Belly Up

* bellies * birth * babies * breastfeeding *

Tuesday, April 19, 2011

Birth Planning

Have you heard this comment or one similar from a nurse or other careprovider?  "When a mom walks in with a birth plan, we just go ahead and set up the OR. Those moms always end up with c-sections."  This line has been said to some of my clients and I myself have heard it said by my friends who are nurses and OBs.  So is it true, do birth plans cause c-sections or at least increase a mom's likelihood of having one?  Should couples try to plan their birth?

First of all, let me just be blunt, these "birth plan" c-sections usually happen at hospitals where statistically a high proportion of women will deliver surgically because that is the birth culture of that hospital.  Basically the odds are stacked against a vaginal birth regardless if a couple walks in and hands the nurse a copy of a birth plan or a copy of a Tolstoy novel.  Furthermore, if this is a widely held view at any given hospital, it is probably not a place that is providing mother friendly care,  I mean it isn't nice to be dismissive of your patients requests and then to blame them for the need to perform a surgical procedure.  

However, where birth plans legitimately get a bad reputation is when a couple's birth plan is a poor match between the care provider they have chosen and the plan they have created.  This represents poor prenatal communication and will usually lead to tension between the various parties present at the birth, not to mention disappointment on the part of the parents.  A well developed birth plan should serve as a tool for communication prior to labor so this doesn't happen, in fact, when a birth plan is supported by everyone going in, it really is not even vital on the big day. 

So first things first, mom and dad have to figure out what they want.  This of course can be challenging as it is hard to know what your options are....when you don't know what your options are.  It is a bit like being at a restaurant and not being given a menu.   However, this is exactly why taking the time to think through your goals important.  Once you have researched and written out your concerns and desires for childbirth, it is time take this loose birth plan and go chat up your careprovider.  (Ideally this should be done when you are not half naked because nothing makes you feel less empowered than asking questions while you are nude and the other person is fully dressed.)  Then examine how you feel about your careprovider's reaction to your ideas.  Was he encouraging, did his answers make you feel supported and confident?  Did your priorities and vision of labor match in most areas?  If yes, congrats, pass go and collect your baby. 

If not, this is where the road is rougher, but make no mistake *you* are still in charge and the choices are straightforward.  You have three options: 1) decide that you will accept the way your careprovider does things 2) try to compromise with your careprovide to find some areas of give and take or 3) start looking for a new care provider  What you can't do is hope and pray and wish upon a star that somehow when you go into labor or reach your EDD that things will magically happen the way you are hoping.

Obviously choosing the first option means doing nothing (except maybe tearing up your birth plan), basically it is the default choice.  At this point mom is often late in her pregnancy, perhaps money has exchanged hands or it may seem overwhelming to start all over again with someone new.  The second option, trying to find areas of compromise, may or may not be easy depending on your comfort level negotiating with someone who will likely counter your attempts with sincere (albeit often biased) concerns about how your requests will jeopardize your baby's health.  However you may be able to get a bit closer to your goals and that is good.  Finally there is the option of switching to a new careprovider.  Most moms think this is the most daunting option, though those that have done it are usually surprised how easy it actually is and the benefits are huge.

Which brings us back to the birth plan.  Research consistently shows that couples that express the deepest satisfaction with their birth experience, no matter the type of birth or the outcome, are those that felt supported by those who served them and that the experience met their expectations whatever those expectations were.  Therefore the birthplan at its best is not a list of instructions for your careproviders but rather a tool to gain information and communicate beforehand so that you can have realistic expectations for your birth.  If the plans you have in mind are different than those of your careprovider it is better to know this beforehand.  Knowing your options and having realistic expectations can increase both your confidence and your chances of having the birth experience you want and a positive birth experience will have a positive effect on the family that can last a lifetime.

Tuesday, April 5, 2011

Does This Gown Make Me Look Fat?

functional or frustrating?
 Ah, the lowly hospital gown.  It isn't much to look at and for moms planning to breastfeed, it isn't all that functional once the baby arrives.  However, donning the gown is one of the very first rituals of giving birth in a hospital.  Most women don't even think twice about shedding whatever maternity clothes they arrived in and dressing for the occasion of their birth,  But can the gown represent something more?

Basically, maybe yes and maybe no.  For some the hospital gown represents the perfect accessory in which to handle the various bodily fluids that are often present during labor and birth.  You take it off when done, it disappears and you never have to deal with any laundry issues that might occur.  Just like Las Vegas, whatever happens to the gown in the hospital, stays in the hospital.

For others though. the hospital gown represents something less about simplicity and more about the idea that once in the gown, a laboring mom becomes a patient with special clothes that separate her from the "civilian" population of the unsick and unhospitalized.    She may even feel that in the gown she is treated like a passive partipant rather than a woman actively engaged in the process of birthing her child. Thus for this mom, the gown represents the lose of power and perhaps the lose of her autonomy over her labor choices.

So is the hospital gown a must for giving birth?  Absolutely not.  If you are the mom that loves the gown, embrace it in all its backless glory.  If you find the gown to be unfashionable, uncomfortable, immodest or otherwise annoying don't wear it.  If wearing the gown makes you feel less able to advocate for yourself and your child, by all means don't put the thing on.  Making the choice to put on the gown or not is the first of many choices you will make in your labor and as far as those choices may go, this one is pretty non controversial; simply tell the nurse you have brought your own clothes or that you prefer to wear what you currently have on.

That still leaves us with the aforementioned laundry question (get some hydrogen peroxide!)  and, well, you will probably want to wear something at least during some of your labor!  There is actually a company that sells labor clothes. I have shown a lovely pic of a model in Binsi skirt that is designed and sold for labor and birth (and as I am linking the site I hope I am not going to be sued for copyright infringement).  However, lots of other options exist.  Some moms make or buy their own hospital gown so that they feel cute during labor and others just wear something that is comfortable.  Obviously at some point your careprovider may have to access certain areas generally found under one's clothing, but these items can be removed easily when the time comes and a skirt is just as easily pushed up as the gown.

laboring in a black sundress
 Bottom line, when you are in labor, wear what makes you feel like the strong, competent and beautiful mom you are.  Wear clothes that enhance your experience of labor. Yes, it is just a gown or just a black tank top, but the choice of what to wear is yours to make and actually starting your hospital experience proactively making a choice can make it easier to make other choices that come your way during labor.  It may turn out to be the most frivolous of the choices you make that day and if things get complicated one that was relatively less important, but you may find laboring in your clothes to be the first step toward a more mother friendly labor.