The Birth Plan: A Few More Choices.

We’re almost through considering your choices and creating your Birth Plan. You’ve done your research and are finding your personal preferences on the big three: location, intention and attendants. But before you put your plan in writing, I’m going to add a few more interesting points for you to brew over.

Let’s look at a few more options and ideas. Whatever you decide, you may wish to include your choices in a written birth plan (more on this in our next post).  And then, of course, it’s time to move beyond planning, and start preparing!

  • Water birth.
    • The option of water birth is now commonly available for home, birthing center or hospital births.
    • Water immersion is recommended for the most intense stages of labor, though some women choose to remain immersed for hours because of the comfort.
    • Pain reduction (some say elimination) and mental and physical relaxation qualities of immersion in warm water have been well documented.
    • Water birth is considered the most gentle option for both mother and baby.
    • Disadvantages include the inability to closely observe and monitor – two elements which for some may be considered an advantage as this assures less interference and scrutiny, and more reliance on the birth progressing normally and naturally.
    • At home or hospital, water birth is more private for the mother.
    • Another disadvantage is the immobility of the mother; you’re less likely to stand, walk around, change position, etc.
    • What are the potential benefits of water birth?
    • Benefits for Mother:
      • Warm water is soothing, comforting, relaxing.
      • In the later stages of labor, the water has been shown to increase the woman’s energy.
      • The effect of buoyancy lessens a mother’s body weight, allowing free movement and new positioning.
      • Buoyancy promotes more efficient uterine contractions and improved blood circulation resulting in better oxygenation of the uterine muscles, less pain for the mother, and more oxygen for the baby.
      • Immersion in water often helps lower high blood pressure caused by anxiety.
      • The water seems to reduce stress-related hormones, allowing the mother’s body to produce endorphins which serve as pain-inhibitors.
      • Water causes the perineum to become more elastic and relaxed, reducing the incidence and severity of tearing and the potential for an episiotomyand stitches.
      • As the laboring woman relaxes physically, she is able to relax mentally with greater ability to focus on the birth process.
      • Since the water provides a greater sense of privacy, it can reduce inhibitions, anxiety, and fears.
    • Benefits for Baby:
      • Provides an environment similar to the amniotic sac.
      • With the warmth and support of water, we can assume water birth is more gentle and easy on baby as well as mother.
      • Eases the stress of birth, thus increasing reassurance and sense of security.
    • What are the risks to the mother and baby?
      • Studies in Europe have shown similar perinatal mortality rates between water births and conventional births. (This from a medical model on line source: americanpregnancy.org)
      • Once again we find, regardless of defensive arguments, no matter how a woman chooses to birth, the likelihood of a safe birth are about the same: very good!
      • Research and statistics have not found water birth to be of added risk.
      • No, babies do not breath underwater. Remember, they’ve been living in water.
    • There are some beautiful, inspiring water births shared on the internet, but seeing the comfort first hand that water birthing can bring to women, and the gentleness with which the baby comes into this world has been convincing of supporting this increasingly popular birthing choice.
    • For more ideas, information and inspiration, I love Gentle Birth Choices by Barbara Harper, who has been an advocate and educator for water birth. And for more info specifically on water birth, please see the book: The Water Birth Book by Janet Balakas.
  • Ecstatic birth. Orgasmic birth.
    • I put these two together as they can be used interchangeably.
    • Ecstatic birth is transcendental.
    • Orgasmic birth is described as more sexual, and sexual energy can indeed be transcendental.
    • Both bring the birthing energy of body, mind and spirit to a higher state, of complete release, surrender and flow.
    • Both require commitment of education, understanding and preparation ahead of time, and then the ability to completely let go and move into the moment.
    • For more information, please refer to Orgasmic Birth by Elizabeth Davis. It’s not just about orgasm, and well worth the read – both for nurturing suggestions and wonderful birthing stories.
  • Unhindered, unassisted or undisturbed birth.
    • Based upon the understanding that our bodies know what to do, and birth is essentially a natural and normal state.
    • Based upon the belief that birth is actually safer and more respectful for both mother and child if not interfered with in any way.
    • Though there is a growing movement for UC (Unassisted Childbirth) counteracting the culture of intervention, many women choosing unassisted birth choose to remain outside of any trends or movements, and are simply choosing what feels most right, safe and sincere to them.
    • Undisturbed or unassisted birth also requires great understanding of the birthing process by the mother (and partner) and a beautiful trust of the self and the process and life.
    • I am personally just awakening to unassisted and undisturbed birth and would like to share a good deal more on this in the future.
    • Recommended reading on this topic: Unhindered Childbirth by Sarah M. Haydock, a shorter but beautifully expressed book on this topic. Unassisted Childbirth by Laura Shanley is a beautiful and worthy read for women wishing to take back birth, choice and their families beautifully and naturally.

Choosing your positions.

(hint: probably not supine)

This is a big detail that I’m giving extra attention to because I’m still amazed how many of us think birth happens best lying down, either in a bed or in the hospital with her feet in stirrups.

Well, guess what? If given the choice (and you have the choice) women rarely choose to lie down. It simply is not natural. Think about it. On your back, your sacrum (bottom of your back) is pushing inwards. Doesn’t it make more sense to allow that to flex outward (yes, those bones do soften and flex in late pregnancy and birth) to make way for the descending baby? Then there is gravity. In the case of lying down, gravity does NOT happen. And finally, there is the consideration of due respect. Women don’t naturally wish to feel like a beetle on their back.

So although this may seem natural that you’ll find your own position (and it is natural, and you will find it…), I’m going to point out a few possibly obvious suggestions just as reminders to what your body may already know.

  • Understanding vertical birth.
    • Vertical birth is a common choice world wide, and one of the most physiologically conducive positions for natural birth.
    • The disadvantages of pushing while lying on the back include:
      • Pelvic outlet is reduced, which creates less room for baby
      • Less urge for the mother to push
      • Baby takes longer to descend—the “curve of Carus” along the sacrum and tailbone when on the back makes more of an uphill route that baby needs to maneuver before emerging under the pubic bone
      • Less oxygen to the baby due to increased pressure from the weight of the uterus and baby on the mother’s inferior vena cava (artery)
      • More difficult for mother to reach down and assist in the birth of her baby
      • Increased pain for mother
      • Uterus has to work harder to create contractions to bring baby down
      • Contractions may slow or stop
      • Increased risk of further aggravating or creating new hemorrhoids
      • Greater risk of perineal tears and lacerations
      • Easier for care provider to perform an episiotomy, if needed
      • Increased insecurity on the part of the mother, as she cannot as easily see what is being done to her
      • Greater risk of shoulder dystocia (where the shoulder becomes lodged behind the pubic bone) because of the decreased pelvic outlet
    • The advantages of pushing while upright and/or squatting include:
      • Squatting increases size of the pelvic outlet, thereby creating more room for a larger baby or baby with a presentation issue (posterior, asynclitic, etc)
      • Gravity helps baby descend
      • The force of the uterus during pushing is helped by being upright—gravity assists in the uterus being able to contract and tilt forward
      • Baby is better able to present naturally in the mother’s pelvis, and rotates into more favorable positions, if needed, while the mother is upright
      • Less pain is felt by the mother as the baby descends past the sacrum due to the fact that there is no pressure (by a bed) on this part of her body
      • Perineal tissues stretch more effectively, often reducing the need for postpartum repairs and/or discomfort
      • Mother is able to help assist in the delivery of her baby, as well as see her own baby being born
      • Sacrum is much more flexible and moves with descent of baby’s head
      • Mother is able to maintain eye contact with anyone present (if she desires) and there are no surprises in touch
    • For more information on vertical birth, and a beautiful book on birth in general, please see Women Giving Birth by Astrid Limburg and Beatrijs Smulders.
  • What are some other normal, natural positions chosen by women around the world?
    • A forward lunge
    • Squat.
    • Assisted squat.
    • Leaning forward (on bed, tub, partner).
    • Pulling down from rope, bar or branch overhead.
    • Birth ball.
    • Birthing chair or stool.
    • Kneeling
    • On hands and knees.
  • Be willing to change positions, flow with it, don’t be rigid or stuck.
  • Dance! Yes… feel it, flow with it, follow it, move with it.
  • Experiment now – what feels right now?
  • Follow your own lead at the time.
    • A ‘sounds good’ suggestion from your midwife, attendant, doctor or birth partner may help you with trying a different position from time to time.

These choices are part of your initial plan that you may work to create and vocalize and insure agreement and understanding with anyone who may be present at your birth, from partners to doctors or midwives. These decisions need not be in writing. You will know, and you will prepare ahead of time accordingly. Of course, sometimes nature takes us on a wild ride that we were not intending. So too must we flow.

“Childbirth is a normal, physiological process that almost always ends successfully. This allows all disputing parties to conclude that their particular set of rituals – anything from routine induction of labor or epidural anesthesia, to birthing alone in a warm pool of water – was what led to a successful outcome.” from Born Free – unassisted childbirth in North America, Rixa Ann Spencer Freeze, page 200.