Don't think you need a birth plan? Think again.

Women having natural births in a hospital often draft birth plans - sort of like a childbirth wish list - to formulate their decisions ahead of time so they can clearly articulate them to the hospital staff.  You might think it’s unnecessary to draft a birth plan for a home birth because you won’t need to fend off an epidural or argue with a nurse over whether you need Pitocin to speed your contractions.  These interventions simply won’t be available to you.  But having a birth plan, even at home, is crucial.

Here’s why:

1. A plan helps everyone get on the same page.

A birth plan documents your preferences: Do you want a water birth? Do you want to eat and drink during labor? What interventions, if any, are you comfortable with? Who will attend your birth? By working with your partner and midwife to develop the plan, you can assure that everyone will have similar expectations going into the birth. Sure, things may change, but at least you have an agreed-upon starting point. It’s far better to work out any differences beforehand.  You can also include instructions for after the birth, such as who’ll be there to help out with the baby and when.

2. Writing a plan helps you visualize your ideal birth.

By thinking about these decisions before labor, you implicitly commit to following through with them. For some reason, when you write your preferences down, they suddenly become more real, and it gives you an opportunity to picture your ideal birth experience. Even if  things don’t turn out the way you imagined, the act of documenting your preferences reinforces your desires and empowers you to make them reality.

3.  It forces you to think about post-natal treatments in advance.

After labor, you’ll be in no condition to decide whether or not you want that Vitamin K injection for your newborn, and your brain may be too foggy to sign an exemption form for antibiotic eye drops. So think about what treatments you may want in advance, research the alternatives, and document your decision in your birth plan. Your can spell out your preferences for the Vitamin K injection, antibiotic eye treatment, the newborn screening blood test, vaccines, and circumcision. 

4.  If you need to transfer to a hospital, a birth plan will help you advocate for your preferences.

Depending on the circumstances of your transfer, you still may want to pursue a natural birth.  And don’t think just because you’re going to the hospital, you’re doomed to a c-section.  You don’t lose all control.  You don’t check your rights at the door. Your birth plan can include preferences about Pitocin administration, epidurals, fetal heart monitoring, and episiotomies.  And you should make clear to the hospital staff that you want to be able to approve all interventions, from inserting an IV line to upping the Pitocin dose. 

5.   A birth plan has all the important information in one place.

You don’t want to be scrambling for the midwife’s phone number or frantically Googling the nearest hospital in the throes of labor. Your birth plan should contain all the critical pieces of information:  names and phone numbers for your midwife, doula, back-up obstetrician, pediatrician, and emergency contact. You can also include phone numbers, addresses, and maps to the nearest emergency room and your back-up hospital (which may be different).

For tips on putting together a birth plan, click here.

For all the multi-tasking mamas out there

Between a full-time job, raising a 3-year-old, taking care of the house and writing, I'm wiped out on most nights. Lately, it's been even more exhausting with all of the (wonderful!) new exposure for How Big is a Placenta Bowl?

It's reminded me of a column I wrote on the 50th anniversary of the birth control bill, sort of an homage to all the multi-tasking we women have to do. Enjoy!

Me multi-tasking: soothing the baby while writing

Want to do it all - and not get pregnant? There's a pill for that

Daily Breeze (Torrance, CA) - Saturday, June 26, 2010

On the 50th anniversary of the birth control pill , as experts expound on its feminist virtues and larger sociocultural impacts, I find myself captivated by this observation from an Associated Press story:

"A world without 'the pill ' is unimaginable to many young women who now use it to treat acne, skip periods, improve mood and, of course, prevent pregnancy."

That a single pill meant to prevent pregnancy now solves all of these problems says a lot about women. Leave it to us to multi-task our birth control.

I mean, who has the time to just prevent pregnancy? If you're going to spend half a millisecond staving off ovulation, you may as well knock out a couple of other errands, too. And so we pop the Pill to treat acne, reverse anemia, manage endometriosis, reduce cramps and cut out menstruation entirely.

Some birth control manufacturers even tout these secondary effects.

Before the federal government slapped them down for misleading advertisements, the makers of Yaz claimed their little pill improved your skin, reduced headaches, curtailed irritability, lessened anxiety, cleaned the bathrooms, cooked dinner and picked up the kids from soccer practice.

OK, maybe I'm exaggerating. But it's no wonder drug companies try to capitalize on the female quest to have it all.

I didn't really get the whole multi-tasking thing until I started juggling motherhood, a full-time job and a husband who'd rather eat three bowls of cereal for dinner than turn on the stove. Now I know why a whole industry exists to help women jam-pack every second of their day with activity.

The other day, while flipping through a women's fitness magazine, I came across an article devoted to "taskercise," which basically entails transforming mind-numbing tasks into mini-workouts. Like doing tricep dips on the edge of the tub while waiting for my kid's bath to fill. Or squats with the laundry basket as I transfer clothes from the washer to dryer. And lunges across the kitchen while preparing dinner.

I guess I should be grateful for the advice. But the whole concept just saddens me. When did I become the kind of person who can't take 30 minutes out of her day to get some exercise? Am I really destined for a life of half-hearted workouts and mediocre dinners?

The picture isn't the same for men. Compared with the 1960s, men today help out more with the housework and child care, but strangely, they also have more leisure time, according to 2005 research out of the University of Maryland.

As for women, now that many of us work outside the home, we've lost that "me" time. Instead, we're heating up food while emptying the dishwasher and catching up with the husband as we sweep the floors.

We turn laundry into sock puppet theater and call it playtime with the kid (I'm grateful my son is still young enough to be fascinated by me folding pajamas).

Almost three-quarters of us women think we have too little time for ourselves, compared with 57 percent of men, and 39 percent of us "always feel rushed." At the end of the day, when I'm reading my son "Goodnight Moon" before bedtime and wondering where the time went, I count myself in that category.

So I don't much fault the makers of Yaz - or any other birth control pill manufacturer - for playing into the hearts of time-strapped women. Promise us a magic multi-tasking pill , and we're happy to indulge.

I'm sure if women stopped to really think about it, we'd laugh it off as the cheap marketing scheme it is, a half-baked attempt to profit off the frantic pace of our lives and our desire to have it all.

But unfortunately, we don't have the time.

Home birth isn't for everyone and that's okay

Every once in awhile, I find myself on a home birth blog or Facebook group where someone posts a question like this one:*

"Looking for some advice from my fellow HB mamas - I'm 34 weeks pregnant with breech twins. Recently I started bleeding, and a trip to the back-up OB confirmed that I have a slight placental abruption. Also, I tested positive for GBS (did I mention I have gestational diabetes?)  I really, really wanted my VBAC home birth, but now I'm not so sure. What do you guys think? Has anyone ever had a successful VBAC/twin/breech/GBS positive/gestational diabetes home birth with placental abruption?"

Posts like this one frighten me on so many levels. First, why are you trying to get medical advice from a blog?  Second, why are you even considering a home birth? Even more appalling are the responses, which can often be downright encouraging of home births in high-risk situations. Just because one person had a successful VBAC-twin-breech home birth doesn't mean that you should.

Let me be clear. I'm not saying that a VBAC automatically disqualifies you from a home birth. Or twins. Or any one of those risk factors on their own. What I'm trying to confront is this increasingly narrow definition of "high risk" that leads many otherwise poor candidates for home birth to believe that home birth would be safe for them. Yes, you might have a perfectly fine birth in your living room. But if you have risk factors, why take the chance?

The research shows that home birth is as safe as a hospital birth only in low-risk situations. We should be grateful that we live in a society with state-of-the-art hospitals that enable high-risk women to deliver healthy babies. As much as I love home birth - and I firmly and strongly believe that women should have unlimited support and access to home birth - I wouldn't chance a risky labor in my house. There's just too much riding on it.

And here's why I worry. The American Medical Association and the American  College of Obstetricians and Gynecologists are just itching to give a big "I told you so" every time a home birth goes wrong. If more and more high-risk women choose home birth and those births result in disastrous outcomes, there could be a serious push against home birth. And that's going to ruin it for everyone.

This is why we need qualified and licensed midwives, why these midwives need to be conservative in their approach, and why home birthers need to trust in their midwives - even if they recommend a hospital birth - and ignore Facebook comments.

Because in the end, it's not just about a single birth. It's about all of us finding support for home birth from a society generally hostile to the idea, and we need all the help we can get.

*It has to be said that this is not an actual post, just a spoof - thank goodness!

Stuff Homebirthers Like #5: Ina May Gaskin

Every good cause needs an inspirational icon - that all-knowing, omnipresent figurehead with just the right amount of elevated expertise and popular appeal. For homebirthers, that icon is Ina May Gaskin.

Don't worry if you've never heard of her. Most people outside the natural birth world aren't aware of the Farm midwife and original homebirth crusader. But to homebirthers, Ina May as we call her (as though we know her personally) has reached goddess-like proportions. When she speaks, we hang on every perfectly uttered word. When she writes, we buy multiple copies of Spiritual Midwifery so we can give them to expectant friends, keep one for ourselves, have another in our lending library...

When she makes appearances, we flock to meet her so she can bestow upon us encouragement and empowerment in peppery aphorisms like "Your body is not a lemon" and “Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.”  Who can't get jazzed up about natural birth after reading affirmations like that?

She's completely likable with her fluffy gray hair and frumpy dresses, sort of like your grandma if your grandma were a tough-as-nails ex-hippie willing to talk shit about the medical industry while empowering generations of women to take back control of their bodies.

So yeah, we worship Ina May. We buy her books. We post her quotes on our Facebook pages and create whole Web sites dedicated to her words. And we pay homage in cheesy photo collages. Ina May - we heart you.