In the spring of 2014 I found out I was pregnant with twins. Written below was the Birth Plan I put together, heavily inspired from Natural Hospital Birth by Cynthia Gabriel and Natural Childbirth the Bradley Way by Susan McCutcheon.
All my wants and preferences were definitely not met. I had to make several concessions but in the end we had a positive experience and I had a successful twin vaginal delivery without pain medication. Even though we strayed from the plan, having a Birth Plan was helpful for me to mentally prepare and envision how it all could play out.
- I want to have the most natural labor possible.
- I would prefer to start labor spontaneously without induction and at my own pace.
- I will ask for pain medication when I feel l need it.
- I want to avoid a csection.
- I would like to labor and push at my own pace in positions that feel comfortable to me. To allow this, I would like to monitor the babies’ heartbeats intermittently.
- I would like a heparin lock rather than an IV and I would like to stay hydrated with clear liquids rather than an IV.
- I would like to avoid an episiotomy at all costs, even at the risk of tearing. If it is absolutely necessary I would like a pressure episiotomy with no local anaesthetics.
- I would prefer to wait at least 3 min to cut umbilical cord or until it stops pulsing. Cord milking may be used if it is impossible to wait.
- In the absence of any complications I would like to nurse Baby A after birth and wait for contractions to start for Baby B and same for Baby B and wait for contractions to start with the placenta.
- Please don’t offer anything to my babies without my or my spouse’s approval.
Birth Plan Cheat Sheet
Nate: Labor coach – Tend to Kendra, coach and comfort her.
Kourtney: Extra support – Give Nate breaks, offer advice and suggestions. Relay information to nurses and doctor, especially when Kendra is in the middle of a contraction. Take pictures.
First Stage – Opening the Cervix
Feelings of safety are vital. If needed, review opening scene scenarios starting on page 123 in Natural Childbirth The Bradley Way. “Early Labor: You are probably hoping the pain won’t get worse. If you think about this pain continuing for several hours you can get depressed. Counteract by staying in the moment.” Keep busy and stay preoccupied. Get hospital things together. Don’t forget to offer Kendra water often. A contraction is timed from it’s beginning to the peak of it’s strength.
Go to the hospital when contractions are 60 seconds long and three minutes apart. Call the hospital to let them know you are on your way.
Don’t fight the pain.
Relax and surrender to it.
Soften your body. Go limp, sag and let go.
Lose your thinking mind.
Mentally hook up what you are feeling to an accurate image of what is causing it.
Move fear into courage and love.
Helpful words while in the hospital: “We’d like to wait an hour.” Try to concentrate on what you want rather than what you are trying to avoid.
There will be issues with the babies’ heartbeats. That is normal. Remain calm.
The woman tends to what is going on inside. The labor coach tends to what is on the outside, the environment.
The labor coach should help make sure the following needs are met:
1. Darkness and solitude
3. Physical Comfort
4. Physical relaxation
5. Controlled breathing
6. Appearance of sleep and closed eyes
Regard emotional signposts and length of contractions more so than dilation.
First Signpost: Excitement: Keep tummy hanging loose at all times. Coach, keep her at home, relaxed and preoccupied.
Second Signpost: Seriousness: Your uterus gets to serious work and so do you. Excitement gives way to concentraion and you feel a definite need to sit or lay down during contractions. You feel the need to work with your contractions. It is a do not disturb and get to work attitude. Coach, you should become serious too.
Third Signpost: Emotional Doubt: Your uterus shifts into high gear and speeds by the centimeters from seven to ten. You begin to wonder why you haven’t reached your destination yet and wondering if you even can. You become uncertain and indecisive.
Contractions may lasy 70 -80 seconds or even 90 and your rest periods are usually one and a half to two minutes. Relax, let go, listen to your breathing, breathe with a quiet steady rhythym. Be super limp and relaxed, permit the powerful sensation of the bag of muscles flexing to be there. It is helping you. Float over each contraction.
Coach, make sure you are taking care of her backache. She will look to you for reassurance. “Remember, the only hurdle here is an emotional one. Physically what is happening is more of the same, contractions, but closer together and longer. It is the hardest part, but fastest. Praise her for her efforts, encourage her to redouble her efforts, and let her know she’s almost there. As a coach, you cannot also experience self doubt.
Second Stage – Pushing:
Sit at a 45 degree angle, legs pulled back by arms, not stirrups. You are essentially trying to imitate a squat.
“You will still be having contractions which start off slowly and build to a peak of strength. They work very well for you, with the uterus pushing down on your baby. When these contractions are just beginning, you certainly don’t want to gulp a quick breath of air and hold it for several seconds, nor do you want to waste your efforts on the early part of the contraction. Instead, you should wait for these contractions to really get underway. Then you can put your best efforts behind them when your uterine muscles are also doing their most concentrated work.
Wait for contraction to begin and take a deep breath. Let it all out without pushing.
Take a second deep breath filling your chest and abdomen and exhale completely, still without pushing.
Now, take a third deep breath. As you do, lift your legs slowly and gently back to the pushing position. This third breath is the one you will hold while you push down because by this time your uterus has really started to work.
Push as long as you comfortably can, holding your breath.
When you can no longer hold your breath, put your head back to open your throat, exhale completely and take one more deep breath.
Now put your head back down toward your chest and push with this fourth breath as long as you can. Your contraction will now be over. Rest.”
*Coach: don’t tell her when to breathe in or out since you cant know when it feels right, but encourage her to take the next breath when she is ready.
Third Stage – Pushing out the placenta:
Wait for contractions to start – skin to skin contact and nursing will help this.
Continue to push as before, at a 45 degree angle.
Your baby has a “rooting reflex” When he feels the breast against his cheek, he will turn toward it. Don’t turn his cheek or put the nipple in his mouth.
On the day of delivery, make sure to nurse and or stimulate your breasts with a hospital grade pump for the first 48 hours every three hours no fail.
Again, the actual events looked very different from “the plan” so flexibility was imperative. For example, I was trying to push at a 45 degree angle and not making any progress. My doctor looked at me and calmly said, I think you should try laying down (they had a terrifying table that locked me in at the wrists and legs). I took his advice, I got locked in, and it really was so much easier. Things started progressing from there. I was lucky to have a doctor who respected my wishes but I knew I could trust.