Birth Plan
Jeanine walked onto Labor and Delivery huffing and puffing. Her husband, Jeff , struggled with 3 bags, and, another woman, carrying a giant red birth ball accompanied them. It was Saturday night, around 8pm. Liz, her nurse, lead them into labor room #3 as I sat with the other nurses at the nurses’ station, waiting for the baby’s fetal heart tracing (strip) to appear on the monitor.
As I read through her prenatal records, I reviewed that this was Jeanine’s first pregnancy and that she wanted a natural birth. Her pregnancy had progressed nicely, without any major issues, so her chances looked good. A few minutes later, Liz came back and handed me a piece of paper. It was entitled “Jeanine’s Birth Plan” and it listed all of the things she requested during her labor:
JEANINE’S BIRTH PLAN:
· No IV
· Do not offer an epidural at any time
· No Pitocin to induce or augment labor
· No internal fetal heart monitoring via scalp electrode
· No medical interventions
· Low lighting
· Speak quietly while in the room
· Jeanine plans to listen to her hypnobirthing CD throughout her labor
· Please use the word “surge” instead of contraction
· Please do not use any negative words to describe the natural birth process such as pushing, distress, contraction, or pain.
· Jeanine would like to walk and move freely until it is time to push
· Jeanine would like to use the birthing tub until she is ready to push
· Jeanine wants skin to skin bonding with the baby after the birth and delayed cord clamping.
Nina, one of the more seasoned nurses grabbed it and said ironically:
“Uh Oh — a birth plan… I hope that doesn’t mean I should go prep the OR in case of an emergency C-section in a few hours!”
“Oh stop it. Don’t be negative!” I said with a pointed look, taking back the papers and putting them in her chart.
“you know how it is, Natasha — once they have a plan, birth does everything it can to blow that up in everyone’s faces.”
Jeanine was contracting every 2–3 minutes on the monitor, a good sign that labor was real. When I went in to check her cervix, the hypnobirthing CD played on a loop about waves and serenity. Her doula, Jenna, was rubbing her back, and Jeff had coconut water ready for her to sip between contractions. Her exam was not easy, as she seemed startled by the discomfort of my fingers in her cervix and she kept closing her legs and pulling away from me. With the help of two people holding her legs, and Jeff grasping her hand I was able to deduce that her cervix was 3–4 cm dilated, 80 % thinned out, and the head was engaged in the pelvis. This was a good starting place and I decided to admit her. Before leaving the room, I asked:
“Any questions?” 20 minutes later I was still there, discussing the fact that I could not predict how long until the baby would be born. I listened and nodded as Jeanine reviewed her birth plan. I gently reminded her to keep an open mind and understand that giving birth is an unpredictable process. Jeanine looked at me, wide-eyed and, clearly, very much afraid of what was still to come.
3 hours later, Jeanine was the birth tub, moaning through the contractions while her doula fed her ice chips. Her hypnobirth CD was still playing, which by now, I had practically memorized:
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“As you feel the surges opening your body, welcome them, breathing your baby into the world…”
I had checked her half and hour earlier and she was 5 cm dilated, progressing nicely and as expected for a first baby. I was thankful for her doula, who talked her through each contraction in the tub. I sat with them for a while and then decided she had a good support team, and then went to my call room for a short nap.
An hour later, Nina woke me on the phone: “Good morning Natasha! Liz wanted me to let you know that our patient wants an epidural, so we need to cross that one off the birth plan.”
So, we had started down the slippery path of undesired medical interventions. I walked into the room where Jeanine stood next to the tub, half draped in her gown, yelling through a contraction:
“I can’t take this! It’s all in my back — please, please get me an epidural! Get it now, I’m not kidding! I need it!” Jeff stroked her arm and said:
“Are you sure, Honey? This is not what you wanted. You are so strong. You can do this!”
“I want the fucking epidural, Jeff! And turn that goddamn hypnobirthing CD off!” Jenna hurried over and turned it off.
“I can massage your sacrum — that will help the back labor” she assured Jeanine.
I took her hand and looked Jeanine in the eyes.
“Listen, you are having back labor — which is the most excruciating kind of labor. The baby’s skull is pressing into your spinal cord with each contraction — err, surge — due to the position of its head. That pain — umm discomfort — is not the kind any person should have to endure. The nurses are calling anesthesia as we speak and we will get you relief within the next 30 minutes. Your nurse is going to give you an IV now so we can prepare you for the epidural. I will stay with you and we will get through each surge together until you have relief. When it’s done you shouldn’t feel them anymore, just pressure.” She nodded at me, tears streaming down her face.
“Thank you. I can’t do this.” She looked defeated.
“You can and you will! We will get you through the next half hour and then you will feel so much better.”
She continued to scream during the contractions, unable to get any relief from massage or reassurance from our words of encouragement. Jeanine was exhausted. She stopped saying “surges” and begged:
“How long until I don’t have to feel these awful contractions?”
Once she had the epidural in place, I checked her and she was 6 cm dilated. Jeanine lay back in the bed, her eyes closed.
“I feel so much better now. Thank you so much!” I squeezed her hand and told her, Jenna, and Jeff to all take a nap before it was time to push. When I got back to the nurses’ station to write my note, Nina took out the Birth Plan and crossed out:
· Do not offer an epidural at any time
· No medical intervention unless it is an emergency
· Jeanine would like to walk and move freely until it is time to push
· Jeanine would like to use the birthing tub until she is ready to push
“Just so you know, I prepped the OR for surgery. We’ve got a few more hours until our night shift ends…” She winked at me.
To all of our relief, after a few hours of sleep, Jeanine woke up fully dilated, pushed with vigor, and had a beautiful vaginal delivery. She was thrilled, holding her healthy newborn in her arms. It had not gone according to plan, but she still wound up having a meaningful birth and feeling empowered.
As a midwife, I encourage my patients to write down a birth plan — but to think of it more as a list of intentions rather than a plan. I like to remind new parents that pregnancy, birth, and parenting are unpredictable, painful at times, joyous at others. When it comes to birth, educate yourself as much as possible, then expect to find yourself in unfamiliar territory and open yourself to rolling with whatever happens. I will always strive to give patients informed choices and guide them with compassion. As a single mother of teens, I now experience the roller coaster of parenting on a whole new level. I never know what moods will pervade my house when I walk through the doors. After one of my 24 hour shifts, when my kids are home alone, the kitchen sink looks like a battlefield. But, just last week I reminded myself, they put the dishes in the sink instead of leaving them all over the place — so that is progress! I am constantly trying to reframe my sense of perspective and pick my battles. This starts during pregnancy, labor, and birth.
So — make a flexible birth plan and ask your OB provider how things work in the hospital where you deliver. Ask all your questions and know we cannot have all the answers, but, ultimately, we are a team and we have the same goal: a healthy infant in your well informed empowered loving arms.
