Showing posts with label teen pregnancy. Show all posts
Showing posts with label teen pregnancy. Show all posts

Friday, August 21, 2009

Why Have a Birth Plan?

“Want a drink? Here’s some tea, with cream and two sugars. Don’t like your tea that way? Or don’t like tea at all? Well, sorry – that’s our standard beverage. If you wanted something different, you should have told us before. There’s not much we can do about it now.
Like that attitude? What if the item in question wasn’t a cup of tea, but your baby’s birth: the culmination of nine months of waiting and wonder – and the beginning of an incredible new life?”

This quote comes from an article on Pregnancy Today on why its important to have a birth plan. I think its a great way to look at the situation.
http://www.birthplan.com/why-would-you-want-a-birth-plan/

As a Doula, I always suggest my clients create a Birth Plan. I look at it like a learning tool, because in my early experiences as a Doula, as well as my experiences being the pregnant woman, I’ve found that there are so many subjects in a birth plan that many couples don’t even know they have a choice about! From the atmosphere in the room, to what a woman chooses to wear, from whether or not she wants pain medication offered to her, to how she wants her baby cared for after the birth, going over a Birth Plan can show a couple all of the various options they can have.

However…

Doing this at 36 weeks may not be the best timing. Its my belief that looking at the topics in a Birth Plan is something a couple should use when interviewing potential doctors or midwives. Why? Because if you choose to eat lightly during your labor, as is a option in a birth plan, or if you choose not to have a medical induction (barring the fact that it is MEDICALLY necessary (a topic that will come up in another post)) or if you want your newborn’s physical examination to be done on your chest and you suddenly find out that your OB or midwife will not permit this, its very late in the game to be switching care providers. Its not that it cannot be done, but why not start out with a care provider that’s on the same page as you and your partner, who has a philosophy about birth that is in line with yours? I’ve heard the stories of the doctor taking the birth plan and throwing it in the trash or the doctor who says to their client, “You should stop reading books and just listen to me.”

Some women may worry that they don’t have the knowledge to make decisions about their birth. I think there is nothing farther from the truth when it comes to the vast majority of women, because most women are perfectly healthy and able to birth their babies without intervention. Rest assured that just because you create a Birth Plan, does not mean it cannot be adjusted if necessary. It is not set in stone. If you state on your Birth Plan that you don’t want any pain medication, and yet during your labor you opt for it, no one will hold you to the Plan… unless you really want them too. :) The plan simply states your preferences, with the knowledge that they can be changed at any time.

All of this said, I heard from a long time L&D Nurse that a Birth Plan handedto the nursing staff may not be enough to forgo certain standing orders your OB might have. Let’s say you opt to not have a routine IV or for a HepLock (what’s basically the start of the IV needle into your arm.) or no routine Pitocin (a drug that is synthetic Oxytocin) to augment your labor. You may get to the hospital only to find out that your OB has standing orders that all of their patients receive this upon presenting in the hospital. A Nurse will not forgo this just because you are holding a Birth Plan stating you don’t want it, even if you tell her your OB ok’ed it.

Instead, get from your care provider a order slip that they have to fill out and give to you, which you bring with you to the hospital once you are in labor. Keep it with your Birth Plan and give it to the nurse as you are admitted.

There are many online resources that you can use to create a Birth Plan. Check out a few versions as some will have different questions, some are more thorough as well.

Lesson's Learned Supporting a 14 year old Mother

I’m a Doula. That might be a word you aren’t familiar with. The short and sweet version of that answer is that I provide women and their partners with physical, emotional and informational support during pregnancy, childbirth and the postpartum period. I attend the birth with them, continuously remaining by her side, helping to create a safe, secure place for her to give birth, whether they choose a hospital, birth center or home birth for their baby while providing my professional knowledge of childbirth to the woman and her partner. It’s an amazing job, both trying and incredibly rewarding. I not only see babies being born, but families being born.

When I first got word of this potential job, I was a bit taken back. This girl was fourteen years old. In various ways she’s a kid herself. Through my mind ran thoughts such as ‘this could be a really difficult job.’ However, at the same time, or maybe a spilt second later, I knew she was ‘my mom’ (that’s doula terminology right there, ‘my mom’. Of course we aren’t talking about our biological mothers, but our clients, our ‘mom’s’). Now, I couldn’t have known that she was, at that point, my client. The email was a notification about a lottery drawing for the job looking for doulas within an organization I belong to, who were interested in providing services for this mother-to-be. Yet, she was mine. I knew it. I felt it. I trust that inner voice all the time. It’s served me in many, many ways.

So, after I was notified that I indeed officially had the job, I wasn’t very surprised. However, I couldn’t have guessed how much I would take away from this birth; how much I would learn from a fourteen year old girl.

Upon meeting my client, I was pleased to find out that she’s a lovely, sweet girl. Teens, I hear, can often be trying clients (even the not so pregnant ones!) yet this particular teen was truly a wonderful young girl. Actually, every teen I’ve supported has been wonderful. She was more educated about pregnancy and birth than I expected her to be and looked forward to her birth experience. Furthermore, I could not detect any fear in her of the birth process. At first I attested it to the fact that I had just met her and that she was not ready to open up to me yet. I could not have been more wrong.

At another meeting I asked her flat out, “So, what kinds of fears do you have about this?”

Her response to me was a shrug along with her telling me that all she was really scared about was the needle for the epidural. She didn’t want that. This fourteen-year-old girl wanted a natural, drug free childbirth.

Looking back now, I could have attested her lack of fear to her being uneducated about birth. But that wasn’t the case. My client knew a lot about birth. She also knew what she wanted and what she didn’t want, including an obstetrician who didn’t talk to her, who didn’t give her time to ask questions, voice concerns or investigate her options. By the time I met her, she had fired that doctor and was looking for someone who would be nicer to her, who would not judge her or her situation and with whom she felt comfortable with. And this was all self directed. While her mother and family were supportive, I could tell that this came from the girl herself.

I’ve had adult clients that can’t advocate for themselves this way, who are too fearful to fire their doctors and look for another who they are on the same page with. I was both proud of her and amazed by her. With some education from me, my client chose a midwifery service for her birth. I was so excited for her and so glad she was advocating for herself this way, even with some emotional hand holding from me when it came time to actually ask for the appointment (but hey, that’s part of the job), because really her perception of prenatal care and birth could have been so damaged had she continued with her original care provider.

When the night of her labor arrived, my client was not yet finished with her 37th week. I had expected her to go early, as many young women tend to do, and while I also advise that my clients labor at home for as long as possible, I did feel that the best thing to do was to call her midwives right away. Her contractions were still only 40 seconds long while being about 5 minutes apart, and she was handling them well, talking to me calmly, but still her dates put her in the pre-term birth category.

We met at the hospital along with her mother and her boyfriend as well. I watched her through contractions as we stood at check in. She was breathing lightly through them, they were still relatively short in length. In my mind I thought she was in early labor but when I was told, after she left triage, that she was 6 – 7 centimeters dilated, I was shocked. Lesson number one: women can have very productive contractions even if they are not lasting as long as the textbooks say.

When I try to look back and divide her labor into stages, from physical observation alone, I can’t. Not really. Except for her vocalizing the feeling of pressure and for some slight nausea, my client stayed just as calm and quiet through her labor as she was when she first called me on the phone.

This young girl never said ‘I can’t do this.’ She never asked for pain relief. She never shouted, she never cried, she never was afraid. She talked to her baby softly during contractions, both in English and in her first language. When she was complete (ten centimeters) she was excited. I have never seen an expression of pure excitement on a laboring mother’s face before.

During her childbirth education class with me, I explained to her how the baby, when descending through the birth canal before crowning, will be visible for a little while during a contraction and then sink back into the body after the contraction is over. Mother Nature is amazing because during this part of the birth, the baby’s head is gently stretching the mother’s perineum. I told her, “It sort of looks like the baby is playing peek-a-boo.”

I’ll never forget her asking me, right at the start of her pushing phase, “Is she playing peek-a-boo yet!?”

It will be a precious memory for a very long time.

Another wonderful memory will be this mother’s expression once we told her that we could now see her baby’s hair. Pure excitement doesn’t even explain it well enough. Nor will my telling you that this amazing young girl was the first woman I’ve ever seen reach down and pull out her own baby, all while exclaiming, “My precious baby girl!” It was one of the most beautiful mother-child meetings I’ve been blessed to witness.

It’s been a while since I cried at a client’s birth, but it was impossible for me not to at this one.

In the days and weeks after this particular birth, I’ve asked myself so many questions and learned some very important things. While some of those things I cannot express without breeching any confidentiality, one of the most important things I learned needs to be shared and talked about. And that’s why I am telling people this story, both in conversation as well as through this article.

This mother did not have the fear that so many of my clients have had and I attest that to two things. First she has only lived in the US for a few years and second, because of her age, I don’t think there was enough time for this girl to be programmed to fear childbirth the way so many other American women do.

Let’s take certain shows on television that are about birth. As a childbirth professional, I see so many things wrong with such shows, as well as film portrayals of birth, but before being educated the way I am, I watched those shows and felt fear. They instill fear and anxiety in women, telling us that all birth is dangerous, all birth has to be within a hospital setting in order to be ‘safe’ and that a woman’s body alone does not really know how to birth her baby. The message is that she can get pregnant and grow the baby, but not birth the baby without all the bells and whistles of managed care, hospitals and Obstetricians.

Female family members and female friends, who for some reason feel the need to tell other pregnant women their ‘horror stories’ help perpetuate fear and distrust in this biological process. While I understand the need to talk about a birth experience, what good does it do a pregnant woman to have the seeds of doubt planted into her mind? Why should she fear one of the most important moments of her life? Why do we do this to each other? Positive and inspiring birth stories need to be shared amongst women. Those are the seeds we need to plant.

How many fourteen-year-old girls do you know who have been present at a birth with someone like an aunt or their own mother? How many fourteen-year-old girls do you know who have seen home birth? Who have cut an umbilical cord? My client did. Before she ever became pregnant or gave birth herself, she saw and participated, in a support role, for her cousin’s birth at home. I can’t help but wonder how this impacted her pregnancy, labor and childbirth. And I wonder what difference it would make if other young women witnessed the births of their family members in a normal, supportive environment. How would this help build their perception of birth? How would this witnessing of natural, normal, supported, beautiful birth affect young women?

The trust in herself, trust in the process of birth, and the lack of fear that this young girl had during her pregnancy and child birth made her experience so very different from many other births I’ve supported, not to mention shorter. A first time mother with a ten-hour birth, from start to finish. That’s pretty wonderful, if you ask me. And it supports all the research that says that support, and lack of fear will shorten the length of labor.

She taught me lessons that I will never forget, that I will look back on and utilize when supporting my future clients. I can’t thank her enough for such a gift. I hope that by reading this one small story, you too will spread it around to your female friends and family members as well as the men who love and support them.

Birth can be so much different than most women in this country know it. This one girl, her beautiful baby and their birth story are proof of the possibilities.

Tamrha Richardson is a Certified Birth Doula and Childbirth Educator in training through Childbirth International. A mother of two, she is passionate about pregnancy, childbirth, and women’s reproductive rights. Tamrha is the Local Representative for Better Birth New York, an online resource for NY women supplying information on birth options. As a co-leader of the Long Island Chapter of ICAN (International Cesarean Awareness Network) she supports women seeking information on VBAC’s and Cesarean prevention. She is a member of The Long Island Doula Association and the Metropolitan Doula Group. Tamrha can be reached through her website www.tamrhasdoulasupport.com or by calling 631-357-4933. Visit her blog at http://alongislanddoula.wordpress.com/