Interview with Haille, Birth Boot Camp Instructor

I’ve had the great privilege to get to know Haille Wolfe through our local group of naturally-minded mommas. She is a wonderful lady with a beautiful family including her husband and five children! Haile teaches a unique type of birth preparation course called Birth Boot Camp. I got to ask her some questions and I’m so glad to share them with you now. Continue reading “Interview with Haille, Birth Boot Camp Instructor”

Birth Plans- Put It In Writing!

Many women have a fear of birthing in a hospital because they fear that their doctor or the hospital staff will pressure them into interventions that they do not want. Others are torn between wanting a natural birth and wanting the security of the controlled hospital setting. I want to tell you that you can have a natural birth in the hospital and not be pressured into interventions you don’t want. I did it and I will share with you how.

What we are really talking about here is patient self-advocacy. Many patients don’t know that they have options, and more importantly, rights when it comes to deciding medical treatment. Your first step in having the birth you want, is to be informed of your rights as a patient.
The most basic right of any patient is the right to consent. No doctor, nurse, lab tech, etc can touch you without your consent. (The exception is if you are unconscious. In this case, medical personnel can assume consent to life saving measures.) In your right to consent you have the right to be informed of all risks related to any treatment that is purposed, any alternative treatment options, and the risks of refusing treatment. You also have the right to seek advice from additional professionals or sources before providing consent. You also have the right to revoke consent at any time. Consent is given in writing with the exception of emergent situations. 
As the patient you also have the right, and I would say the responsibility, to be directly involved in deciding your treatment plan. This is where a written birth plan becomes so important. (We’ll talk about why it needs to be in writing in a moment.) In making your birth plan, you need to be informed on the decisions you are making and need to discuss all of your options with your health care provider. You need to feel comfortable talking with  your health care provider and discussing both your ideal birth situation and emergent care policies. It doesn’t matter if you are using a midwife, an OB, or a talking frog, you have the right to be involved in these decisions. If your provider does not allow you to exercise that right, exercise your right to revoke consent.
After you have done your research and discussed any questions or preexisting conditions with your health care provider, put your birth plan in writing and then discuss it with your provider again. Then you can finalize your birth plan and have it ready for mommy and baby’s big day. In your delivery bag, you need to have your birth plan in writing, and at least a few extra copies. When you go to the hospital to be admitted, hand your nurse your written birth plan and ask for it to be put in your chart. If you change wards in the hospital (example going from labor and delivery to postpartum care), check that your new nurse has a copy of your plan as well. Here is why it is so important to have it in writing: If you put your wishes on paper, no one can claim they didn’t know. This is essential to making a birth plan work in a hospital. You will also need to be very clear in the wording of your birth plan. Do not leave room for guessing on issues that are important to you.
Next I will go over the main items you will want to cover in your birth plan and then I will include my birth plan for Alex. My plan isn’t perfect, but I did receive compliments from several of the nurses about the plan itself. I am going to assume that a natural vaginal delivery is the goal. If that is not your goal, feel free to tweak the plan to meet your needs. Even if you going in for a scheduled c-section, having a written birth plan is a great idea. Last, but most definitely not least, remember that every birth is different and unpredictable. Even if this is your tenth birth, you cannot predict how it will go. You and your plan need to be flexible to accommodate the ever-changing birth process.
Here are the main areas you will want to address in your birth plan and some questions to consider:
  • Visitors: Who should be allowed to visit and when? Who will be there for the delivery itself? How much privacy do you and your partner want? Remember ladies- this is a big day for dad as well. He might want a lot of friends and family around or he might want a more intimate experience.
  • Labor Preferences: Do you want to walk? Use a birth ball? Birth on a bed, on all fours, in a tub? (In a box, with a fox, in a house, with a mouse…)
  • Pain Management: Labor hurts. I hear that some people can birth and not feel the pain. I’m slightly convinced that they are aliens. What mechanisms do you plan to have available? You may want to be very specific in this area.
  • Interventions and C-sections: Here is where you should consider interventions that may be done during the labor process. What drugs or treatments are you comfortable with? Do you have any hard and fast rules regarding any of the possible interventions?
  • Birth: The big event! How do you want this to happen. Are you okay with an episiotomy or do you want to be allowed to tear naturally? What about forceps or a vacuum delivery?
  • Immediately After Birth: Who cuts the cord and when? Where should baby go first? Should they wash the baby before you hold him or her?
  • Infant Care: Include your preferences for vaccinations, medications, feeding, rooming, diapering and circumcision, particularly if you are opting out of vaccinations, breastfeeding, or have strong feelings regarding circumcision. As a new mom, you have just inherited the right and responsibility to give or deny consent on behalf of your child. 
Let me explain my thinking behind some of these areas and then show you how it all turned out. 
We knew that my family was planning to fly in for the birth. I very much wanted their support, but I also wanted the birth to be a very special and intimate time with Philip. We decided that we would welcome visitors during labor but it would just be us during the birth itself. I wanted the most natural labor possible and wanted the freedom to allow my body to work as it was intended in this process. This meant that I wanted intermittent monitoring. When talking to my OB beforehand he noted that he was uncomfortable with the mother being off the monitors once active labor was under way so I amended the plan to also state that I would like monitoring breaks when possible. (When I actually went into labor the OB on call let me do intermittent monitoring until my BP started to rise.)
Pain management was a big one for me. I was adamant that I not have an epidural, so much so that I did not sign the consent form. My OB and I discussed this for a little while. Being my first, he didn’t want me to rule out any options, but was respectful of my choice. We did also discuss what my options would be should I have a c-section as most c-sections are done with epidurals nowadays. I was less fervent about other interventions and wanted to leave my options a bit more open here. I wanted a natural, unassisted labor but also understood that there were interventions to help with specific situations and that some interventions can prevent larger problems. You will see I also left the episiotomy up to doctor discretion. There is a lot of debate on the episiotomy issue and my thought was that I won’t be able to see what’s going on down there to make that call myself.
For infant care, I wanted to exclusively breastfeed Alex and at the time of writing the plan wanted to use cloth diapers while we were in the hospital. We ended up using their disposables just for the convenience of it, but when we did our tour, the nurses and the nursery agreed to cloth if we wanted. We also wanted to be with him for as many procedures and exams as we could. Philip went with him for all of them except his circumcision and when they checked him for jaundice just before discharge.

Getting Ready to Leave the Hospital
This is the post that never ends! But here is our birth plan in its entirety. Please feel free to comment with any questions. You will notice that the language is very specific in some areas. Once again, these were my preferences. Feel free to use any of this you find helpful and adjust it to your needs.
The Campbell’s Are Coming!
How we would like to welcome baby Alexander into the world…
Overall Philosophy
Labor and birth are natural processes that the female body was designed to accomplish. The end goal is a healthy mom and baby. We would like to reach that goal in the most natural way possible.
Visitors
Friends and family are welcome to visit during the laboring process. We ask that only mother, father, and medical staff be present for the delivery itself, any checks or interventions, any procedures done on the baby, and any nursing sessions. Visitors may be asked to leave the room at mother or father’s request.
Labor
I would like to have freedom of movement and position for as long as possible during the laboring process. I would prefer intermittent fetal monitoring to help maintain freedom of movement for as long as possible with breaks in monitoring as often as possible.
Pain Management
Labor is an uncomfortable and painful process, however, please do not offer me pain medication of any sort. I do not want any drugs for pain unless surgical intervention is required. I have discussed this issue with my doctor and have made an informed decision on this matter.
Interventions
Please only offer interventions when needed for the safety of mother and baby, not for comfort. The most natural and least invasive interventions and methods should be exhausted before proceeding to more extensive, risky, or invasive options whenever possible.
C-Section: This should be reserved for emergencies, or when all other interventions have failed and there is risk to mother or baby to continue to attempt a vaginal delivery only.
Birth
I would like the option of birthing in the most comfortable position for me at the time. I prefer an unassisted vaginal birth if possible. An episiotomy should be done only if needed; to be decided at the doctor’s discretion.
Immediately After Birth
We would like skin-to-skin contact immediately after the birth. The father would like to cut the umbilical cord. Mother would like to attempt to nurse as soon as possible after the birth.
Infant Care
Vaccinations/Medications: Standard medication and vaccines should be given.
Feeding: I plan to exclusively breastfeed. Please do not offer Alex any bottles or pacifiers.
Rooming: We prefer for Alex to room with us.
Diapering: We prefer to use cloth diapers only. We will supply the diapers and containers for dirty diapers, and will be happy to discuss cloth diapering with any staff.
Mother or Father would like to be present for all infant exams or procedures as permitted.

Alex’s Arrival

The little one is asleep and the husband is off enjoying his first Black Friday shopping adventure not as a retail employee so I think I will try to write out the story of how Alex entered the world. (This will be very detailed. I wish I had heard more detailed stories for other women and I wanted to remember the details down the road myself.)

Alex had measured big for all of my last trimester so when we hit that magical 37 weeks and “full term” we started working to encourage little Alex to get out before he got too much bigger. Philip and I went walking around the neighborhood every night and I added in some walking and sets of squats at work. At my last prenatal doctor’s appointment, I was 37 weeks 4 days and dilated to one centimeter and about 75% effaced. The doc tried to manually stretch my cervix to see how ripe it was. It didn’t move, but he was very encouraging that the effacement was a good sign. We made the appointment for the next week but doc said he wouldn’t be surprised if he didn’t see me then.

Well, we kept up the walking and squatting and I ate as much spicy food as my heartburn would let me.  The nesting instinct hit hard soon after that. I wanted to clean everything and get everything organized. I could hardly sleep or concentrate on anything because I had such a long list of things I wanted to get done. (Most of which were still waiting when the three of us got home.)

Thursday the first I started having contractions while we were out running errands. Nothing too bad, but they were noticeable. I called the on call doctor after about two hours of contractions and he said that it didn’t seem like enough. Well, they kept coming so I called Labor and Delivery. The nurse advised me to try to make them go away instead of working to keep them going. That was more effective at seeing if it was real labor or not. Well, they went away.

Friday night I had some more contractions with one or two being a bit painful. However, I could make them go away by drinking water or resting for a bit.

Early Saturday morning, right around 3 am I got up to use the bathroom and feed the cat (just like I had done at 3 am every morning since about 25 weeks). While I was up I felt a pretty strong contraction so I decided I would put up some of the clean dishes and see what happened. The contractions continued and were rather uncomfortable, though not quite painful and kept up for about forty-five minutes or so. I remembered the nurse’s advice and went to lay back down in bed and see if the contractions kept up. After laying there for about fifteen minutes there were no more contractions, but I needed to pee again. So around 4 or 4:15, I decide that I will go to the bathroom then try to get some more sleep. After all, this could be my last Saturday to sleep in…

I get to just outside the bathroom door and gush! This was no trickle. There was no mistaking it for peeing on myself. My water broke in true movie style. For once I was glad for our ugly concrete floors. I grabbed a towel for the floor and put another between my legs as I walked over to the bed and woke Philip up. We were packed and ready to go in no time. I sent a text to family letting them know that we were headed to the hospital to see if this was the real deal but that I was pretty certain and I called L&D to let them know we were on our way.

We get to the hospital and I change into the lovely gown that I will be wearing for the next two days. When the nurse goes to do the amniotic fluid test, she takes a quick look and says that she’s pretty sure I’m ruptured. Well, I was. I was also about 90% effaced at this point though no more dilated. They admit me and we fill out all the fun paperwork. I also find out that my doctor is not on call this weekend at all and I would be starting with the doctor that I had left because I didn’t like his personality.

I give the nurse my birth plan and we get started with all the fun wires and tubes. I get hooked up to the monitors. I also get an IV for the routine fluids to keep me hydrated. I also get started on antibiotics as I was group B strep positive.

The doctor then comes in to check on me and discuss the birth plan. My water broke but I wasn’t in active labor. We discussed the timeline that this put us on. The longer you labor with your water broken the higher the chances for infection, prolapsed cord, and other not-so-good stuff. Dr. B said that he would feel comfortable with me trying to get labor started on my own for 24 hours before we needed to start Pitocin. That was all I needed to hear. I would get labor going within 24 hours come hell or high water! He checked my cervix. Due to the group B strep he checked my cervix rectally. This was extremely uncomfortable, and he said, not very accurate. Well, he said I was at about a 2 and because I wasn’t in active labor, he would let me get up and walk around off the monitors for periods of 15 minutes. Every 15 minutes though I had to get on the monitors for the nurse to check the heart rate.

Well, we keep up the 15 minute schedule for about an hour and half, maybe two. Then the nurse said I had to stay in bed. At each check my blood pressure had been taken and apparently it was getting pretty high and concerning. She wanted me to stay in bed and try to relax, perhaps being up and moving so much was just pushing it too far. Then Dr. B came in. Apparently my blood pressure wasn’t getting any better and was raising some rather big red flags. The traditional, normal treatment is Magnesium. Dr. B said that normally he would just go with the Mag, but if he started the Magnesium it would likely stop my labor. Then we’d have to start Pitocin and doing so this early into the labor process gave me a high chance of a c-section. Dr. B says that there was another option. We could do a half-dose of demerol (half of what they normally give you for labor pain). He said that he understood that I didn’t want pain medication but that the demerol would lower my pulse and blood pressure and could help stop the escalation he was seeing. Demerol it was. Oh, and I had to stay in bed on my left side with the exception of getting up to use the restroom.

Fast forward a bit. Family got into town around 6 or so Saturday night. Around the same time, my labor started getting more intense. Normally in hospitals, you get your cervix checked pretty frequently, but because of the strep, they weren’t checking me unless I asked them to do so. This just meant that I had no clue how I was progressing for much of the time. At the same time, they stopped telling me what my blood pressure readings were. My blood pressure was checked automatically every 15 minutes and at first the nurse or Philip would read me the number. Then it started just being, “It’s pretty high” and “That one wasn’t so bad.”

That night gets rather fuzzy to me. I went into active labor sometime Saturday evening though I’m not sure when. I just know that eventually it went from kind of uncomfortable to noticeable painful with each contraction. We did do another half dose of demerol and then later a full dose closer to transition. Philip and the nurse became more and more strict about getting up just to go to the restroom and then getting right back into the bed. I would rest for a second when I sat up, and the contractions were a lot easier to deal with when sitting, but I had to be quick. What they weren’t telling me, or what I wasn’t understanding at the time, was that my blood pressure was reaching very dangerous levels every time I sat up. We’re talking 200/100+.

I do remember the 2:00 hour Sunday morning as we took note that the clock wound itself back for Daylight Savings Time. By that point and for some time previously, the contractions were very, very painful. I would grab hold of the railing to the bed with one hand and took Philip’s hand in the other. I thought for sure I would rip the railing off that bed or break Philip’s fingers. Both ended up making it out okay.

At one point I looked at the nurse (who was staying in the room most of the time) and told her that I felt like I needed to push. When she had checked me last I had been at about an 8, now I just had a tiny bit of cervix left. I knew in my mind that I needed to wait until that last bit of cervix was gone or pushing could do more harm than good, but I really wanted to. Finally she said it was gone and it was time to start pushing some. As this was my first, we would do some “practice” pushes before the doctor got there and another nurse came in to help. During this time I experienced something that nearly every laboring woman does, but no one talks about: I had several bowel movements while pushing. It’s the same muscle group and feels about the same. Everyone does it, the nurses are used to, but no one talks about it. Now you know. Well, after some time of pushing the nurses told me to stop pushing or I would have the baby without the doctor being there.

If you’ve never given birth, here’s something they don’t always tell you and that you can’t properly describe: When you get to that point of the delivery process when the baby is right there, to not push is like trying to hold your own head underwater and not breathe. It is so completely against your instincts and feels like you will literally die if you don’t push and anyone telling you to stop must be completely off their rocker.

Well, Dr. G gets there (Dr. B was no longer on call) and they let me start pushing again as she’s getting suited up. A whole bunch of other people come in too, but I’m too busy to notice. Dr. G introduces herself and proceeds to say that she knew I had a birth plan, but she didn’t get to read it yet and then asks me how I feel about an episiotomy. Keep in mind, I am pushing a baby out right now. We agree to an episiotomy as she thinks a short cut will help his head come right out, and it does. His head came out just seconds after the cut. Next came his shoulders and the rest of him just slipped right now. To be honest, once the head was out the rest just seemed to slide out almost on it’s own.

At 6:21 am on November 4th, I heard his first little cry. It was a little gurgled and not too loud, but had a good hearty sound to it. They pick him up and I see his little face and his flailing body. Philip gets to cut the cord and they give him a quick rub down. I wanted skin to skin time as soon as possible and I ripped off that gown. (Modesty just got completely forgotten for the next several hours.) After the cord was cut, they handed me my little boy. He just wiggled for a second then he settled down and snuggled into my neck. I was in awe of him, just in complete awe. Here was this tiny little person who just minutes ago had been inside of me.

During that time I delivered the placenta. After a little bit, they took Alex to the warmer off to the side of the room to be checked out and Philip went over there with him. Dr. G then tells me that I have a fourth degree tear. Externally, there was only a third degree tear, but internally I tore a lot worse. His head had fit with the episiotomy, but his shoulders had caused most of the tear. The tear went through the vagina, perineum, and rectum. The sphincter wasn’t torn which was the good news. Dr. G did a three layer repair and reinforced the sphincter just to be sure. She finished her repair and explained the recovery briefly while the nursery worker finished with Alex.

And then, just as quickly as it seemed everyone had swarmed into the room, they were all gone. It was just me and Philip and the nurse. Soon, Philip went and got the family and they got to meet little Alex. I felt rather good afterwards. I had to keep having my blood pressure monitored and was still stuck to the IV as they had started Magnesium some time during transition. I would stay on the Mag for 24 hours after the birth to ensure that I didn’t have any seizures. It probably took a day or so for me to feel like there was anything physically “wrong” or like my body was recovering from anything.

And that’s how I became a mother.

He’s Here!

Alexander was born on November 4, 2012 at 6:21 a.m. 27 hours after my water broke. He weighed 7 pounds, 12 ounces and was 19 inches long. He is absolutely precious and wonderful. My family was able to be there when he was born and stayed with us for a few days. We had a few health scares in the hospital but Mom and baby are both healthy and my recovery has gone very smoothly. I’ll post more details later.