Birth "Plan"

I have to admit that the idea of having a birth plan sounds a bit silly to me. Maybe it's part of the whole pregnancy-after-infertility mindset, but seriously, if the conception part didn't go according to plan, why would I assume the birth part will? But I do see the value in having some idea of what you would like to have happen, if for no other reason than to have an answer if/when you are asked whether or not you want to undergo a particular intervention. I want to be prepared for whatever might happen, so our approach thus far has been to learn about all the different possibilities and options. And when people have asked, I've been hesitant to say whether I want to do a medicated or non-medicated birth.

Does anyone ever truly know what they want until they are actually in the moment, experiencing it first-hand? I've had friends who were 100% convinced that they wanted X, Y, or Z and would not even consider the alternatives. And I've had other friends who were maybe on the fence about what they wanted, only to find out in the moment that they didn't really have a choice under the particular circumstances of their situation. But at the end of the day, does it really matter which path you end up taking, so long as everyone is safe and healthy once you reach the final destination?

All this to say, after attending our first baby class yesterday (called "Great Expectations"), Paul and I have come up with what we're calling our "Plan A (+ contingencies)."  Am I dead set on this plan? No. Could it change the closer we get to the due date? Of course. In fact, we're taking a second birth class in about a month that focuses more on the application of natural birth theory using a hands-on approach to learn about comfort measures during labor and delivery. We may walk away from that course with additional modifications to our "plan." Or nature may decide to step in earlier than anticipated and we may end up having very little choice in the matter. You just never know. But for now at least, our plan goes something like this:

Early Labor

• Stay home as long as possible. This will depend somewhat on where I am when I begin the process. Home is about an hour from the hospital, give or take. My work office, however, is on the same campus (less than 2 blocks away) from the hospital. Ideally, I want to be at home when I begin this phase, but if I am at work (or if traffic and/or the weather are looking bad) we'll have to adjust. 
• Stay active/distracted. This piece of advice came from yesterday's instructor. She actually advises patients to do whatever they can to keep moving and keep the focus off of any fear or pain for as long as possible (i.e. go for a walk around the neighborhood, go shopping, basically just stay out of bed). The reasoning for this is that if you are active when true labor has begun, you can actually help move the contractions along and ensure that you are progressing. She argued that the contractions are going to come, whether you want them to or not, so you might as well make them work for you and keep things moving in the right direction. Also, movement helps the baby get into position better, which in turn allows gravity to work for you. By being vertical rather than lying in bed, gravity will increase the pressure from the baby's head on the cervix, helping it to stretch and thin more efficiently (which can not only speed the entire process but might lead to less tearing - yay!).
• Eat small, energy-boosting snacks (nothing to crazy). They say that in the later stages, you won't want to eat (and most likely they won't let you anyway), so this is the time to do it. 

Active Labor

• This is ideally the point at which we would get to the hospital. 
• Stay out of bed and moving/changing positions as much as possible between contractions. I'm a bit of a pacer anyway (I pace when I'm on the phone) and I tend to rock a lot when standing (I take after my dad and aunt) so I think this might come somewhat naturally to me. And not that I've experienced anything like labor yet, but pain does make me restless.
• When one starts, find my "focus" and concentrate on breathing (I've really got to make it a point to do my yoga videos every day from here on out so I can work on the breathing!).
• Use whatever comfort measure techniques that we learn about in next month's class! I'll be relying on Paul a lot for this, but I'm not worried - he'll be a great birth coach/partner.

Transition Labor

• Umm... Pretty much my goal here is to just survive it and make it as short as possible.
• Paul's goal will be not to tell me when the next contraction is starting (as our instructor pointed out, we will know) but rather to tell me when I'm at the peak and the wave is starting to recede.

Drugs or No Drugs
Right now, we are leaning towards no drugs. Our reasons have nothing to do with thinking that drugs are evil (I work in cancer clinical research and I did IVF, so obviously drugs can be good), nor do I feel that I need to go the all-natural route so that I can prove something (to myself or others). It's just that after doing some reading and attending the class yesterday, we have come to a realization of what makes the most sense to us. Here's some stuff we've learned that has impacted our decision:

• Getting an epidural means being mostly restricted to the bed. You can still sit up and move around some in bed, but no more pacing the hallway or freely changing positions.
• The lack of movement can actually slow things down. Depending on your situation (how long you've been in labor, whether or not your water has broken), this can be a problem. You might still have contractions, but they might not be doing anything to dilate you further.
• Our hospital's protocol is to allow you 24 hours after your water has broken to deliver. Otherwise, the risk of infection (for the baby) goes up. If you are stalled or significantly slowed after receiving the epidural, they will intervene to keep things moving.
• The most common intervention to keep things moving is to give pitocin. This is a drug that I'm not interested in receiving (will have to post more on that later). And even then, it might not work or might not work fast enough. If things really aren't moving and you are nearing the 24-hour mark, you will have a c-section.
• Epidurals take away the pain, which is a good thing, but they can also mess with what your body is trying to tell you. It can be difficult to tell when to push because you don't get the "urge" that you would without the epidural. 
• If you are on an epidural and pitocin, the timing of the contractions and pushing during the delivery stage of labor is very different. Sans drugs, the contractions will be very powerful and intense, but there are longer breaks between them so you can get your breathing under control and save some of your strength for the next one. With the drugs, the contractions are much closer together so you don't really get any break.
• When they give you the epidural, they use large pieces of tegaderm and paper tape to keep everything in place on your back. I am allergic to the adhesive that is used in these. My adhesive allergy has gotten worse over the years - I can no longer wear bandaids and even hypo-allergenic stuff (like paper tape) will cause me to break out in hives if left on for too long (especially when there are other factors, such as in infection or say... stress from labor?). This is just one more reason for us to avoid the epidural unless it becomes absolutely necessary.

So, when might we consider adding drugs? Since we don't know how my labor will go or how I will handle it when it's time, we talked about when we would be open to adding drugs. We might consider it if:

• I've been laboring for over 16 hours and still have a ways to go.
• I'm over halfway dilated but still less than 8 cm and things are moving very slowly.
• If I've clearly lost control of my breathing/focus and am letting the contractions torture me instead of helping them help me.
• If I ask for an onion with whipped cream... Allow me to explain. Our instructor suggested we have a code word between us. If I'm asking for the drugs but not using the code word, Paul will tell them not to give me the drugs. If I use the code word once, still no drugs. If I use it again, then he can tell them that I'm truly ready for the drugs. Our code word is "onion" because an onion is something I hate and would never ask for unless I really meant it. If I ask for an onion and any of the above scenarios are true, then he can tell them to give me the drugs. If I ask for an onion with whipped cream, even if none of the above scenarios are true, then it means I'm really serious and he'd better find the people with the drugs ASAP because I dislike whipped cream almost as much as onions. So in other words, an onion with whipped cream is kind of the override phrase for the code word.

I realize this all sounds a bit silly, and I could be completely wrong about what is going to happen and how I will react. But like I said, we're calling this Plan A (+ contingencies) for a reason. There are many things that could alter this plan. There may be other factors involved that we haven't even considered yet. When you've never given birth before, you really don't know what to expect. But at least it is something. For now...