The Best Laid Birth Plans

My daughter’s birthday is coming up, so I decided to dust off this piece I wrote about her dramatic entry into the world. It’s edited for length and ancient type-os. 


Happy birthday, kiddo of mine. I sure do love being your mom. 

Prologue

Somewhere around the end of my first trimester, I started looking into natural birth classes. I had talked to a lot of friends who had had unmedicated, low or no-intervention births. I had seen “The Business of Being Born“. I had read about Ina May Gaskin. Heck, I had even attended a friend’s home birth. I believe that women’s bodies know how to have a baby, and in many cases, they can do so with very little medical intervention. I liked the idea of a home birth in theory, but my general anxiety prevented me from exploring that path too enthusiastically. 

I chose a midwifery practice with an OB who would attend to any birth that got medically complex. We hired a doula. I researched hospitals with good reputations for supporting natural labor and have low c-section rates, and options like water birth. I wanted to labor at home as long as possible and then go to the hospital when active labor really got going. In order to do that, I knew we needed to educate ourselves about laboring at home and get serious about prep work.

Les and I attended a Bradley Method childbirth class together and loved it. We both felt informed, empowered, supported, and eager to meet our baby. Throughout the 10 week course, we were coached with strategies to keep the pregnancy and delivery low-risk: proper nutrition, exercise, stretching, relaxation and massage practices, and safe ways to get labor going if I went past my due date.

On the very first day of our Bradly class, our instructor handed out sheets of paper and boxes of crayons and invited us to draw our Ideal Labor and Delivery.

Here’s what Les drew for us:

Home as Long as Possible (distressed chihuahua)
Baby doesn’t arrive in transit
Three Pushes and OUT!!! (Medical team behind us that didn’t need to do anything)

We were also encouraged to write a Birth Plan. A Birth Plan is the politely-worded document you hand to your Labor and Delivery nurses when you check in, along with a box of chocolates and a sweet smile. Your Birth Plan outlines your earnest requests for unmedicated labor. Since the vast majority of women expect and want to use pain medication immediately or almost immediately upon getting to the hospital, the Birth Plan is intended to get everyone on the same page about your preferences and your wish to avoid medications and unnecessary restrictions on your labor strategies. 

I want to go on the record that I don’t judge women who want or use pain meds. There is no “right way” to have a baby. I do think that you should have options, and pursue the path that gives YOU the most confidence, peace, and security as you gear up to meet your new family member. For me, that path was to try for a natural, unmedicated labor.

Our Birth Plan was two typed pages, with separate sections for Labor, Delivery, Emergency Care, and Baby Care. It included requests like:

  • Our wishes for a natural birth are respected and drugs will not be offered unless an emergency arises.
  • Jill will be free to walk, change positions, and use the bathroom as needed, including laboring in the shower/tub and use of a birthing ball if available.
  • Jill prefers not to have an IV; she will be allowed to eat and drink during labor, as desired, to maintain energy and hydration.
  • Medical induction will be avoided, including stripping of membranes, amniotomy, Cervadil, and Pitocin.
  • Labor will be allowed to progress at a natural pace.

The Plan went on in that fashion for the full 2 pages. I had given it to our midwife, and she had sent it on to the hospital. I also had a hard-copy in my hospital bag, right next to the bag of fancy chocolate bars to hand out as a thank you to the nurses who would have to put up with my screaming, tub-laboring, eating and drinking and walking to the bathroom-self for who knows how many hours. We were as “prepared” as we were going to be. Now we just had to wait for labor to get going.

About that Plan

I have to say, after the first trimester of non-stop nausea, my pregnancy was not anywhere near as gruesome as I expected. I felt pretty good most of the time. I continued working part time, and even worked on my due date. I never had any Braxton-Hicks or real contractions. My midwife practice recommended you come in for a check up on your due date if you haven’t had any signs of labor yet, so I showed up on my due date hoping they could tell me what was going on in there. They hooked me up for a non-stress test, and I laid back in the Lay-Z-Boy with a stack of magazines and a big bottle of water and chilled out for about 30 minutes with Baby Girl kicking away.

The midwife came in to read the test results, and got a bit of a furrow in her brow. “Baby’s heart rate is not quite what we’d like to see at this stage. It could be we just tested at just the wrong time, so if you have time, you could stay for another test or come back later today to re-test. The heart rate is still technically within the “normal” range, but it is pretty different from the other 4 non-stress tests you’ve had already. You may just want to go to the hospital for an ultrasound, just to be safe.”

*** Somewhere in the distance, I should have heard the bzzzzzzcrunchchompzzzzchompcrunchzzz of our Birth Plan in the paper shredder***

I called the hospital from the parking lot, and they could not get me in until the next day. Ok. Cool. I’m sure everything is fine. The midwife would have told me if I needed to go to the hospital immediately, right?

I went to work the next day, and then drove calmly to the hospital, checked in calmly, and rested in the dark room with the ultrasound tech as she chatted about babies and baby girls. She, of course, said nothing about what she was seeing on the screen. I had to wait for a doctor for that. 

The doctor, who was the on-call OB at the hospital that day, came bounding in a few minutes later with a strained smile on her face. This was her opening line: “Are you ready to meet your baby?!?! We’re going to induce you today!”

I thought she was in the wrong room. 

“I’m sorry, what’s going on?”

“We’re going to induce you today!”

“But what is going on?”

“You have zero fluid left in your amniotic sac. Like, none. Did your water break?”

“I’m pretty sure I would have noticed that.”

“Have you been leaking fluid?”

“I’m pretty sure I would have noticed that, too.”

“Well, in any case, your baby is in distress. You are going to be induced. I have a call in to your OB and I’m just waiting to hear back from him. Call your husband, and ask him to get your stuff together. We’re going to admit you. The nurse will take you down to Labor and Delivery.”

She walked out, and I sat there, stunned and crying alone and still not sure what was going on, or just how much distress my baby was in. I was clearly in a whole lot of distress, but the OB was in and out of the room in under five minutes. 

I called Les. I told him to take his time and do what he needed to do and have dinner and everything, because I was just going to be sitting somewhere waiting for some new plan to unfold. I texted our doula, and told her that the nurses said that “nothing would really get going until the morning”. She thanked me for the heads up, and told me to keep her posted. This is when I found out that the OB who is part of my midwife practice was out of town. They would assign someone on-call. I prayed it was not the bizarre, coldly chipper woman I had just met. (It was not, thank God).

Let’s fast-forward a bit, shall we?

They started the induction at 6:30pm, and started the actual Pitocin around 9:30 that night, so I could “sleep through the early contractions”. If you’ve ever had Pitocin, you are cackling at that suggestion. 

Les slept uncomfortably in the fold out chair next to the bed. I writhed around and prayed most of the night. By morning I was really starting to feel the contractions, but I couldn’t enact our pain coping plan because I was hooked up to a bunch of monitors to keep track of Baby Girl’s heart and my blood pressure, plus the Pitocin drip and an IV of antibiotics that I needed because I had spiked a fever. I was essentially bed-bound, though they did help me get everything on a portable pole so I could walk the halls a bit while the contractions were still walk-throughable. 

Here’s the part where I call my doula to let her know it was time to rock and roll, and find out that she AND her back-up doula are BOTH AT OTHER BIRTHS. Yep. Two other clients went into labor in the 12 hours since I texted her. This is the part where I started to weep.

Les gets the brilliant idea to call our Bradley teacher for help. There were 2 doulas-in-training in our class, one who had just finished up her certification a couple of weeks ago. We knew her. We liked her. We said a prayer that somehow, miraculously, she would have instant access to child care for her own two small children, and would be overjoyed to come to the hospital for God Knows How Long with zero notice. Guess what? She was, and she did. I cried with gratitude. 

And for the next 4 hours or so, I pretty much just cried, screamed, mooed, and begged for help as the Pitocin ramped up and tore through me like lightning. I couldn’t move from the bed where I was tethered to all the machines and monitors. The midwife checked me, and I was only 3 cm dilated. Three centimeters after almost 18 hours of Pitocin. I screamed the kind of scream you scream when you have already exhausted your energy reserves and you have made no progress. The midwife gently suggested that perhaps it was time for an epidural. I hugged her and shrieked YES!!! PLEASE! GIVE ME AN EPIDURAL! She knew, and I knew, that someone had to give me permission to surrender to the fact that My Plan was toast. 

Sweet Relief. I felt nothing from the navel down. They could amp up the Pitocin as much as they wanted, I couldn’t feel a blessed thing. Even Les rubbing my legs felt like a strange, not-quite-sensation. Glorious. Les and I said a prayer of thanks for pain medication. I labored for what felt like a thousand more hours, but it was probably more like 8. 

Here’s what you need to know about those hours of labor. Baby Girl’s heartbeat was ALL OVER THE PLACE. They did not want me to progress too quickly, for fear that that would stress Baby Girl out even more. My bag of waters eventually broke, but, as expected, there was no fluid in it, only meconium. Another sign of Baby Distress. 

The Neonatologist came in to kindly and gently break the news that I could not have immediate skin-to-skin with her, could not nurse her right away, could not let the cord pulse, Les couldn’t cut the cord… the NICU team would take her as soon as she was born, and I would not get to hold her until she was stable. Les could go with her to the NICU if he wanted. Tear the entire “Immediately After Birth” section out of my Birth Plan and set it on fire.  

After what seemed like days, I was finally 10cm and ready to push. How do you push out a baby when you cannot feel your lower half? My midwife used verbal and visual cues to help me focus my energy to the right place. The OB who was assigned to us turned out to be incredible. Totally and completely sent by God. I liked him even better than my regular OB, and he and my midwife were a great team. It was a good thing, too, because after an hour and a half of pushing, they decided that Baby Girl needed to come out RIGHT NOW. 

The OB explained their concern for her heart rate, and how long she was in the birth canal, and suggested a vacuum. Bring it, I said, I want her OUT. Give me all the interventions. The NICU team was standing by in the room with their special baby bed and equipment, Les was holding one of my awkwardly splayed legs, my doula had the other, the OB, Midwife, and at least 3 nurses were down near the Business End. They attached the vacuum to her head and informed me I had 3 contractions to PUSH THIS BABY OUT, or I would need a c-section. 

I had roughly 15 people cheering me on as I pushed. Have you ever been naked in a room with 15 cheering people? Naked with your legs hoisted up to your armpits? That’s delivery. It was a nail biter. The OB told me to push like I was turning myself inside out. On the third push of the third contraction, with a room full of people shouting “YOU CAN DO IT! ONE MORE PUSH!”, I felt her head come out. “ONE MORE PUSH!” yells the doctor. And out came the rest of her. I opened my clenched eyes just in time to see my beautiful, bloody baby stare at me with her huge eyes and start screaming. I collapsed as they whisked her away to the NICU team.

They were able to get her stable right there in the room, and, thank God in Heaven, and let me hold her for a few minutes before they took her to the NICU and got her started on her monitors and IV antibiotics. At the end of 27 hours of anxiety, determination, surrender, and plans being shot to hell, I was overwhelmed with thankfulness for modern medicine, pain medication, interventions, and highly-trained professionals who are compassionate, skilled, and empathic (let’s just forget about that first horrendous on-call OB). We survived. Les was a rock-star. My back-up back-up doula saved my sanity. And our feisty, skinny, wide-eyed little girl was worth every single second. 

Note her Cone-Head from the vacuum.

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