WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM Writing a Birth Plan A birth plan is a way of communicating with the midwives, doctors, and nurses who care for you in labour. It tells them about the kind of labour you would like to have, what you want to happen and what you definitely want to avoid. It's not written in stone because the best birth plans acknowledge that things may not go according to plan. You need to write the plan in such a way that your nurse, doctor, or midwife doesn't feel she has her hands tied. She may need to recommend a course of action which is not what you had originally hoped for, but which is in the best interests of you and/or your baby. Before you start writing: Get as much information as you can: • Go to prenatal classes. A good prenatal teacher will help you make the best choices for you. Classes that we recommend are: Jeanne Lyon’s, Childbearing Society, Birthing from Within, and a few others. Please ask us for information if you need help choosing one. • Talk to women who have given birth at the hospital you are going to, or to women who have had a home birth, if that's what you are hoping for. Find out how easy or difficult it was for them to get the kind of care they wanted. • Talk to your partner or the person who will be your birth companion. What sort of labour and birth would they like you to have? How do they see their role? Then jot your 'birth wishes' down on a piece of paper -- just as they come to mind. You can sort them out later. What to include in your plan Here is a list of headings that you might want to use in your birth plan. You certainly don't have to use them all. Perhaps only a few are really important to you. Perhaps there are others which you can think of which aren't included here. Birth companion Write down who you want to be with you in labour. Do you want this person to stay with you all the time, or are there certain procedures or stages in labour when you'd prefer him or her to leave the room? You are not limited to only one person – we are happy to have whomever your choose to have with you. Positions for labour and birth Labour is a process, often one that takes many hours. You will most likely use many different positions in your labour. WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM Pain relief Say what kinds of pain relief you want to use, if any, and in what order (for example, you might prefer to try Entonox (laughing gas) before an epidural). Water Birth If your hospital is open to water birth, or if you are renting one to use at home, write down whether you want to use it for pain relief and/or to give birth in. Care of the Newborn You will need to communicate with your care provider your preferences for newborn treatments. This includes eye care, Vitamin K, PKU, and plans for circumcision. We will discuss the options during pregnancy and make note of your preferences. Third stage (delivery of the placenta) You may be offered an injection to speed up the delivery of the placenta, called "active management" of this stage of labour. We will discuss the pros and cons of active management vs. physiologic. Feeding the baby Be clear about whether you want to breastfeed or bottlefeed. Also be clear about whether your breastfed baby is allowed to have any bottles. If you definitely don't want her to have bottles, say so. Unexpected situations Some women write down what they want to happen if their baby has to go the newborn intensive care unit (NICU). They might want to be allowed to care for him as much as possible themselves, and to be transferred with him to another hospital if a transfer is necessary. They might ask for their partners to be allowed to stay with them at the hospital. Special needs You may have very special needs that you want to mention in your birth plan. If you have a disability, write about the kind of help you will need in labour. Say whether there is any special equipment that would assist you. If you have particular religious needs, make sure that you include these. It might be important for you to have certain rituals carried out when your baby is born. Or you might require a special diet during your hospital stay. Write all of these things down. Hospitals and health professionals are committed to being culturally sensitive and treating people as individuals. WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM What is a Doula? Birth Doula: A woman trained and experienced in childbirth who provides continuous physical, emotional and informational support to a woman during labour, birth, and the immediate postpartum period. Postpartum Doula: A woman trained to care for new families in the first weeks after birth providing household help, advice with newborn care and infant feeding, and emotional support. Eleven studies showed the following effects of Doula support: Effects on Birth Outcomes: Labours are shorter There are fewer complications Cesarean rates are reduced There is less need for oxytocin to speed up labour Need for forceps is reduced Women request less pain medication and epidurals Effects on the Mother: Greater satisfaction with their birth experience More positive assessments of their babies Less postpartum depression Effects on the Baby: Babies have shorter hospital stays with fewer admissions to special care nurseries Babies breastfeed more easily Mothers are more affectionate to their babies postpartum Effects on the Health Care System: The cost of obstetrical care is dramatically reduced Women are pleased with the personalized care they receive The Benefit of continuous support in labour is recognized by: The World Health Organization (WHO) The Medical Leadership Council (an organization of over 1200 U.S. Hospitals) The Society of Obstetricians and Gynaecologists of Canada How Doulas Practice: Privately – hired directly by clients As hospital employees WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM As volunteers in community or hospital programs We are happy to provide you with contact information for several doulas that we can recommend. Please let us know if you are interested. WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM Signs of Labour Signs that labour may begin soon: Lower back ache – similar to the feeling like when you’re getting your period Cramping, or an increase in Braxton-hicks. May be accompanied by discomfort in thighs Soft bowel movements – may be accompanied by cramps or digestive upset. Bloody Show – vaginal mucous tinged with red or pink blood. This is a sign that your cervix is beginning to change. Nesting instinct: sometimes a burst of energy and desire to prepare for baby, sometimes it is wanting to withdraw and be alone and mentally prepare. Signs of Early Labour: More regular contractions or cramps Loss of appetite Feeling “weird” or nauseous What to do in early labour: If it is nighttime – try to sleep. If it is daytime, carry on with life as normal. Try to distract yourself and not focus on labour. You can call your midwife and give her a head’s up that you might be in early labour. Take a shower or a bath Keep eating and drinking Signs of True (more active) Labour: Contractions begin to increase regardless of what you are doing. Contractions become more regular, last longer, and become more uncomfortable You cannot walk or talk during the contraction and you need to focus. There may be leaking or a gush of amniotic fluid What to do in Active Labour: Try walking – if you are in active labour it will increase the contractions, if not the will slow down. Breathe deeply and slowly through contractions. Focus on relaxing your entire body. Try to get into comfortable positions where you can completely relax. Switch to eating lighter foods and keep drinking Call your midwife when: Your First Baby: WESTSIDE MIDWIVES at Jericho Village ♦ Camille Bush, RM, Kate Blake, RM, Carole Miceli, RM During the late night hours we kindly ask that you page us when: You are having contractions every 4 to 5 minutes apart (counting from the beginning of one contraction to the beginning of the next contraction). Your contractions are approximately 60 seconds long. You have been having these contractions for at least one hour in duration. You can no longer walk or talk through the contractions. Your Second, Third, Fourth…Baby: During the late night hours we kindly ask that you page us when: You are having contractions approx. 5 minutes apart. You have been having contractions for approx. one hour. You feel any rectal pressure or that the labour is progressing quickly. “What should I do if my water breaks?” If your water breaks at night, and you are NOT having contractions, put a pad on and go back to sleep. This is nature’s way of telling you that you will be going into labour within the next 24 hours! Call the midwife and let her know your water broke first thing in the morning. Page the midwife if your water is meconium stained (green or brown), has a foul odour, or if the baby is no longer moving.