Birth Plan: HypnoBirthing

This was originally written on Wednesday, March 05, 2008:

Here is my birth plan, finally! For those who aren't familiar with this concept, during your pregnancy it is important to figure out what you want and don't want during childbirth. Studies have shown that childbirth goes better for women (and their babies) who do this, opposed to those who go into it blindly and just let the doctors direct the experience. Hospital staff prefer to have a hard copy of your birth plan, so Joe & I recently wrote out ours.

For my first trimester I was completely clueless as to what I wanted (just the thought of labor made me cringe, so it wasn't something I wanted to ever think about), but as time went on (and I realized that childbirth was going to happen whether I thought about it or not) and the more research I did, the easier it was to figure out my ideal scenerio.

Note that last part--because that's what a birth plan is--your ideal, not necessarily what is going to end up happening. It is important for women to not get caught up in "this is how it has to be"--it is not a success/fail type of situation. You have not failed if you find that life doesn't allow you to follow your birth plan. A person with the opposite birth experience is not more of a success. You're there to deliver a baby, not to stress yourself out with curve balls that might be thrown at you. You can't predict every possible scenerio, nor can you know what you're going to do in every situation. No matter what your story ends up being, it will be special to you and unique. At the end of the day all that matters is that your baby is safe, and once you bring them home you won't think or care about your labor!

Since being pregnant, I've heard a hundred stories, but not one is similar to someone else's. So there's obviously no way of me knowing exactly what my experience will be like. My particular labor is not something I can completely prepare for, but having a birth plan gives me a goal to shoot for, a path to try and follow, and something to focus on while I'm in the moment. For a lot of women, it does end up going as planned, so I hope that things go smoothly and that it can be that way for me. Either way, I've learned some great tips that can work throughout motherhood and life.

It all started when a friend of mine from high school and college had her first child in 2005. I was in awe that she not only had a completely natural vaginal childbirth (no medication, no epidural) but that she said the labor wasn't bad at all. How could that be possible? My entire life all I've heard is how bad the pain is; on TV women are screaming during the birth, etc. But she had nothing negative to say about the experience. I thought she must be a rare exception.

Her next child was born in 2007 the same way--just a day after I found out I was pregnant. When I revealed my news to her a few weeks later, she recommended the book HypnoBirthing: The Mongan Method by Marie F. Mongan, M.Ed., M.Hy. She insisted that she wasn't "lucky" or "special," but that this method could work for anyone.I was definitely interested in giving it a shot. My worst fear since I was a little girl is being paralyzed. The thought of having an epidural stuck into my spine and not being able to feel from my waist down is scarier to me than any pain! (And, although very slim, there is a chance of error that could lead to permanent paralysis.)

Plus, it is no secret that epidurals slow down labor (the purpose of contractions are to push the baby out--when a woman can't feel "down there," she misses a lot of cues and her cervix may stop dilating and the baby may stop moving), so labor is often dragged out/longer for women with an epidural, which means more need for pitocin (because epidurals completely cut off the flow of natural oxytocin)--but pitocin causes more pain than the natural oxytocin (what causes contractions). . .thus, a cycle.

There is also an increased likelihood of bladder catheterization, internal monitoring, and operative (i.e. forceps, episiotomy, cesarean) delivery.

According to the internet, other reported side effects include:

Dural puncture
Hypotension (29%)
Nausea, vomiting, shivering (frequent)
Uneven, incomplete or nonexsistent pain relief
Feelings of emotional detachment
Respiratory insufficiency or paralysis
Convulsions
Toxic drug reactions
Slight to severe headache
Septic meningitis
Allergic shock
Cardiac arrest
Maternal death

Long term for the mother:

Neurological complications
Backache (weeks to years)
Postpartum feelings of regret, loss of autonomy
Fecal and urinary incontinence or bladder dysfunction (inability to urinate)
Paresthesia ("pins and needles")
Loss of perineal sensation and sexual function

For the baby:

Direct drug toxicity
Fetal distress, abnormal FHR (can lead to emergency cesarean)
Drownsiness at birth, poor sucking reflex
Maternal fever (impeded thermoregulation from numb skin) leads to fetal hyperthermia and neonatal
NICU workup (spinal tap, etc.)
Poor muscle strength and tone in the first hours
Neonatal jaundice
Decreased maternal-infant bonding, behavioral problems
Hyperactivity up to seven years

Economic:

Increased costs (all epidural patients)

After hearing stories from women I know who did experience plenty of these, it just seemed that in a world where you can't avoid many negative things, I might as well avoid what I can--i.e. the epidural. Especially since another "ideal" for me is to not have a C-section, and as stated above, they've been linked to epidurals.

A Cesarean section, or C-section, is the delivery of a baby through a surgical incision in the mother's abdomen and uterus. It is a major abdominal surgery, so it is riskier than a vaginal delivery. Moms who have C-sections are more likely to have an infection, excessive bleeding, blood clots, more postpartum pain, a longer hospital stay, and a significantly longer recovery. Injuries to the bladder or bowel can occur. Also, a mother is not able to hold her child immediately after birth--she has to wait until she has been returned to her post partum room.

This is what my friend Kendra said after her VBAC (when comparing her cesarean and vaginal birth--she, too, had a natural labor without drugs):

Why I Loved my VBAC: The SMALL Stuff!

1. I ate lunch IMMEDIATELY after I delivered my daughter (Isabelle). I believe I was munching on my rib sandwich while I was being stitched.

2. I am able to pick up my toddler daughter with no restrictions.

3. My husband can never complain about getting hit in the genitals again (not like it happens frequently). I have him beat!

4. I have an ongoing excuse for taking long whirlpool baths 2 or 3 times a day.

5. I was able to quickly leave the hospital and get some REAL sleep.

6. I have no numb areas (I was numb around my abdomen for months after my cesarean)

7. People who know nothing about VBACs look at me like I have achieved some unbelievable feat.

8. I can compare vaginal birthing stories AND cesarean birthing stories with other moms. I love being versatile!

9. NO CATHETER!

10. Did I mention: NO CATHETER!?

As Kendra said, after a Cesarean delivery, you'll be dealing with a sore belly for quite a while. C-section patients typically stay three or four days in the hospital (opposed to one or two) before going home.

You'll either get a shot of pain medication every three to four hours or you'll use a system called "patient-controlled analgesia": You push a button when you're feeling discomfort and medication is delivered through your IV.

You may feel groggy and possibly nauseated right after surgery. Nausea can last up to 48 hours. Many moms also feel itchy all over, particularly those who received narcotics in their epidural or spinal.

You may feel numbness and soreness at the incision site, and the scar will be slightly raised, puffy, and darker than your natural skin tone. Sneezing, coughing, and other actions that exert pressure on the abdominal area can be painful at first.

If everything's okay, your doctor will remove your IV and urinary catheter, usually within 12 hours of surgery, and you'll be able to start eating when you feel like it.

You might have some gas pain and bloating during the first two days. Gas tends to build up because the intestines are sluggish after surgery.

In three to four days, your doctor will probably remove your sutures or staples. After that, if all's well, you'll be sent home.

Expect to need help — and lots of it — once you get home. Don't expect to toss your pain medication as soon as you get home. You may need prescription pain killers for up to a week after surgery, gradually transitioning to over-the-counter pain relievers. (If you're breastfeeding, don't take aspirin or drugs containing acetylsalicylic acid.)

Drink plenty of fluid so you don't become constipated. Your incision will continue to be tender for several weeks.

While it's essential to get plenty of rest once you're home, you also need to get up and walk around regularly. Walking promotes healing and helps prevent complications such as blood clots, but don't overdo it. Start slowly and increase your activity gradually. Since you're recovering from major abdominal surgery, your abs will feel sore for some time. Take it easy and avoid lifting anything heavier than your baby for eight weeks.

In six to eight weeks you'll be able to start exercising moderately — but wait until your caregiver gives you the go-ahead. It may be several months before you're back to your former fit self. You'll be able to resume sexual intercourse in four to six weeks if you're feeling comfortable enough, with your caregiver's okay.

I think by now you can see why I don't want a C-section. (Before Joe knew all about it, he thought that concept sounded better.)

Unfortunately, though, sometimes it's clear that a woman will need a Cesarean even before she goes into labor. Conditions that may require a planned C-section include:

• You've had a previous Cesarean with a "classical" vertical uterine incision or more than one previous C-section. (If you've had only one previous C-section with a horizontal incision, you may be a good candidate for a vaginal birth after Cesarean, or VBAC.)

• You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).

• You're carrying more than one baby. (Some twins can be delivered vaginally, but all higher-order multiples require a C-section.)

• Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

• Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)

• You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

• The baby has a known illness or abnormality that would make a vaginal birth risky.

Conditions that may cause an unplanned Cesarean delivery:

• Your cervix stops dilating or your baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven't worked.

• Your baby's heart rate gives your practitioner cause for concern, and she decides that your baby can't withstand continued labor or induction.

• The umbilical cord slips through your cervix (a prolapsed cord). If that happens, your baby needs to be delivered immediately because a prolapsed cord can cut off his oxygen supply.

• Your placenta starts to separate from your uterine wall (placental abruption), which means your baby won't get enough oxygen unless he's delivered right away.

According to the September issue of Mothering magazine, in 2005 30.2 percent of the nation's births were by Caesarean. That's the highest rate ever recorded. The World Health Organization says that any time a country's Cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the lifesaving benefits it is supposed to provide. But it doesn't seem to matter that, in the U.S.:

1) A woman is five to seven times more likely to die from a Cesarean delivery than from a vaginal delivery.
2) A woman having a repeat C-section is twice as likely to die during delivery
3) Twice as many women require rehospitalization after a C-section than after a vaginal birth
4) Having a C-section means higher rates of infertility, ectopic pregnancy, and potentially severe placental problems in future pregnancies.
5) Babies born after an elective Cesarean delivery (when labor has not yet begun) are four times more likely to develop persistent pulmonary hypertension, a potentially life-threatening condition.
6) Between one and two babies of every hundred delivered by C-section will be accidentally cut during the surgery.

So then why so many Caesareans? Doctors are making the decisions based on fear of malpractice suits rather than medical necessity. But biologically, birth is a normal life process that is more likely to go well on its own, with little or no intervention. Women in comas have given birth undetected! Animals give birth easily, without screaming!

Instead of everyone being scared of birth-related morbidity, why aren't women and their doctors concerned of the chemicals that are dripped into their spines and veins--the same substances that have been shown to lead to more C-sections? Why aren't they worried about the harm those drugs might be doing to the future health of their children, as studies are now beginning to indicate is the case? Why aren't they afraid of picking up drug-resistant Staphylococcus infections in the hospital? And why, aren't women terrified of being cut open?

Because we've put more faith into science and technology than in allowing natural processes to carry on. Nature is to be feared, technology to be trusted.

That didn't logically make sense to me. But I knew from my experience with off-the-chart menstrual cramps that not having an epidural might be easier said than done. On the other hand, I've been told that the type of cramps I personally experience when having my period are similar to labor pains, and therefore I might be so used to them that I have a higher tolerance for pain. But imagine this: what if you don't have to suffer horribly without an epidural and can also reduce the need for a C-section? What if you can be 100% present and actually enjoy the experience as pleasant? That's what HypnoBirthing is all about.

On the East and West coasts this method is becoming more and more popular, which means in several years we should all be hearing about it in the Midwest, haha. In places like New Hampshire, where it originated, there are hospitals designed to help pregnant women throughout their pregnancies to prepare for this type of childbirth. For those who aren't that lucky to be able to deliver in a Hypnobirthing hospital, the book does a good job of teaching us the techniques, and there is a CD that comes with it.

Its main message is that we have programmed ourselves with the wrong message. For centuries we've set ourselves up to fear childbirth like none other. But, according to page three of the book, when fear is not present, pain is not present. Fear causes the arteries leading to the uterus to constrict and become tense, creating pain. In the absence of fear, the muscles relax and become pliable, and the cervix is able to naturally thin and open as the body pulsates rhythmically and expels the baby with ease.

Thousands of couples who have followed HypnoBirthing swear that this is true. After learning to embrace the body's innate knowledge of birthing, relaxing into the birthing process, and working with body and baby, a woman trusts that each knows how to do its job. In doing this, she also eliminates fatigue and shortens her birthing time.

HypnoBirthing is about women reclaiming their right to call upon their natural birthing instincts. It helps you to frame a positive expectation and to prepare for birth by developing a trust and belief in your birthing body and in nature's undeniable orchestration of birthing. By teaching you the basic physiology of birth and explaining the adverse effect that fear has upon the chemical and physiological responses of your body, you learn simple, self-conditioning techniques that will easily bring you into the optimal state of relaxation you will use doing birthing. The four basic HypnoBirthing techniques are: Breathing, Relaxation, Visualization, Deepening. (These are good to use in any stressful situation, throughout the rest of our lives!)

And, no, this doesn't go against the Bible. Scholars have found that there was never an actual curse placed exclusively upon Eve. In Genesis, God uses the very same wording in speaking to Adam as to Eve. The translators, though, influenced by the terrible conditions surrounding birth at the time, chose to translate the dictum delivered to Eve differently. So even church has falesly programmed us to think that childbirth is supposed to be horrible!

According to page 40, with our modern knowledge, we understand more clearly how fear of complication and resulting in death, not fear of birthing, caused women to look upon labor with horror. Extreme fear created extreme tension, and the tension, in turn, resulted in a taut cervix, unable to perform its natural function. Those who lived through the ordeal, as well as those who witnessed it, attested to the agony that was experienced in birthing.

Deaths in hospitals were the result of lack of sanitation and exposure to the contagion of illnesses of other patients, rather than complication or the danger of birthing. Nevertheless, deaths occurred, and the fear of death became even more strongly associated with giving birth.

It wasn't until the mid-nineteen-seventies that it was discovered that a source of natural analgesic lies within the body itself. American researchers discovered that opiate molecules, locking onto special receptor sites of neurons in the central nervous system, slowed down the firing rate of the neurons. They found that if they decreased the firing rate of the neurons, it resulted in a decrease in the sensation of pain. A state of calm was the missing ingredient that made the decrease possible. Endorphins--neuropeptides in the brain and pituitary gland--have an effect 200 times that of morphine. Endorphins produce a tranquil, amnesiac condition.

This was reassuring for me to read because I also didn't like the idea of any other medication during labor, either. It is a myth that the drugs they give don't cross the placenta to the baby. The placenta has no barrier.

The well-respected Physicians' Desk Reference clearly states that at this time there are no adequate and well-controlled studies for the use of these drugs with pregnant women. The PDR also points out that it is still not known whether these drugs can cause fetal harm when administered to laboring women.

Even pills, or any of the injected drugs used to take the edge off, can supress a laboring mom's efforts to work with her body's surges, as HypnoBirthing moms are trained to do. These narcotics can cause reduced muscle tone and prolong labor. Because of the numbing effects of drugs, the laboring woman is less aware of her surges and may not be able to efficiently assist in working with them to facilitate opening.

Fetology experts are now saying that the disorientation that a baby experiences when his mother has accepted drugs can result in disconnection between mother and baby and cause a long-term feeling of abadonment on the part of the baby. Studies have shown that babies whose mothers were medicated lacked the ability to crawl to the breast and were unable to suckle even with assistance. As long as indications point to a healthy, strong baby and you are in no dnger, be willing to protect your baby from the assault of drugs.

There may come a time when all accomodations to your wishes has been extended, but for some reason, your baby is not weathering it well. In such an instance, it may be determined that your birthing needs medical assistance. In this kind of situation, you will find that your relaxed HypnoBirthing attitude and techniques can still help you through whatever turn your birthing may take. Understanding the need for medical intervention and, along with your birth companion, being a part of the decision-making team will help you accede to whatever preparations need to be made. You will remain calm and in control of your circumstances.

So, to sum it up, Joe and I will be requesting that there be no medication administered, no epidural, and hopefully no pitocin or episiotomy.

As my HypnoBirthing book says, The more nature is able to take its course, the less likely you are to need an episiotomy. The thick rim of the perineum needs to gradually thin and unfold through each surge by natural pressure of the baby's head until, at last, it folds open fully to allow the baby's head to pass through. Tears in the skin can be avoided if the mother has practiced perineal massage and there are no rushed, violent pushes.

I would like L.J. placed immediately on my chest for skin-to-skin contact (it has been known to help with bonding, plus it is the most natural thing, as all mothers' body heat adjusts to the needs of her newborn!), some extra time before they put ointment in his eyes (an anti-biotic given to all babies since they are sensitive to germs for the first time), no hepititus B shot (as stated in one of my prior blogs, completely unncessary if the mother isn't sleeping around or using drugs), and Joe doesn't want to cut the umbilical cord--so the doctor can do that when it has stopped pulsating. (When it is prematurely cut, it abruptly cuts off the flow of blood to the baby, depriving him of that source of oxygen and of the many nutrients that will affect his health for a lifetime.) Finally, L.J. will be circumsized, although there is no medical reason to do so nowdays (it's our aesthetic preference).

The best part about all of this, is that I am actually looking forward to labor now, rather than dreading it. I will let you know how it goes!

UPDATE: You can read Logan's birth story here.