I was 37 weeks pregnant and had just completed a busy Monday in the OR, my last scheduled shift before maternity leave. While relaxing in front of the TV that night, I found my fetal kick count to be significantly lower than normal. I spoke with the on-call OB team, and after going back and forth, we decided it was best if I go to the hospital for further monitoring. I threw on my slippers and jacket (was already in pajamas) and said, "See you in an hour or so," to my husband. I never made it home that night, and six days later I brought my baby girl home from the hospital!
The fetal non-stress test showed that she was ironically doing well, but my blood pressures and urine sample showed that I had developed preeclampsia. My leg swelling was increasing over those last few weeks, but things just got real. My husband dutifully showed up with my pre-packed bag and birth plan. Yes, I had a birth plan - but not the long, detailed essay that some women present to eye-rolling hospital staff, replete with all sorts of unrealistic demands involving birthing balls, hot tubs, candles and music. As an anesthesia resident on the obstetric service, we used to joke that those women with the most detailed and rigid birth plans would inevitably be the women who ended up with "emergency" epidurals at 3 AM, or worse in the OR for a crash C-section.
The feedback I got from nursing and on-call staff about my birth plan was good; they seemed appreciative of the precise and explicit set of preferences that could be passed on through numerous shift changes. I will say, however, that even with my minimal birth plan as a "good luck charm", things still didn't go the way we had originally hoped. And yet, once my daughter was born, none of that mattered one bit. Meconium was present on delivery so she was handed off for resuscitation instead of immediately placed on my chest as I had hoped, we couldn't do delayed cord clamping, etc. But she was healthy! I was lucky to have a smooth albeit slow induction with no complications and a quick period of active labor (only 45 minutes of pushing). We didn't have to go to the OR. I only needed two stitches post-delivery. Again, she was alive and she was healthy! After experiencing a pregnancy loss, I admit that a fear had persisted deep inside me even into the late months of gestation that I would lose her without getting to see her face.
Nothing went exactly as expected, and yet everything turned out fine. Nothing went exactly as expected, and yet everything turned out fine. This is my new mantra, and it would be a good one for all pregnant women to adopt. Because in the instances of labor and childbirth, resistance and rigidity pose potential risks to both mother and baby.
Have you had an experience with a birth plan, either yours or a patient's?
Congratulations on the birth of your baby, as well as your health and hers too!!! What a long journey for you, and now a new chapter ahead!
ReplyDeleteMy birth plan was,
1) the baby is alive and well
2) I am alive and well
If these things were possible!!
Thank you, and great birth plan 😉!
DeleteThat was supposed to be a smiley face... :)
DeleteCongratulations!
ReplyDeleteThank you!!
DeleteHuge congrats and hugs!
ReplyDelete(I did not have a written birth plan with any of my pregnancies but if I had it would have read: please do what you have to do to ensure a healthy baby and healthy me...oh and epidural as soon as humanly possible.)
Thank you, and absolutely on the epidural!
DeleteMy actual written birth plan was completely focused on what to do if my hormonally-sensitive epilepsy got out of control postpartum. I'm a little jealous of people who have the health to write preference-based birth plans.
ReplyDeleteMy verbal plan to my doctor and husband was prioritize saving my life over anything having to do with the baby. If my life is not at risk, prioritize anything having to do with the baby over my health.
I understand, having a rare condition myself. It was helpful to have thing written down with all the nurse pass-offs, which I'm sure was true for you too.
DeleteCongratulations!! My husband and I took a childbirth class. Best thing we took away from the class was that whatever you want your labor/childbirth experience to be, expect the opposite! All that matters in the end is a healthy baby and mama.
ReplyDeleteAgreed!
DeleteI'm a third year med student, and I had an alternative out of hospital birth in a birthing center. Of course, my main priority was the health of my baby and myself, and I fully trusted my birth team (a physician and a doula) to make the best decisions for our care. My birth preferences were simply no epidural and intermittent monitoring, which is why I chose a birthing center rather than a hospital. I didn't really make any explicit requests because I knew that by virtue of being in a birthing center, I wouldn't really need to. My daughter was born in a tub of water, and we did immediate skin contact with delayed cord clamping. My 2 year old daughter was present in the adjacent room, and she got to meet the baby right after she was born. I did not get the Hep B vaccine (I received it at the pediatrician's office a few days later), but I did get the vitamin K shot. We went home the same day and received home visits from the doctor for the next few days. It was a great experience (my first was born in a hospital with a certified nurse midwife, which was also a great experience). I haven't had my ob/gyn rotation yet, so I'm sure it will be a lot different, but I just wanted to share my experience :) I think it's a great thing for women to have choice in how they give birth (safe choices, of course!).
ReplyDeleteThe way things went for you sounds wonderful! I did the same for vitK and HepB as you did.
DeleteIs not helpful to paint mothers who have birth plans as not wanting the best for their babies. Women/mothers are smart, and should be respected enough to be the primary decision makers in their care and the care of their children (unless deemed by the state that it is not the case--another story all together).
ReplyDeleteI totally agree with you, aNd I support people having them even though lots of physicians poo poo them which is why I wrote the piece. But I do think women should carefully consider what they put in the birth plan with thoughts as to the safety of those involved.
DeleteGreat post! I love your mantra. One point I think of, though, is those mothers, birth plan or no, for whom everything does NOT turn out just fine (with the baby). If the baby is not well, it puts a whole other spin on the birth experience. I guess that is an obvious statement. But postpartum, with a healthy baby, I think your mantra is just perfect.
ReplyDeleteThat aside (and assuming a healthy baby at the end), the whole topic of birth, delivery, birth plan etc is just so LOADED with, well, everything it seems - medicine, medical risk and facts, emotion of course, memory, culture, feminism, pragmatism, hope, desire, guilt, self-reflection.... I could go on and on. As a mother of three, I would describe the experience of giving birth as being absolutely positive and transformative; an experience that I will remain grateful for for my entire life. Other mothers I know reflect on their birth experiences with little emotion. Still other woman I know focus on their birth experience in a very negative light: even many years later, they remain angry and frustrated. This is where the many layers of hope, emotion, knowledge, expectation, etc come in. As an aside, I truly believe that overly zealous anti-medicine messaging about birth and delivery does as much harm to the woman as the "unnecessary interventions" that it seeks to avoid.
I am digressing. With respect to birth plans (your topic), I think they are a smart and reasonable thing for a pregnant woman to have, a real plus, as having a birth plan indicates that she has put thought into this entire process. I dislike the eye-rolling that may accompany a birth plan, whether the plan is "reasonable" or not, as I do not think it is for us to judge the woman's plan - it is for us to provide her with medical information about her labour and delivery, as it progresses, and try to accommodate the birth plan if and when possible. If it is possible to accommodate requests that may seem to be "unreasonable" (and that definition changes for each provider, so an example could vary from provider to provider), then why shouldn't we, if it is safe to do so? I wanted to deliver my third child on my hands and knees, but my doctor absolutely refused. I was in a new city with a new MD for baby #3, and in the middle of labour, I was in no capacity to state my case, so I delivered on my back as she preferred. Is it a huge deal to me now - no. Was it then - no, but it was frustrating and annoying. I don't really ever think about it, except I have done so in reflection of your post, but for some woman, that might have REALLY mattered. It might have been in their birth plan - so why not?
Anyway, long reply:-) I loved your post, and a huge congratulations on your daughter. Many blessings to you and your family.
Thanks for your thoughtful comment. I think it's a good point you make that certain things we do as physicians may stick with patients for a long time. I wish birth preference were more discussed in detail so as to better educate patients about the benefits/risks of things they desire. But we all know about time constraints in clinic, unfortunately.
DeleteI remember how up-my-butt some people got about my "birth plan" which consisted of 1) epidural, and 2) have husband cut the cord if possible. I didn't really get it. It's as if to these people, anything other than full submission to the medical establishment was unacceptable. But shouldn't patients be allowed to express a hope/preference for how they want things to go?
ReplyDeleteCongrats on your healthy baby!
Thank you! Yes, I do think patients should be able to express preferences. It would be ideal if we could come together more as doctors and patients regrding realistic preferences, though.
DeleteThank you for this post and your introduction post as well. As a surgical resident in one of the "easier" years of residency, my husband and I decided to try and conceive. One chemical pregnancy and one missed miscarriage (followed by two D&Cs) later I am pregnant again. During my most recent pregnancy I started making detailed birth plans. This time, my birth plan is simple-deliver a healthy baby.
ReplyDeleteAlthough I admire women with detailed birth plans and do believe physicians should attempt to follow through with them within reason, my priorities have shifted. I just want to take a health baby home. Perhaps this will change as I get further along in this pregnancy . . .
Thanks for your comment! I totally get your feelings of simply wanting a healthy baby, having gone through IVF and a miscarriage myself. Good thoughts to you for the rest of your pregnancy!
DeleteI had a birth plan too. Natural birth, delayed clamping, immediate skin to skin and breastfeeding. I wanted my mom to be there as well. My daughter had other plans. My water broke 3.5 weeks early the week my mom was gone while I was rounding. Nothing went as planned. I required medication and a quick nicu stay. I realized that births never go the way you want and that I should be happy that my baby ended up being healthy and I didn't require a section.
ReplyDelete