Season 2

Episode 2

 

 

The Birth Plan

My plan was to have a home birth, without drugs. I was excited for it. I wasn’t particularly scared of childbirth, in fact, I think I was just very naive to it all. I had never seen a birth before mine except for the few I had seen on video. It never occurred to me before getting pregnant how important this is and how much of a disservice it is to humanity that we don’t participate in this huge part of life more often. 

Regardless, I planned for my birth with this very common level of naiveness. The home-birth-no-drugs part of the plan was easy… to plan. It felt simple enough. Actually, all of the plans of what we expect to do as a mother or parent feels pretty easy before it’s actually in practice. Yet, there were still all these other practical decisions that were quite exhausting to even think about. For example:

Some Decisions for Before:

  • Homebirth? That’s an option for some provinces in Canada.
    • If you’re planning a home birth you need to get everything ready. Our midwife clinic offered a session on what to do. How many blankets to get, how many towels, how to dress the bed.
    • Even if you plan for a home birth (in Canada and/or Ontario) you may to register at the hospital in case you A) change your mind or B) need to go to the hospital because something wasn’t going as planned.
    • Where in your house will you plan to give birth?
  • Or Birthing centre? That’s also an option in Ontario and likely some other places in Canada? 
  • Or hospital? Pretty much an option everywhere I believe! 😃 
  • What will you do with your pets? This is a decision likely no matter whether you go away or stay in your home? I guess cats can stay on their own for awhile… 
  • Do you have plans to help ease the labour discomfort… the comfort measures?
    • Have you thought about an epidural? Thinking about it is a good idea so that you can at least make this decision rather than just going with whatever flow is around you.
  • Water bath? I wasn’t a fan but many people are. And it’s no easy (or quick) task to fill the damn thing up. 
    • Where you’re going to rent it from and do you trust that it was cleaned properly?
    • Who’s going to fill it? and when?
  • Who will be there? 
    • Your partner?
    • A midwife or OB? 
    • Doula?
    • Mom? Dad? Mother-in-Law? Other Motherly figure?
    • Sister? Brother? 
    • Other non-cis-gendered friend?
    • Best friend?
    • I wanted lots of people there, in theory. But we had a small apartment so it just felt impractical.  
  • Video recorded? Photos? Who will do this?
  • What food will you have prepared? For before? During? As snacks? A particular yummy meal for right after? Snacks for the first few days?
  • What will you wear? Seriously? Before… during… after?

Some decisions didn’t require much of a decision, but rather just require some forethought and organization. But others do necessitate some information gathering. For example, for me, I wanted to know the science and theory of having a home birth. I didn’t just assume I would have a hospital birth and I am glad that I began to question it because in the process I learned more about how stress affects labour. No animal wants to give birth when they feel threatened. So they often won’t. I actually knew this from an animal behaviour perspective, given my background as a behavioural neuroscientists but I hadn’t actually applied that knowledge to humans before lol! The stress hormones can halt birth until a safer space becomes available. If someone feels safe, then it helps promote birth. Knowing where you feel safe is important. For some people a hospital offers that sense of safety. The hospital offers a safeguard against the millions of things that could go wrong, even if they often don’t. For others (like me) the thought of being at the whim of medical personal who would impose their fear-based practices on me during labour, did not feel right. 

In order to make decisions, ideally one should be making informed decisions and ultimately giving informed consent to the procedures being done. But being an informed patient is not only difficult, it is virtually impossible. As a scientist I can very well appreciate that we rarely deal with absolutes in science and, by extension, neither so in medicine. Instead, we deal with probabilities. So as a patient, we’re expected to make decisions that are informed by these probabilities. Most people have a difficult time thinking in probabilities. And then having to weigh probabilities is even more difficult. All of this makes being “informed” a relative concept. 

The decisions for us started early as we began to plan our ideal birth. Midwife vs OB/GYN? Home birth, birth centre, hospital? Epidural? Actually, that wasn’t a real decision… an epidural was just not an option for me… until I got one. Hire a Doula? Hypnobirthing? Prenatal classes? The list was long and at times it felt like as soon as one decision was made, 5 more crept in that needed resolution. What I really needed was a few doubles of me who thought exactly the same way as I did, who I could task with researching and then picking between all the options. I just didn’t have enough brain power or time to do it all. This makes me somewhat appreciate those who just don’t want to think about it at all. But I’m not like that. And you probably aren’t either, which is why you are still reading this. So the decisions never ended until they came and went. 

Some Decisions Immediately After:

  • Vitamin K? Vit K helps blood clot. Without it, a newborn could bleed to death. It’s rare not to have it but potentially fatal if one does. And easy to fix with a simple injection to a newborn. It’s overly cautious and unnecessary for MOST babies. So it’s used for those rare situations when it’s is necessary and otherwise unknown. But still a choice...
  • Eye drops? Just before I gave birth, there was a call to change this routine postnatal practice.  From the CBC article posted: 
    • Health-care professionals use the eye treatment to prevent babies from getting neonatal opthalmia — or conjunctivitis (pink eye) that happens in the first four weeks of life — from gonorrhea or chlamydia. The treatment is required by law in Ontario, British Columbia, Prince Edward Island, Alberta and Quebec. The Canadian Pediatric Society is urging doctors to advocate for the repeal of such laws because the treatment is "of questionable efficacy.” "The health-care professional's caught in the middle of this. They don't actually think this is a good idea to do because it doesn't work, but the law says they have to do it," said Dr. Noni MacDonald, lead author of the organization's position statement.
  • skin-to-skin? (AKA Kangaroo care) This is routine in, I think, every hospital in North America, which is a far cry from the old practice of taking the baby away from mom immediately following birth to weigh them and then soon after send them out to the incubator to stay warm. Now, birth professionals are encouraging skin-to-skin immediately so that the baby feels the warmth of their birth parent. This practice is believed to promote bonding, latching for breastfeeding, and also physiological regulation to help prevent SIDS.  
  • delayed cord clamping? Many birth professionals believe that cord clamping — which is done to separate the birth parent from the baby. It has typically been done immediately — should be delayed for some time. The range of delay includes a few minutes to however long it takes for the pulse to stop. Delaying it seems to increase the baby's  iron supply.  
  • saving the cord blood?
  • keeping the placenta?
    • and dehydrating/eating/cooking it? aka “placentaphagia”
    • I wrote all about it here
  • and if a C-section happened 
    • requesting skin-to-skin in emergency room. See supplemental information included.
    • vaginal gauze for bacteria
  • Breastfeeding? I actually hate to think that this is even a question… yes I will judge for it. It is recommended and encouraged by any health organization I know of. It just also be the first attempt at feeding an infant, ideally at least for the first 6 months. When that doesn’t work for whatever reason, alternatives (formula and donated breastmilk) exist. 

I think the idea of having a plan, generally speaking, and the process of generating the plan can be very educational. So in that way, I totally recommend it… if you like knowledge. But if someone doesn’t want to make these decisions then by all means, the possibility to defer to the professionals is legitimate. Many people will tell us that we should be empowered when giving birth. Yes, I think we should always be empowered, when possible. But the problem with the decisions around birth is that they can easily lead to feeling disempowered and defeated by a tremendous amount of information that we can’t possibly understand well enough to make truly informed decisions. So maybe the question is “are we informed enough?”. That will vary from person to person. Inevitably, something could come up that hadn’t crossed our mind, even with the best and most supportive Doula and/or Midwife and even with the most curious of brains. I thought I knew a lot but in the end, I was unprepared to know what it meant in key points at the end of my pregnancy.