Monday, January 13, 2014

What is in a birth plan?

Photo courtesy of Birth Boot Camp

I recently had my home visit in preparation for my home birth and one of the main things we covered was our birth plan. When our midwife brought this up I thought it seemed a little silly to have a birth plan for a home birth. It is my house, so won't everyone be following my rules anyway? Luckily, she provided us with a worksheet that helped me to see that there are many important things that need to be covered in a birth plan - even in the case of a home birth. Here are the basic pieces of a birth plan:

Format: Remember that you are not your care provider's ONLY patient - especially if you are in the hospital. Make sure it is short and to the point, but also gives your care providers a good idea of who you are and what you expect. A great way to do this is to write a short bio about yourself and your birth and follow it up with a list of "Yes, please" and "No, thank you" procedures and preferences below that. Try to keep it to one page so it can easily be added to your chart.

Content: Below are some things to think about when creating your birth plan. Remember, put emphasis on what matters to YOU.

Prenatal Care
Though you may not need to write all of this out, it is important to know what you want in terms of your prenatal care. This becomes even more important as your due date approaches. Which, if any, tests would you like to be performed on you during your pregnancy (GBS test, glucose tolerance, etc.)? How do you feel about vaginal exams late in pregnancy? What will happen as you approach and possibly pass your due date? If induction becomes necessary, what methods are you willing to use? Bring these issues up with your care provider at your next appointment to make sure that you are on the same page.

Early Labor
Think about where you imagine this portion of your labor happening. Do you want to be at home or in the hospital? What comfort measures would you like to have available? Who do you want for support at this stage? What kind of environment do you expect for this part of your labor? Would you like to be able to eat and drink freely during this time?

Active Labor/Transition
This portion of labor can be very demanding on you and your birth team. It is important that you have a birth plan for this time so that your care providers can easily cater to your wishes when you may be unable to articulate those wishes to them. Who do you need for support at this point in your labor? Where would you like to be for this portion of labor? Would you like to labor in water? Do you need anything special (music, dim lights, etc.) to help you relax?  What kinds of relaxation techniques do you plan to use? How do you wish to be monitored? How often would you like vaginal exams, if at all?

Birth
At last, it will be time to meet your baby. Which positions would you like to try for pushing? Do you need to be directed to push or would you like to push instinctively? Who do you need for support? What kind of environment do you need to concentrate on delivering your baby? Do you prefer a natural tear or an episiotomy? How do you feel about instrumental delivery? Who should "catch" the baby? Is anyone taking pictures/video and what would you like them to capture/avoid?

After the Birth
Not only do you have to plan for your baby's care after birth, you should plan for your own care as well. Would you like to delay cord clamping until the cord stops pulsing? Do you want immediate skin-on-skin time with baby? Who should cut the cord? Would you like to deliver the placenta naturally? Are you planning to breastfeed? Which newborn tests and procedures do you consent to? Should baby be given a pacifier or bottle in any circumstances? Where would you like baby to sleep?

Just In Case
It is a good idea to talk over what may happen in an emergency with your partner and your care provider. You can choose to put this information in the same birth plan, make up a separate birth plan, or ensure that you have someone that will advocate for you in a time of emergency. If you must have a c-section, who should be with you in surgery? Would you like to remain conscious during the procedure? Would you like to have more children vaginally after a c-section and need a low transverse incision? Where should baby go after delivery (if it is healthy)?

If you are an over planner like me, it may be difficult for you to keep your plan concise. I highly recommend that it is as simple as possible so that your care team can give you what you want without spending the entire birth reviewing your chart and wishes. In order to decide what you feel is best for you and your birth, I recommend taking an awesome childbirth class like Birth Boot Camp so that you will be well prepared for your mission ahead. Check out my class schedule for my latest class offering.

Saturday, January 11, 2014

An update: Relaxation during pregnancy

After setting the goal of making 2 posts per week on this lovely blog, I ran into some difficulties with my pregnancy that occupied my entire life for a period of time. I took the time to concentrate on my health and I would like to share my new found perspective with you over the next few posts.

photo from Birth Boot Camp

I have always been a high strung person. I make lists about other lists, I plan out shopping trips days ahead of time, planning for family parties takes multiple Pinterest boards and months of preparation, budgeting is my passion. I love to be in control. When I started to have pregnancy induced hypertension in my second trimester, I felt totally OUT of control. The more I stressed over it and tried to control it, the worse it got. At 30 weeks, I showed signs of early preeclampsia in a blood test. With some diet changes (see the Brewer Diet for more information) and some stress management, I was able to get my body back on track for a healthy pregnancy.

First, I went down to part time at work. The first week was rough as I tried to balance fitting my 40 hour work week into 20-24 hours. When I became accustomed to this new schedule, it was amazing how much less stress I felt. I had plenty of time to tackle projects at home as well as at work, and it has helped me to transition my coworkers into my maternity leave plan. It was also quite stressful at first to balance our new financial situation. How did we combat this? We simplified. We cut our food expenses, went down to one vehicle for commutes, kept our older child at home instead of at daycare, and we were able to be more mindful of our spending.

Second, I took some time to myself. I took up a hobby (crocheting, in my case) and dedicated at least 1 hour per day to myself. It was often after everyone else went to bed and I could take a moment to crochet out my stress. It was pure bliss - especially paired with unlimited episodes of Call The Midwife.

Finally, I practiced relaxation exercises from my Birth Boot Camp toolkit. There is nothing like real stress to test your coping skills. My husband and I worked through some meditation exercises and comfort measures. I spent a lot of time praying and meditating about my baby and visualizing our awesome birth. I watched birth videos to gain confidence in my body and it's birthing power. I read and re-read books about natural birth. Preparation is key - and for me it greatly lowered my stress level.

Have you been faced with a difficult situation in pregnancy? What did you do to reduce your stress level?

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If you would like to learn more about Birth Boot Camp and my class offerings in Bath, Maine, check out my class schedule.

Friday, November 29, 2013

Pregnancy Snack Monday (on Friday!): TURKEY!

Hello everyone! I was so busy preparing for Thanksgiving, I forgot to post a snack on Monday!

TURKEY!
 
I know many of you meat eaters had your fill of turkey yesterday, but if you find yourself with about half a turkey in your refridgerator (like me) you may be wondering what you are going to do with it. I have some answers!
 
First off, turkey (that is properly cooked) is awesome for your pregnancy. Not only does it have over 30g of protein in each 4oz serving, it is packed with selenium which is necessary for healthy thyroid function. No need to feel guilty for the amount that you packed in yesterday!
 
So, what to do with the leftovers? Here are a few ideas:
 
Turkey Sandwiches: If you love thanksgiving food, why not keep it going by making thanksgiving sandwiches all week? Lather up some whole grain bread with homemade cranberry sauce, stuffing, gravy, leftover veggies and TURKEY! Make it a little bit fancier by adding cheese and making a Panini.
 
Turkey Salad: Along those same lines, cut up your turkey into bite size pieces and mix it with some greek yogurt, nuts, grapes, and apple pieces (or whatever else you fancy) to make an awesome turkey salad. Use it to top some leafy greens or to fill a sandwich, or just eat it plain!
 
Turkey Pot Pie: Gather up all of your leftovers and throw them in a pie! I hope you made plenty of gravy :)
 
That is what I am planning for my turkey, what do you like to do with your leftovers?

Monday, November 18, 2013

Pregnancy Snack Monday: Peanut Butter Banana Smoothie

PREGNANCY SNACK MONDAY!!!
 
 
Maybe I am the only pregnant woman out there that is starving all the freaking time. Maybe I am not.
 
Every Monday I will post an awesome snack or meal that has great benefits for your pregnancy and your pesky cravings :) If you need some more guidance on your pregnancy diet, check this out.
 
 
Today's specialty is my morning shake. I like to put whatever is in my kitchen that I can justify into this shake. Here is a basic recipe:
 
 
1 half of a large ripe avocado
1 ripe banana
1 cup of kefir
2 Tbsp of peanut butter
1 Tbsp flax seeds
Splash of milk (any kind will do, just to make sure it will go through my straw)
 
Blend thoroughly :)
 
It tastes like it is so bad for you - BUT IT ISN'T. It has healthy fats (avocado and peanut butter), fiber (flax seeds), probiotics (kefir), protein (peanut butter), and it is SO GOOD!

Monday, November 4, 2013

The beginning: a birth story

I feel that my first pregnancy and birth story has shaped me so much as a woman and birth educator that it must be shared. I also realize that I have never put it into words and I am compelled to do so before baby #2 arrives. My current knowledge may have clouded the story slightly, but here it is to the best of my recollection. Please forgive me for the excruciatingly long post....

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After a few short and intense months of dating, my boyfriend and I had decided to get married and start a family. While planning our dream wedding, we got a pleasant surprise - we were going to have a baby!

Needless to say, the timing was not ideal. We were currently without a car (by choice) and living in a one bedroom apartment. We were 30 miles from the closest relative and there were only 2 OB practitioners in our town.

I did a little bit of asking around about practitioners before deciding on one. He came with a high recommendation from my boss at the time. Her words - "Since I had to have a C-section, I was glad to know that he had performed the most C-sections in our county." Knowing what I know now I should have run far, far away at that point.

We got a confirmed pregnancy test and scheduled our first appointment with the C-section happy OB. When I reached my 8th week of pregnancy, we went in and had an ultrasound to confirm our due date (even though I knew my exact date of my last menstrual cycle) and saw the heart beating on our little love bug. The OB met with us for a few brief minutes and asked a few questions about my health. I explained that I had recently quit smoking, and that I exercised daily teaching dance class at the Boys and Girls Club that I was working for at the time and walking to and from work every day. He told me that dancing was dangerous and that I should stop immediately and he would see me in four weeks. Needless to say, I didn't stop dancing and I started to have my doubts in that doctor.

We went to our next few appointments without any big developments. We made it to the 20 week mark and found out that our little love bug was going to be a girl! Since I was one of four girls, I was so ecstatic!!

Shortly after that visit, my contract ended at work and we decided to buy a car and move closer to my husband's family. This meant a change in practitioners. When I called into my current doctor for a referral, they just told me to call the women's health center in our new city. When I did so, they referred me to an OB - the only one with openings for my due date - and told me that all of her patients loved her. She had a great bedside manner, but our meetings with her were very brief and we did not spend any time planning for the birth at all. She did a vaginal exam (which was very uncomfortable and caused more bleeding than I had expected) a few weeks before my due date and I refused the rest of them, simply because I was afraid she would do a membrane sweep and put me into labor.

My OB worked out of two hospitals in the city, so we set out to tour each hospital. We really didn't know what we were looking for in a hospital, so we chose the one with one large birthing suite that included a tub (and gave out cookies in their tour!). I thought that would be the ideal place to give birth! I was hoping to arrive at the hospital, check into that large suite labor naturally in the tub and then seamlessly move to the bed to bring my daughter into the world.

My entire life, I had assumed that when a woman went into labor she went to the hospital and walked through her contractions, sat on a yoga ball, took a shower, and birthed her baby with the coaching of her husband. I had watched birth shows on TV that showed a different side of birth with fear and emergency, but I knew that was not the route for me. I was sure that upon arrival to the hospital, the nurses and doctors were simply there to help me along my journey and would follow my wishes. I signed up for the childbirth education class at the hospital so that my husband and I could get some ideas for coping with labor and then we would be ready for the big day.

At our first class, we went around the room and introduced ourselves and explained why we had chosen to take the class. All but one other person in the room said that they were taking the class so that they knew how to make the birth as easy as possible. They all seemed to be most looking forward to the discussions regarding the epidural (which really seemed like a terrifying alternative to natural labor to me - a big needle in your back... ouch) and information regarding how quickly everything would pass.

Out of the two sessions, each lasting about two hours, we stayed for about 45 minutes total. My husband and I learned about the natural progression of labor and the coping techniques and we left class for the numerous discussions on pain relief medications and other medical interventions. I trusted that I could birth my baby my way and I didn't want any of the alternatives to cloud my judgement. We felt well prepared for our time at the hospital and we were ready to greet our little lady into the world.

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On the morning of January 20, 2012 I had a lot planned for the day. I was due on January 21st and was sure that I would far exceed my due date. Therefore, we had set aside this day to go to the courthouse and finally get married. My fiance had requested the day off work and we had our wedding scheduled for 3pm so that our family and friends could join us.

At 3:45am, it seems that the little lady had different plans. I had been experiencing a mucous discharge and bloody show for a day or two and my doctor had told me that I was 2cm dilated weeks before so I just assumed that labor was still far off. I got up and went to the bathroom and felt that I was experiencing some contractions. I stayed up until about 4:30 am monitoring the contractions, but they were fairly weak and far apart so I went back to sleep.

When our alarm went off at 7:30 am, I explained to my fiance that I was having some regular contractions and that I may be in labor. We decided that we would go on with the day as planned and see if anything progressed. The first item on our day's agenda was to pick up his paycheck and deposit it at the bank. By the time the paycheck was deposited and we were on our way home, my contractions were increasingly more uncomfortable and closer together. There was no doubt in my mind that it was time to meet our baby at last.

We called the courthouse to see if they could push up our appointment since I was in labor. I had a feeling that the labor would last quite a long time, but I was anxious to make sure that our marriage was official before our daughter was born. They said that they could fit us in right before lunch, giving us about an hour to get ready and get over there. We both proceeded to get ready, although I was no longer able to concentrate through contractions so I had to stop every 5-7 minutes.

We called all of our friends and family to alert them of the change in plans and they seemed content to congratulate us in the hospital instead of at the courthouse. We made the snowy walk from the street parking into the courthouse, stopping every few minutes in the freezing cold to work through my contractions. When we arrived for our ceremony, everyone was intent on getting us out the door before they had to deliver a baby! We were rushed from room to room to have all of our paperwork set up and finally into the courtroom for the wedding. Amazingly, throughout the entire 15 minute ceremony, I did not have a single contraction! Maybe the little lady wanted to be sure to hear what was going on :)

At the end of the ceremony we decided that it was time to call the hospital and let them know that we were on our way. When we called, we found out that the birthing suite was occupied! I asked how long they felt it would be before it became available as I was planning to avoid pain medication and labor in the water. They informed me that pain medication preference did not matter, and they could not guarantee me any time in the water. With that nurse's poor attitude and the likelihood that I would not have the birth that I wanted, we called the other hospital and let them know that we were on our way.

Upon arrival at the second choice hospital, it seemed that my new husband was finally aware that we were in labor. The urgency he possessed as we met the valet at the entrance was unseen up to this point. I refused the wheelchair and walked in to the waiting room to be admitted. The front desk was occupied by a couple having their tour of the birth area. I was in no rush (since we finally arrived to the birth place) so we sat and waited. My husband on the other hand, was a little bit more impatient. After about one contraction he alerted the front desk that I was in labor and we needed to be seen by the nurse. She quickly ended her conversation and led us into the triage area.

I was hooked up to the contraction and fetal heart rate monitors and told that they would need to get about a 30 minute read out before they could make any decisions on whether I could be admitted or not. The nurse left the room and my husband and I were left alone to call our family and let them know that we were finally at the hospital.

After the allotted 30 minute wait time, the nurse confirmed that I was having contractions (like I didn't already know) and told me to change into a hospital gown so that I could have a vaginal exam to assess progress. I was already at 5 cm! My body had been working so hard while I wasn't even paying attention! She also took my vital signs to record on my chart. My blood pressure was slightly elevated (maybe 140/90), but she said that it could be nothing and that they would check again shortly. She also had my husband and I sign all of the admittance papers at this time. She came to a release form for pain medications, specifically those administered by an anesthesiologist and I told her that there would be no need to sign that unless it was an emergency. She insisted that "you never know" and I insisted back that I did not need that form in my chart. She said she would keep it out just in case I changed my mind.

When we moved into the room (that had a giant tub!!) I was told to lay on the bed for a few minutes and rest before they took my BP again. I asked the nurse to fill the tub so that I could get in it as soon as my blood pressure came back normal. She obliged and my husband and I talked and relaxed for a few moments while we waited. Another nurse came in and retook my blood pressure. The reading was unchanged and she seemed slightly alarmed. She asked me if I had any other issues regarding blood pressure throughout my pregnancy and I informed her that I had not. She said that she would call the doctor and see what his recommendation was.

When the nurse came back into the room, she informed me that my OB was the doctor on call but she was currently occupied in surgery. She had to call the back up doctor and he recommended that I get an epidural as the high blood pressure was a sign that the pain of labor was stressing me out too much. This confused me, as I was probably the most relaxed as I had been all day. I was finally able to sit down with my husband and work through labor using the skills we had learned from class. I told the nurse that I was not going to have the epidural and I simply wanted to get into the tub. She insisted that it was unsafe to get out of my bed and she would consult the doctor again.

They left us alone for about 30 minutes and we were able to call our family (mine were about 1200 miles away so they were unable to join us for the birth) and let them know that we were admitted and they were welcome to head over the the hospital to wait. We worked on breathing and I tried my best to stay hydrated. When the nurse returned, she came with a threat to administer magnesium for my blood pressure which may make me sick and make the entire thing worse, leading to an epidural anyway. She said my best bet at this point was to just have the epidural put in so that my blood pressure would go down. I insisted again that I did not need the epidural, I could handle the pain and I just wanted to get into the tub. She informed me that my regular OB would be out of surgery in about 45 minutes and they would consult her then.

In the mean time, they sent in a nurse to put in an IV plug, just in case. I had agreed to the plug simply for the ease of administering emergency interventions. The first nurse poked twice to no avail and called the head nurse on staff. She looked at my veins and decided that there were none that she felt she could safely reach. They called in an emergency room nurse to try to get an IV. They explained their preference for a hand IV, just so that it would be out of the way. After a few unsuccessful attempts we were finally able to place an IV in the crook of my arm. It turned out to be a complete waste of time since it popped out when I was pushing.

At this point, my husband was starving (we had forgotten to eat anything with all of the excitement). After checking the fridge on our floor, he decided he needed something a little more substantial. He went down to the cafeteria to grab a burger and the nurse brought me some orange jell-o (clear liquid diet, yuck). The three or four contractions I had while he was gone were the worst of my whole labor. They seemed to go on forever. Being confined to the bed was intolerable to me and I remembered the "focal point" noted in my childbirth education class. The hospital logo was on the wall across from my bed, and it became my focal point for the duration of my labor. I channeled every pain to that little geometric logo on the wall.

When my doctor finally got out of surgery (a little after my husband returned and ate his dinner), she called down to check on me and told the nurses to allow me into the shower. At this point, I had been in the hospital nearly 3 hours and had been bed ridden the entire time. The nurse wanted to check my dilation before I got up and found me to be at 8 cm. Imagine how fast it could have gone if I would have been allowed to work with my body!

My husband changed into his swim trunks and joined me in the shower. It was so great to be able to move around and finally work with my body. He sprayed the jets on my lower back and over my belly. The contractions were stronger than they were in the bed, but they were so much easier to handle with movement.

About 5 minutes into the shower, my water broke. The nurses were in the room still preparing a new gown for me to step into and cleaning up my room a little bit. They told me that this was my cue to get back into the bed (are you kidding me!). As I stepped out of the shower to be helped into a new gown, I felt overwhelmingly nauseous. I told my husband and he conveyed that feeling to the nurses. One responded with, "You are probably in transition. At least you are in the perfect place to throw up!" And with those words I saw the yucky orange Jell-O for the second time. Luckily, that feeling passed quickly and I returned to the bed without further incidents.

The force of the vomit had caused a lot of pressure and some bleeding in my nether regions. This really alarmed my husband, and he asked the nurse to check me out. She did, and found that I was just about 9 cm. A few moments later, I felt the urge to push. The nurse told me that I was only at 9, so I should lie on my left side and it will help the contractions to subside and I will be more comfortable until it is actually time. Like a good patient, I rolled onto my left side and endured about 20 minutes more of contractions. My husband was by my side, offering some counter pressure to my lower back and helping me pant through the contractions. I told him I didn't want to do it anymore. It was time for the baby to come out, and I wanted her out now!

The nurse returned and I told her that I knew it was time to push now. She checked me again and said that I was still 9 cm and I needed to wait a few more minutes. The urge was overwhelming. This baby was coming and the nurse just did not understand! She said she would be back in 10 minutes to check again. I rolled back onto my back and attempted to sit up. The contractions were becoming so strong that I simply could not hold still any longer. Nothing was comfortable. Those 10 minutes felt like an eternity - I could not have made it through without the encouragement of my husband.

When the nurse returned, she checked me again and found that I was indeed at 10 cm! She made some adjustments to my bed and helped me sit up slightly and told me that when the next contraction came on it was time to push!

I pushed through one or two contractions with no progress. Then I stopped trying to listen to all of the tips I had been given about pushing and tried to work with the rhythm of my body (yes, it was a little like pushing on a big poo). I pushed through 5 or 6 more contractions and my baby girl was starting to crown. I could see her hair!

At this point, the nurse said that I needed to stop pushing for a while and she would go get the doctor. There were two whole contractions after she left the room and I was doing everything I could not to scream and push my baby out. Finally, the nurse returned accompanied by three or four other people, a cart of tools, a warmer for the baby, and the doctor (finally!). The doctor opened up a cabinet in the ceiling above the bed and revealed a giant spotlight and they turned on the bright lights above my bed. The rest of the room looked dark in comparison. They pulled the stirrups from the bed and adjusted my body into the perfect position for the doctor.

When the next contraction came on, I was able to push again. The nurses and my husband were around me counting as I pushed. I held my breath and tucked my chin and pulled my legs back, just as I was told to do. Somehow my little lady positioned herself so that she could push against my ribs on my right side to maneuver her way out. This made my position extremely uncomfortable, especially between contractions. It was only about 5 minutes after that point that I gave my final push and our princess was born!

They lay her on my belly for a moment so that dad could cut her cord and they could suction her mouth so she could let out a loud scream. She was then whisked away across the room to the warmer and I could only hear her tiny cries. I kept asking everyone around me, "She is a girl, right?" Finally my husband confirmed, she was indeed a little girl and she was perfect! She came in at 7 pounds 6 ounces, 19 3/4 inches long. Such a tiny girl for all of the ruckus she was causing in my belly :)

I had thought that I would cry or feel great relief that I had actually done it! I brought our baby into the world with the support of my husband and nothing else! I didn't have a chance to react though, as the nurses and doctor were gathered around me to stitch me up and forcibly remove the placenta (yeah, ouch). I received a quick Pitocin injection to help remove the placenta and then the stitching continued for about 30 minutes.

The nurse noticed that my daughter had a pretty severe tongue tie, but when she brought her over to me to nurse she made sure that we established a great latch before we moved to our recovery room. Nursing the first 2 months with the tongue tie was very painful and difficult, but I am eternally grateful to that nurse for believing in us for 45 minutes while we figured it out.

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Though it was not my ideal experience, I learned so much about the value of proper preparation in attaining the birth you want. If you want to have an amazing birth, be sure to check out my class schedule page to see when the next Birth Boot Camp class is offered!


Wednesday, October 30, 2013

Welcome!

Welcome to Birth Mission!

mission noun \'mi-shen\ :a task or job that someone is given to do.

Bringing a baby into the world is an important task. It is a mission that only you can complete. It is hard work, but with preparation, planning and dedication, it can be amazing.

If you have arrived here because you are planning to add a new member to your family - CONGRATULATIONS! I hope to provide you with valuable information to help you through your journey and to encourage you as a new parent. Enjoy!