Preparing a Birth Plan: Details & Discussion

When I hit the third trimester, it was time to start seriously thinking about a birth plan. We had a serious discussion with my OBGYN about a VBAC and what he said was both positive and yet not reassuring.

Our First VBAC Discussion

The positive was good: he would attend a VBAC and seeing as we want more children agreed it was a good idea to attempt one. The worrisome part was harder to hear: he does not have a lot of experience with them.

The explanation that followed made perfect sense with everything I know about the middle to upper classes of Mexico. Most of his patients desired minimal pain (an epidural as soon as possible) and prefer to go with a repeat cesarean rather than deal with the unknowns/pain of labor. They also tend for the most medicalized options so to speak and do not generally care for an informed labor, putting their faith fully in God and the doctor. Reality check indeed.

I was at an impasse and needed to form a plan:

How do I realistically envision the birth? What do I need to set up or research beforehand? Should I stay with my doctor or change to a different one? What process will best enable my vision to become a reality?

A couple of weeks later we were back.

When we last left of, I had seen my doctor and we had discussed a VBAC. This time we wanted to go through some details and see both our options and the doctor’s reaction to my preferred plan.

Birth Preferences Checklist

I used the Baby Center birth plan worksheet to mark my general preferences and used that as a jumping off point for our discussion. Approximate answers by the doctor in italics.

As long as the baby and I are doing fine, I’d like to have intermittent rather than continuous electronic fetal monitoring. Does the hospital here have wireless telemetry? No
I’d also like to be allowed to progress free of stringent time limits, to avoid an IV and artificial enhancement of labor. Of course
During labor, I’d like to try varying positions: Sure
Is there an option of using a birthing pool/tub? This is supposedly unsanitary? Doc says no.
Please don’t offer me pain medication. Um, ok
When it’s time to push, I’d like to do so instinctively and be allowed to progress free of stringent time limits as long as my baby and I are doing fine: We’ll see
During delivery, I’d like to give birth without an episiotomy. (didn’t mention this one)
After birth, I’d like to hold my baby right away, putting off any procedures that aren’t urgent, to breastfeed as soon as possible. No problem
I’d prefer not to get oxytocin (Pitocin) after I deliver the placenta unless it’s necessary, to wait until the umbilical cord stops pulsating before it’s clamped and cut and my partner to cut the umbilical cord. (didn’t get into these either really)
If I have a c-section, I’d like to warm baby skin to skin (no incubator), if not by me than by my partner, and to breastfeed my baby in the recovery room. We’ll see.
What do you think about if we hired a doula? They don’t do much but whatever floats your boat.

All in all the discussion made the doctor quite uncomfortable and slightly defensive. I am probably not the best judge as the whole discussion was very emotional for me but we definitely came to the realization that I should probably look into another care provider.

While he may be able to attend my natural birth, we are probably looking at an uphill battle if we stick with him. It was time to explore our options.