Creating a Birth Plan - Part Three: Postpartum

Labor and delivery are over and you're now the proud parent of a beautiful baby boy or girl (maybe both!) - But, the planning doesn't stop there.  While you've delivered your child, the journey of giving birth is not quite over yet for you and your little one.

Your postpartum care will be, in part, determined by the manner of your delivery - this includes the type of facility (or home) that you give birth in.  For home deliveries, customization and comfort will be more readily available.  For hospital births, your options may be more limited because of standard procedures in place at your hospital's labor and delivery ward.  The important thing to remember, though, is that options STILL exist.  Plan ahead and know what to expect.

• Breastfeeding:  One of the most difficult aspects of my postpartum experience with my son was breastfeeding.  I had a lactation consultant assist me when I encountered trouble and even then I wasn't as successful as I hoped I'd be.  Prior to delivery, do your research - maybe even take a class about it.  Determine the lactation assistance available at your hospital or birthing center and know at what point you'd like to have help brought in.  You should also look into breast pumps, just in case those are necessary for your child to consume breast milk.  Research baby formulas if you do not plan, or are unable, to breastfeed.
• Pain Management:  It goes without saying that you'll be slightly uncomfortable (if not MORE than slightly) following the birth of your child - whether you give birth vaginally, via c-section, with or without medication.  Discuss your pain management options with your doctor and determine what you're comfortable with - acetaminophen, percoset, etc.  If you know that you'll be having a c-section, discuss what your wound care routine will be and the timeline of recovery.
• Hospital Stay:  For those of you giving birth in a hospital, be sure that you know what normal procedure is for hospital stays for all birth options - For vaginal unmedicated, many hospitals will plan for a discharge 24 hours following birth.  For vaginal deliveries with an epidural, it might be extended.  That extension will go even further with a c-section.  Plan ahead and know what to expect.  Perhaps there is flexibility and you can opt to get out of the hospital sooner.  Discuss these options with your doctor and pack your hospital bag accordingly.
• Nursery or In Room?:  This wasn't even an option for me, but it should still be discussed for hospital deliveries.  Once you've been moved to your recovery room, would you like your child to remain in your recovery room with you, or would you prefer that your baby be taken to the hospital's nursery?  If you'd prefer the nursery, would you like your baby brought to you for feedings or would you allow the hospital staff to bottle-feed?
• Baby's First Vaccination:  Controversial topic warning!  Another consideration for a hospital birth is when and whether you would like your baby's first vaccination administered.  A pediatrician will be monitoring your child while you are in recovery and during their rounds, in the United States at least, you will given the choice to have the Hepatitis B vaccination given.  Will you be following a traditional or an altered vaccine schedule for your child?
• Circumcision:  For those moms expecting little boys, there is the question of circumcision.  This can also be a contentious topic, so I will only say that you have the option as a parent to elect to have your son circumcised, or to not have them circumcised.  The decision is yours so be sure you know the method used at your hospital and what the care instructions would be should you elect to have the procedure done.
• Guests:  Another important consideration for your recovery is who you would like to come to the hospital to visit with you and your new baby.  It's important for those giving birth in a hospital to know their hospital's rules on visitors who are under-aged, and if those policies change during flu season.  Know what visiting hours you have available and plan accordingly.  I personally chose to limit my visitors to my sisters and my parents... the woman who shared a recovery room with me opted to have 1,000,000 people with her from the minute visiting hours started until the minute they ended.

Up Next!

Hopefully this gave you a few things to think about when considering your options for postpartum care.  Next I'll be discussing emergencies - the least fun part of this series.   However, I feel it's important to plan for everything - even if it means thinking about unplanned c-sections and NICU stays.

Creating a Birth Plan - Part Two: Delivery

Now that we've covered considerations for labor, it's time to think about the main event - Delivery!  Again, I don't want to exclude any birth options here - just give you a few things to think about.  If you have additional items on your birth plan regarding labor or delivery, please let me know in the comments - it's always great to hear from other moms.

• Positioning: During labor you may have used specific techniques to work your way through contractions - now that it's time to push, do you have a plan?  Would you like to squat, have assistance with leg support, stand up, be in a birthing tub, lay on your side, etc?  Be sure to share your preferences with the staff at your hospital/birthing center, or have the area ready well in advance if you've chosen a home birth.
  
  
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• Coaching: Are you going to "wing it" as you push, or are you going to have coaching support?  Following your body's natural instincts may seem a little scary, but I found that my body just took over once I began the final stages of labor - But what if you're not comfortable with that?  Perhaps you have a doula or you have developed a plan with your partner - regardless of your approach, let those around you be aware if you'd like to depend on them for guidance.
• How's it looking down there?  Would you like to watch as your child enters the world by aid of a mirror?  Do you want to keep your eyes as far from that experience as possible?  Some women enjoy the ability to watch as the baby crowns and then eventually makes it's way into the world - I wasn't one of those moms.  A good way to judge this is to either witness a birth in-person or watch a birthing video so that you know what to expect.
• Episiotomies and Tearing: I covered this last time as well, but it bears repeating - Have you thought about whether you would like to try alternatives like perineal massage before resorting to an episiotomy?  Would you rather tear naturally than have the incision?  Talk to your healthcare provider about their approach to tearing as well so that you're prepared for their advice during labor.
• The Big Moment:  Would you like yourself or your partner to pull the baby "up and out?"  Are you going to have the baby placed on your chest immediately after birth?  For C-Section moms, would you like to try for as much facial contact as possible once the baby is delivered - and will your partner follow the baby out of the operating room or stay with you?
• Cutting the Cord: This is both a question of "Who?" and "When?"  Would you like to cut the cord yourself or would you like your partner too?  Are you okay with immediately cutting the cord or would you like to delay this until the cord stops pulsating?  What about banking of cord blood - are you familiar with what that process is like and have you already paid to set up cord-blood banking?
• Placenta: When it comes to the delivery of your placenta, would you like to have spontaneous delivery?  Are you interested in viewing the placenta or retaining it?  Should your healthcare provider discard it?  It's become much more mainstream to consume your placenta after birth - are you aware of the options and the benefits? 
• Baby's First Exam: Often in hospital births the nursing staff will remove the baby to the other side of the delivery room to complete baby's first exam - Would you prefer that this process be completed while your baby is still on your chest?  If not, would like yourself or your partner present during the exam?  Also consider heel sticks - my son got one without my knowledge when he was born - be sure you're fully aware of everything that is happening to your baby!  If you are having a home birth, what is the plan if your care provider feels that your child needs medical attention?
• Post-Delivery Medications for Mom: Pitocin following delivery is common for the prevention of postpartum hemorrhage - would like this administered or would you prefer to skip it?  What about acetaminophen, percoset, stool softeners, or laxatives for pain relief following delivery?
  
• Post-Delivery Medications for Baby: Eye ointment is very common for babies, used to prevent blindness.  Vitamin K injections are also fairly common for bleeding prevention.  Do you have a preference for when these medications are administered?  Would you prefer that your child not receive one or the other?
• Bathing your newborn: Do you want your baby bathed after birth, or would you like to wait?  Do you know the benefits of vernix on your baby's skin and what a 24 hour absorption period can do for your child?

Next Up!

Postpartum, Emergencies, and Composing your Birth Plan are still to come in this series.  Keep updated on future posts by following or subscribing to The Cozy Life!

Creating a Birth Plan - Part One: Labor

Once Cozy Baby #2 became a reality, I was determined to develop a plan for my labor and delivery.  This has been such an important element of my pregnancy that I wanted to share the information with all of you!  With my first child, I had nothing planned - Zero.  This resulted in a stressful birth where I had no clue what was going on and how to answer even the most basic of questions.  I had known that a lot women had "birth plans," but I didn't even know where to start on creating one - I hope that this can help anyone going through a similar situation.

So WHY am I even bothering with this after successfully navigating an unmedicated birth last time without one - Surely I'm better prepared and know what to expect, right?  I don't think so.  First of all, I gave birth to my son six years ago - that's a long time and I've changed a lot since then.  Second, while I was overjoyed at having my son, labor and delivery wasn't a happy experience for me.  Third, I want to make the most of what will likely be my last time giving birth.

Also, just to clarify, this isn't a series that will push "natural birth versus medicated birth" - I support all birth options, even if you choose to go a different route than me.  What's important about giving birth is that YOU are comfortable with what's happening... and that changes from woman to woman.

So let's get started!

• Who?  This is an easy question for me, but might be a hard one for those with large families, or family members planning to fly in from out of town for the delivery - Are those family members expecting to be in the delivery room with you?  Do you WANT them in the delivery room with you?  Do you have older children that you want in the delivery room?  My hospital doesn't allow siblings under the age of 12 - Do you know the policies of your hospital or birthing center?
• Induction: What happens if your labor stalls, or if your labor just DOESN'T start at all?  Have  a plan in place for induction - Do you want to try natural approaches to inducing labor, or are you comfortable starting with medications like Pitocin?  Are you even aware of the natural methods available to you?  Do your research on things like homeopathic/herbal interventions, nipple stimulation, and even acupuncture.
• Hydration: IV's are typical in hospital labors - But what if you'd feel more comfortable eating and drinking during labor?  Talk with you healthcare provider about how they handle hydration during labor so that you know what to expect - and so that you can request alternatives if you aren't satisfied with their normal procedures.
• Contractions and Birth Aids: Have you taken birthing classes that taught you a specific method to "ride through" your contractions?  Do have a preferred approach to handling the pain of contractions - like breathing methods, a birthing ball (my personal favorite), a stool, specific positioning, etc?   Be sure you know how you want to approach your contractions so that the people around you can support you as you work through your labor.
• Monitoring the Baby: I mention this one because it was the MOST frustrating part of my labor experience with my son.  Do you know how your healthcare provider is planning to monitor your baby's heart rate and how often?  Are you comfortable with continuous external monitoring?  What about a scalp monitor?
• Medication: This is the BIG one.  Most conversations about the labor experience start with "medication or no medication?"  Definitely have this planned out - I didn't with my first and it was really confusing to feel pressure from healthcare staff and family to do one or the other without really knowing what I wanted.  Talk to your healthcare provider about the different medication options for pain, how they may impact the progression of your labor, will the medications effect your baby, and what (if any) is the recovery time associated with each option.  Epidurals aren't the only options out there, so educate yourself!
• Episiotomies and Tearing: This was another reality from my first labor - Have you thought about whether you would like to try alternatives like perineal massage before resorting to an episiotomy?  Would you rather tear naturally than have the incision?  Talk to your healthcare provider about their approach to tearing as well so that you're prepared for their advice during labor.
• The Unspeakables: Labor can come with some really unappealing experiences - like urinary catheters, enemas, etc.  Yuck, but sometimes a labor reality, depending on your healthcare provider.  Would you prefer to set the ground rules from the beginning that you don't want either?  Do you not care?  Do you even know when they might be needed?
• Atmosphere: Is the environment in the delivery room really important to you?  Maybe your birthing center has specific options available for lighting, music, and aromatherapy?  If you're giving birth at home, do you know how you want the room set-up?  If you're giving birth in the hospital, what options are available to limit noise? 
• C-Sections: Some women know going into labor that they are having a c-section - you've been advised against a VBAC, your child is deemed too large for vaginal delivery, health concerns, etc.  If you are one of those women, have a very long and detailed conversation with your healthcare provider on what to expect - Length of the procedure, what happens to the baby afterward, what the recovery time is like, etc.  Be educated - this is a major surgery and there is a lot that comes with it, despite the current culture that c-sections are "normal."

This is only the first post in my "Birth Plan Series" - this series will also cover Delivery, Postpartum, Emergencies, and Composing your Birth Plan.  This isn't, of course, going to include every possible consideration - but it'll hit the bigger topics and touch on alternative interventions.