Creating a Birth Plan – My Birth Plan for Baby #2

“Isn’t that the way with babies–we think we have prepared ourselves and then they come, turning us inside out and showing how little we indeed know ourselves after all.”

-Jeannine Parvati Baker, Prenatal Yoga & Natural Childbirth

At my 28 week appointment with my midwife she suggested I create a birth plan for the delivery of our second baby. The best piece of advise she gave me was to, “Focus on what you do want, versus what you don’t want.” We’re still in the midst of the Covid-19 pandemic and new safety measures and restrictions are in place. Although that does mean some things will be different, it doesn’t mean we can’t take control and plan for our ideal birth and newborn care experience beforehand. We had a wonderful home birth experience with our first daughter and look forward to a home birth once again with our second birth. 

A “birth plan” is not meant to be an unbending set of stipulations but rather an exercise of thought and intention. Birth cannot be “planned.” Even if you’re on the road to a scheduled cesarean, labor can start and change the timeline at any point! A birth plan is your voice. It’s about you and your baby. It’s for you, your partner and your family. Use your birth plan to communicate your preferences and choices for labor, delivery,  and newborn care to your birthing team. The ultimate goal is the safe arrival of your baby. There are many options and decisions that will present themselves during labor and delivery and newborn cuddles. It can be difficult to think logically and make decisions at the height of the moment. Creating a plan before the grand event ensures clear expectations for everyone involved. 

There are many options of what can be included in a birth plan. I love the wide variety of options presented in this free birth plan by Earth Mama. As you’ll note from this extensive example, you can communicate your desires for everything from birth location, to elements that take place before labor begins, desires for environment, pain relief, monitoring, various stages of labor, delivery, cesarean, newborn procedures, hospital stay and more. Your birth plan is about voicing your ultimate desires for your experience of labor, delivery and for the care of your newborn. Make it what you wish. This article on 10 tips for writing a birth plan is helpful as well.

The following is my personal birth plan based on our desire to have our baby at home, as well as addressing a few points for hospital care should it be needed. There are so many ways a baby can be brought into the world. Whether your plan is for a home birth with a midwife, a free birth, a hospital birth, a cesarean, a delivery at a birthing center, etc., the purpose is to visualize your labor, delivery and newborn moments as you hope them to be, and then surrender to the process and remain flexible as you approach each moment.

This is my birth plan in a simplified bullet point form. The following list is what I share with anyone I hope to have involved (and especially with those present) at the birth—My midwife and labor and delivery team, family, a trusted friend, etc. For simplicity sake, I often share only these main bullet points so the list is short and easy. These are my desires and my basic reasoning behind each decision. You may desire something similar or you may desire something opposite.  It’s your body, baby, birth and family. Thinking through these decisions ahead of time is meant to ease your mind and prepare you for the possibilities that lie ahead in this beautiful season. Keep your birth plan short, aim for a one page summary. Hold ideals loosely. Focus on the positives.

BIRTH PLAN

I will bring my whole-self to each and every moment of labor and delivery, surrendering to and embracing the process. I welcome encouragement and your experienced guidance to help me birth as naturally as possible, with as few interventions as possible. I trust my body and my baby. 

DURING LABOR:

• Natural rupture of waters
• Intermittent monitoring
• Lights dim
• Waterbirth or laboring in water
• Pain relief – Massage, birth tub or shower, essential oils, cold compress, birthing ball, free movement.
• Limit cervical exams 
• No episiotomy or forceps 
• If Group B Strep (GBS) Positive – No antibiotics unless water has naturally ruptured and labor persists over 18 hours post rupture. Then intermittent antibiotics until delivery.
• Gentle cesarean (if cesarean needed) – Skin to skin with father if I am unable, baby reunited with mother ASAP, vaginal swab.

AFTER DELIVERY:

• Immediate skin-to-skin 
• Please don’t wipe baby down or bathe
• Delayed cord clamping, partner to cut cord.
• Placenta delivered on it’s own
• Save placenta
• No vitamin K shot, no hepatitis B, no eye ointment
• Delay exams for bonding
• Baby with father if mother is unavailable at any point

I’ve gone into more detail below explaining our reasoning behind each decision.

“Many of our problems in US maternity care stem from the fact that we leave no room for recognizing when nature is smarter than we are.”

– Ina May Gaskin, Birth Matters: A Midwife’s Manifesta

DURING LABOR:

• Natural rupture of waters – My body is smart and I trust labor to progress as it’s designed. I don’t want to interfere with the natural flow of labor unless it is absolutely necessary. Forced rupture can often increase the intensity of contractions and increase risk of infection. Even so, there are some cases where this is helpful or even necessary.
• Intermittent monitoring – Minimal and intermittent fetal monitoring allows for mother’s mobility during labor. I’m all about free movement as in many cases it leads to shorter and less painful labor.1 I was uninhibited and able to move freely anywhere and everywhere around my home during my labor with my daughter. This freedom allowed me to lean into the process without limitations.
• Lights dim – This is all about the mood of the space for me. Candles, gentle music, peaceful atmosphere.
• Waterbirth or laboring in water – Personal experience with my first labor taught me that being immersed in water seemed to cut any feelings of pain in half! My eyes welled with tears of relief the first time my belly sank below the water line while I was in active labor. It was just what I needed especially with continual back labor. I once heard it said that water helped to transform pain into urgent pressure, and that is just what I experienced. I had hoped for a water delivery this time around, but unfortunately that is not an option with the Covid-19 pandemic and new regulations. Thankfully, this is one of very few regulations for home births and I can still labor in the tub. This is a great article about the evidence on waterbirth with main benefits pointing toward maternal health outcomes versus directly influencing newborn outcomes.2 During our first labor and delivery we learned that getting in the warm tub during early labor can actually slow labor, while getting in during active labor can helped one relax more fully into each contraction which in turn helps dilate the cervix faster and bring the baby sooner.
• Pain relief – Massage, birth tub or shower, essential oils, cold compress, birthing ball, free movement. I love this quote from a book I read written by a midwife and mother of five, “I chose the postures that brought on the strongest contractions, having long ago given up the notion that women have babies to get comfortable.” 3 In as much as labor is about leaning into the process, there are some “tricks” we can play on our brain to confuse how our bodies process pain.
• Limit cervical exams – “Reasons to limit a cervical check include: Increased risk of infection by putting a hand in the vagina, discomfort, disruption to the labor progress, and frustration when not much progress has been made.”4 There are plenty of other ways to assess the progress of labor without these checks, though sometimes they are very helpful! My first check was encouraging and helpful in that we discovered after several hours of labor I was 9cm dilated and had a cervical lip. This let the midwives know how to coach me on different labor positions to help the cervix fully dilate and eliminate the lip.
• No episiotomy or forceps – My body is designed to birth this baby, and if at all possible, I’d like to trust this process without interventions. It’s often a longer and more painful process to recover from an episiotomy than from a natural tear. I had a second degree tear and sutures in two locations with my first delivery, and the healing process was even shorter than I would have assumed! [PS. My number one fear before birth as a first time mom was tearing. Yes,  more than any other aspect of labor and birth. I discussed this with my husband and my midwife and made sure I understood exactly what would happen if I did tear and need sutures. My anxiety was needless as when the time arrived and I held my baby in my arms, the suturing process seemed almost inconsequential. It needed to be done, the local anesthetic was the most painful portion (which was over very quickly) and I asked questions as they were sewing to make sure I understood what was happening. Birth hormone highs and learning to nurse my new little baby kept my mind occupied and it was all over before I knew it! All that to say, it’s not as big of a deal as many people make of it!]
• If Group B Strep (GBS) Positive – No antibiotics unless water has naturally ruptured and labor persists over 18 hours post rupture. Then intermittent antibiotics until delivery. – I tested positive with my first pregnancy. I hate needles and IVs and felt being perpetually hooked up to an IV would severely limit my feeling of freedom and peace during labor. Not to mention the idea of loading my body and my babies body with antibiotics while our immune systems would be more delicate didn’t feel right. I asked for all the information and made sure I understood the risks clearly before choosing this plan of action. In the end, my water didn’t break until I started pushing and my daughter was born about an hour later so we didn’t need antibiotics. We monitored her closely for signs of infection the first two weeks. Check out this article by Mama Natural for more information about GBS, what it is, and potential treatment options.
• Gentle cesarean (if cesarean needed) – Skin to skin with father if I am unable, baby reunited with mother ASAP, vaginal swab. A “gentle cesarean” is more or less the same as any other cesarean, but it’s more about a shift in attitudes. The main goal is to get the baby to the mother as soon as possible and it provides a little more freedom regarding what the mother and father can see and touch and when they can do so. It honors the gentle birthing culture the family hopes to create and still allows for things like a birthing playlist, the father cutting the chord,  an opaque surgical curtain so the mother can see the baby emerge, and skin to skin time as soon as possible. For more information about the vaginal swab, check out my section on probiotics here or read this article. Also, this is a company that I adore and their blog and free content on instagram is gold for mamas! Here is an excellent article they created, Let’s Talk: C-Sections.

AFTER DELIVERY:

• Immediate skin-to-skin – Also known as kangaroo care, the concept behind skin-to-skin is trying to keep the baby in a womb like condition for the first days and weeks post birth to help them adjust to life on the outside. Skin-to-skin care (with mom or dad) helps stabilize the baby’s body temperature, helps initiate breastfeeding and stimulate/regulate milk supply in the mother by boosting oxytocin and prolactin levels, helps to prevent postpartum depression in mothers, regulates baby’s blood sugar,5 helps baby develop healthy bacteria from mother’s bacteria, cuddle time reduces crying time, it supports and nurtures the bonding and communication between baby and parents, and the list continues. Kangaroo care is akin to the greatest newborn “hack” of all time. It just feels right. There are loads of proven benefits, plus, I just want to soak in all of those tiny coos and cuddles.
• Don’t wipe baby down or bathe – Vernix is the white waxy coating on a newborn’s skin that protects their delicate skin during their time in the amniotic fluid in utero. It’s a natural moisturizer for their skin after birth and can provide protection from bacterial infections. Just rub it into their little bodies like a luscious natural lotion.
• Delayed cord clamping – Delaying the clamping process allows more blood to circulate from the placenta to the infant and can boost the infant’s blood volume by up to one third and improve their iron stores for up to six months after birth.6 
• Placenta delivered on it’s own – Personal preference in that I’d rather let nature take it’s course once again rather than having someone pull at the umbilical chord to help the placenta out sooner. 
• Save placenta – I chose to encapsulate the placenta after Libbi’s birth and plan on doing the same this time. There have been little to no scientific studies conducted on the benefits or risks of placental consumption, however my personal experience and the testimonies of other mothers can attest to the benefits. Plus, the custom of consuming the placenta is actually centuries old! Placental consumption can help postpartum mothers balance their hormones and iron levels post birth, which boosts their mood, provides energy, curbs anxiety and fatigue and speeds the healing process. I would say that all of these were accurate for me!
• No vitamin K shot, no hepatitis B, no eye ointment – VITAMIN K: I originally chose no vitamin K shot and no hep B because I hated the idea that my child would be pricked with a needle in their first moments of life. I hate needles as an adult and it just seemed wrong to me. We chose oral vitamin K for Libbi and will do so again. It is easily administered with a few drops on the nipple while breastfeeding. Here’s a good article about routine newborn procedures including Vitamin K. It’s important to note there can be potential risks if declining vitamin K all together. I also take 200mcg of VitK2 with 10,000IU VitD3 daily and small but helpful amounts of those nutrients are transferred through breastmilk. HEPATITIS B: It is generally recommended that newborns receive their first dose of the hepatitis B vaccine within the first 24 hours of their life. This seems ludicrous to me. I’m not going to get into the vaccines debate here, but I am confident this is unnecessary this early on. I’ve been tested and don’t have hep B, so it would be pointless regardless. Secondly, I’ll just say that many vaccines contain toxic agents—anything from aluminum, formaldehyde, microorganisms, mercury, ethylene glycol and other toxins that are dangerous at low doses and potentially detrimental at extremely high doses.7 Just read the insert that comes in the vaccines packages and see if you feel comfortable with the ingredients. I didn’t spend nine months growing this baby in utero and specifically avoiding household and common toxins to inject them with a toxic load upon arrival. EYE OINTMENT: Antibiotic eye ointment is given to newborns to prevent blindness that can be caused by a mother infected with gonorrhea or chlamydia. It’s a common procedure but seldom actually needed.
• Delay exams for bonding – I want to soak in all of that newborn and hormonal bliss without trying to rush into measurements and exams. 
• Baby with father if mother is unavailable at any point – Baby needs time to connect, bond and get skin-to-skin time with their daddy soon after birth as well! Auren held Libbi while I showered and changed about an hour after birth. 

All the best as you think through, dream about, and plan for the birth of your baby. It’s a wonderful stress relief and preparation to have these decisions made ahead of time.

“Remember this, for it is as true as true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.”

Ina May Gaskin, Ina May’s Guide to Childbirth

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