Birth Plans, Nurse's Perspective

This post is written with sympathy to all expectant mothers. Giving birth is beautiful, empowering, and certainly the most special day of your life. It seems, however, that many of you come to the hospital with certain expectations that I would like to analyze. These "rules" are sent to you with love from labor nurses everywhere, in the spirit of sisterly sharing. These guidelines apply to full-term labor and delivery, and only touch on key points. This should not be taken as any medical advice, but merely sister-sharing from someone who has been in the trenches! Here are recommendations from someone with 10 years of experience in Labor and Delivery, and three births of my own:

We can do it!  Image copied from http://copperkitten.files.wordpress.com/2010/06/motherhood_manifesto.jpg

1. The first rule of motherhood is to stay flexible, and it starts before birth. The goal of every childbirth from your health care provider's viewpoint is a SAFE and HEALTHY delivery for both mother and baby. THIS IS NOT NEGOTIABLE. Get your head around that for a second, because while you may want to use Lamaze or Bradley methods to labor and push out your baby it becomes a moot point if your baby is not tolerating labor (or if you have a necessity for induction of labor). Things change so quickly; we do our best to explain what's happening but we like to act quickly for your safety and your baby's.
2. If you have never pushed a human being out of your body but want an unmedicated labor and delivery, DO YOUR HOMEWORK. Practice the method of your choice all the time, make it second nature--do it on the toilet, or during lunch, or when you have your daily run of Braxton-Hicks contractions. Plan on doing it alone, because unless your baby-daddy is Mr. Awesome, he is going to need a break and you might end up breathing through many contractions alone. Get your focal point and use it early. If you tell the nurse not to offer you pain medication, don't blame her for following your wishes. And don't feel guilty if you change your mind.
3. Understand that labor is a MARATHON for most people, with a SPRINT at the very end when you are the most exhausted you have ever been. (And then after that you get to take care of a baby...more on that later).  We are going to be "coaching" you through every contraction during pushing, so don't hold back and give us all you can.
4. If you have medical conditions like preeclampsia, gestational diabetes, or other chronic pre-pregnancy conditions, please make room to accomodate them in your birth plan. It is likely that pitocin will change your mind about things, and so will magnesium sulfate. Refer to rule one. If you have preterm labor with an infant born and sent to Neonatal Intensive Care (NICU), we will encourage you to pump shortly after delivery, visit baby often, and will support your care of the baby as much as possible. Refer to rule one. This may be completely opposite of what you expected.
5. If you look up a birth plan to borrow from online, please pick only the five most essential options. If you pick more than five options, and you are very rigid, we will see you in the operating room. It's nothing personal, but Murphy's Law tends to dictate those cases more often than not. Again, see rules #1 and #2 above. Flexible and prepared. This mainly refers to the big things--pitocin, pain management, food, movement, etc. The little things like when and who cuts the cord are usually easy to accomodate in any birth.
6. You have been with your OB/GYN for some time now. It's your job to build a rapport, to understand their dictates and preferences, and to accept them as they apply to your own birth experience. We know your doctor quite well, and we will advocate for you as needed, but you have had 8 or so months to propose and agree upon a plan for this baby, while we just met you. If you don't trust your care provider-- get it worked out sooner rather than later! 
7. If you plan to breastfeed, have your OB/GYN take a look at your nipples. While this is very personal and private during pregnancy you can rely on the fact that some nurse is going to have her hands all over your boobs trying to get your baby to latch, and it's a lot easier if your nipples stick out. Wearing nipple shells during pregnancy can help. Rule 2: Prepared.
8. In the end, if you are healthy and your baby is healthy then MISSION ACCOMPLISHED. Do not look back and dissect how things went, you are somebody's Mother and that is no small thing! Get sleep while you can, enjoy your baby, and take good care of yourself.

With love, from a Labor Nurse.

ADDENDUM: #9 (recommended by a friend) If for some reason your labor is really fast, and you wanted an epidural but couldn't get one in time, quit complaining. You have been blessed, the pain is over now, and we are happy for the safe and healthy delivery on your behalf. There is no need to write a letter of complaint to the hospital blaming us, we have no control over your labor unless we are running pitocin...and even then, honestly, it could go in any direction.

ADDENDUM #10: Please stop scaring your friends, neighbors, sisters, and distant foreign relatives with your birth story. It is what it is, hold your baby and be glad. Save the drama for your husband, he should be the only one you are scaring with that story. There is no need to make a first time momma feel more frightened of labor and delivery than she already would normally be. With that being said, women do this every day and while it is a rite of passage, and sacred, be realistic. Tomorrow you have to get out of bed and start caring for yourself again no matter how you gave birth. Keep your perspective and get on with life.



(This blog will return to its usual topic at a later date).