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Right. So labor. It’s clearly on the brain. That, and milkshakes. Because a milkshake a day keeps the 9-month pregnant woman happy. As the saying goes.

James and I dusted off the birth plan we’d crafted for Addison’s arrival, and reviewed it with our midwives and doula. Given that I’ll be delivering in Vermont under the care of midwives, many of my requests are more than standard practice.

What a relief! Labor is challenging enough without having to fight the medical staff to pay attention to the requests you’ve made about your care. With Sunny’s birth, the nurse who primarily oversaw the labor process was terribly detrimental to the overall experience. She kept telling me that it didn’t have to be this hard, that most women didn’t do it this way (i.e. without pain medication). Her actions and words were clearly a part of what sent me spiraling into self-loathing and doubt toward the end.

Additionally, many of my requests were ignored and challenged without medical reason or need. I am still furious that the nurses, two hours after labor, took advantage of my exhausted, totally overwhelmed self and convinced me that Sunny needed to have deep suctioning, when she had been breathing normally and strongly for over two hours. My birth plan VERY CLEARLY stated that I did NOT want deep suctioning unless absolutely medically necessary. But they kept pushing and whispering and questioning my choice as a mother, so I caved in a moment of weakness when James was out of the room and my doula and doctor had gone home. I will not be so vulnerable or intimated this time around.

Similarly, I had to call my doctor from Doctor To You in the middle of labor so she could verbally tell the nurse to let me shower and take off the fetal heart monitor and contraction monitor. I was healthy. The baby was healthy. We didn’t need to be monitored through every damn contraction. But my written request to have minimal monitoring was not enough.

And finally, I didn’t want pitocin after birth unless I was showing signs of hemorrhaging. And yet, despite showing all signs of a totally healthy, normal constriction of the uterus, the nurses switched the IV of water that I’d had right before pushing to pitocin. I wasn’t even aware until the drip was nearly finished, as I was wrapped up in bonding with my infant.

Yet again, written requests TOTALLY ignored.

Talk about feeling taken advantage of and disempowered. Yuck.

Look, I understand better than anyone that birth is not something that I can control. There are going to be things on my birth plan that cannot be accommodated because, ultimately, I’m not driving the bus. My body and the baby are going to do what they’re going to do. Flexibility is key.  I don’t get to determine when I go into labor. My body and this baby do. It could be 2 minutes from now, or 2 weeks. It’s not for me to say. It’s not for me to say where or when. And it’s most certainly not for me to say how that process will then play out. (Note: There are plenty of women who schedule their C-sections and inductions. Their reasoning is their own, and it’s their bodies and their choices and I honestly do not begrudge any woman for the choices she makes on behalf of her body and baby. She knows her needs better than anyone. But for me, this is how I think about and approach labor and delivery.)

The birth plan is a guide. It is my attempt at educating myself about the birth process and determining my needs and comforts with all the possible variables. While I want as little medical intervention as possible in a process that is completely natural and that my body is more than equipped to handle, I am completely open to managing the situation in whatever way best gets me and that baby through the experience.

For instance, while my birth plan states that I do not want my water broken by medical staff (I want it to happen naturally), that was just not working with Sunny’s birth. After 10 hours of active labor, and four hours stuck at 6cm, and a bulging, unbroken bag of water to show for it, my doula and doctor suggested that the process may be stalled because of the bag. Was I open to having it broken for me?

HELL YES! I was on the verge of throwing in the towel and having them wheel me into the OR, so a more minor intervention like having a doctor break the amniotic sac was a brilliant suggestion.

It was also suggested that I was seriously dehydrated and that that might also be stalling the process. Was I willing to have them put in an IV of water? Again, YES! Anything to get us to 10 – just get me to 10 CM!

Lo and behold, two minor interventions later and I was at 10 cm, and less than 20 minutes later holding my baby in my arms. While I had not wanted these interventions under the best of circumstances, I found I ultimately needed them to help me get through the experience.

The difference between why I am not angry about those interventions but I am about the ones listed previously? I was a part of the decision with the former. I was an active participant in that decision making. And that kind of empowerment and agency makes all the difference.

So what does this document called a birth plan look like? I’ve had queries from friends and family and beyond, and I am more than willing to share. This is what works for me given the research and education I’ve done, and it in no way would work for every woman. Its goal is to allow for the birth process to play out as naturally as possible, trusting that the female body is designed to do what is best for mom and baby, and that, under the best of circumstances, I should not need any medical intervention or support.

It is flexible. It is a guide. It helps me feel some sense of control in an experience which is largely out of my hands.

I’ve made notes in red to help explain.

We know you’ve seen a million of these, and we’re sure that many are boring and excessive. But since this is our birth, it is very important to us, so please bear with us! We expect to be very pre-occupied with the birth of our baby and we may forget to show our appreciation for all your hard work. Given that birth is a team effort and we’re grateful to have you on our team, please accept this little token of appreciation in advance. Yes, we’ll be armed with homemade cookies for the medical staff.

We understand that our choices below may not be possible in an emergency. If there is anything below that is against hospital policy, we are happy to discuss it and sign a waiver, if necessary.

DURING LABOR & DELIVERY:

* We are hoping for an unmedicated birth, with as little intervention as possible, and hope to have a nurse who supports and believes in unmedicated births.

* I understand that the baby and I must be monitored, but I prefer it to be done as little as possible. According to ACOG standards is fine. I would also prefer to have limited vaginal checks. Only as needed. This includes allowing my bag to break naturally.

* I am not planning on using pain medication or an epidural. Please help me avoid them.

* I wish to eat lightly if I feel hungry. I wish to drink if I feel thirsty. (My midwives have approved this until I hit 5 cm. Given that I had no interest in food or drink during Sunny’s delivery, I am comfortable with this compromise. Given the physical exhaustion of labor, however, I like to have the option to eat while in labor in case I need a boost of energy).

* I prefer a hep lock (or saline lock) to an IV. This allows for easier physical movement during labor.

* I wish to labor in water, and potentially deliver in water, if a tub is available.

* Please allow me to push with my natural urges, at my own pace. I would like to avoid holding my breath and counting when pushing. I understand that the second stage takes a little longer this way so please be patient with me and the process. Also, I may want to push and deliver in alternative positions such as squatting, side lying, and hands and knees.

* If available and if I am in an appropriate position, I would like the support of a mirror during pushing. This was not something I had requested with Sunny, but my OB demanded it when I started to pull back and doubt my ability to deliver her. It helped immensely to see the progress I was making.

* Please help me avoid an episiotomy! Please offer hot compresses and gentle perineal massage to help avoid tearing.

* I would like to avoid instrumental delivery.

* We wish to delay clamping and cutting the umbilical cord until it stops pulsing.

* I would prefer to not have routine Pitocin after birth, unless necessary.

* If a cesarean delivery becomes necessary, please allow my husband to be with me throughout the entire surgery and recovery.

AFTER THE BABY IS BORN:

* Barring complications, please place the baby directly on my abdomen (skin to skin) after the birth. I would like at least two hours with our baby undisturbed to bond and breastfeed.

* Do not perform routine deep suctioning on the baby unless medically necessary. This is not done at the hospital in VT unless the baby is not breathing. WHEW!

* Please do not administer the erythromycin treatment for the baby’s eyes until she has breastfed for the first time after birth. Since the treatment temporarily blinds the baby, I want her to first have the opportunity to breastfeed with the advantages of sight before the treatment.

* Please give our baby the vitamin K shot while breastfeeding. This is to make the shot less jarring for the new baby.

* Our baby is to be exclusively breastfed- please do not give any artificial nipples

* We would like to bathe our baby ourselves.

* We do not want our baby to go to the nursery at all. If the baby must be taken to the nursery, my partner will accompany the baby at all times

I’ll have reports as to how much of this was possible in the coming weeks. *Fingers crossed*