Birth Planning in 4 Easy Steps

“Birth has a mind of its own, so what’s the point of writing a plan for one?”

The simple answer is birth planning means discussion, research & getting everyone on the same page, which is important if you want to be supported well.
When I work with my clients, we talk about common scenarios that can arise, both welcomed and ones you wish to avoid. These common scenarios are the most likely culprits to change your birth plan late in the game. This opens up lines of communication with your birth team and gives mother’s the time to begin deciding what their favoured options are now rather than feel overwhelmed if you haven’t considered it until labour. That way you can be flexible and convinced of the right thing to do for you and your baby.

So what are some of these possibilities & how can you easily navigate the research and your choices now? I have summarised a few for you here & listed questions you can start thinking about to help you create the best birth plan there is.

Going past your Estimated Due Date

As you get closer to the 41/42 mark your caregiver will usually broach the topic of induction due to “Prolonged Pregnancy.” According to Australian Clinical Practice Guidelines a pregnancy is prolonged from 41+6 weeks and yet many women are being induced earlier than this without any other complication. That means, that is a likely scenario that you may face so it’s good to start thinking about what you feel comfortable with. The reason your hospital or caregiver is recommending induction prior to 42 weeks is because there is a jump in risk from a woman who is 40 weeks pregnant compared to 42 weeks.

Your options are:
– wait until your baby is ready to be born, regardless of how long that takes
– decide to wait until a certain time period and then discuss induction if you are still pregnant by that chosen time.
– agree to your induction on the date made available/recommended by the hospital.
– plan to initiate natural induction therapies ahead of time (homeopathics, sex, dates, acupuncture, acupressure)

What should I start thinking about?
The 2019 Mother’s & Babies Report stated that in Australia 34.7% are being induced. I ask my mother’s to think about whether they believe majority of these parents included in the statistic would have had something bad happen to them or their baby without induction? Considering this question allows you to put into perspective how you feel about the actual risks when you begin doing your own research. Other questions to consider include, what are the risks (percentage) of prolonged pregnancy past (40/41/42 weeks)? What are the advantages of induction for prolonged pregnancy for mother & baby? What are the benefits of waiting for spontaneous labour compared to induction (eg; intensity, cascade of intervention).

When your water breaks but no contractions have started

This is a really common occurrence in full term women & is termed PROM (Premature Rupture of Membranes). According to RANZCOG (Royal Australian & NZ College of OB’s & Gynecologist’s), 70% of women will start spontaneous labour within 24 hours, while 85-95% of women will start a spontaneous labour within 96 hours. Usually each hospital will work differently and it also depends on how busy they are, but if your contractions do not start within 12-24 hours your caregiver will recommend starting you on an induction drip. You are also advised to take antibiotics due to a risk of infection now that the baby is not confined to it’s bag.

Your options are:
– wait until labour starts on the likely possibility of labour beginning in it’s own time, also known as expectant management
– start using alternative therapies to encourage your contractions (homeopathics, acupressure, acupuncture, breast stimulation)
– agree to augmentation (induction) when recommended by your caregiver.

What should I start thinking about?
What are the actual infection (percentage) risks associated with PROM? What increases these risks? eg; sex, cervical examinations, water immersion. Based on what I have researched on induction, do I feel that the benefit of augmentation outweighs the risk for me personally?

When your water breaks and there is Meconium

“Meconium Staining” is babies first poo that is released in their waters prior to birth. ‘Mec’ is comprised of all the stuff in your babies belly that has been with him or her since conception. Ideally, when baby is born they will have their first brown, tar like, sticky poo into their nappy. Although sometimes it can before this, and appear in your amniotic fluid that baby still sits in. The concern your hospital or caregiver may have is a small worry that baby will inhale the sticky fluid and then have a hard time breathing when they’re born. This is called MAS (Meconium Aspiration Syndrome). It is an extremely rare complication – around 2-5% of the 15-20% of babies with meconium stained liquor will develop MAS (Unsworth & Vause 2010). Due to this risk you will be asked to start induction if you’re not in active labour. You most likely won’t be able to birth in water & continuous monitoring will often be suggested. A paed will be in the room for your birth too. The reason they want to speed your labour is because the longer your baby is in the womb, then the more time they have to ingest the mec.

What are my options?
– decline induction and labour as you normally would.
– agree to induction if you labour has not started or decide on a timeframe for how long you are willing to wait for labour to begin.

What should I start thinking about?
I always remind women that many women’s water’s don’t break until close to birth or during labour. Sometimes we don’t even have time to assess whether there is mec in their waters because they are in the water labouring or the waters are only released before baby is born. How do we handle that situation because who knows how long the poo has been there for? We treat them like any other woman with a low complicated pregnancy. This helps to put things into perspective when researching the likelihood of MAS.

When it’s time to take the Group Strep B test

Group B Streptococcus is a bacteria that naturally occurs in the bowel, bladder and vagina in small quantities and is not considered a health concern outside of pregnancy. The bacteria can appear as quickly as it disappears and can affect a newborn baby in 1-2% of women that carry GBS at time of birth. The test is a vaginal or rectal swab, which is usually conducted by the woman between 35-37 weeks of pregnancy in most hospitals. You can test positive in pregnancy & be negative by birth. If you are positive for Group Strep B then you are usually asked to take antibiotics during labour every four hours. This may also mean you are induced if your waters break early & some hospitals don’t like a woman to labour in water.

Your options are:
– decline the test
– take the test and if positive, decline antibiotics during labour and have the midwives monitor your baby to look for any infection signs.
– Take antibiotics during labour as recommended

What should I start thinking about?
Interestingly, you can test negative at the time of the test and be positive at the time of labour because the bacteria is transient. So there will be women out there who are not offered antibiotics when they normally would be & women who are given antibiotics when they no longer need it. So, once again it helps to realise that a large number of GBS positive women are going unnoticed and yet we don’t have reported surges of ill babies. More questions you can consider are, what are the pros/cons of antibiotics to a newborn and mother? What is the percentage of risk to my baby if I am GBS positive & decline antibiotics? What are the warning signs of a baby negatively impacted by GBS? How is my baby treated if they are ill from GBS?

Final Thoughts

Hopefully after reading you can see how your birth plan can be flexible. Many believe that a woman who rocks up to hospital and has her wish list on paper is someone who is not prepared for changes. This is not true when you work with me because when you correctly prepare for birth you have planned for changes & this help you to embrace them if the need arises!

As your doula I help you to consider other possibilities & explain what each eventuality can look like. On the day, I’m whispering in your ear (or dad’s) if I need too as I anticipate possible conversations the midwives or OB’s will have you with. My aim to is to alleviate the stress and also help remind you draw on the information we have discussed in your pregnancy. Not to mention all the practical and comfort measures we discuss as well as when to call me & how we get through early to active labour. Enjoy your research & check out some of the online resources & recommended reading below to find reliable information to start you off.

My hope for you is at the end of your pregnancy journey you can be prepared & confident to follow the twists and turns of labour and birth based on the information you already have viewed!

Evidence Based Birth
Midwife Thinking Blog
Mama Natural

Gentle Birth, Gentle Mothering – Dr Sarah J Buckley
The Down to Earth Birth Book – Jenny Blyth
The Natural Way to Better Birth & Bonding – F Naish & J Roberts

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