almost 3 days post partum, my milk supply came in with a BANG! I was actually on facebook chatting with my doula for help I was so engorged. It rapidly resolved itself, however, and an awesome breastfeeding relationship was established. Three weeks postpartum my mother-in-law came to visit, and she stressed me out so badly that half way through her visit I started taking them once a day again. Amazingly, it worked! She was still driving me nuts, but suddenly I was calmer about it and able to focus and make it through the week.

The best thing for me was how it affected my breastfeeding. My supply was much stronger than it had been with my other two. I LOVED watching my baby get so beautifully chunky! However, a couple of weeks ago at 4 ½ months postpartum, my supply again dipped. I immediately took out my reserved placenta capsules and while we work on figuring out why my body does this, I am using them to keep my supply at a good level.

It’s fun for me to see the journey to crunchy I’ve taken. I was sick in November and saw the PA in my Dr.’s office. While going over my history I noted I’d done placenta encapsulation and he was really fascinated. The Dr.’s wife is a nurse in the office and a friend of mine. She told me later that the PA came to her and asked if she’d ever heard of ingesting the placenta. “Oh,” she replied, “you must have met Kailah.”

Bio:

Kailah is wife to an amazing man, and babywearing, cloth diapering, co-sleeping, breastfeeding, stay at home mountain mama to 3 kids under 3 whose births turned her into a crunchy birth geek, and VBAC and homebirth advocate.

Email – zarikailah@yahoo.com

twitter – @klabrost

facebook – http://www.facebook.com/klabrost

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

• If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
• If I had only vaginal births would I have understood and fought so hard for VBAC moms?
• If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.