Birth Plans/Preferences

Being a L&D nurse I actually like it when patients come in with a birth plan. It shows me that they have put some thought into their wishes and it makes it easier for me to provide care for the mom and partner if I know what they want or are expecting. However, sometimes people come in with very elaborate birth plans and have unrealistic expectations, which can make caring for them more difficult for all parties involved. Most people who write birth plans have realistic wishes that are most likely already going to be done; like putting baby on moms chest right away, waiting for the umbilical cord to stop pulsating, wanting the baby to stay with the parents in their room, or mom wanting to breastfeed, to name a few examples. 

The most crazy unrealistic birth plan I ever saw was…my own. During my first pregnancy I hadn’t been a nurse for very long and I was working in long term care. I thought I had done adequate research on pregnancy and birth, but what I was actually researching was severely biased. With my second pregnancy I was working in L&D and had been for about a year or so. I went back to look at my previous birth plan as reference to make another one and what I saw was shocking. I hadn’t even remembered everything I had put on there and then looking back at it with my new nursing experience made me realize that moms and their partners need more education on pregnancy and especially the birthing process. 

One important thing to note is that no birth plan is going to go the way that it's planned. You can't anticipate everything that's will happen. So, it's good to be mindful that things can change and that what you had in your mind as to how your beautiful birth would go down flexibility and having an open mind is essential. Here’s what is going to be useful in a birth plan/preferences.

·      Your name and your partners name.

·      The name of your doula if you have one.

·      Your doctors name and clinic

·      Your baby doctor and/or clinic

·      The name of people you would like or not like in the room during birth. If the nurses need to kick people out at your request we will. We don’t mind being the bad guy. Realistic Expectation #1: Sometimes people like to have their whole village come to see them in labor or afterwords. If there are too many people in the room in order for the nurses and doctors or midwives to care for mom and baby safely we will ask people to exit the room. But we do want you to have the people around you that you love but as long as we can ensure safety.

·      What do you want to do for pain relief or comfort? Hydrotherapy (laboring in the tub), positioning, counter pressure, music, lighting, aromatherapy (if the hospital allows it), birthing ball, walking, or you may not know. 

·      How do you feel about medications for pain relief? Usually there are two options, if not three. Obviously the most common one is an epidural. Another option available (but may not be available everywhere) is IV pain medication, called fentanyl. A third option has only in recent years become available in the United States, even it’s been available in other countries like the UK for many years. The third option is nitrous oxide; which may not be available everywhere. If you don’t want us to ask you about pain medication in fear that you will ‘cave’ and want it even though pre-labor you doesn’t want it, we should accommodate that. Realistic Expectation #2: I will say that sometimes pain medication is what the mom NEEDS. I only say this because of my own experiences, more specifically my own births. With my second birth, my plan was to have an unmedicated water birth. My anxiety completely took over my mind and I was no longer in control. I believe that I needed it in order to move forward. Sometimes when pain medication is administered, it allows the cervix to relax and is more apt to open up and be less tense. This works for some but not all, because of course not all births are the same. 

·      Do you have thoughts when the time to push comes? Do you want to be able to move around? Do you want to have a water birth? Do you want to be in bed? Do you want to have a mirror so you can see your pushing progress (trust me it works)? Do you want the Lion King soundtrack playing in the background?

·      Are you going to breast feed, formula feed, both, or exclusively pump?

·      Medications to give your baby. There are typically 3 kinds of medications given to the baby after delivery. There is an antibiotic eye ointment, the first of the Hepatitis B vaccine series (this is a shot, which can be done later at the clinic depending on your provider), and a vitamin K shot. Realistic Expectation #3: PLEASE PLEASE PLEASEgive your baby the vitamin K shot! I will do another post about these 3 medications, but it is my professional opinion to encourage parents to give their baby vitamin K after birth. Babies are born with a limited amount of vitamin K and this is necessary for blood clotting and can prevent brain bleeds. 

·      Are you ok with testing? Typically 24 hours after delivery there are some tests that are performed on the baby. These include:

o  A hearing screen

o  Checking baby’s heart rate and oxygen levels together to screen for possible heart defects. 

o  A bilirubin screen. Bilirubin is the product of red blood cell breakdown, which is normal. Eventually, bilirubin is passed through the liver and leaves the body. When there’s a high build up of bilirubin, it can cause jaundice. This is when the skin and eyes will turn an orange/yellow color. When the bilirubin level is higher typically the treatment is bili lights or phototherapy. 

o  There’s also a small blood sample taken to test for congenital diseases. 

·      Realistic Expectation #4: Sometimes people come in and either don’t want to be on the fetal monitor or only intermittent monitoring. I’m 150% an advocate of natural birth and doing less monitoring, IF it’s safe for mom and baby. If the nurse or provider wants to check on the baby, it’s because they are concerned for you and your baby. I want you to be an advocate for yourself, but also realize that we all want a healthy and happy mom and baby at the end of the day. 

·      Do you have plans for your placenta? I know what you’re thinking: What would one do with a placenta and why would I have plans? Some people ahead of time have made plans to consume it in some form, bury it for cultural practices, take a picture of it or whatever your heart desires I suppose. I can do another post on this topic if people would like. 

·      Are you doing cord blood banking? This is not commonly done, however if this is something you want to do you need to let us know beforehand.

·      Do you have specific desires about your baby’s first bath. Most people don’t care when this is done and will have it done within a couple hours after birth. Some choose to wait 24 hours and others wait until they are home. Some want the staff to do it and others prefer to do it themselves. If you’re a first time parent, demonstration of the first bath and education is very helpful and necessary. Some people choose to wait because some believe that the vernix is good for the baby’s skin among other reasons. 

·      If you’re having a boy, do you want a circumcision? If so, do you want it done in the hospital before you leave or in the clinic? PS…It’s usually cheaper if you do it in the clinic. 

There are other things you can add to your birth plan of course if there’s something that is really important to you. I highly encourage everyone to take their birth plan to their appointments to have their provider read it. This sets you up for realistic expectations for your birth and have questions or misunderstandings answered.

Doctors vs Midwives

So you’re pregnant and now you have to choose where to get your prenatal care. Do you choose an doctor or a midwife? I, myself, have gone to midwives for most of my adult life. This isn’t because I don’t like doctors. I actually love most of the doctors I’ve worked with and think they’re awesome and I’m so thankful that we have them. I’m just more comfortable with my midwives and their philosophy for my own care. There’s a lot of misconceptions about what these types of providers can and can’t do. There’s not a whole lot of differences but here is how they compare.

 

An OB/GYN is a medical doctor or a doctor of osteopathic medicine in the specialty of obstetrics and gynecology. Another doctor that can take care of you during pregnancy is your family practice (FP) or primary care doctor! I didn't figure this out until I worked in OB. I had no clue. A CNM or a certified nurse midwife is a registered nurse who has a maters or doctorate degree in midwifery medicine. An OB doctor went to medical school after their undergraduate degree, then did 4 years of residency. A CNM most likely has an undergraduate degree in nursing and then did another 3-4 years for their midwifery program. There are some midwifery programs where they don’t need to be a nurse first. This is called a CPM, certified professional midwife.

 

Stereotypically, women who want more personal care empathy choose a midwife. Midwives are also known for doing more natural births, including water births. In my own experience working at the hospital midwives will be more hands on and do more cares with the mother compared to OB doctors. However, there are many OBs who prefer to be more hands on and stay through the labor process. All providers are different on how they give care. Some are OBs, some are CNMs. Some are hands on, some are hands off. Some like pizza, some like kung pao chicken. This is also why it’s important to find a provider that works well with you and has good chemistry with you.

 

A CNM can do most of what an OB/GYN can do. If a women needs more care during her pregnancy because she’s high risk she may need to be under the care of an OB depending on the policies of the facility and the providers’ experience. Also, an OB can do surgery whereas a CNM can’t.

 

Now, here's the differences between a FP and OB/GYN doctors. Not all family practice doctors do prenatal care. Some choose to make it a part of their practice and others don't I've worked in a hospital where it was quite uncommon for a FP doctor to be there delivering babies and most of the time it felt as if they didn't know what they were doing. This isn't because they aren't good at what they do. They just didn't deliver babies often enough. If I suddenly were asked to go to the ICU or behavioral health, I'd fall flat on my face, but that wouldn't make me a bad nurse.

 

I've also worked in a hospital where seeing a FP would be the norm. Approximately 50% of the providers there would be FP and sometimes I'd forget which one they were because that's how often they were there. One thing I loved about working with them is how well they knew their patients. This is because they are their care provider for everything, from well visits and annual check ups to OB/GYN related matters. However, they are not surgeons, so if their patient is requiring surgery or a c-section they can assist but an OB/GYN doctor will be the one actually performing the surgery.

 

These are a lot of options to consider. So, if you find yourself not knowing where to go, start asking your friends. If your friends have good/bad experiences with someone, this is a good starting point in your search. Either way make sure you have good chemistry with them and feel like they'll support you.

Welcome Friends!

Hi!

My name is Catie. I’m a nurse, wife and a mother to 2 amazing and energetic boys. 


I’ve thought about staring this blog journey for a very long time but never had the guts or enough ideas to start it. I finally came up with what I felt like a great idea and there is a need for right now and something I’m very passionate about. I want this blog to be all about pregnancy, birth, postpartum and being a parent. 

I’ve been a nurse for about 8 years now and I have 3 ½ years of labor and delivery and postpartum experience. Being an OB nurse has truly been in the top 3 best experiences of my life. I’m currently a triage nurse at an OB/GYN clinic. This is something different for me with a slower pace but I’m learning about new things every day. Which brings me to how this blog idea came about. 

I left my bedside RN job as a L&D nurse and working nights to have a steady day job so I could be home more with my husband and kids. However, my sacrifice led me to a stage of grieving a loss in my life that I didn’t know I would feel. For weeks I was depressed because I missed my job so much and my wonderful co-workers. Even though it was very difficult and stressful and most of the time I was sleep deprived, I loved it and I felt like it was one of my purposes in life. So, I decided to start a new endeavor in my “free time” to write about what I’m passionate about and hopefully help people. 

One thing I always saw with parents, especially new parents, or parents who had less resources is that most people are uneducated about pregnancy, birth, and being a parent. There’s A LOT of classes out there, but most cost money and are usually out of people’s budget. There’s also too much information on the internet for people to research through and know what’s accurate and unbiased. Your healthcare provider is a great resource for a lot of questions; however, they have a very limited amount of time with you. 

So why are there such limited resources? I’m not entirely sure; and there’s many answers. I do know that when I talk to my patients, I try to give them any advice and resource I can to help them in their situation because I want everyone to succeed and feel supported in this crazy life. I know this because I’m a parent! It’s HARD! Nothing in my life has been harder and more rewarding than being a parent. So why not give advice and knowledge that I have to others who are looking for it. And if you don’t want it or like it, that’s okay too. I’m far from being an expert in my field but I know a lot and what I do know I’m willing to share.