Optimum Birth—The Options Involved
Table 1.1 presents a list of options in which many women have shown an interest. Not all of these options will be appropriate for you. If any of them are important to you, but your caregiver doesn’t seem welling to accommodate your desires, encourage him to discuss his reasoning. If, following the discussion, you are still not comfortable with his response, you have the option of seeking care elsewhere. Be sure to let your original caregiver know your reasons if you make this decision.
The options in Table 1.1 are divided into four categories—pregnancy, labor, delivery, and postpartum. They are geared to the low-risk woman having a normal, uncomplicated labor and birth. Read the list and check those options that are important to you. Add any other options that you may desire. This list will be your birth plan. Take it with you when choosing or consulting with your doctor or midwife. A list of cesarean options is also provided, in Table 1.2.
After you and your caregiver have agreed on your birth plan, make several copies of it. Keep one copy with your record, give one to your labor partner, and give one to the nursing staff when you check into the hospital. You might want to have your doctor or midwife sign or initial all the copies of your birth plan to indicate his or her agreement with your desires.
▣▣ Note that this table is better viewed on tablet screens or computer monitors. It may be deformed on smartphone screens. ▣▣
Option | Reasoning |
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DURING PREGNANCY | |
Optimum nutrition | The No-Risk Pregnancy Diet can reduce the danger of complications for you and your baby to the lowest possible level. See Chapter [3]. |
Supportive caregiver willing to be flexible in your labor and delivery choices, including birth place (hospital or birth center) |
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Consumer-oriented childbirth classes | Consumer-oriented classes inform you about all the available options rather than just the routine of a particular hospital or doctor. They enable you to make educated decisions about what options you want for your childbirth experience, plus provide you with thorough training for labor and delivery. |
No smoking, taking drugs, or consuming alcohol | These have been shown by experts to have adverse effects on the baby. See Chapter [3]. |
No routine use of ultrasound during pregnancy | Routine screening of all women is not recommended by the National Institutes of Health or the American College of Obstetricians and Gynecologists. See Chapter [2]. |
DURING LABOR | |
Presence of a support person during the admission procedures, examinations, labor, and birth. |
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Presence of other family members or friends during labor and/or delivery. |
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Enema only if needed | An enema is unnecessary if you had a good bowel movement within 24 hours. A soapsuds enema can be very uncomfortable. However, if you have been constipated, you may desire an enema; a small disposable enema will suffice. See Chapter [6]. |
Freedom to move about and to assume a position of comfort. |
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Laboring in water | Laboring in a tub or shower enhances relaxation and decreases the need for pain medication. See Chapter [7]. |
Liquid nourishment and high-carbohydrate, low-fat snacks as desired. | Foods that are high in carbohydrates and low in fat are digested quickly and supply energy that will be needed during labor. Liquids prevent dehydration. See Chapter [6]. |
Ice chips, sips of water or clear juice, or Popsicles. | Your mouth can become very dry when you do the breathing patterns. See Chapter [6]. |
Personal items (for example, nightgown, music or flowers) | Familiar articles can enhance your birth experience by encouraging relaxation and comfort. See Chapter [6]. |
Prep (shaving of the pubic hair) only if desired | Shaving of the pubic hair does not decrease the incidence of infection, and the regrowth of the hair is uncomfortable. See Chapter [6]. |
Intravenous (IV) fluids only if medically indicated |
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Electronic fetal monitor only if medically indicated |
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Spontaneous rupture of the membranes |
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Medication administered only wen requested by you and with full information regarding the possible effects on you, the baby, and the labor. | All medication has the potential to affect you, your baby, and your labor. Knowledge of the benefits and risks of the medications your caregiver uses most often will enable you to make informed decisions. See Chapter [7]. |
Presence of a professional labor support (childbirth instructor, registered nurse, trained doula, licensed massage therapist, or midwife not associated with the hospital or birth center) |
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Pitocin to induce or augment labor only if medically indicated |
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DURING DELIVERY | |
Comfortable and efficient pushing and delivery position |
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No use of stirrups | The lithotomy position, in which you lie on your back with your feet in stirrups, works against gravity and forces you to push the baby uphill. Wide stirrups, while giving the caregiver a good field of vision, cause the perineum to be stretched taut and increase the need for an episiotomy (a small incision in the vaginal outlet to enlarge the opening). See Chapter [5]. |
Episiotomy only if needed |
• An episiotomy shortens the pushing stage. It may be necessary if fetal distress is detected and a faster delivery or the use of forceps is required. Many doctors do an episiotomy routinely, whether or not it is needed. |
Use of a birthing room or the same bed for labor and delivery | This avoids the stress and discomfort of being rushed to a delivery room during the expulsion stage and of then being awkwardly moved onto a delivery table. Most hospitals do provide birthing rooms for labor and delivery. See Chapter [6]. |
Regional anesthesia only if medical or surgical intervention becomes necessary |
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Leboyer delivery (gentle birth) | Gentle birth is an attitude as well as a procedure. It decreases the sensory and physical trauma to the infant as he is delivered. See Chapter [8]. |
Cutting the cord delayed until the pulsating stops | The delay allows the baby to continue receiving oxygen through the cord while his respiratory system begins to function. See Chapter [6]. |
Father cutting the umbilical cord | This increases his participation in the birth. See Chapter [6]. |
Collection of cord blood for banking | Collection of cord blood for donation or for storage for your own personal use may provide lifesaving benefits. See Chapter [6]. |
Baby placed immediately on your bare abdomen or in your arms |
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Baby allowed to breastfeed as soon as possible |
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Antibiotic ointment or sliver nitrate drops delayed until after bonding | These can interfere with the baby’s vision, which is so important during the bonding period. See Chapter [6]. |
Placenta allowed to detach spontaneously from the wall of the uterus | Strong traction or massaging may cause placental tissue to be retained, which can cause postpartum bleeding. See Chapter [6]. |
Bonding | The first hours after birth are very important in the development of maternal and paternal attachment to the newborn. See Chapter [6]. |
Taking snapshots or making a tape | These are wonderful ways to remember these unforgettable moments. |
POSTPARTUM | |
Breastfeeding |
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No separation of mother and baby unless medically indicated | Continuous mother-baby contact enhances bonding. It also increases the opportunity for the nurse to provide baby-care instruction. The initial bath can be given in the mother’s room. See Chapter [6]. |
No supplements (water or formula) or pacifiers if breastfeeding |
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Full 24-hour rooming-in |
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Father staying in the room with the mother until discharge |
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Sibling visitation with mother and baby |
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Circumcision Is strongly recommended |
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Discharge from the hospital within 24 hours after birth |
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