Sunday, October 06, 2013

birth plan

Birth Plan

What is a birth plan?
Birth plan is a document that you draft to express your ideas and expectations for your labour and delivery. Birth plan is a way of communication with the doctor and nurses who car for you in labour. In the birth plan, you have to describe about what type of labour that you would like to have, what would like to have and things to avoid throughout the labour.

In order to write a birth, you will to get as much information as possible. Do some research, read some books, talk to the ladies who had already given birth at the same hospital and doctor as you are, attend ante-natal classes and not forgetting, your husband (if you wish to have him by your side). What is the point of you writing a birth plan not knowing what you are requesting? 

In short, birthplan is made with careful consideration, knowledge of optionsm attention priorities and preparation to back them up. Our role is to tap into her inner strength and resources and to carefully listen to her body's cues during labour and birth.



After much discussions with Mr. Afif, we decided on these points 
  1. Birthing Position
  2. To be free when I admitted myself to the hospital
  3. No drugs to be offered 
  4. Minimal vaginal examination
  5. No episiotomy
  6. Delay Cord Clamping
From these points, we developed a little bit longer birth plan. Alhamdulillah, we handed it to Dr. Fidak, she agreed to almost all the points we requested except for 2. So, thumbs up!


Maybe you are wondering, why the birth plan? Why going through the trouble writing it down?

Oh well, first of all, I want to remember my first birthing experience(I want it to be drug-free labour). Next, I want the best for my little munchkin (again, no drug to be used). I want the doctor and nurses to listen to my requests since I am the one who will be delivering my little munchkin (We do have the rights! and no surrendering myself). I want it to be as natural as possible, our bodies know better, a mother's instinct knows better, Allah SWT created our bodies perfectly to deliver a baby  (no medical intervention since doctors are there to be the life guard and not playing God!). Moreover, giving birth is a natural process of life. 

Maybe, I could explain more why we put forward those 6 points:

Birthing position 

Normally, we see in movies, pregnant ladies gave birth by laying down,flat on their backs, correct? But, this position is the worst position and yet, it is still practiced in hospital. The idea of clamping your legs and not being able to move are just in my opinion, cruel. When you are flat on you back, your uterus compresses against the major veins in our bodies (even doctors suggested us to stay off our backs and lie on our left but why during labour?) which compromises blood flow and may make your contraction less effective

The baby is coming out from our vagina which is situated lower than our uterus. Ever thought of gravity? Remember how the apple fell from the tree to the ground what was found by sir Isaac Newton. Why don't we apply the same concept during the labour? When we are upright, isn't it easier for the baby to go down? rather than going horizontal? 

Maybe this image explains better than me.

There a number of suggested positions and I have seen videos on Youtube where mothers gave birth in these positions :

  • squatting
  • kneeling (like cats, dogs all 4-legged animals)
  • standing 
  • sitting either on a birthing stool, toilet 


Our second point is to be free when I admitted myself to the hospital. This being said, I would like:
  • to be able to walk around - to shorten the labour
  • to eat - to have enough energy during active labour phase
  • to hydrate myself -no drips, IV
  • to have intermittent rather than continuous and strapped on in order to monitor the baby's heart rate - when we are strapped on, our position will be on our back and the major veins are compressed and no oxygen will be transferred to our baby. So, most cases I heard, the baby will be distressed which leads to C-sect. 
  • to change my birthing position as I pleased according to my comfort level and to ease my labour sensation
No drugs to be offered during labour. This applies to all type of drugs - induction (to artificially induce childbirth), any sort of pain killers (epidural, laughing gas, narcotics etc..). I put forward in our birth plan, to use natural oxytocin (love hormone) stimulation. The goal of this hormone is to bring contractions (contraction has its own rhythm) that dilate your cervix in a timely way and help the baby descend. If pitocin (artificial oxytocin) is injected into our bodies, the rhythm of our contractions will become abnormally long, too frequent and strong and this could stress our baby. In most cases, when this is introduced, we are prone to ask for pain relief drugs and most of them, lead to C-sect. So, the conclusion is, when one drug is being offered and introduced in our system, the cascade of events will happen (from induction to epidural to c-sect) and this is what I am trying to avoid, dependent towards drugs. 

What is vaginal examination? Basically, this is done by inserting two fingers in you vagina in order to check the dilation of the cervix (Refer the image below). I have had heard from a few mothers and read on forums, this procedure hurts and painful. It is not the pain that I am afraid of. What I am concern is when this procedure is done (usually during the last few weeks of pre-natal check ups) and my water has not been broken, it will lead to premature membrane rupture (water broke) when it is not ready. 


However, once I am in labour and my water has broken, I would like it to be done at the very minimal counts (at least, once every 4 hours or less!). The reason being I would like to minimize any sort of infection (although it is done with a pair of gloves) and more towards psychologically. When you are in labour, the dilation should be 1cm per hour. If your dilation is not increasing like it is said to be, won't you be very worried and effect how you feel and your hormones?


But why the dilation is not increasing? different people has different rate of dilating and can not be compared to others. Dilation does not happen in a straight line of progress. During early labour, cervical dilation tends to happen very slowly. Sometimes you will stuck at that particular reading for hours and you have reached a plateau. Obviously, you will feel discouraged at this point. During active labour, this is when the dilation will go much more quickly. You can refer to various type of Friedman's Labour curve showing different types of curves.



Episiotomy is a surgical cut in the muscular area between the vagina and the anus (this are is called the perineum) made just before delivery to enlarge your vaginal opening. It is done routinely to speed delivery and prevent from tearing especially for first vaginal delivery. It is said that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. 

It is said various studies have shown, there is no good evidence that episiotomy offers your vaginal tissue and pelvic floor muscles any real protection and this procedure may cause problem. For this reason, the American Congress of Obstetricians and Gynecologist now agree that this procedure should not be done routinely.  So, thumbs up for no episiotomy! 

My fellow mothers who had no episiotomy said that their tearing healed faster than for those who had it. It is easier to handle after the delivery. You can even prevent or minimalised our perineum from being torn. Some suggested methods to soften our perineal area, more elastic are
  • consume virgin coconut oil  (I started doing this at the early of my pregnancy mainly because of my immunity level. I fell sick easily and at least, I would be on medical leave once a month)
  • perineal massage from week 34 onwards

I choose to delay clamping the cord because it will transfer the between 80 to 100 milliliter blood to our baby. It happens only up to a few minutes after the birth. Why waste it? WHO recommends to cut the cord after one to three minutes after baby is born. By doing it, the chances of having anemia (this risk is reduced by half, after a few days of being born), iron deficiency is low (0.6% vs 5.7%). The iron that is being stored will become the baby's main source of iron till he starts on solid food. The iron will form red blood cells and transport oxygen, to build muscle and to develop his brain cells. However, jaundice seems to be slightly increased but by delaying cord clamping, it does not need further treatment and does not cause long term damage. I have a friend who delayed the cord clamping for 45 minutes and alhamdulillah, her baby did not have any jaundice. Thus, this does not prove that delaying cord clamping causes jaundice. 

By delaying clamping the cord also, it will help us to expel the placenta instead of having synthetic oxytocin in our system. This is done by not clamping the cord and wait till there is no pulsation. This is known as physiological third stage because right after the baby is born, the baby is brought directly to mother's chest for a skin-to-skin session. The baby will search for the breast and at the same time, mothers will released her own oxytocin - contracting the uterus and expelling the placenta. See, how Allah created our body? no need for external medical intervention. Our bodies know how to do it!

Always put your trust in Allah, our creator

Disclaimar : This is our personal birth plan after much studying and attending classes. Different people different opinion. 

*Information gathered from The American College of Obstetricians & Gyneacologists,  World Health Organization (WHO), Babycenter,  Medical News Today

6 comments:

ainsuffian said...

Aslm, sis Dhirah.. am blogwalking on gentle birthing and found your blog.

Nak tahu, now ni kan Ain checkup with Dr Fatima at KJMC. So macam mana prosedur if let say Ain nak tukar kpd Dr Fidaak kt TMC? I am covered by AIA,fyi.

Hope to hear from you soon. Thank you!

Ain (ainsuffian@gmail.com)

Dhirah Abdullah said...

Wsalam Ain,

Actually senang je. I did not show up for my appointment with Dr. Fatima and set up an appointment with Dr. Fidak kt TMC. Mase 1st visit, bawa skali the blood test yang Ain dh buat kt KJMC (if dah buat la).
Takde special procedure actually. :)
Hope this helps.

Dhirah

ainsuffian said...

Great.. thanks Dhirah!

BTW, kat TMC diorg nyer appointment ada yg after office hour x?

note : blood test dah buat, this thursday baru amik resultnye =)

Dhirah Abdullah said...

you are welcomed :) ada after office hour, monday ptg 5pm-830pm. :)u dah bape minggu?

ainsuffian said...

Hi Dhirah..

me this week 22 weeks.. ehe =)

ainsuffian said...

Salam, Dhirah..
If you don't mind, can u share ur birth preference with me?

my email : ainsuffian@gmail.com

oh! btw, time berapa bulan dhirah handover the BP to Dr Fidak?