My Pregnancy Bucket List
I've seen so many things online about how much women treasure their first pregnancy - make memory albums, take photos, record every single little milestone. The joke goes that the more pregnancies the have the less you, and others, care about the pregnancy journey.
My experience has been the complete opposite. For Judah, I have probably less than ten photos of me pregnant with him. I had more, but they were taken on my wedding day (and therefore I haven't kept them). I definitely think I took my first pregnancy for granted and I'm not really sure why. Maybe because I wasn't a birth worker then. I do remember not wanting a fuss or to draw attention to myself, possibly because I was conscious of how young I looked.
When my marriage ended I had to face the hard reality that more children would be out of the question for me, perhaps for years. I had wanted another since Judah's first birthday. As my life was falling apart around me, as I was losing my home and my security, those I had been pregnant with the first time around were announcing their second pregnancies. I work with mothers and babies which was emotionally tough as I tried to make my peace with this. I donated all of Judah's clothes and baby equipment to charity and resigned myself to being a mother of one.
Then, this baby. I did not expect them to announce their arrival in my life just as my divorce was being finalised. This year has been one of the hardest years of my life but this baby has been a strong, shining focus point to make me keep going. I have made a conscious effort to celebrate every week, to do the things I never even thought to do the first time, being conscious now when I wasn't before that this could be the last time I get to do this. Having lost everything before, I take nothing for granted now. I have cherished this pregnancy. I am so so grateful to be able to have another child.
So bringing you my pregnancy "bucket list" which I just completed!
1.) Take a weekly photo
It has been incredible to watch the weekly changes in my body, and also to see myself softening around my face (my favourite part of pregnancy!)
2.) Do a proper announcement
We chose to decline ultrasound which meant we had to get creative!
3.) Have bump henna done
Thank you to the fantastic Zoe (Instagram: hennabyzoe) for doing this design for me. I had seen mothers with them in birth photography before and was in awe of how beautiful they were. The design lasted about two weeks and made me feel beautiful!
4.) Have a mother blessing
Probably better known as a "hippy baby shower". We ate cake and drank tea and blessed and energised the birth space, talked about motherhood and bound ourselves with red cord around the wrist that we can only cut off when baby has arrived safely.
I wouldn't have had the confidence to do something like this first time around, and I didn't have the amazing women in my life then that I do now.
5.) Do a belly cast
The kit was from Amazon and was really easy to do and good fun too :)
6.) Paint my belly
My partner did this for his first baby and it was so much fun - just face paint that washed off but a nice way to celebrate the pregnancy just shy of 39 weeks.
7.) Have maternity photos done
How amazing is Helen?
I absolutely adore these photos and will treasure them forever.
8.) Hire a doula
Couldn't justify the cost first time around but know the true value now. What better advertisement could there be than a doula hiring a doula?
We Never See (Undisturbed) Birth
Once thing that the natural childbirth movement has for it is science. Did you know that only 12% of guidelines in maternity services are formed from grade-A evidence? Everything else is grade B, C or D or just what is done as standard. I am obsessed with evidence. I am a huge nerd for peer-reviewed studies. I'm the one saying "Do you KNOW what percentage that risk is? How else can you make an informed choice?" emailing articles late into the night to people trying to make a decision.
For example, I know that as a low-risk second-time mother the safest place for me to be is at home and far away from any maternity unit or hospital. Simply change the place of birth and you can see the interventions such as epidural, episiotomy, assisted delivery, caesarean section climb up. I am the same person. Place of birth matters and yet home birth is still considered risky and brave? I beg to differ.
I cannot do my job without this evidence. I cannot support women to make the best choices for them without it. And yet...
My hero, Ina May Gaskin. Ina May runs her own birth center in the United States and believes that a woman who is emotionally supported in her labour rarely needs intervention. She keeps her own evidence and statistics of her births. I love her and I believe in her work with all my heart. I KNOW that is the way birth is meant to be. She began with little to no knowledge and built it up through experience.
Dr Tadashi Yoshimura, author of "Joyous Childbirth Changes the World" speaks of his disdain for evidence. He is an obstetrician who had a change of heart in the way he supported women and now runs a birth center. He asserts that all statistics are based on disturbed, medicalised birth and are NOT accurate for his birth practice. He and Ina May both report caesarean section figures of around 3%... coincidentally the same percentage as women who are physiologically unable to breastfeed.
I agree with him. I believe in him.
How can I love evidence-based decision making and yet love these two pioneers of undisturbed, uncomplicated birth? I read Yoshimura's book with frustration as I said to myself "How lovely for you in a peaceful birth centre in Japan - how is your opinion relevant to those of us working with women, consultants and midwives in South Wales? Undisturbed birth doesn't exist here. We need the evidence to navigate choice and negotiate care in less than ideal circumstances."
I came to the conclusion that they are my Utopia. In my dreams every woman gives birth with an Ina May or Yoshimura. When there is no fear of birth, no intimidating appointments, no scaremongering. I doubt that will happen in my lifetime. Rationally, realistically, this model of Evidence-Based Decision Making is the best that we've got. It feels a bit like treating the symptoms rather than the cause. I am furious, daily, with what I'm hearing and seeing in our hospitals.
Sitting in a room full of women feeling like I'm preparing them for the system rather than working to dismantle it. My love of evidence is contrary to my love of uninhibited birth. I hate the patriarchal, medical system of birth and a large part of my job has now unfortunately become toughening women up to face it, dare them to challenge it. It feels so wrong.
In the interests of women facing the medical system I share as much evidence as I can so they can make rational, thoughtful decisions - completely opposed to instinctive, intuitive birthing. I once spent a long time with a woman going over everything that could possibly happen for her birth plan, and came away feeling like a failure, thinking that what I really should have said is "I have confidence in your body's ability to birth your baby". It's what I believe. I support all choices. But what if all this evidence and informed decision making is detracting from everything that I believe to be true about birth? That it is normal, and that the majority of interventions arise from that simple PLACE of birth and the stress the system puts mothers under.
Discussing once with a client planning her home birth we touched on undisturbed birth, call it 'freebirth'. We were both enamoured with the concept. Ecstatic, unhindered. I know it exists, even though I've never seen it. I hope one day I do.
My Birth Plan
Why birth plan?
So often I hear women say 'midwife said not to bother with a birth plan' and 'what's the point when you don't know how it's going to go anyway?' and both statements terrify me! To put this into perspective, most women wouldn't just show up on their wedding day without making any preparation and it goes without saying that my child has outlasted my marriage.
I didn't make a birth plan with Judah - my birth plan was blind optimism and positivity and a denial that anything would go wrong, ever, in my home birth. Then, when I transferred to hospital due to the home birth team being at another birth, neither of my birth partners knew what I wanted. It was a good birth and birth experience. But it wasn't as I wanted. I wish now I'd had my wishes written down and understood by everybody present.
As a doula, the birth plan is my JOB DESCRIPTION. I should not deviate unless the mother changes her mind and indicates otherwise. Problems arise? Birth plan. Any issues negotiating care? Birth plan. It takes the responsibility away from the labour support and makes it clear that the birthing woman is the one calling the shots.
It's not just the physical document that is important. Though they really are, especially when a woman's wishes have been pre-arranged with a consultant and midwife and we need to make sure it all goes smoothly on the day. The fact that you've even made a birth plan shows that you are an empowered, knowledgeable woman who understands her options and that is the most important thing!
My birth plan isn't a list of things YOU personally should or shouldn't want. It's tailor-made for me, my situation, my experience and my personal assessment of my risk factors.
My Birth Plan
· I wish to birth at home in water with my partner Dom and my doula Sam. Please notify my mother to collect my son Judah.
· Should my pregnancy progress beyond 42 weeks, induction is not an option for me barring certain medical conditions (ie. obstetric cholestasis and pre-eclampsia) which we can then discuss.
· When I request midwife support please contact them. If anybody present makes me uncomfortable they may be asked to leave the house. I may prefer for them to wait in another room until needed.
· I may find blood pressure and Doppler checks intrusive and may withdraw consent at any time.
· I will be using a birth pool to labour in. Do not offer me pain relief unless I request it.
· I will consider consenting to one vaginal examination to determine baby’s position and cervical dilation if I have any concerns about the progression of my labour. Do not offer me vaginal examinations.
· Do not talk to me whilst I am experiencing a contraction.
· In the second stage do not instruct me to push.
· I wish to catch my baby myself.
· I wish to have a physiological third stage and lotus birth where cord is left intact until the placenta is delivered. Once that has occurred my partner and I will burn the cord to separate it from the placenta. Should there be any concerns about blood loss my preference is to eat a piece of the placenta. Should this not be effective we can then discuss syntometrine.
· I will be having a minimum of one hour of undisturbed skin to skin with my baby wherever I feel most comfortable, whether that is in the pool or out. Any exams will be delayed for at least an hour.
· I prefer to tear over episiotomy. In the event of any perineal trauma I would like to discuss healing naturally versus suturing.
· We are consenting to Vitamin K.
· Please take photographs of the birth.
· We are saving the placenta for encapsulation, it must be bagged and placed in clean tupperware in the fridge within half an hour after delivery.
Should there be any legitimate health concerns about myself or my baby we can discuss transfer to the hospital. I would want to transfer if there was significant blood loss during labour or concerns about baby’s heart rate. I do not wish to transfer just because labour is slow. In the event of transfer I would prefer to go to University Hospital of Wales rather than Royal Glamorgan. If transfer occurs after birth and I must travel separately from my baby I wish my doula to accompany me and my partner to accompany our baby.
After my baby is born I do not wish to be physically separated for any reason other than major resuscitation.
I will be breastfeeding my baby. If I am not available due to being in theatre I would like my doula to accompany me and my partner to have skin to skin during this time. If there are concerns about baby’s sugar level please contact my friend x who will wet nurse my baby.
In the event of caesarean section I would like the drapes lowered and immediate skin to skin. If a general anaesthetic is used I do not want photographs to be taken as this will upset me and we will have a rebirthing ceremony at home.
I've definitely come a long way since blind optimism, as you can see the plan covers a few eventualities so that my birth partners know how best to follow my wishes. It's important to have an advocate as there are some points in labour where you cannot speak, and worst case scenario where you may be unconscious or not physically present to care for your baby. The knowledge and the evidence-based information that has been used to create my plan is not apparent, but is accessible for anybody interested in their birth choices. Some things to think about...
1. Place of birth
2. Methods of pain relief (including water)
3. Methods of monitoring
4. Vaginal examinations
5. Room conditions (lighting, music etc.)
6. Language and behavior of medical staff
7. Second stage preferences (instinctual vs. directive pushing)
8. Third stage preferences (cord clamping, physiological vs. managed)
9. Vitamin K
10. First hour after birth (skin to skin and feeding preference)
11. Methods of induction - have you made a plan beyond the 'due date'?
The website Evidence Based Birth is my go-to for all things birth related!
And anything else that is significant to you. We need to give the knowledge and control back to women to make the best decisions for them and their babies, whatever those decisions are. Only then can we achieve truly empowered, positive birth.
I will be discussing this plan with both partners before the birth to make sure we are all on the same page and happy!