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Sunday, September 12, 2010

Your Birth Experience

 Ina May's Guide to Childbirth
What type of birth experience you want to have will help you decide where you should have your baby and who should be there to help you.

The hospital is a good place to birth if:
  • You have good insurance or are independently wealthy (my bill was about $20,000)
  • You want the option to have your pain be managed with drugs such as an epidural
  • You like the idea of having the equipment, knowledge and a broad range of skill on hand in case a complication arises.
  • You do not need a doctor or midwife with you most of the time you are in labor. Many times the doctor will arrive just in time to deliver your baby
  • You would prefer a scheduled C-section if your provider will allow it
  • You like the idea of not having to prepare much and trust your provider to do what needs to be done
  • You understand that the hospitals goal for your birthing experience is a healthy baby and a healthy mommy and may be quicker to use interventions if they see something that could possibly interfere with that.
At home, with a midwife is a good place to birth if:
  • You do not want/need pain management
  • You are willing to pay about $1,000-$3,000 out of pocket (insurance rarely covers home birth)
  • You like the idea that many home birth midwifes will come to your home for your pre-natal care
  • You want the comfort of home while you give birth
  • You will be comfortable giving birth at home
  • You have the confidence and belief that women have been giving birth since the beginning of time, your body was made to do this and are not concerned about the possibility of complications for you or your baby
  • You worry about the fact that hospitals need to protect their interests and are quicker to use interventions
  • You are ok with not getting an ultrasound if you choose only home midwife care
  • You can handle your peers, family and medical professionals questioning your choice. 
    • If you are seeing a hospital OB or midwife in addition to your home midwife pre-natal care, some offices will write you a letter after the birth of your child discontinuing their care of you, some will no longer see you if you tell them you are planning a home birth
An unassisted home birth (free birth) could be an option if:
  • You are ok with the fact that most experts, even home birth advocates strongly do not recommend this option
  • You want a home birth, but live in an area where a home birth midwife is not available or illegal
  • You feel educated (on the topic) and confident enough to be both patient and "doctor" during your labor.

Unfortunately, most of us probably agree with a few bullet points from two or more of the categories and there are some other options to help you find a middle ground.

Birth Centers
If you are lucky enough to live close enough to one of these centers, they can be a great middle ground. They have some medical staff who can do basic medical procedures and are equip to easily transfer patients to a hospital if needed. They tend to focus more on natural childbirth and natural pain management. Epidurals are not available at birth centers. Some insurance companies will reimburse you for your stay and the costs are lower than in hospitals. The American Association of Birth Centers can provide you with more information.

Can offer care directly to you. They do not provide medical support, but are there to encourage you and help you through your labor. They can offer new positions to try for pain management and also be there to support your support personnel. Doulas can range in cost anywhere from $0 (a doula in training) to about $1000 dollars. I have not heard of insurance ever paying for a doula. You can find more information on Doulas at DONA International.

In-Tune Professional Care
Finding an OB or midwife that is on board with your birth experience and choosing a hospital that also supports the way you want to labor is a huge factor in getting the birth experience that you want. This can be hard to do because most practices will have many midwifes or OBs on staff that you like, and some that you do not. However, whichever one is on call when your little one decides to make an appearance is who you get. Some OB/Midwife practices will work with you if there is a particular provider that you have a conflict with. I would highly recommend doing so.

A Birth Plan
Having a birth plan is very helpful. It informs and reminds your professional staff of the experience you would like to strive for. It also helps you remember what you wanted to strive for after you have already had 20 hours of labor with more to go. It is suggested that birth plans be one page long or less, but I had a lot of information I wanted on there. I opted to put my "preferred" birth plan on page on and then any "emergency" information on the second sheet, since it would not be needed unless something did indeed go wrong.
Great things to have in the birth plan are:
  • If and when you want drugs for pain management. It can be helpful to specify if you do not want pain drugs offered to you. Many women do not think to ask for them, but are eager to take them when offered.
  • Who you want in your birth room? Some women like to have the whole extended family with them, others just want to be with one or two trusted family members or friends.
  • Emergency plan. If you end up needing a C-section or if there are other complications, who do you want called? Do you want your significant other with you in recovery or with your baby?
  • This one was odd, but I had in my birth plan that I wanted to eat and drink during labor and the midwife indicated that since it was in my plan she would allow me to, whereas otherwise they would not.
  • Do you want to bank cord blood?
  • Do you want to wait to cut the cord to allow the blood to leave the cord?
  • Do you want your baby to have Hep B, Vit K shots or eye drops?
  • Do you want your baby boy to be circumcised?
  • Do you prefer to tear or have an episiotomy?
  • Are you ok with an IV?
  • Do you want to breastfeed right after birth?
  • Can baby have formula or a pacifier?
  • Do you want to see a lactation consultant after birth?
  • I also included a paragraph on me and my personality to help them understand me, as I think I have a pretty strong personality and not everyone knows how to handle it.
A copy of my birth plan can be found here. I have changed personal information to 0000 or 555-555-5555, so if you see that it means something identifiable was there. Everything above the dotted line is the "main" birth plan that I gave copies of all of my nursing staff. Everything below the dotted line was in my chart in case of emergency and they needed more detail.

Informed Hospital Nurses
When you check-in, let the hospital nurse know how you plan to birth. They can assign you someone who is good with moms birthing naturally or someone good with moms who choose an epidural.

An open mind
Not every birth is going to be exactly what the mom wants it to be. It is important that moms understand that things can go wrong. A successful birth does end with a healthy mom and a healthy baby. (Thanks Jessica)

What did I choose?
I chose to have my baby in the hospital. The hospital where were at seemed more in-tune with natural child birth than most hospitals I have heard about. Overall I was happy with this decision. My placenta ended up not delivering at the end and I needed to go in the OR to have it removed. I was glad I was in a hospital for this, but I don't think I would have died if I need to be transferred.

I do wish I had spent the extra $500 for a doula. I feel like I could have labored longer (they used a vacuum to get my son out), but felt that I was given the option of that or a c-section (the hospital reports indicated otherwise however). By then I was exhausted (4 hours into pushing) and didn't have the breath to argue for more time.

Birth Stories from blogs I stalk follow:

Baby Mamas Drama Part 1 Part 2
Exploiting My Baby
Our Little Online Corner
Gabbing with Grace
...and Baby Makes 3 Part 1 Part 2 Part 3 Part 4 Part 5

*Tara - 3 home births + one hospital transfer = 4 girls

*I do know quite a few people who have had home births, so although I do not follow their blogs (or they do not have one) I asked a few of them to share their birth stories as well to get a more rounded list of stories for you. I will link more as they get back to me.

Please feel free to link to your birth experiences in the comments section! As always, I am also very open to corrections or additions as long as they are presented kindly.

Next post: Childbirth education. What options are available in your area? Did you/are you planning to take a childbirth education class?


  1. All this time, I had no idea this was your blog! I don't know why my brain didn't make the connection. duh! :)

    great post!

  2. Sorry I haven't been able to get you mine Catherine. I've barely been on the computer at all with uncoordinated nap times between 2 kids. I'll keep trying.

  3. I was really excited to see you link to Birth Kalamazoo. Jessica was my doula and I don't have enough positive things to say about her. It was my husband who actually suggested hiring a doula! We had a great midwife and a wonderful natural water birth at Bronson. I'm really glad that you're talking about birth and letting your readers know they have choices!