Genius Toiling in Obscurity

The Best-Laid Birthing Plans

Last week, I had the prenatal visit where they give you information about labor and delivery, and a big packet of brochures and whatnot from the hospital and from Our Corporate Sponsors. ("Are you planning to breastfeed?" the nurse asked me. "Yes," I said. She handed me a packet of glossy Medela propaganda.) The hospital information tells me how wonderful the Mother-Baby Center is, but, to my disappointment, reveals that the remodeling that was underway when my son was born is still underway three years later, meaning that not all of the Post-Partum rooms have been converted to private rooms. Last time I had a baby, I got the very last available private room, and having now been in the hospital with a new baby, I am even more convinced than I was before that I would find a "semi-private" room intolerable. If the baby is born, and they only have a "semi-private" room available, I'm going to say, "We'll just go home now, then. I have a private room there."

Oh, look, I just noticed that there is a Similac brochure in the packet, too. Lovely.

What I wanted to write about, though, is the bright yellow "Sparrow Health System Birthing Preferences Checklist" included in the packet. "We want to help you achieve the birthing experience which best meets your wishes and the needs of your baby," it says, and that is followed by 12 yes/no questions. I am supposed to fill this out and bring it to the hospital, and I am finding it simply impossible to do, for a couple of reasons.

First, my memory is that last time, nobody paid the least attention to my Birthing Preferences Checklist. In general, my wishes were respected, but nobody read my wishes off the yellow sheet. We had to tell everyone. Over and over.

More importantly, having done this before, I am too aware of how unpredictable the whole thing is. I had a good experience giving birth to Eric. I was content with the medical interventions we accepted, and those we rejected. I have been happy enough about the whole thing that, while I like to tell the parts of the story that make me seem heroic (No epidural! Pushed him out in 14 minutes!), I am just as likely to tell the parts that make me look weak (screamed so loud once they called in from the nursing station to find out if everything was OK--even though there was a nurse in the room! Whined, "David, make it stop," on at least two occasions!).

But even so, I was wrong about some of the pre-birth "preferences" I formed. My friend Carla had warned me that "this whole walking-around-in-labor thing is overrated," and that was true to my experience as well: I had no interest in taking a stroll. Yet I am asked to check Yes or No to "I want to walk around during labor." How can I know that, until I'm in labor? An acquaintance of mine told me recently that during one of her labors, she just wanted to lie still in one position; in the other, she was restless and paced a lot. Will I want to lie around this time? Will I want to pace? Ask me when I'm in the Labor & Delivery room! I find myself wanting to modify that question to, "I want to be allowed to walk around during labor if I feel like it. As if you'd be able to stop me."

Two questions further down: "I want to use techniques to reduce the need for episiotomy." Well, yes. Though last time, I went into the hospital rabidly anti-episiotomy, partly because my reading suggested an episiotomy was generally unnecessary but more importantly because I found it very disturbing to imagine being deliberately cut, whereas I was not disturbed by the possibility of tearing at all. Accordingly, when it came time to start pushing, David told the o.b. at least twice, "She doesn't want an episiotomy!" I honor him for supporting my stated wishes, but at that moment, I didn't care in the least. I still would prefer not to have an episiotomy, but I remember that at the moment when the cutting would have happened, I was completely indifferent. So I suppose if my o.b. thought there were some compelling reason for me to have an episiotomy, I would be at least open to the possibility.

And further down: "I want to have my partner or me cut the umbilical cord." I have never understood the big deal about cutting the umbilical cord. I can't remember whether David cut Eric's cord; in a recent conversation, David revealed that he can't remember, either. Clearly this was significant for us! But I'd still like to leave it as a "maybe." One of us may find we want to do it, when the moment comes. Though I expect we'll be more interested in the baby.

I do have a short list of things I want to do differently this time. OK, two that I can think of off the top of my head:

1. Be slower to go to the hospital if my labor is not progressing. Last time, I thought I was being bold and contrarian because I didn't get to the hospital until about 5 hours after my water broke, although they tell you to go immediately if your water breaks. I'd been having only light contractions during those five hours, but I didn't realize until later just how light those contractions had been (they were stronger than any of the Braxton-Hicks contractions I'd had). They were coming very close together, and had gotten steadily closer together during those five hours. So I didn't know I wasn't in active early labor, and can't blame myself for showing up at the hospital when I did. Still, the only bad moments in my labor and delivery came because I showed up at the hospital with my bag o' waters broken but not fully engaged in active labor, and we had to fight with the resident, who wanted to start Pitocin, until my o.b. got there. Not going to the hospital too soon is the best way to avoid unwanted medical interventions, as another acquaintance of mine, who didn't show up at L&D until she was at 8 centimeters, will tell you.
2. Get a look at the placenta. I remember vividly what the placenta felt like being delivered (warm, wet dishrag), but I never took a look at it. I find I'm curious, so this time, I'm going to sneak a glance before it goes into the Approved Medical Waste Receptacle.

Perhaps I should add "I want to get a look at the placenta" to the bottom of the yellow sheet. Not that anyone will notice. Or care.

UPDATE: from Adrianne, via IM: i almost threw up looking at [a friend's] placenta, btw. and i'm not usually squeamish, as you know.

Food for thought.

Posted by Su Penn at March 2, 2004 05:07 PM | TrackBack