I am Pumped to Birth this Baby!

There's an epidemic in America right now. We have an unnecessarily high c-section rate and birth is no longer seen as a natural, physiological process, but rather as a medical ailment and something that needs to be treated or cured.  For anyone who is pregnant or trying to become pregnant, I highly suggest you watch Pregnant in America and The Business of Being Born. They are both extremely eye opening. Ina May's Guide to Childbirth and The Thinking Woman's Guide to a Better Birth are really great resources as well.

My goal is a natural, un-medicated water birth. My hospital is the only one in the state that allows water births! I know some of you are probably thinking I'm crazy. "What? Natural?! We'll see...."  "Why not just get an epidural?" "Why put yourself through that?" And my favorite, "It's not like you get a medal for going natural..." You know what? Women may not get a medal for going natural but they sure as hell deserve them! You get medals for running a marathon. Marathons are mentally and physically challenging, just like birth. Why not give credit where credit is due?!

Why I want a natural birth:

• I think that women in America are given far too little credit for their abilities to birth babies. We are made to do this; I am made to do this.
• After everything it's taken me to get to this point (See: New? Start here.) I would really like to experience the natural birth process.
• I want to experience that total rush of oxytocin, the baby high, when I birth my baby. Drugs can interfere with this natural occurence. 
• Every drug given during the birthing process will cross the placenta to the baby. I want to see an awake, alert baby when I meet her for the first time. AND since I'm encapsulating my placenta (maybe I need to do another post on this topic?!) I would rather not have any of that stuff in there.
• A natural birth will lessen the  chance of a cascade of interventions, decreasing my risk of needing a c-section. 

 Of course all this goes out the window if mine or baby's safety is jeopardized. The ultimate goal is obviously to have a healthy baby safely but due to my low risk pregnancy there is absolutely no reason to think that my birth plan can't become a reality. Mike is totally on board with my birth plans and has been so caring and inquisitive. Yesterday, when we were taking a walk with our girls, he asked me what kinds of things I would like him to say to me during labor and which words I would find comforting and motivating. I know he's going to be a great sense of support for me during labor! However, last week we decided to hire a doula to also assist and support us during birth. Why? Well, we're first time parents and have no clue what to expect. I'm more afraid of the unknown than I am of labor pains.  Back in the day, women often labored with the support of other experienced women or  attentive midwives who were able to help them through the pain and all the scary unknowns. This is where a doula comes in. With her help, I am more likely to be successful in my natural birth hopes! She will not take Mike's place in the delivery room. She will, however, be an additional support person for me as well as for Mike.

What is a doula?

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.
A Birth Doula

• Recognizes birth as a key experience the mother will remember all her life
• Understands the physiology of birth and the emotional needs of a woman in labor
• Assists the woman in preparing for and carrying out her plans for birth
• Stays with the woman throughout the labor
• Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
• Facilitates communication between the laboring woman, her partner and her clinical care providers
• Perceives her role as nurturing and protecting the woman's memory of the birth experience
• Allows the woman's partner to participate at his/her comfort level

A birth doula certified by DONA International is designated by the initials CD(DONA).
Research evidence shows that the quality services of a postpartum doula can ease the transition that comes with the addition of a baby to a family, improve parental satisfaction and reduce the risk of mood disorders.

Why use a doula?

Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.
DONA International doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.

Numerous clinical studies have found that a doula’s presence at birth

• tends to result in shorter labors with fewer complications
• reduces negative feelings about one’s childbirth experience
• reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
• reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:

• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence
• Have less postpartum depression
• Have lower incidence of abuse

                                                                                                                                                                                          

I met with my doula yesterday to go over my hopes for birth and what I expect from her.  I chose her based on a number of factors--she's a friend, she's experienced but not yet certified (so we can actually afford her!) and she has a history of infertility, which makes it much easier to talk to her about our journey so far. We went over my birth plan, discussed my fears and anxieties, she explained her role in the delivery room and shared some stories about the hospital were I'll be delivering. I am so pumped to birth this baby now! I can't wait to meet her, to nurse her and I know my family and friends are very excited to learn her name! I can't believe that I will be full term tomorrow. We are so close to meeting our little miracle! I hope that I get the birth experience I'm dreaming of. If I end up needing help with the pain I hope it will be only after I have tried everything else first.

In other news...Mike's orders came through yesterday so it's finally official--we were moving to Fort Rucker! By 10 October we will be officially be southerners. Okay, not really...I can't imagine ever considering myself a southerner (I'm actually very nervous to live down south!) but we can pretend. :)

My Natural Birth Plan

My birth plan has been submitted to and discussed with my midwife. She's totally on board with everything and most things are already standard procedure in her practice, which means the on call midwife who delivers me will be too.  I'd be lying if I said I wasn't scared about labor and delivery but Mike and I plan to attend a natural child birth preparation class next month, which will hopefully help put my fears and anxiety to rest. I'm currently reading Natural Hospital Birth and Ina May Gaskin's Guide to Natural Childbirth, which have been incredibly informative and eye opening.

Birth Plan for Megan H                                                              Estimated Due Date: 17 August 2012

Michael H, Husband                                                                   Christina M, ARNP, CNM

• We are attempting to have a natural, un-medicated birth without medical or chemical interventions.
• I plan on not being induced until after 42 weeks, in accordance with ACOG’s recommendations.

During labor, we would like:

• To have minimal monitoring and limited vaginal exams.
• To eat and drink as desired.
• To have a saline lock instead of an IV.
• To move around as much as possible.

During labor, we would like to avoid:

• Artificial rupture of membranes.
• Suggestions of chemical interventions, to include anesthetics or analgesics.
• Any references to “things moving along”, “pain”, “hurt”, etc.

During delivery, we would like:

• To push at my own pace (Mother-directed pushing).
• To birth in any position, especially standing or squatting.
• To use warm compresses, food-grade oils, and perineal support to help prevent tearing.
• To lower the bright lights at the moment of birth.

During delivery, we would like to avoid:

• Loud coaching or counting during pushing.
• Pushing while lying on my back.
• The use of vacuum or forceps.
• An episiotomy; I prefer to tear naturally.

Following birth, we would like:

• To delay the cord clamping as long as possible, until it stops pulsating at the least.
• My husband to cut the cord.
• To have baby placed on Mother’s abdomen immediately.
• The APGAR to be tested while the baby is on my chest.
• To delay any non-emergent newborn procedures, including the vitamin K shot, the PKU heel stick, eye prophylaxis, bathing, measuring, weighing, and foot printing until after our bonding period.
• To bathe her ourselves.
• To breastfeed exclusively. (No bottles, pacifiers, syringes, formula, etc.)To meet with an IBCLC or a local La Leche League Leader as soon as possible.
• To retain my placenta for encapsulation.

Following birth, we would like to avoid:

• Clamping or cutting the cord before the cord stops pulsating.
• The Hepatitis B shot and eye ointment.
• Pitocin during the birth of the placenta.
• Wiping or rubbing off of the vernix.

Back-up Birth Plan (for a Cesarean Delivery)
Instead of a cesarean, I would like to return home or remain in the hospital for monitoring if my labor fails to progress. I do not consent to a cesarean delivery based on fears of what might happen to my baby if we don't. I only consent to a cesarean delivery if my baby is showing distress on the monitors and if there is a time-sensitive emergency. If there is time for me to wait for an operating suite, watch a consent video, or wait for my personal doctor to arrive to do the surgery, then it is not a time-sensitive emergency.  I would like to obtain a second opinion if my physician recommends a c-section.

During the prep, I would like:

• To have my husband present.
• To be introduced to everyone in the OR and have their roles explained.
• To be kept informed of what is taking place.
• I do not consent to tying down my arms unless I am unable to control them.
• I do not consent to tranquilizers, sedatives, or amnesiac drugs.

During the procedure, I would like:

• To have only necessary staff present
• For the atmosphere to be as gentle and unhurried as possible.
• To delay the cord clamping as long as possible, until it stops pulsating at the least, so that my baby gets all of its cord blood and so that my baby will not need oxygen from a different source.
• To have the baby be immediately placed skin-to-skin with an uncut umbilical cord on my bare chest and covered with blankets for warmth, unless there is an unusual situation.

During the repair, I would like:

• To keep the baby skin-to-skin on my chest or in my arms instead of using a warmer, even throughout suturing, recovery, etc.

• The APGAR to be tested while the baby is on my chest.
• To keep the vernix on my baby’s skin so that I can rub it in myself.
• My husband to cut the cord.
• To delay any non-emergent newborn procedures, including the vitamin K shot, the PKU heel stick, eye prophylaxis, bathing, measuring, weighing, and foot printing.
  The opportunity to breastfeed the baby immediately, even while the surgeons are finishing their work.
• To retain my placenta for encapsulation.

In recovery, I would like:

• To be visited by an IBCLC or a local La Leche League Leader as soon as possible.
• To keep the baby with me at all times.
• To delay the baby’s bath, weight, and other measurements until after our bonding period.
  
  
  
  
  
  And a big congratulations to Jessica, whose twins made their very early appearance last Saturday!

23 weeks

How big is baby? The size of a pomegranate or about 11.8 inches. Approximately 1.5 pounds.
Symptoms: stretch marks on my breasts, gagging, insatiable thirst, braxton hicks, acne and it's getting much harder to bend over and sit up in bed. Oh and how could I forget? Peeing all.the.time.
Total Weight Loss/Gain: I was a little worried about how much I've gained since I have my appetite back thanks to Zofran but I'm officially up 16 pounds. My midwife says that's great!
Maternity Clothes: I'm going to need some new jeans soon if the weather doesn't start warming up. They're getting tight on my belly and butt!
Sleep: Insomnia still comes and goes.
Best Moment This Week: Starting the nursery and working on decorations.
 Gender: GIRL!!!!
Movement: Lots! I love it.
Food Cravings: Today I drove past a Krispy Kreme and just HAD to have one--I haven't had one in years! Baby girl enjoyed her first (and second) Krispy Kreme. :)
Funny moment: You know that scene in The Last Crusade where the librarian is stamping the book as Indiana Jones is busting up the floor? I had a similar experience this morning involving baby kicks and artillery fire. Kick, kick...BOOM. It was pretty funny to wake up to!
Labor Signs: None.
Belly Button In or Out? Still in but getting more and more shallow every day.
What I miss: Beer.
What I am looking forward to: Finishing the nursery, buying her crib, making it to viability.
Next Appointment: 11 May
Milestones: One week closer to viability! Starting the nursery.



Had a great midwife appointment today. The results of my a/s were perfectly normal, baby's in the 55th percentile for weight, my weight gain is on track (I was worried about it since I got Zofran and got my appetite back!) and no more placenta previa! She was really enthusiastic about my birth plan and said they already do everything on there so not to worry. She let me decline the pertussis vaccination until I'm not longer pregnant and we talked about the vit k, hep B and eye ointment. She's totally okay with me not doing them but I think we'll elect to do the vitamin K shot. I think it's probably a really good thing we're not headed for Rucker right now because I love my midwife. ♥

Fort Rucker Bound

So it's semi-official. We are heading to Fort Rucker! Mike's reenlistment paperwork was turned in yesterday and we should get the "official" word from Uncle Sam in the next several days. His estimated report date is 10 July, so about 5 weeks before my due date. Eek! We are so excited about this new adventure in Army life. I am looking forward to warm weather and being back within driving distance of more family members.  I'm even more excited that Mike won't be deploying for a long time! We've waited so long for this little girl and it will be so special to keep our family so Mike can witness all her big firsts.  What I am a little (a lot) apprehensive about is not only traveling 2,800 miles at 33 weeks pregnant but also giving birth in a very anti-natural birth climate.


Throughout this entire pregnancy I have had a pretty specific vision of how I hope my labor and delivery to go. This is very likely going to be our only child and I would really love to experience everything that labor brings. I know some people will call me naive or even ridiculous for having such a long list of goals and wishes but I am determined to do my best to make it happen. I am not totally opposed to the use of drugs or interventions, especially if my baby's in danger, but I would definitely like to try to labor naturally first. This wasn't going to be an issue with my current midwife--she will allow me to walk around during labor, eat, use the tub for pain management and push in whatever position feels comfortable to me rather than what is convenient for her.  I have had some incredibly painful tests during my infertility journey and it was so hard to be still while I was in such pain. I can't imagine being in that much pain for hours and being required to lay flat on my back.  In Alabama, midwives are illegal. Yes, you read that right. Midwives are not allowed to attend hospital births and can be prosecuted for attending out-of-hospital births. While I'm not interested in a home birth, I think it should be a choice left up to the parents and not a choice forced on them by state legislation. There is not a single free standing birth center in the entire state of Alabama.

Anyway, I've started my research and found out that there are two hospitals that serve the Fort Rucker area. Flowers Hospital and Southeast Alabama Medical Center. Based off the websites alone, I am leaning toward SE Alabama Medical Center because of the way the birthing suites (complete with jacuzzi tubs!) are set up. Flowers doesn't even mention having tubs and that's important to me. When it comes to choosing an OB, I haven't got a clue. I currently know one woman who is living down there and her OB induced her on her due date because she (the OB) was going out of town and my friend was anxious to meet her baby.  Some people might think, "What's wrong with that?" but I personally feel that induction just for the hell of it can lead to potential problems for your baby and that you're almost guaranteed to have a snowball effect of interventions. For this reason, I do not want to be induced unless there is a valid medical reason or baby or I are at risk.
Mike and I had talked about hiring a doula when I first became pregnant. We felt like it would be unnecessary here because my midwife and hospital were so supportive of the type of labor I am hoping for. We thought we'd be able to handle labor and delivery with just the two of us and I liked the idea of Mike being my sole support system during all of it. Now they're we're moving cross country at such a late stage in my pregnancy, with little time to develop a relationship with an OB, we have readdressed the doula issue and have decided to hire one. We feel like she will be a tremendous help in the delivery room when it comes to advocating our wishes to the staff and helping us be successful with our goals. Mike and I won't be able to attend any child birth classes with the timing of our move and upcoming training he has so a doula will be a great resource for relaxation and pain management techniques. She won't take the place of Mike but will be there to guide him to fill the supportive role I will need during labor and delivery. I've already contacted a doula and received a response! She doesn't really care for any of the OBs down there but suggested one that I was actually considering because someone else suggested that he was natural birth friendly. She said he's allowed her clients to eat/drink, walk around, refuse IV meds, use only intermittent fetal monitoring, etc.  Since I won't have a lot of time to "interview" OBs once we get down there I guess I will have to make an informed decision based on the opinions of others. I've made a list of my labor and delivery goals to help me figure out exactly what I'm hoping to find in an OB. Wish me luck!


Home Labor Goals
I would like to labor at home as long as possible, with our doula present, before going to the hospital.

Hospital Labor Goals

• We plan to have myself, my husband and doula present. Please turn away all visitors and unnecessary staff until we have had time alone with our baby.
• We are attempting to have a natural, un-medicated birth without unnecessary medical or chemical intervention.
• We understand that there are procedures which may become necessary.
• Please do not offer me pain medications or ask me to rate my pain.
• Except in the case of an emergency, we ask that we be given the opportunity to accept or refuse any procedure or medication.
• We request that the least invasive or restricting versions of procedures be used.
• I prefer to have minimal monitoring and limited vaginal exams.
• I prefer not to have any unnecessary medications or interventions.
• I would like to the opportunity to be up and moving around as much as possible during labor.

Delivery Goals

• I would like to push at my own pace (Mother-directed pushing.) 
• I do not want an episiotomy unless medically necessary. I prefer to try perineal massage and a warm compress first.
• I would prefer to push in whatever position is comfortable for me, rather than the traditional back and stirrups position. 
• If labor seems to be stalling I would like the option to try different positions to get the baby to come down (hands and knees, squatting, birthing ball, etc.)
• Upon delivery I would like the baby to placed on my chest right away. I would like to have at least 1 hour of skin-to-skin contact before the baby is taken away for measurements.
• I prefer to breastfeed our baby as soon as possible after delivery. I prefer not to be disturbed until after the first feeding.
• We prefer to wait to cut the cord for 1-2 minutes or until it has stopped pulsating. Please offer my husband the opportunity to cut the cord. 
• Please retain my placenta for encapsulation.
• I would like my doula to be allowed to take photos during the entire labor and delivery process.

If a Cesarean Becomes Necessary:

• I would like to be conscious with my husband and doula in the room. I would still like to nurse our baby as soon as possible and for my placenta to be retained.

Recovery Goals

• I would like the baby to room in with us rather than in a centralized nursery.
• I would like either my husband or myself to be present for baby's first bath.
• I would like to establish a strong breastfeeding relationship. Please do not introduce a bottle or pacifier without notifying us of a medical reason. 
• I would like to meet with a lactation consultant to have breastfeeding techniques checked.