Why You Should Write a Birth Plan

Every now and again I come across a blog post or article about why birth plans need not be written. I've read birth can't be planned, making a plan just encourages disappointment, there's no benefit, choices can be made on the fly instead, and that birthing women are unqualified or even selfish to have preferences on how they will give birth. Silly women and their silly preferences!

Those arguments are all very short-sighted, miss the purpose of writing a plan, and don't place the woman at the center of birth. I think they're wrong.  I think you should consider writing a birth plan and that it can be an important part of preparing for birth.

Writing a birth plan isn't about planning your birth, it's about planning for birth.  

Birth Plan vs. Birth Preferences

First, let's get into some semantics.  I prefer to call birth plans birth preferences.  When I'm working with clients we talk about how to write a birth preference list.  The purpose and intentions are the same whether you're writing a plan or a preference list, but language is important.  It's true that you can't map out exactly how your birth will go, but you can always have preferences!

Considering Options

Your birth preference list or birth plan is an important tool for preparing for birth.  It helps you to think through your options, how would I prefer to handle discomfort during labor?  What position(s) might I prefer for birthing my baby?  How do I feel about standard newborn care procedures?  What happens in the event of a cesarean?  You might not have preferences on everything, but it's a good practice to think about what is important to you and then highlight those points on your list.

Preparing for Birth

Thinking through options and electing preferences on points that are important to you allows you to think about what you will experience.  How do I envision my early labor?  What will happen when I arrive at the hospital?  What happens after my baby is born?  Thinking through the process step-by-step allows you to research and ask questions ahead of time so that you're more educated going into the birth.  It also allows you to address any fears or concerns you may have. This allows you to feel more confident going into your birthing time.

Communication Tool

Your birth plan is a tool to help you communicate with your health care providers.  It conveys to them what kind of birth you're hoping to have and what is important to you during your birthing time.

Going over your preferences with your OB or midwife during a prenatal visit allows you to make sure everyone is on the same page.  This discussion provides your care provider an opportunity to voice their opinions on your preferences and gives you a better idea of what to expect during the birth.

If you're hoping for intermittent fetal monitoring and your OB is going to recommend continuous fetal monitoring, this is something you want to consider before you're actually in labor.  If you are envisioning birthing your baby in an upright position and your OB is going to ask you to get in the bed when you begin pushing you want to know this before you're working to birth your baby!

Likewise, if you are birthing in a hospital you can hand over a copy of your birth preferences to your nurse upon arrival.  Your nurse is not likely to be someone you will have met or chosen beforehand, but they're going to be a major player in your birth team!  You want to convey to them what your preferences are, how you envision your birth, and what you and your OB or midwife have discussed together ahead of time so your nurse can help support your wishes.

Labor Tool

If your health care providers understand the kind of birth that you're hoping to have they will take that into consideration with their actions and suggestions during your birthing time.

If your nurse knows that avoiding pain medication is very important to you they may suggest you utilize a tool such as a birth ball instead of offering an epidural.  If your OB knows that it's very important to you to keep your birth as quiet and intimate as possible they may not bring along the medical student who is shadowing them.

Your preference list provides your birth team with something to reference to remind them of your wishes. It's also helpful in the event of a shift change when a new nurse, OB, or midwife will be taking over your care, allowing them to quickly review your wishes.

Tool For A Positive Experience

People who are active participants in their birth, making choices that are right for them, have a more positive experience overall. You're not incapable of making decisions or communicating during your birthing time, but it simplifies things if there are as few surprises and major discussions as possible. Writing a birth plan helps with this.

During birth circumstances may change, preferences may change, you may have to make decisions on the fly; when it comes down to it you can't plan birth, but you can plan for birth.  You can prepare prenatally and go into your birthing time feeling informed, confident, and supported.

A thoughtfully written birth plan, utilized with purpose, can be a fantastic tool to help you prepare for birth so that once the time comes you can focus your energy and attention on what's important: birthing your baby and having a positive experience while doing so.

How to Become a Doula

Where did you go to doula school? 

I've been asked this several times now and the answer is: doula school doesn't exist.

Typically, what people mean when they ask this is how do you become a doula.  (Of course this is often asked after I've already answered the what is a doula? question.)

Because there is no national or state level certification, licensure, or standard for doulas there are many routes to becoming a doula.  I'm going to talk about how to become a professional doula because that's what I know.


Training

First, you need to be trained.  But I already have experience with birth, or maybe even supporting women in birth, you say.  If you're representing yourself as a doula and not just an experienced support person, you need to be properly trained.  There is always more to be learned and it's very important that you understand what exactly the role of a doula is if you're going to call yourself a doula.

There are many training organizations out there, some are complete distance learning, some have in-person components, some offer lifetime certifications, others have ongoing education requirements in order to maintain your credentials.  They're not all created equal.

If you're ready to be trained as a doula the best place to start is by exploring the various organizations that train and certify doulas to see which might be the best fit for you.  Here is a chart comparing several of the larger organizations.

I chose to train and certify with DONA International because they're one of the oldest, largest, and most well respected doula certifying bodies.  I very seriously considered pursing a distance learning program because I'm an enthusiastic self-learner, but luckily there was a DONA approved training offered locally in Columbus so I decided to go for the in-person workshop with DONA and I'm SO glad I did!  I love learning at my own quick pace, but I believe there are many benefits to attending an in-person training.  Workshop lengths vary based on the organization and trainer.  The workshop I attended was 4 full days.

After you attend the workshop you are knowledgeable about the basic technical aspects of how to be a doula as well as what your scope of practice is.  Some doulas stop here and practice as a trained, but not certified, doula.


Certification

In order to go on to obtain certification as a birth doula there are typically additional requirements beyond the initial training.  To become a DONA certified birth doula, once you have attend the training workshop there is additional required reading, childbirth and breastfeeding education components, attendance, documentation, and evaluations from care providers and clients at a minimum of 3 qualifying births, several essays, professional references, and several other miscellaneous items.

I never questioned whether I would certify, that was my plan from the start.  I'm a professional and it's important to me to be held to the highest standards and that my credentials reflect my skills and expertise, not only to clients, but also to other birth professionals.  The additional requirements to obtain and maintain certification help me to be a more knowledgeable and well rounded doula and hold me accountable to standards set forth not only by myself, but also my certifying organization.

In order to maintain my certified doula credential I have to meet a minimum continuing education requirement of 15 hours every 3 years to ensure that my skills are always growing and that I am staying current with birth practices.  Because I have to re-certify at regular intervals this challenges me to continuously grow as a professional and remain dedicated to my birthwork.

I completed my doula certification less than a year after I started my doula journey, but many doulas spend around 2 years working on their certification, some up to 4. My certified doula credential isn't just some letters after my name, it's an achievement I worked towards for quite a while, propelled by my desire to offer the highest quality and most professional services I can to the clients that I serve.

When searching for and interviewing doulas for your birth it's helpful to ask about their training, experience, and certification.  Ask any doula you may potentially hire why they chose to train with and/or certify with a particular organization.  It can help give you insight into their background as well as the standards that they uphold.



Additional Resources:

Birth Professionals of Central Ohio Classes & Specials

Top Ten Questions for Choosing a Doula Training

What It Means to be a Professional Birth Doula

TENS for Labor

I recently completed an advanced doula training with Sunday Tortelli to learn about TENS for labor. I love continuing education opportunities and I strive to be able to offer my clients a variety of options to help them have a more comfortable birth experience!

TENS, or transcutaneous electrical nerve stimulation, is a method by which electrical currents are used to stimulate nerves for pain relief purposes.  TENS units are commonly used by physical therapists, chiropractors, and for women in labor.  They are not currently in widespread use for labor purposes in the U.S., but are a popular tool in Canada, Australia, and parts of Europe.

TENS units work by sending mild electrical currents through the skin via electrode pads placed on the area of discomfort, for labor purposes they are placed on the lower back.  The person wearing the pads controls the level of stimulation and feels a light pulsing or vibrating sensation as the unit stimulates the muscles.  These sensations work to interrupt the nerve pathways, which  decreases pain, while increasing the body's own pleasurable hormonal response, endorphins, to help naturally ease discomfort.

Research shows that TENS units are most effective at relieving back labor, which is often challenging to manage, and many women who have experienced TENS in labor report that they would want to use the tool again for future births.

TENS is a safe option for relief of some types of labor pain and can be easily utilized or discontinued if necessary.  I'm excited to now offer this as a tool for labor!

Use Your BRAIN

One of the topics that I always discuss prenatally with my clients is the importance of making the choices that are right for them. I provide non-judgmental support and it's important to me that my clients understand that this is their birth and I am there to support them on their journey.

Birth is a complex process and what might be best in one situation may not be the best fit in another. That's why we can't talk in absolutes when it comes to birth, every birth is unique!

An important piece of feeling empowered during birth is being an active participant in any decision-making processes. My desire is for my clients to feel confident about the choices that they make during their birthing time and my role as a doula is to help them navigate their options, often by facilitating conversation with their health care providers, their doctors, midwives, or nurses.

Informed choice is important and you need knowledge about the options being presented in order to make a decision that you feel good about!  B.R.A.I.N. is an easily remembered acronym that helps formulate questions to ask your care provider in order to obtain necessary information to consent to, or refuse any intervention that may be suggested.


Benefits - What are the benefits of this procedure?  How will this help me/my baby/my labor?

Risks - What are the risks of this procedure?  How might this negatively impact me/my baby/my labor?

Alternatives - What are the alternatives to this procedure?  Are there other options available to me at this time?

Intuition - What are my instincts telling me about this situation?

Nothing - What if we do nothing at this time?  What if we need more time to make a decision?  What kind of timeframe are we dealing with for needing to make a decision? 


These questions can be asked in a variety of situations such as while exploring options for prenatal testing, methods of induction, or interventions that may arise during your birthing time ranging from something as routine as I.V. fluids upon admission or something more invasive like artificial rupture of membranes. There is usually time to discuss these questions with your care provider, if not, that's when having a care provider you trust becomes even more important because you want to know that they understand your hopes and wishes for this birth and that they are making any quick decisions with these desires in mind.

When we discuss informed choice/BRAIN prenatally it seems very simple, but if it needs to be utilized during your birthing time it's often less straightforward.  This is when it's helpful to have someone knowledgeable, like a doula, there to remind you of these questions and make sure that you have not only the information, but also the space that you need for you and your partner to make a choice about which you feel confident.

Family-Centered Cesarean

April is Cesarean Awareness Month.  Currently, about 1 in 3 births occur via cesarean in the U.S and cesareans are the most common surgical procedure worldwide.

As with any birth, when planning a cesarean birth you have options to explore and the right to consider what you want for your experience and your baby's birth.

Often, moms giving birth by cesarean feel they miss out on being an active participant in the birth, making decisions from a variety of choices like those presented as part of a vaginal birth. A surgical birth doesn't mean you're merely a passive participant.  This is your baby's birth, your body, and your birth experience and often you do have choices available to you.

Enter the family-centered cesarean.  Also called a gentle cesarean or natural cesarean, a family-centered cesarean is about recognizing that cesarean birth is birth and not just a medical procedure. It's about celebrating life and family and asking you what your hopes and desires are for the special moment when your baby enters this world.

When considering options for birth I think it's prudent for all families to consider what their preferences are regarding cesarean birth because you never know exactly what your journey to birth will be.

Some options you might consider for cesarean birth:

• In the event of a planned cesarean, wait for labor to begin on its own before birthing by cesarean.  

• Schedule for the earliest time slot available.  The birth is more likely to happen on schedule (or close to) and you will be asked not to eat after midnight the night before so you won't have to go all day without food.

• Discuss the procedure ahead of time.  Have your care provider walk you through what to expect, what type of closure they prefer and why, what your anesthesia options are, what kind of dressing they prefer and why, what pain medication will be available to you after the birth, will there be a support band offered during your recovery, etc.

• Your birth partner and/or doula, or other support person be allowed to support you emotionally throughout the birth including pre-op, the O.R., and recovery.

• Have your partner apply an essential oil or scented lotion that appeals to you on your chest, upper lip, wrists, or even their wrist for you to smell throughout the birth.  A good scent option is lavender.

• Dim surrounding lights to create a more relaxing atmosphere.  

• Play music out loud, an alternative might be to wear headphones.  

• Keep non-medically necessary chit-chat to a minimum among the medical staff.

• Place pulse oximeter on your foot to allow your hands to remain as free as possible. Place ECG leads somewhere other than your chest so it's free to receive baby after birth.

• Do not administer supplemental oxygen unless medically necessary

• Arms remain free of restraints

• Warm blanket be placed on you once pain medication has been administered.

• Have your doctor, nurse, or doula inform you of what is going on with the birth throughout.

• Lower the drape and slightly raise the head of the table so you can watch your baby coming into the world.  An alternative could be a clear drape or mirrors.

• Allow baby's birth to occur slowly with a more "hands off" approach.  Once baby's head is born they can begin to breathe while still attached to the placenta, allowing time for uterine contractions to squeeze fluid out of their lungs and auto-resuscitate similar to a vaginal birth.  

• Reach down and assist with helping baby from your womb.

• Take pictures, video tape the birth, and/or record your baby's first cries.  Ask that your birth photographer be present to document the birth.

• Allow baby's cord to stop pulsating before it is clamped and cut.  Ask that your partner be allowed to cut the cord.  

• Place baby skin-to-skin on your chest as soon as possible after birth.  Your partner can help support baby on your chest while your medical team is completing the surgery. If you are unable to be skin-to-skin ask that baby be placed skin-to-skin with your partner. 

• Swab baby with vaginal fluids to seed microbiome.

• You, your baby, your partner, and doula or other support person(s) transition to recovery together and baby is not separated from you after birth unless medically necessary.  In the event that baby must go to the nursery for medical need, ask that your partner be allowed to accompany them while your doula or another support person remains with you in recovery.  

• Warm blankets and plenty of pillows be made available to you in recovery.  

• Lactation support be made available to you in recovery so that baby may begin breastfeeding as soon as they are ready.  It's possible you may need some help getting baby situated and yourself comfortably supported to allow for this to happen.  

These are merely a list of options to consider.  There is no one right way to birth by cesarean just as there's no one right way to birth vaginally.  Any preferences will need to be discussed with your care provider ahead of time and then again immediately before the birth with the other care providers who will be involved, especially the anesthesiologist.  You can contact the hospital ahead of time to find out if they routinely offer family-centered cesareans.  And remember, you are a consumer.  If necessary and possible, feel confident in shopping around to find the right care provider and birth location for you.

Family-centered cesareans are gaining in popularity and accessibility with major media outlets reporting on the topic and hospitals beginning to implement some family-centered practices as standard for uncomplicated cesarean births.  Individual birth experiences can be so profoundly impacted when personal preferences are considered by a supportive birth team and family-centered births are the heart of positive experiences.

6 Tips for New Parents from a Doula

You're birthing time has come and gone.  You have an outside baby, congrats!

Now what?

After riding a birth high for a few days it's not uncommon to feel a little overwhelmed and intimidated once it really sinks in that you're now in charge of meeting the every need of another (tiny) human.

Parenthood is rewarding and challenging and amazing and demanding, all at the same time.  It can be particularly arduous navigating those first few weeks.

Here is my advice, as a birth professional and mother of two, for new parents.

Sleep When Baby Sleeps  

Yeah, yeah, I know.  This is the not the first time you've heard this advice and it's so much easier said than done, right?!

It's well known advice for a reason!  Let's just get this out there now: your normal sleep pattern is going to be interrupted with a newborn and you're going to be spending a whole lot of time and energy meeting their needs.  Make getting the rest you need a priority!

Try to sleep when baby sleeps.  Stay in bed in the morning (or even into the afternoon), leave your PJs on and go back to sleep after feeding and changing baby rather than getting up to start your day.  Take a nap rather than do the dishes, or worrying about laundry.

If you really can't sleep, at least do something relaxing while you have some free time.  Sit in a comfy chair and read a book.  Lay in bed and watch a rerun of your favorite TV show. Take a bath!  Whatever you can do to recharge and unwind a bit.

Let Baby Sleep Where They Want

While we're on the subject of sleep, let baby sleep where they want.  I know you lovingly planned and decorated the perfect nursery and you daydream of bringing your new bundle of joy home to sleep in the crib that you've painstakingly set up, but they very well may not want to sleep there early on.

Babies are biologically programmed to want to be near you all the time, including while they sleep. Some babies have a higher need for close proximity than others so if you and your baby are happy with them sleeping in their crib, great!  If they're not happy there, let them sleep where they are comfortable and happy so that you can sleep too!  Just make sure they're sleeping safely wherever they are doing it.

Just because baby will only sleep in a bassinet in your room, or in a swing, or in your bed right now, doesn't mean that's the only way they will sleep forever.  Just like everything else during the first year, sleep needs evolve quickly!

Accept Help From Loved Ones

See my statement above about ignoring household chores like dishes and laundry and instead focusing on recharging your batteries?  But I need clean coffee mugs and some fresh socks wouldn't hurt, you say.  Accept help from loved ones!

When your mother-in-law comes over to visit and asks if there's anything she can do to help, take her up on the offer!  Ask her to empty and reload your dishwasher.  When your friend calls to tell you she's stopping by after work for a quick baby snuggle ask her to pick up the milk and bread that you need from the store on her way.  When your brother comes to see you and baby use the time to take a shower and dry your hair rather than playing hostess, he will be more than happy to hold your baby for you while you do.  Spread the word that "cost of admission" to see the new baby is food. Not having to worry about getting food in your belly is priceless when you have a newborn!

Loved ones really do like to help you during this time of transition.  It allows them to feel like they're a part of things. Let them know what you really need and don't be shy about asking for, and accepting, help.

Know That It Won't Always Be This Way

After a few weeks, being trapped under a baby all the time might lose its luster. Nursing around the clock, changing yet another dirty diaper, operating on less sleep than you ever have, all challenging.  It can be hard to be needed so much.

Adjusting to being a parent and trying to figure out your new normal isn't easy... and it won't be like this forever.  Yes, having a newborn can be very demanding as well as filled with awesome, and they won't always need so much of you.

In fact, they probably won't need you like this in just a few weeks. Babies bellies quickly expand to hold more milk, they become more efficient nursers, your body heals and figures out the milk production thing, baby gets days and nights figured out and starts sleeping for longer, more predictable stretches, and you have a minute to catch your breath.  Things won't always be so intense!

Trust Your Instincts

Think you don't know what to do with a baby?  Think again.  Clear out all the social commentary (no, you can't spoil a baby!) and expectations about what you "should or shouldn't be" doing and really listen to your gut.

You're biologically programmed to respond to your baby's needs.  If something feels right, like holding your baby close, it probably is.  If something feels wrong, like not responding to your baby's cries, it probably is.  While caring for a newborn can be demanding on your time, it is relatively easy to meet their needs - keep them fed, warm, dry, and close and you've done your job.

Give Yourself Some Grace

You're new at this, you're figuring things out. If this is your first baby your life is probably going to change dramatically.  You know that your focus is going to shift once baby arrives, but nothing can truly prepare you for your world to start spinning on the axis of another person like it does once you're a parent.  Give yourself some grace as you're figuring out this whole parenthood thing.
This is still true for subsequent children, even if you're already a parent you're new to being a parent of two (three, four...) kids.

There's going to be a transition and you need patience with yourself during this time.

A Positive Birth Experience Isn't About How You Birth

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I have two children and neither birth was my ideal experience.

Both births were very similar on the surface, yet when describing the birth of my second child I use words like: healing. empowering. positive.

What changed?


My second birth was about more than just getting baby here safely, the journey was important as well.

I was more than just a vessel carrying the baby who was the main focus and priority.

My thoughts, feelings, and opinions mattered.

I was an active participant in my baby's birth, making choices I felt good about.

I had a supportive birth team whom I trusted.  Our relationship was built on a solid foundation of mutual respect.

We had common goals: healthy mom, healthy baby, positive experience.

Instead of finding myself a few hours postpartum, holding a newborn, feeling dazed and disheartened as I did with my first birth, I snuggled my second baby, feeling confident and satisfied.


What changed?

Support.  

Support for me as a woman.  Support for me as a mother.  Support for me as someone worthy of an opinion on what happens to my body and my baby.  That support is key.

Having your ideal birth is not required in order to have a positive experience.  A positive and satisfying birth experience has more to do with how you feel while you're birthing than how you birth.

My personal birth experience is a significant piece of why I became a doula.  I understand just how important is is to feel supported on your birthing journey. I want to support you in having your confident, empowered, and satisfying birth.