Our Birth Preferences

In her informative and heartfelt book, Birthing Normally After A Caesarean or Two, Helene Vadeboncoeur concisely paraphrases Michel Odent regarding how women who have been labeled "high-risk" need to be treated with even more patience, gentleness, kindness and encouragement during labour than an experienced birther or perhaps even a first-time mother.  She says that “in contrast to the usual view, women who are the most likely to experience difficulties and the ones who are considered the highest risk are the ones who are most in need of the favourable conditions for labour, i.e. discrete support with minimal disturbance, dim lighting and comfortable surroundings.”  This flies in the face of common practice in hospitals, in which VBAC moms, when they are *allowed* to labour at all, are subjected to a barrage of obstetrical technology in an effort to save their babies from imminent danger and almost certain death or permanent injury.  This was certainly my experience when I was in labour with my son.  The way in which the hospital staff spoke to me and condescended to me, the flashing lights and incessant beeping of the CTG made me feel anxious, nervous that perhaps something was or would be wrong with me or my baby, and I felt I had failed before I had really even started.

As someone recently remarked to me, "Know better, do better."  In that spirit, and after a substantial amount of re-search and soul searching, I have composed the following birth plan for whenever Baby Number Three decides the time is right to join our family and manifests him/herself within me.  It is still a work in progress.  (Note the gap at the top of page 2 ... I still need to do more research to find out when is the best time to confirm that position of the placenta is ***ideal*** ... any recommendations on this point are most welcome!)  However, the basics are all there.  I decided to write preferences for VBAC on one page and preferences for an emergency caesarean on a separate page, as it helps me psychologically not to have the two things intermingled on the same page.  I am certain I won't need page 2 anyway!  I also wrote a short cover letter of sorts.  My plan is to cut that page in half and just staple the half-sheet on top of the two separate birth plans.  A few bits were "borrowed" from some of the lovely mothers on a Facebook VBAC group with whom I have been conversing ... You know who you are, and thank you!!!  I hope that my words will be equally beneficial for you.

Our Names                                                                             EDD:

THANK YOU AND WELCOME TO OUR BABY’S BIRTH DAY!

We would like to thank you for all your support and expertise and for enabling us to provide the safest and most positive birth experience we can for our baby.  We have created this birth plan in order to give us the best chance of successfully achieving our VBAC.  We appreciate the need to be flexible and understand that some circumstances will mean our preferences cannot be accommodated, but we hope that you will facilitate our needs to the maximum extent possible.

Above all, our aim is to allow the normal physiological process of giving birth to take place unimpeded with a minimum of disruption and interference as long as it is safe to do so.  To that end, we ask to be informed of ANY and ALL procedures in advance and to be allowed the chance to give informed consent. 

THANK YOU!!!  YOUR UNDERSTANDING AND KINDNESS WILL FOREVER BE PART OF OUR MEMORIES OF THIS SPECIAL DAY!!!

 During the Pregnancy

· I have no wish to discuss elective caesarean until I reach 40+14.

· Only one ultrasound to be performed at __ weeks’ to confirm position of the placenta.

During Labour

• My husband and doula to be present with me at all times.

• To labour without arbitrary time limits in any position that feels comfortable for me.

• I do not consent to any vaginal exams except upon admission to the hospital and if I decide to request one.  PLEASE DO NOT tell me the findings of any V.E. unless I specifically ask for such results or if immediate medical decisions need to be made. 

· I do not consent to CTG and am happy to sign an AMA to that effect.  I am happy to follow WHO recommendations regarding intermittent monitoring: once/hour during latent phase, once/half hour during active phase and once/5 minutes during pushing.

• I do not consent to episiotomy.

 I do not consent to ARM or any form of induction or augmentation, incl. 3^rd stage.

· Lights should be dimmed and the room quiet with interruptions, questions and conversation kept to a minimum.

· Use of the shower and/or bath and a birthing ball.

· Light eating and drinking if desired.

· Please do not offer pain relief medication.  If we need it, we will ask for it.

· Assistance with use of a mirror so that I can see my baby being born!

· Please do not reveal baby’s gender to me…I can’t wait to see for myself!

· If birth position allows, please let my husband or I touch/catch our baby first.

· WHEN IN DOUBT, REFER TO MY HUSBAND AND DOULA FIRST.  THANK YOU!!!

After the birth

· Immediate skin-to-skin.  Please do not bathe or clean the baby or remove the vernix.

• My husband would like to cut baby’s cord AFTER it has finished pulsating.

· Natural third stage without use of synthetic oxytocin.

• Vitamin K drops. No injection.

· If our baby must go to the nursery for evaluation or medical treatment, my husband will accompany our baby at all times.

Caesarean Birth

If a caesarean birth becomes medically necessary, we would like this to be as positive and “normal” an experience as possible for our baby and us. 

· I would like to have a midwife and my doula present for the birth.

• I would like my husband to be present with me at all times, especially for the spinal.

• I would like to leave baby’s cord pulsating for as long as possible before cutting.

• I would like immediate skin-skin once baby is delivered while surgical team finish.  Please do not clean the baby or remove the vernix.  My husband can assist if necessary.  Blankets to keep body temperature up and shield baby’s eyes from the bright lights of the theatre.

• I do not wish to be separated from my baby or my husband under any circumstances.

In event of General Anaesthetic

• I would like my husband to be present at all times and to have skin-skin with Baby while I recover.  They should not be separated under any circumstances.

Feeding

Do not give our baby supplements (including formula, glucose or plain water).

If I am unavailable to breastfeed my baby, I would like the following steps taken to feed my baby in accordance with WHO guidelines (milk by cup/syringe/dropper):

1. Expressed mother’s milk. 2. Expressed donor milk. 3. Formula as a last and final resort.

THANK YOU FOR TAKING THE TIME TO READ AND HONOUR OUR WISHES!

 

Two Stories, One Lesson

I am sure you have not failed to notice one striking similarity between the two brief stories I have shared so far.  In both instances, I was trying to accomplish something significant but didn't fully appreciate the level of commitment it would take to achieve my goals.  And in both cases, what I required was a very concise and clearly defined instruction.  

When learning to breastfeed my newborn, I really needed that La Leche League group leader to spell it all out for me very distinctly:  Take to the bed with your baby, maintain skin-to-skin contact and allow her free access to the breast as often as she likes.  Period.  Throw away the complicated feeding charts and the "top-ups."  Nevermind the nurse's long-winded directives to feed the baby for twenty minutes, then burp her, then swaddle her, lie her down in the cot, etc. etc......  Just do the thing that you are trying to do.  It's not easy, but it is simple.

Likewise, I hoped I would be able to VBAC, and I listened to my affirmations for about 10 or 20 minutes before I went to bed every night to foster a positive attitude and self-belief.  I realise now that hope is not a plan.  When my VBAC failed, I analysed everything time and again in an effort to determine what went wrong and why all of my plans unraveled so quickly as soon as I encountered the first obstacle.  Again, I needed someone to explain matters to me in simple, straightforward terms - a no-nonsense approach.

It was my husband who introduced me to Bob Proctor and his videos on YouTube.  Mr. Proctor is often talking about how people can make more money and become financially free, so you may see titles such as, "Make a Million with Bob Proctor."  Strangely enough, however, as soon as I heard him speak about his philosophy in his own very succinct and unique way, it was like an epiphany for me, and I realised that I didn't get the result I wanted because I didn't invest enough of myself in the process.  In one of the videos I've now watched countless times (see below), Bob Proctor refers to one of his affirmations for wealth and explains, "You don't just say it once.  You say it maybe a thousand times a day for ninety days."  Then, he says, you will see your thought patterns, and thus your behaviour and your outcomes, beginning to change.  Hearing that was definitely one of my "A-ha!" moments, as Oprah Winfrey would say.  I was too afraid to indulge in my fantasies because I worried that I would fail and be disappointed.  So what happened?  I was thinking and feeling more about failure than about success, and that energy manifested itself in my life as another caesarean birth.  I didn't want to do visualisations for fear that the actual birth wouldn't live up to my lofty expectations.  I didn't want to move myself to tears watching uplifting and inspirational birth videos just in case it made me too sad about my own caesarean or in case things didn't go as planned with my VBAC.  I didn't get involved emotionally in a plan, and I didn't develop the "success consciousness" Nancy Wainer Cohen and Lois J. Estner discuss in Silent Knife.  Being emotionally cautious isn't going to get you a VBAC.  It's like falling in love.  You have to be willing to get hurt and jump in with two feet anyway.  I believe that there are probably alot of other women like me who are overly academic in reading, studying and preparing intellectually for major life events like becoming a mother but are unwilling or unable to get involved in the messy emotional issues that will actually open them up to the wider experience of allowing vulnerability, faith and the possibility of true joy to come into their lives.

As a result of these two powerful learning experiences that motherhood has given me, I now have a thorough understanding of and an unshakable faith in what I need to do to grow a beautiful, healthy child within my womb and achieve a vaginal birth after two caesareans.  Only with a concerted, sustained mental effort over a long period of time with regard to repeating affirmations and visualisations, and a laser-like focus on my objective can I hope to succeed in giving my child the serene pregnancy and the safe, natural birth experience s/he deserves.

"Whatever the mind can conceive and believe, it can achieve."
~Napoleon Hill

Affirmations

This is the affirmation I composed for myself for National Breastfeeding Week this year:

I am so happy and grateful that my amazing body instinctively and automatically knows how to create, nurture, protect, nourish AND BIRTH my beautiful, healthy children.

Up until recently, I had no idea what affirmations actually were.  I had heard of them, read about them and even used them in different situations.  I certainly thought I knew what they were, but my experience of being in labour with my son and our subsequent CBAC demonstrated that I clearly had no idea whatsoever what  affirmations really are and how to use them.  I thought that listening to some affirmations on a CD once or twice a day was going to somehow fill my mind with new and wonderful ideas about myself, my body and my ability to give birth and that this would give me the self-belief and the sense of calm I needed to make my VBAC dreams come true.

No.  Just no.

The CD's were a great idea and a good start, especially for someone like me who needs alot of help and guidance when it comes to relaxing.  Relaxing was not a skill I had ever taken the time to develop properly.  However, relaxing and hypnosis CD's are only a beginning.  I have learned through various sources which I have been reading and studying over the past year or so that if you are going to change your subconscious programming and habitual beliefs and behaviours you are going to have to devote an enormous amount of time and energy and effort to the repetition of these affirmations.  You are also going to have to practice an enormous amount of visualisation - detailed mental pictures of what it will look like when you achieve your goal - with which you become emotionally involved.  Now, I practice thinking with every single chance I get.  At a red light?  Practice affirmations.  Putting the kids to sleep?  Practice visualisations.  In the shower?  Practice, practice, practice.  A hundred times a day or more, whenever I can remember to do them, I am practicing thinking properly.  I am changing my mind and my habitual thought patterns, and I am happier every day because of it.  It is the most powerful thing I have ever learned in terms of contributing to a positive quality of life.  Please stay tuned, because over the next while I am going to be sharing all the wonderful sources of this information about the mind right here on this blog in hopes that it can help you to achieve your goals and change your life, too.  

"We become what we think about."   ~Earl Nightingale

Happy National Breastfeeding Week! 1 - 7 October 2013

Naturally enough, my original intention was to start this blog about birth by writing in more detail about the births of my two children.  However, when I realized that National Breastfeeding Week had arrived, I could hardly pass up the opportunity to discuss what my husband refers to as my "new religion." Actually, it is probably an even better place to start.  I say this because, above all else, it was the almost impossible challenge of learning along with my first child how to breastfeed, in spite of poor guidance and advice from some health care professionals, that led directly to the spiritual and psychological revolution that changed my life forever and for the better.

My daughter was born by "elective" caesarean section in 2010 due to frank breech presentation and suspected IUGR.  The word "elective" seems to be applied quite loosely and freely by medical professionals generally, but please do not take this to mean that I wanted and opted for a caesarean.  I spent my pregnancy reading books such as New Active Birth by Janet Balaskas, The Pregnancy Book by Sears and Sears, and Tracy Donegan's Better Birth Book.  I was taking antenatal yoga classes to foster good health and strength and to prepare myself for the hard work of giving birth.  My husband and I, like many other first-time parents, really wanted to welcome our baby into the world with a natural, unmedicated, physiological birth.  However, there was probably no obstetrician in Ireland who was going to entertain a vaginal breech birth, and at the time I had unquestioning faith in my consultant and in the overall *atmosfear* of the maternity hospital.  I did everything I could to try to encourage my baby to turn, from reflexology to acupuncture, from assuming all sorts of strange positions on the floor to resting a bag of frozen peas on my bump in hopes that she would get too cold and turn around.  Nothing worked.  I tearfully - and fearfully - signed my consent and endured a surgical birth.

My daughter was 6 lbs. 2 oz. at birth.  She was indeed tiny, and she did not have the benefit of labour to prepare her for life outside the womb.  She was alert, looking and listening and taking everything in, but every time she went to the breast she fell asleep.  In fact, it was three or four weeks before I emerged from my groggy surgical haze, so whatever pharmaceuticals they gave me in the spinal block must have taken quite some time to leave both of our systems.  In the meantime, I tried to dismiss all the feelings of failure, anger, devastation and sheer terror I had as a response to the surgery and focus on my dainty little pixie.  She was like nothing I had experienced before, impossibly soft and wrinkled with strange, gurgly sounds and calming, breathy sighs. Still covered on her shoulders and back with soft, downy lanugo, she was something maybe like a tiny alien.  Throughout my pregnancy, it was a foregone conclusion that I was going to breastfeed my baby, and like everything else in my life I was very specific about it.  I would breastfeed exclusively until she was six months old and continue as part of a mixed diet until she reached her first birthday.   I took a one-day breastfeeding preparation course and assumed I was prepared with all the information I needed.  After all, it's totally natural.  If cats can nurse their young, why can't I?

Well, yeah, but.....

So there we were in the recovery room with our quiet, observant baby, who had been all bundled up before being handed to us.  (I was so foolish, I didn't know I could ask for skin-to-skin after a caesarean!)  Couplehood had been enhanced by parenthood quite suddenly.  We were all at once smitten with our new charge, overawed as we marveled at her very existence, and overwhelmed by a new and terrifying level of responsibility was literally thrust into our laps.  As weary and woozy as I was, I really wanted her to breastfeed right away, so I stripped all the clothes off her immediately, untied my hospital gown and placed her on my chest.  We must have been a sight, my husband and I bumbling around with my breasts and jumbling our daughter from side to side, here and there, nipples everywhere, trying to get her to latch on.  She would latch on briefly, weakly, sleepily.  I didn't know if she was "feeding" or not, but I had a strong suspicion that this was not quite right.  Today, I'm sure I would react differently than I did at that time.  Introducing her to the breast was probably a wonderful start after all we'd been through.  However, I already believed that I was a failure at birth, so I didn't need much to convince me that I was going to fail once again at this aspect of motherhood.  There was a midwife at the foot of the bed who spent alot of time writing things into the precious red folder.  I asked her a few times if we were doing this correctly, but she didn't seem particularly interested.  There were other midwives milling around, chatting and laughing, and one of them told me that our baby was just fine.  I was not convinced. 

The remainder of our stay in hospital was characterised by variations on that theme.  Baby and I were in a chemical haze.  I was an emotional, tearful wreck, and my husband was trying his best to cheer me on and lift our new family's spirits.  My milk was not coming in, so in between my baby's feeds I was trying to express, day and night, just to keep up the nipple stimulation.  Nothing was coming out.  I asked for breastfeeding help from the midwives time and again.  One lactation consultant tried to be very helpful.  She spent alot of time with us one afternoon and told us that we needed to keep "stimulating" our daughter because every time she latched on she fell asleep.  We were stroking her with cold water on cotton wool.  We even pinched her heels a couple of times. (I couldn't bear to keep doing that one!)  We were told that our daughter had a slight tongue-tie, which would make it difficult for her to latch on properly.  That particular LC was sympathetic and helpful, but we never saw her again.  One lactation consultant is definitely not enough for a maternity hospital of that size.  (I believe that there is another on the staff, but she only works three days a week).  And so many of the other midwives hadn't the first faintest notion what they were doing.  I'll never forget one who squeezed my left breast so hard I had to fight back tears.  I couldn't understand what was wrong with me.  

In addition to my daughter's tendency toward breast-induced narcolepsy, we faced the troubling task of filling in a feeding chart.  This was the single worst, most demoralizing, ineffective, inaccurate and psychologically damaging way to promote and encourage breastfeeding I can imagine.  They wanted me to write down every feed: what time she latched on, what time she finished and how many minutes of "active feeding" she'd had.  I was told she should be feeding every 2 hours.  I also had to keep track of her wet and dirty nappies, which provided further evidence that my breasts were not up to the job for which they were intended.  Following these instructions and adopting this mindset resulted in my violating the cardinal rule of breastfeeding: Trying to schedule feedings and neglecting to tune into my daughter's cues.  I still well up whenever I look at pictures from my daughter's first days and see written on the back of my hand the times, like 12:45 - 12:56.  I tried so hard!

Inevitably, I was told that I would have to "top her up" after several feeds a day, so we were handed a box full of jars and teats.  She was losing weight, too much weight.  In fact, she was down to just 5 lbs. 4 oz. by the time we left the hospital, but I was desperate to get home.  I didn't know how I was going to sort out this problem, but I was much too stressed out and depressed in the hospital to think clearly.  She was swimming in newborn clothes that were much too big for her as we packed up and drove home on the fifth day after the caesarean. 

The Public Health Nurse was meant to come check in on us at home to see how things were going.  What a great system, I thought.  Someone to take care of us even after we've left the hospital.  Surely this nurse would be the one to help me get this breastfeeding thing up and running properly.  She rang us the day we arrived home, but I told her not to come over until the following day.  I was cross.  At least give us a day to settle in!  When she arrived, my daughter weighed 5 lbs. 10 oz, and we were instructed to give her a top-up after every feed.  Needless to say, my milk still was not coming in properly, and my daughter would gain a few ounces and then lose them again and again over the next week or so.  The nurse was coming to see us at least every second day.

It was on one of these occasions that my moment finally came.  I had been under the impression that we'd turned a corner, that my daughter was nursing better than ever and had finally put on a bit of weight.  I was devastated when the nurse weighed her and told me that, in fact, she had actually lost a couple of ounces again.  My self-esteem and trust in my body at an all-time low, the stress of worry about my baby's health and self-loathing at a record high, I was unable to hold back my tears.  I bawled my heart out right there in my living room, feeling so small and ashamed of myself in front of this professional woman.  I was utterly humiliated, but through that one moment of vulnerability I opened the door to a whole new life.  The nurse, in a misguided attempt to comfort me, remarked sympathetically in response to my tears, "Oh, I'm sorry.  I know you had your heart set on the breastfeeding."  I was sitting on my sofa weeping openly, but inside me something rose up.  Maybe it was the mammalian instinct of a mother defending her young.  Maybe it was the fury that only a scarred and scorned mother can know.  Whatever it was, it was powerful enough to cut that first thread, to pull that first fibre in the tapestry of my mind which, over the next few years, would all but completely unravel and that would ultimately challenge and change all of my attitudes and beliefs.  "This isn't over yet," I thought.  "How dare she speak to me as if this is over?"  This wasn't breastfeeding support of any kind.  She was no more interested in helping my baby and I learn the time-tested and ancient art of infant feeding than she was in watching paint dry.  She wanted baby on the bottle, gaining weight in accordance with her charts and timetables so that she didn't have to mind us anymore.  It wasn't anything to do with what was best for my baby and I.  She wasn't taking a personal interest in us.  It was all about what was most convenient for her.  This nurse was only ever trying to persuade me to bottle-feed.  Here is your local Public Health Nurse, brought to you by SMA.  The midwives at the hospital were also guilty.  My entire warped view of the medical professions as being the caring and concerned safeguards of our health was suddenly brought into sharp focus.  How naive I had been.  Health care professionals have their own agenda.  Only my husband and I prioritize our baby's (and our own) health and well-being above all else.

That afternoon, I rang a local La Leche League leader in desperation.  It's funny, when I was pregnant I would have said, "Why do you need a club or a support group to breastfeed?  Support groups are for alcoholics and people with problems.  Breastfeeding isn't a problem!"  No, but learning to breastfeed in a culture that does not honour, protect and pass down women's wisdom from one generation to another as in traditional cultures is a heroic, uphill battle.  This leader told me to take to the bed with my baby, both naked, and let her suck constantly as often as she liked.  She told me to cut way back on the "top-ups" and gradually get rid of them altogether.  She told me to stay in the bed with my daughter and recognise my own need to heal after the surgery.  It was the only good advice I'd received, and although round-the-clock feeding and screaming was extremely difficult for the first 3 or 4 days, my milk did come in.  I nursed my girl until she had passed her third birthday, before, during and after my pregnancy with my son.  I attended many La Leche League meetings and learned all about how human beings are "carry mammals" and why I couldn't bear to put my daughter down, make her sleep in a cot or hear her cry.  Most importantly, I learned that the health professions have pompously assumed responsibility for things such as breastfeeding when this is really not their brief at all.  Let them stick to the pharmaceuticals and the surgeries.  If you want to know about breastfeeding, go to the moms who do it.

Happy Breastfeeding Week 2013 to all the bf moms past, present and future!

www.llli.org