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.

Sunday Comment Roundup

You Guyssssssssss!!

Your comments this week about my posts and Instagram questions have been SO GOOD. So good. I am so thankful for each of you. Your willingness to be open and vulnerable about our very personal and often fraught relationships with food and eating and diet culture has been motivating and humbling. I wanted to share some of the comments I received, anonymously, in case you see any of your own twisty, bunchy, scratchy eating-stuff (or calm and balanced approaches!) in any of these experiences.

Here is how some of you replied to my prompt about whether you remember your mom dieting as a kid, and if so, how food was talked about in your home growing up:

  • “I think I always wished they noticed something about me besides that I ate the food in front of me.”
  • “I remember relatives commenting how “the Smith* girls are always clean platers!” *not their real name.
  • “Portion control!”
  • “I don’t remember diet, but remember lots of unhappiness with how mom felt about how she looked. No shorts, no bathing suits.”
  • “We strived for balance in meals, not a lot of soda/packaged snacks; eating together as a family, having treats when out sometimes but later in life when the fat craze was happening, it was about eating more of those to replace other things (we know better now, but didn’t like the rest of America at the time).”
  • “My mom dieted. I specifically remember her using Slim Fast shakes and bars. She was also a dietician…”
  • “Mom once told me she felt accomplished if she went to bed hungry.”
  • “My family went through feast and famine. Grandma or the church would roll up w groceries.”
  • “She started Jazzercise at age 40 and really cut out sugar, fried foods, etc. I feel like she did it correctly!”
  • “I can’t even fit that can of worms in this box.”

I’ve also heard from several of you via calls and text messages with longer stories and examples of your childhood food life and how that has bubbled over into your adult eating habits. And a couple of you called me after my post about my doctor’s appointment to share your experiences with your doctor, or the experiences of a spouse or other family member.

And one of you, after reading my post about my doctor’s appointment, texted me this:

“I’m glad she [my doctor] could show you God’s love for your body today.”

Which reduced me to a blubbering pile of sobs. Whooo-boy. There’s a lot to unpack there. (Thanks, decades of “our bodies are inherently sinful and our “fleshly desires” will pull us into all manner of disobedience” teaching). I’m not even going to touch that today, except to say that it has been a trip to think about all the ways growing up in conservative Protestant churches have shaped my body image and conception of food and eating. Book project?

THANK YOU, friends. I’m grateful for you. Let’s keep talking and thinking and unpacking, shall we?

Photo by Pixabay on Pexels.com

I was hoping for at least a little shame.

Lest anyone think I am on the cusp of full, healthy self-acceptance, let me give you a peek at some of the miasmic content of my inner life.

My annual physical was today, except I haven’t been so stellar on the “annual” part. I thought I had, but my official records show that the last time I went in for a well visit was in March of 2018. Whoopsy!

In anticipation of today’ visit, I steeled myself for the “I-have-your-best-interests-at-heart” beat down I was expecting from my primary care doctor when she and I got to the part about my current weight. I imagined her concern about the number on the chart, especially relative to the 2018 number, and rehearsed my response to her prescription for weight loss with some subtle fear/shame drizzled over the top for full effect.

In these mental rehearsals of my doctor’s imaginary scolding, I envisioned that I would stack her comments in a neat crisscross pattern, whip out the Queen of Hearts Zippo lighter given to me by a roommate 15 years ago, and ignite the bonfire of food restriction and punishing exercise I planned to enact immediately.

“Well, I have to do it, you know. For my health. Doctor’s orders.”

Photo by Min An on Pexels.com

Here’s the thing though. She didn’t mention it. Not one syllable about my weight. I have an amazing PCP who is actually not perpetuating weight stigma or diet culture, and there I was, disappointed. We got all the way to the end of the check up and I started to panic. Was I not going to get my hall pass back to orthorexia? How was I going to get the validation I wanted to take extreme measures to shrink my body if my doctor wasn’t going to give it to me?

As the appointment was wrapping up, she asked me if I had any health concerns, and I blurted out “This is the biggest I’ve ever been and I’m kind of freaking out about my weight gain. I don’t feel like my eating habits have changed much. I’m afraid I’m going to gain more weight.”

Do you know what she did? Could you even believe me if I told you?

  • She normalized weight gain during a global pandemic. “Many people have put on weight this year. Stress can really contribute to weight gain, even if your diet hasn’t changed.”
  • She normalized people’s bodies changing over time. “As women slide through those last ten years leading up to menopause, our metabolism changes dramatically. Our bodies technically need fewer calories as we come out of our child bearing years. Many women notice weight changes in their 40s.”
  • She validated my concerns about my health. “We’re going to run blood work, and we’ll look at your thyroid and your blood sugar and other markers. Your previous blood work has always come back fine. If we see something amiss this time, we can make adjustments. If you feel like you want to lose weight, we can talk about that.”
  • She carefully advised against dramatic calorie restriction. “Your body needs fewer calories as you age, but it’s difficult to feel satisfied on a restricted diet. Finding exercise or a sport that you enjoy and ramping up your time moving is a more sustainable approach. Eat food you truly enjoy, and try to avoid eating or drinking things out of boredom, or things you don’t actually enjoy eating.”
  • She didn’t even breathe the letters “BMI”. She didn’t print out handouts about weight loss. She didn’t remind me of risk factors for diabetes or cancer or heart disease. She did show me the fitness app she uses for body-weight-resistance strength training “You don’t need any special equipment! And weight training is good for your bones!”.

My doctor did all the things I know so many people want and need their doctor to say to them. She focused on my actual overall health (bloodwork, how I am feeling in this body of mine, my mental health in this train wreck of a year) rather than one number. From what I have been reading, I know this is not the norm. I am thankful for my very English, very proper, very weight-neutral doctor. I am also thrown for a loop. If I’m not motivated by fear and body shame, I guess I’ll just have to be motivated by the endorphins of exercise and the pleasure of eating what I truly enjoy? I am honestly not sure I know how to do that.

Between 2 – 15% Risk

I schedule my annual mammogram and annual physical for the week of my birthday so I won’t forget to present myself to the medical establishment every year for inspection. I went for my first mammogram right after my 40th birthday, so today was my third time at the outpatient imaging center for a breast exam. I am all for every kind of screening, image, blood test – anything a doctor will give me to keep an eye on this cunning body of mine. I have this nagging suspicion that there is always a secret coup simmering below my epidermis. Whispers and encrypted messages are being sent along my neurons, my cells just waiting for me to start watching Bridgerton again so they can take advantage of my distraction and initiate a violent overthrow.

I sat in a chair in front of a drafty tinted window, wrapped in my watermelon pink medical gown, arms snaked around my torso to keep from freezing. I answered all the pre-mammo questions: Family history of breast cancer? No. Could I be pregnant? No. How old was I wen I had my first period? 12. How many full term pregnancies? One. A couple of questions about my ethnic heritage and my cycle and my nipples, and the mammography technician swivels on her stool to look at me and asks “Do you want me to click this button to calculate your current and future risk for breast cancer, based on your responses?”

DO I?

Do I want to know? They’ve never asked me this before. I was totally unprepared for this Magic 8 Ball moment.

“Yes” I blurt out.

“Ok, the computer says you have a 2.14% chance of having breast cancer right now, and a 15% chance of developing breast cancer in your life time.”

“I’ll take it.”

“You’re considered low risk.”

“Great!”

The mammogram process itself was uneventful and cold and squashy, as always. A few hours later I had a new message in MyChart to let me know that the radiologist had read my images and my breasts looked healthy and to come back next year. Terrific! It won’t be the breasts to lead the mutiny this year!

Next up, I’m due for a colonoscopy in 2021. Since my mom’s colon cancer was so aggressive, I’m on an Every Three Years schedule. I’ll ask my primary care doctor at my physical next week if I should go ahead and schedule it, or wait until the post-COVID pax romana we are all eagerly anticipating. Colonoscopies themselves are not bad – you’re out cold for the whole thing. It’s the prep and the immediate aftermath that can be unseemly. But I would sign up for a colonoscopy as often as they’ll give them to me if it means catching a polyp before it breaches my large intestine.

Get your mammogram. Ask if you can just mix Miralax into your favorite sports drink rather than using the nasty standard colonoscopy prep mix. And remember to love your body enough to check in on it regularly. Check in on your body like you would check on your kid who has been playing quietly in her room alone for a while. She’s almost certainly building an elaborate chateau out of Lego bricks and toilet paper rolls, but she may have just started painting your puppy and the walls with nail polish. Just go check.