This podcast covers a lot about preparing for the birth experience you want. If you listen to this podcast, you are educated about labor and birth. You are learning what your options are, and you know what is evidence-based. You got this! The more you prepare, the better likelihood that you get the birth experience you want, or pretty close to it. I wish I could tell you that everything will go as planned, and it will be magical and perfect. I genuinely hope it does. There will always be unknowns. Many factors can impact your labor and birth, and many of those are out of your control. Should you still plan for the birth you want? Absolutely. Should you also have a backup plan? Yes! This episode covers why you should have a backup plan for your labor and birth, how to prepare for unknowns, and what your backup plan should include.
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Preparing for the Birth You Want
I talk a lot on this podcast about preparing for the birth experience you want. If you listen to this podcast, you are educated about labor and birth. You are learning what your options are, and you know what is evidence-based. If you listen to this podcast, you know you should be working with your doctor or midwife to make sure everyone is on the same page, and your partner is involved. You got this, and the more you prepare, the better likelihood that you get the birth experience you want, or pretty close to it.
What if Your Labor and Birth Do Not Go as Planned?
I wish I could tell you that everything will go as planned, and it will be magical and perfect. I genuinely hope it does. There will always be unknowns. Many factors can impact your labor and birth, and many of those are out of your control. Should you still plan for the birth you want? Absolutely. Should you also have a backup plan? Yes!
A simple way to illustrate how some births do not go as planned is to look at the rate of cesarean births. According to CDC data, in 2019 in the United States, the overall cesarean rate was 31.7%. Of those mothers who had their baby via cesarean, some would be high risk or need a cesarean for medical reasons. Some of those mothers may schedule an elective cesarean. If you look at the low-risk cesarean rate, it is 25.6%. Low-risk mothers are at least 37 weeks, first-time mothers, with a baby in the vertex (head down) position. One in four low-risk women is giving birth via cesarean. Do one in four women plan on a cesarean for birth? Or is it possible that their birth did not go as planned?
To dig a little deeper, one study of over 38,000 women who had their baby via cesarean. The biggest reason for cesarean was a failure to progress. 35.4% of mothers in this study who had a cesarean was because labor was not progressing. The next most prominent reason for cesarean was non-reassuring fetal heart rate, which accounted for 27.3%.
What does this research tell us? I am simplifying a lot here, but just looking at only these two statistics tells us that 62% of women who ended up having a C-section in this study didn’t go into labor planning on a cesarean. These were births that did not go as planned. A cesarean can be a lifesaving procedure, and I am thankful we have access to that medical technology when we need it. The takeaway from these figures is that statistically, not everyone is going to have their birth go as they plan.
Why You Should Have a Backup Plan
Labor is an intense experience, and a lot can happen that puts you in a position where you or your care provider has to make quick decisions, or something can happen that changes the trajectory of your plan. By having a backup plan, you will not be caught off guard. You will know what to expect and understand what your options are. Here are several scenarios you should be educated about and plan for, depending on the birth experience you want.
Every expecting mother should be knowledgeable about cesarean birth. Looking back at the stats we already covered, nearly one in three mothers in the United States has their baby via cesarean. In a cesarean birth, you have a lot of options, including a gentle cesarean and possibly vaginal seeding. The more you know, the better you will be able to navigate your choices, in the event your baby makes their entrance in an operating room.
If you are planning for a home or birth center birth, you need a backup plan in the event you need to transfer to a hospital. The majority of these transfers are not emergency 911 calls. You may decide you want an epidural to rest. Something may come up that makes your midwife recommend you transfer to a hospital.
You should know what hospital you would transfer. If it is not the nearest hospital, you should also know where that is in the event you needed to transfer more quickly. If possible, it would be nice to have a doctor who you know your care would transfer to if required. Some birth centers and home birth midwives have OBGYNs they work with regularly in the event of a transfer, and they may be able to assist in connecting you with an OBGYN.
Hospitals tend to have stricter policies on who can accompany you. Your partner should be able to be with you, but your midwife or doula may not be able to accompany you. You should know what capacity your midwife can continue your care. Depending on the circumstances and the laws where you live, some midwives will be able to stay with you in the capacity of a doula, and others would have to hand over your care completely. Ask your midwife to walk you through what a hospital transfer would look like in terms of how they can, or cannot, continue to support you. This support could be in person, virtual, or postpartum.
Changing Preferences for Interventions
In the course of your labor, you may change your mind on the interventions to which you opt-in or out. If you are planning a natural or non-medicated birth, you could decide that you want pain medication or an epidural. Even if you are planning on intermittent rather than continuous electronic fetal monitoring, you should know about both. In any case, it would be good to understand what your options are. Plus, educating yourself about these procedures ahead of time will give you more confidence in discussing them with your doctor or midwife.
The COVID-19 pandemic has presented some new challenges to hospitals, birth centers, and home birth policies. For a good explanation of how these policies are changing, check out this episode with guest, Heather Delaney. You should have a conversation with your doctor or midwife about how changes in policies could affect your birth. While those policies may change between now and when your baby is born, having open communication with your doctor or midwife will help you be on top of what you need to plan.
What is your plan if your partner tests positive for COVID-19 or has symptoms at the time you go into labor? Do you have a plan for how to quarantine them and limit your risks of getting the virus? If they are unable to be with you for your labor and birth, do you have an alternate person who can be with you? This could be a doula, friend, or family member, someone who will support you during your birth. If your doctor or midwife has a solo practice, who is their backup in the event, they are not able to attend their birth?
Creating a Backup Birth Plan
I am a huge advocate for creating a birth plan. Some people think birth plans are a waste of time. I know from helping thousands of expecting moms through this podcast that birth plans are an excellent way to prepare and go into your birth feeling confident. Ultimately, having a plan will get you closer to your ideal birth experience.
If you have seen my birth plan, you know that I had two birth plans. One for the birth center I was planning to birth at, and a second backup plan in the event I transferred to a hospital. Creating that backup birth plan helped alleviate some fears of things not going as planned. After running through a backup plan, I was more confident about the birth I wanted and had a plan if things went differently. Creating a backup birth plan will help you prepare for what you want, help you understand how your situation could change, and how you would handle those changes. If you would like to get a free copy of my birth plans, click here.
Please keep in mind that creating a birth plan is so much more than writing your preferences on a piece of paper. Through the process of creating your birth plan, you will learn what your options are and get clear on what you want. For a step-by-step guide on creating and writing your birth plan, check out the Your Birth Plan book. This book also has sample plans for everything from home birth to a cesarean, with a template you can download and customize to fit your preferences.
Talking to Your Doctor or Midwife
The process of creating your birth plan heavily involves your doctor or midwife. You need to communicate your preferences to them ahead of time and make sure you are on the same page. It will be challenging to get the birth you want without your care provider’s support. Plus, they bring a lot of experience and expertise to the table.
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