How To Get the Birth You Want (for you and your baby)

Temerity Jane’s post today got my wheels turning about how to effectively get the experience you desire from your birth.  It’s a topic I’ve been meaning to write about for AGES.  Talking about it on twitter was not doing the topic any justice, as 140 characters were simply not enough for my wealth of knowledge thoughts, and I fear I was unintentionally coming off as a douche.  Worrying about your upcoming birth and delivery is ABSOLUTELY valid.  It’s a big deal, and a day that you will remember for the rest of your life.  Also, while modern medicine has its advantages, sometimes the laboring woman herself feels left out of the picture.

Any of you that have been reading here for a while probably realize that for the past 6-7 years (I lose track), I’ve been a birth doula and childbirth educator.  Every Monday night since Joan and Kate were wee, I’ve taught classes about labor, delivery, breastfeeding, etc.  I also give tours at our hospital.  And, of course, I spend time in said hospital whenever one of my clients is in labor.

I can only speak from my experiences here in Minnesota (though I’ve worked as a doula in at least 4 different hospitals, one being at Georgetown University in Maryland) (long, cool story there, for another time).  Keeping that in mind, here are a few guidelines for anyone looking to give birth (like, most of the internet) at a hospital anytime soon.

1.  Don’t be a “good patient.”  That’s right, just don’t.  Don’t worry about what the nurses think, or if they are talking about you in the hallway (they’re usually NOT), or if you’re being “that mom”.  Their job is to make sure that you and your baby reach delivery as a healthy duo, but their job is also to help you have a good experience.  It’s ok to be “annoying” and make them do their job.

(For the record, nearly ALL of the nurses I’ve worked with really DO want to give mom the experience she desires if possible.  I have not witnessed any catty “making fun of laboring mom’s CAH-razy requests” in the hallways.  Probably, if you are asking for something, you are not the first, or even the first THAT WEEK.)

1a.  Don’t stay with a doctor that you discover you don’t like. If, at any time during your pregnancy, you realize your views on birth are not compatible with your doctor’s, SWITCH providers.  It’s not too late, even late in pregnancy, and it will be SO WORTH it.  “Sticking it out” with a doctor that you no longer love or trust is not a good idea.

2.  Know what you want.  Your providers cannot give you what you want or need if you do not know what you want or need. Identifying what your strong desires are (and aren’t) is the first step in having those desires met.  (In TJ’s case, she’s not so worried about the birth as she is about the baby care afterward.  But she has very CLEAR ideas of what she wants for her baby, which is the first step in getting what she wants.)

3.  Tell your doctor.  Tell your nurse.  Tell your next nurse.  Tell the baby’s nurse.  Write it down, have a birth plan, discuss it in the office before the birth, ask to meet the baby’s doctor, etc.  Again, don’t worry about being “that mom” (see number 1).  They cannot meet your expectations if they don’t know what they are.  Also, for specific worries (like, “will my baby be given a pacifier without my permission?”), find out what the standard of care is.  You might be worrying about things that are unnecessary (“We don’t give babies paci’s.  If your baby needs a paci, you need to bring one with you to the hospital.”)  A hospital tour is a great way to figure out which of your concerns are valid and which you can safely lay to rest.  (Bring a list of questions.  You won’t remember them all once you get there if you don’t write them down.)

A good example of this is when I found out, after a 28 hour labor, that I had to have a C-section with my 3rd baby.  I strangely had peace about the surgery, but I had SPECIFIC DESIRES for my baby, so I asked (as they were prepping me for surgery) to speak to the baby’s nurse.  I requested that my baby not be bathed and dressed while I was in surgery and that her dad would hold her until I was ready.  I also didn’t want the meds in her eyes before her first feeding.  I WAS ok with them weighing her, because I knew as I was in surgery I’d be curious about her weight.  The nurse agreed that all of these things could be met, and they were.  Had I not asked, or had I not spoken directly to the baby’s nurse, or had I not been very specific, some of this might have been overlooked.

(Of course, there are times when a mother’s wishes cannot be met, which is frustrating and sad and can be really hard to get over later, when mom is still upset about her birth day.  From what I’ve experienced, however, as long as the request does not interfere with mom’s or baby’s health, the request will be honored.  It’s okay to be ADAMANT about your wishes if you are being told No.  Ask to speak to someone else, ask who makes the rule, ask, ask, ask.  They should be able to a) give you a reasonable, rational explanation for why they CAN’T do something or b) meet your request.)

4.  All of us are New Moms at some point.  It’s scary and intimidating.  And it’s frustrating when people chuckle at your thoughts about birth or baby care, making you feel like you are just so CUTE for thinking that way, you NEWBIE.  (Insert head-pat here.)  Even though  you’re a new mom, you DO have good instincts about yourself and your baby.  Trust them and listen to them.  The rest will come with time.  Whether this is your first or your sixth baby, it’s still YOUR baby and YOUR body and YOU know what’s best.  I promise, you do.

One final tip:  interview a doula* or the person(s) that teach childbirth classes in your hospital.  These women will have a really good idea of what exactly goes on in the labor and delivery unit.  They’ll be able to address your concerns and answer your questions, as well as give you some helpful tips for navigating your hospital experience.  They might even be more forthcoming with their answers since they won’t be talking to you within earshot of other L&D nurses.

*Of course, since I AM a doula, I’m all for hiring a doula.  We’re very familiar with the hospital setting and all the little quirks of The System, the doctors, etc.  We’re good at helping you get your questions or requests expressed.  We know the ins and outs.  And if having a doula is not for you, I think even just TALKING to one that is familiar with the hospital you’ll be delivering at is very helpful.  Most of the time doulas are not employed by the hospital (but contract privately with their clients), so they are not bound by “work politics” when telling you how things really go down at your hospital.

So many women– waaaaay too many– have a Bad Birth Experience.  I really wish that this was not true, but we all have read the surprising number of horror stories that exist out there.  And every hospital, every region of the country, every OB has a different standard of practice.  Studies show that if mom feels loved and nurtured on her delivery day– no matter what the outcome, or how close to her “birth plan” it went– she will remember the day fondly.  Having your desires respected and your wishes followed is VERY IMPORTANT in helping you feel nurtured, and therefore in helping you have a positive experience.

So, for those of you who’ve already walked the childbirth walk, what tips would you add to navigating the hospital experience?  (Please leave horror stories–  i.e.  my SIL’s mom’s neighbor– out for now.)

P.S.  Hands down, no question, THE best resource for new parents (or even experienced parents, for we didn’t use it until baby #3 and now have NO IDEA how we survived without it for the first two), is The Happiest Baby on the Block.  I think the DVD is better than the book, as you see Dr. Karp in action.  Seriously, rent/borrow/buy this DVD.  GENIUS information for how to help your crying baby that really works.

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17 thoughts on “How To Get the Birth You Want (for you and your baby)

  1. I advise seeing if you can go in and talk with the maternity nurses ahead of time, and ask how things are done and—if necessary—how to go about getting them done differently. The tour is good but is often standard (and often in a group, where I didn’t want to monopolize with my own specific questions), and it’s nicer to get things settled before you’re there to get down to the business of delivery.

    Plus, it’s nice if you find out ahead of time that a worrisome issue doesn’t in fact need to be worried about or DOES in fact need to be worried about: for example, at my hospital the nurses don’t feed babies (so no need for bassinet-labeling or panicking about possible formula-usage), but they also are extremely adamant about rooming-in (it would have been nice to know that beforehand, since all my books said things like “Let the baby go to the nursery so you can sleep!,” and then that option wasn’t readily available).

    • Yes! Good advice. At our hospital, when you preregister, you get a private (albeit standard) tour of L&D. Plus we give one to all of our couples that come to class (in a group, but it’s a group that’s been together for several weeks, so it’s not so awkward to ask questions.) But talking directly to the maternity ward nurses is also an EXCELLENT resource, and I bet they’d be really helpful.

  2. I LOVE this. And I love the TIMING of this! I knew a lot of it already, but it is so nice to see all this helpful advice written down in one place.

  3. Such good advice! I inadvertently spoke to someone before having my 1st … there was a lactation consultant across the hall from my OB’s office, so I thought I’d have an appointment with her prior to giving birth to talk about breastfeeding. She talked about SO MUCH MORE than breastfeeding and helped me formulate what was/wasn’t important to me. She also gave me her opinion of OB, which gave me confidence going into the Big Day. (“He’s almost like a midwife, but he’s a doctor.” PERFECT for me.)

    • YES! I should have added that! Speaking to a lactation nurse BEFORE you deliver (especially if you have any special circumstances, but in any case, really), is an EXCELLENT idea. I’ve found lactation nurses/lactation consultants to be ANGELS on earth. And they are so well-informed, nurturing, and HELPFUL.

  4. I am bookmarking this for if/when we ever have kids… (Because while I find all this FASCINATING, I really have no idea where to even BEGIN, planning-wise. Am guessing that happens once an expectant parent starts reading about it seriously?)

  5. I don’t have kids (and frankly am not sure I will want them), but I’m very curious about the process, and I want to feel prepared in case I change my mind (or have a surprise). Here’s a silly question. The local hospital has a birth list where you can check off things regarding the eye medicine, etc. Which leads me to believe that there must be some reason that moms don’t want that done, but of course the check list only gives you options and doesn’t tell you the pros and cons. Any recommendations for a site that lists the various birthing “choices” with reasons why you might or might not want them?

    • It’s been a long time since I’ve relied on websites for those types of questions, so there are possibly better options now. I’ve always relied on Askdrsears.com for getting the “other” side of these types of questions.

      The eye cream, for example, is in case mom has gonorrhea or chlamydia which can infect the baby’s eyes as s/he comes through the birth canal. However, all pregnant women are screened for these STD’s, so using eye ointment across the board is overkill and not necessary. And YET it’s “standard of care” in many (perhaps most/all) places.

      There’s so much to read up on while expecting!

  6. Your guidelines are so excellent and spot on. It is such an amazing time and so supercharged with emotions and so difficult to consider that we might not be in control of how things happen. As someone who has given birth twice, but been slightly obsessed about everything babies, pregnancy and birth forever – I can’t help but add my two cents.

    I switched doctors more than halfway through and it was the best thing I did. My new doctor was not perfect but had the amazing ability to make me feel calm, which I new would be great during delivery. Even so, after delivering two babies at the same hospital I realized that there are standards for the hospital and standards for each doctor and of course sometimes they are different. This is frustrating if your doctor isn’t there for your delivery.

    I was obsessed with birth plans. I spent hours reading them online and drafting my own. Sometime during my first pregnancy I realized I didn’t have control, couldn’t have control and gave up control of the whole situation. It was the best thing I did. I felt confirmation of this when talking to an OB nurse a few weeks after I delivered and telling her about it, then hearing her say that the moms with the elaborate birth plans are the ones with the most complications during delivery.

    Another thing I want to throw out there. I had daydreamed about having a home birth once up a time, but I would always panic at the thought of having something go wrong. The doctors and nurses are the ultimate experts and they almost always do what is best for the patient. After doing my own research I may have devised my own opinions about certain practices, but ultimately I am no expert. I do not have the experience and knowledge that comes from doing this hundreds and hundreds of times. If my doctor recommended something I went with it.

    It might be comforting to some to have a support person with you who knows your wishes and will make sure they are met for you. I think that was something that bothered me. I knew that I was going to be in no state of mind to communicate what I wanted while I was actually in labor. But if you know that someone else will, then you can relax. Maybe a doula would do this? (Not having a doula is probably my only regret.)

    And mostly for Temerity Jane, I too was worried about what would happen with the baby after the birth. All my worry was for nothing. Taking a tour will help ease your mind as will talking to other parents who have had babies at your hospital. Even better…talk to the lactation consultant before hand. Mine was a godsend.

    And lastly, I wish I had spent more time reading about babies than labor and delivery. Labor was long, but it ended. Babyhood lasted a lot longer. Dr. Karp is a genious but I wish *everyone* could know that if you have a “colicky” baby there may be no way to sooth them. That’s a whole different subject though. Maybe a new post idea for you Marie? Sorry this is so long.

    • I don’t have any personal experience with a truly colicky baby, so I’m afraid that wouldn’t be a good post topic for me. However, I think lots of babies are not truly colicky, but simply fussy babies and THAT’S where Dr. Karp comes in. In fact, my third baby wasn’t even a “fussy” baby, but his techniques STILL helped us. If someone has a fussy or colicky baby, I think it’s totally worth a shot to TRY Happiest Baby techniques… I think if all new parents saw that video, there’d me MANY FEWER babies labeled as “colicky” to begin with. And then, perhaps, the truly colicky babies could get the medical attention they deserve. (I feel like now, with so many babies being labeled with colic, that dr’s don’t take it seriously.)

      Anyway, thanks for you comment! And yes, the primary role of the doula is to know your wishes and help you communicate them in your labor. (As well as provide comfort measures during labor, of course.)

  7. This is a fantastic post, and very useful.

    And here’s where I throw in my two cents that I should probably keep to myself? Because I am NO EXPERT.

    My birth plan consisted of exactly this: No Birth Plan.

    I had three excellent child birth experiences. Partly this is because I had absolutely NO IDEAL in mind. I had nothing to compare to and be disappointed by. I realize that everyone is different, and this strategy TOTALLY WORKED for me (and Brett). And it worked all three times. All three births were very different (save for the fact that I was induced each time… stubborn cervix!), and not without various twists and complications. But I am sincerely happy about each one.

    I think so much of it has to do with perspective. And that’s not to trivialize truly horrible birth experiences, that of course unfortunately DO happen. But I think lots of us strive for some sort of perfection that we’ll never meet.

    There should be a wider middle-ground, where we are encouraged to take it seriously, to allow the experience to matter, but where we don’t set such high expectations that we perpetually set ourselves up for disappointment.

    • YES.

      I think for some women, having a “birth plan” gives them a false sense of control, as if they can actually PLAN how their labor and delivery will go. When events stray from The Plan, the woman is left feeling sad, disappointed, or like she “failed.” Which is why going into your delivery with a completely open mind is a good idea. However, I think some people do not know ENOUGH about their options– putting their trust completely on the doctor’s advice– and then LATER, as they do learn more, feel upset about how things happened.

      Actually, I think the answer is to have a midwife. I hear much less horror stories from patients of midwives, probably because midwives take so much more TIME at each appointment…

  8. Great post!

    My husband and I took our hospital’s tour and took a birthing class with a midwife who works closely with my OBGYN’s practice and with our hospital. Between those things, I had a high level of comfort about the hospital’s practice and knew everything from the types of epidurals they offered to the size of the birthing balls in the delivery rooms. It was comforting to know that I didn’t have to get all medieval on them about things I wanted, because the things I wanted turned out to be the defaults there (i.e., having the baby stay in our room overnight; having time with the baby to start breastfeeding immediately after delivery).

    We also hired a doula who had some experience with our hospital. I can’t go on enough about how awesome the doula was, in ways I didn’t expect. I would wholeheartedly recommend one to anyone giving birth.

  9. Also, this is kind of unrelated to the overall theme, but for anyone giving birth in a hospital: BRING YOUR OWN TOWELS (for yourself and your husband if he gets to stay over).

    Hospital towels are basically large napkins, and the first post-partum shower is not a time to be rubbing a scratchy, too-small piece of fabric on your body. I knew this ahead of time so packed a big bath sheet in my bag, but my husband didn’t think to bring one and was most dismayed.

  10. It never occurred to me before my first baby was born to ask about the hospital default policy on giving pacifiers or bottles to newborns. I was so worried about the birth, I didn’t even think of any of that after stuff. It turned out fine, but I like your advice on asking about those things during the hospital tour. I would also have asked my OBGYN and pediatrician about what times they would visit the hospital each day to check on the baby and me. It was weird not knowing.

  11. Marie, I have a four posts that I emailed to myself in the past few weeks that I keep meaning to comment on! I’m such a slacker, but this post finally got me off my arse (or phone.)

    Anyway.

    I wish so much that I would have been more assertive with my doctor when I was expecting my son. I wish that I would have had the nerve to switch doctors. I did end up having a very wonderful birth experience, though it wasn’t exactly what I’d wanted. These tips are SO GREAT.

    Also, Happiest Baby on the Block nearly saved my life in those early weeks and months.

  12. You know, I had such an excellent birth plan before my first baby, but then he was born 8 weeks early and spent the first 3 weeks of his life in the NICU. I had a great birth plan before my second baby, but then she was hopelessly tangled in her cord and needed a crash c-section. By my third, I thought I’d really do well and follow that plan, but my water broke at 23 weeks and I delivered a breech baby at 29 weeks by c-section.

    Plans are a really, really good idea, but I’d like to find a way to be OK with things when they don’t go the way one would expect.

    I am so glad that I was able to be a strong advocate for my babies when they were in the NICU and that I was able to work with the hospital staff to get the things that they needed.

    I would echo one of the previous commenters and say I wish I’d read more about babies and breastfeeding than Labor and Delivery. I was woefully unprepared when I brought my first baby home and really had no where to go for help, apart from my excellent doctor. That was hard on both of us!

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