Since the babylanche is continuing with new pregnancies all the time, I thought I’d drop this here so people can look it up when it comes time or I can point them to it if they ask.
Background: I was at higher risk for pre-eclampsia than most women. (It’s not uncommon, mind you, the rate I heard most was 5% for most first time mothers, increasing to something like 25–50% for me. I did not, in fact, develop it.) And I spent most of my pregnancy fretting about it. When my doctors weren’t fretting about it, which wasn’t often. At the same time, while this made my pregnancy “high(er)-risk” (or, I guess “abnormal”, because a lot of people refer to their low-risk pregnancies as “normal”) I wanted a lower intervention labour and birth. If I’d been textbook low-risk* I would have liked a homebirth.
In the end I was induced 11 days after my due date and had an instrumental birth, so, not low intervention. But I found all the research and preparation really helpful, nonetheless. I really recommend knowing what you can, because, unless you are homebirthing or do birth work yourself, you go into an environment you’ve never been in before to give birth the first time and you are dealing with people with multiple agendas while you’re there. One of them is to help you give birth safely, but others (depending on the birth practitioner) include things like practising their skills with instruments and hopefully getting off on time and definitely not getting sued. And not only that but you’re in a place where you don’t know the rules, or what’s normal, or what the options are. And every one to five minutes your uterus is squeezing open and down. So I am pro-preparation!
Onto the various things.
In terms of reading, I wish there was a single thing I could recommend, but I can’t remember something that really stood out. And I was reading a lot of birth activism at the time around things like abusive doctors and routine augmentation (routinely adding IV syntocin even to women in spontaneous labour) and it was frightening and I had to stop. That’s an anti-recommendation. If you’re interested in a low intervention/natural birth it might be worth focussing a little more tightly on what interventions your birthing place performs. My Birth has some information about intervention from the birth activism point-of-view.
I also wish I could recommend something to prepare for “I’d have liked low intervention but it’s not working out that way”, because if I’d, say, been hospitalised for monitoring and then induced early, which was what would have happened if I’d had pre-eclampsia, I felt like the response of the birthing community was “yes, some interventions are medically necessary… um… sucks to be you?” I think there’s stuff out there but I while I could find “yay epidurals never labour without! yay!” and “I am traumatised by my birth and feel crappy”** and “I would never accept medical intervention for any reason” I couldn’t find much “I didn’t love syntocin but here’s how I dealt and some tips”.
So reading… I guess try reading widely. There are lots of birth stories about these days, perhaps try reading various largely positive ones from different women who did different things and see how it worked? Here’s a few I liked: Rivka’s first (induced with membrane rupture, vaginal, no pain medication), Rivka’s second (spontaneous, precipitous, vaginal, no pain medication), Heebie-Geebie’s first (spontaneous, vaginal, no pain medication), Yatima’s second (spontaneous, vaginal, narcotic pain medication), Blue Milk’s second (induced with syntocin, vaginal, epidural). I also liked Rivka’s whole sequence of posts about her first pregnancy and really learned nearly as much from that as most other things. (Note that, as you will see mentioned at that link, she miscarried her second pregnancy in a traumatic way. So, keep that in mind if you click around to read about her later pregnancies.)
The most helpful thing I did bar none was hiring a doula. This isn’t a standardised job title, but a doula is a professional birth attendant who is with you during labour and while the baby is born and does things like massages, fetching your partner food, talking to you, suggesting coping mechanisms. If you have particular plans for the birth, like you don’t want pain relief drugs, they can help you plan how to do that.
It’s really really good to have someone there is who there for you, has seen it before and has your immediate comfort as their top priority.
Yes Andrew was there too, and I was strongly focussed on him for emotional support to the exclusion of almost everything else and probably if I’d had to choose I would have had my partner there over a doula, but luckily I didn’t have to choose. And lucky for him too, because while he was not at all intimidated by the, um, physicality of the process (the man has a surgeon’s nerves) he did find it hard to watch me be upset. And doulas watch out for that too.
If you’re in Sydney I can pass along contact details for my doula, whose name is Brooke Martin. Also in Sydney, the Australian Doula College passes out work to their trainees and graduates, so they’re a good place to call, that’s how I got in touch with Brooke. You can also find lots of hits for doulas (at least for Australian capital cities) on Google and meet them on pregnancy boards and so on. If you have a friend or relative who has seen a few births and who you think you would get along with in a stressful situation that could work just as well or better depending on the people.
Some of what a doula does would overlap with a midwife, especially if you see one during the lead-up to birth and have a chance to discuss your feelings about labour. But (in Australia) if you are a private patient or a higher risk public patient like I was, your labour will be overseen by a midwife but you likely will never have met her (rarely, him) before, your pre-natal care will have been done by doctors. For me the doctors were more or less exclusively focussed on my blood pressure and kidney function and neglected a couple of routine tests, let alone doing any discussion of birth with me. But if I’d had the choice I would have gone with midwife pre-natal care***, which is standard for public patients in a lot of hospitals and perhaps tried to get into Ryde Hospital, which has caseloading midwifery, that is, you have a midwife assigned to you for your whole pregnancy and birth.
In any case, even if you have a midwife I’m told a doula is still excellent, because the midwife is focussed on the birth from a medical/safety point-of-view and the doula is focussed on caring for you.
To give you an idea of cost, hiring a doula is about $300 (trainee) to $1000 plus (very experienced) in Sydney. You can (currently…) hire a privately practising midwife to do your pre-natal care, attend a birth at home, or to attend although not assist at your hospital birth. I didn’t look into that closely but I understand in Sydney it’s about $5000 and up.
After hiring a doula, Andrew and I were very glad we attended Renee Adair’s birth and early parenting classes. She’s a doula and doula trainer, not a medical professional, and every so often we noticed she was wrong. But she’s attended lots and lots of births as a doula. They weren’t cheap ($450 I think) but it was worth it to have just us and one other couple there for two days of discussion about labour and about what parenting a baby under six weeks is like. Privately run childbirth/parenting classes are an absolute luxury, but we really really felt very good about having taken them.
We did a subset of the hospital antenatal classes as well. When you compare a few hours involving eight couples with about twelve hours involving two couples, obviously we got more out of the privately run classes but the hospital classes were good for the introduction to hospital policy and a few other things. They also focused a little more on higher invention births, which since I ended up having a syntocin induction was good to know about, if scary and a bit sad.
The midwife who ran the hospital classes also told me, as a doctors’ clinic patient, to try and get one midwife visit at least to discuss labour plans. We did (it happened to be the head specialist in the clinic who I saw when we asked for this, and he thought it was very strange, discouraging, but he did sort it out) and that was very worthwhile, so that’s useful for higher risk patients in the public system.
If you have a partner/friend attending the birth I think having them along to classes is useful; most people do bring them. But many male partners (in my classes there were no other kind) seemed quite unsure about what they’re meant to do: stand there? Isn’t it going to be a bit… boring? The teacher explained that in normal births the midwife isn’t even often in the room in early labour, and in any case the woman is in an alien environment doing a really hard thing. And the videos were helpful in showing the various things that other people do, which is talking and stroking and reassuring and cheering. (And, if your child needs to go to the warmer like mine did, or to the nursery, then the partner/friend is super-useful, because they go with the baby if they can and you don’t have to think about it all alone.)
Don’t forget to find out what you’re supposed to DO with the baby during its first hour or so. (Feed it. And let it poop its entire supply of meconium all over you, if it’s Vincent. Apparently most of them wait a while for that.) There seem to be quite a few birthing guides that don’t actually say much about this. And what I didn’t know is that within about half an hour, if you seem vaguely competent, you could be left alone with the baby. I remember Andrew holding V on the other side of an otherwise empty room saying in a vaguely worried tone “um, do you remember what the hunger signs are…?” There was some kind of emergency in another delivery room and the staff were not coming back to help us out if they could help it. Once I was in the regular ward I could page them when I didn’t know what to do.
Oh, and special tip from my own experience: do NOT invite your family to come to the ward in the hours after the birth unless you have either been transferred to a room, know that it’s about to happen, or you’re OK with them coming to the delivery room. Because I didn’t realise how serious my blood loss had been and that they didn’t want me to move for hours, got on my phone, invited four family members to come basically right away, and they were shown into the delivery room before the blood was cleaned up and Andrew, still high on adrenalin, got quite explicit about the birthing and my sister nearly ended up on the floor.
So in conclusion, we spent quite a lot of money on labour planning. And it was worth it too.
* Actually I would never be textbook low-risk in any case, because the textbook now seems to say that estimated birthweight of 4kg+ is higher risk. I was an extremely tall baby, my son was quite a tall baby, sub-4kg was never really much of a possibility. But the birthweight thing is pretty weird these days, so let’s leave that.
** I’m not making fun of this, it’s just that it didn’t apply to me.
*** A midwife pointed out to us that she couldn’t see any especial reason why this would have been such a bad model even for me. They are perfectly able to check for pre-eclampsia and escalate to a doctor when needed. But they didn’t get to make the call about who did my care, the doctors did.
