Plan for natural childbirth in the maternity hospital. Birth plan: preparing for a natural birth in the hospital

If you have already decided to give birth in a particular maternity hospital, have found a doctor whom you completely trust, but want your child to be born as naturally as possible, you should talk about this with the doctor in advance.

Of course, it is impossible to foresee everything - if any problems arise during the birth process, part of the plan (or even all) will have to be abandoned. However, if nothing threatens the health of you and the child, then a number of medical procedures remain at the discretion of the woman in labor and the obstetrician.

These points should be discussed with your doctor - here is an approximate list of such questions.

If you are determined to have the most natural childbirth possible, then:

• should be able to come to the maternity hospital with contractions - if, of course, you have the opportunity to get there within a reasonable time;

• during contractions you should be allowed to take a comfortable position, move freely, drink water;

• you should not have an amniotomy (opening of the amniotic sac), or have it only after the cervix is ​​almost completely dilated; it is desirable that the bubble bursts on its own;

• Any medical manipulations performed on you must be agreed with you (unless we are talking about emergency actions), moreover, you must be aware of the indications for their implementation, as well as the possible consequences;

• refuse to induce labor unless absolutely necessary;

• try to do without epidural anesthesia - there are unpleasant sensations during natural childbirth, but they are quite tolerable;

• refuse episiotomy (surgical dissection of the perineum), in any case, it should not be planned;

• the umbilical cord should be clamped only after the end of the pulsation, the newborn should be on the mother’s stomach during this time;

• no later than half an hour later, the baby should be put to the breast and left with the mother for at least an hour;

• the newborn must stay with his mother around the clock;

• The baby should not be fed or given additional water - this is an important condition for the development of breastfeeding;

• Vaccination of a child in the maternity hospital can only be carried out with your consent.

Why is it important to meet these particular conditions?

Drug induction of labor

During the natural course of labor, a woman has time to adapt to gradually increasing pain; most mothers describe them as “tolerable.” Oxytocin injections make contractions stronger and more frequent. Such artificial acceleration of labor not only forces the use of painkillers, but also increases the risk of uterine bleeding. Moreover, the child may not be ready for such a high-speed birth - his lungs will not have time to prepare, which threatens him with asphyxia.

” Moscow neonatologist Tatyana Aleksandrovna Bachurina believes that additional portions of oxytocin in the general circulatory system of mother and child lead the baby to a state of stress, and even uses the term “children stressed by oxytocin.”

“These children have neurological symptoms, often in the form of hyperexcitability syndrome, and subsequently often neurotic reactions, emotional and behavioral disorders, and difficulties in social adaptation,” she writes in her article on home birth.

Anesthesia

Indications for the use of painkillers and, especially, epidural anesthesia must be very serious - a pathological course of labor or the need for a cesarean section. Epidural anesthesia itself is a rather unsafe procedure - from 2 to 3.4% of maternal deaths (according to various sources) are due to complications from anesthesia. But even a procedure carried out without obvious violations can provoke postpartum depression in the mother, and in the child - complications during childbirth (depression of the respiratory center).

Amniotomy

Piercing the amniotic sac is undesirable (at least up to 8-9 fingers), because it can involuntarily cause labor to be stimulated; if the anhydrous period after puncturing the bladder lasts longer than 12 hours, the doctor willy-nilly will have to decide what emergency measures to resort to to remove the child.

Amniotomy can fix which will lead to complications during childbirth (for example, facial presentation). To be fair, it should be noted that changing the presentation of a child whose head has already “emerged” in the birth canal is already very difficult, and an amniotomy performed at the wrong time can only aggravate the situation.

Piercing the bladder makes the birth itself more difficult. Blister pressing on the cervix with helps smooth and soft opening of the cervix.

” On the Internet, you can find, for example, the results of a study conducted by specialists at the University of Liverpool (England), who studied the birth histories of 4,893 women and concluded that the amniotomy group had a higher risk of undergoing surgery and the risk of receiving a low Apgar score.

At the same time, amniotomy had virtually no effect on the duration of labor. Doctors considered that amniotomy could not be considered as a standard procedure and should be prescribed only for strict medical reasons.

Episiotomy

The Cochrane Collaboration, an international non-profit organization that studies the effectiveness of medications and techniques through randomized controlled trials, analyzed the birth histories of more than 5,000 women in 2009. The researchers concluded unequivocally that: “The policy of limiting the use of episiotomy appears to have a number of benefits...there are fewer posterior perineal injuries, fewer suturings and complications, no difference in most pain measurements and no difference in the incidence of severe injuries.” vagina and perineum. However, there is an increased risk of injury to the anterior perineum.”

Removing vernix

A baby wearing lubricant may not look as attractive, but during the first 24 hours it effectively protects the newborn's skin, allowing him to adapt to the new external environment.

Newborn eye treatment

A stage that most mothers simply do not pay attention to. Meanwhile, the need for this procedure is not obvious at all, not to mention the fact that in our maternity hospitals such potent agents as silver nitrate and sodium sulfacyl are still used. If the neonatologist considers that such treatment is necessary, be sure to ask what drug will be used; today, erythromycin phosphate can be considered the safest.

Tying the umbilical cord

” In five to seven minutes of pulsation of the umbilical cord after birth, the baby can “take away” 100-150 ml of blood from the placenta, which is not at all superfluous for him.

It is only important to ensure that the baby is below the level of the placenta (otherwise a backflow of blood is possible).

Early breastfeeding

Early breastfeeding (if possible, before clamping the umbilical cord) is not only an emotionally priceless moment of childbirth, a moment of very special closeness between mother and newborn, but an effective prevention of a number of pathologies - diathesis, dysbacteriosis, and other allergic manifestations. The baby should stay at the breast for at least 15 minutes (preferably an hour). Even if he swallows just a little colostrum at this time, the intestines will still be inseminated with acidophilus bacillus. In addition, this is the first step towards strengthening the sucking reflex.

For the mother's body, the baby's first attempts to suckle at the breast are a kind of signal that everything went well, and you can start working on other tasks, for example, increasing lactation. Breast stimulation also increases uterine contractions, making it easier for the placenta to pass.

” The first skin-to-skin contact is similar in importance. This not only calms the baby, but also allows him to “get acquainted” with the microflora of the mother (preferably also the father).

Fortunately, today there are more and more maternity hospitals that are friendly to mother and child, where such desires of the mother in labor are not considered a whim and a whim, and even on the contrary - the mother is offered to put the baby to the breast and ensures that mother and child stay together from the first minutes of life. Choosing a maternity hospital and a doctor with whom you will find a common language and who will be sympathetic to your wishes is your first responsible act as a mother. Don't miss the opportunity to do it!

Article updated 12/7/2014

Prepared based on material by Anastasia Gabets,

perinatal psychologist at the School “Birth for Two”

The birth plan has recently become popular and is increasingly being planned for the future, as it is very useful during childbirth. Find out what it should conclude and how to write it because this is an important and serious event in your life!

Before going on vacation, you prepare a shopping plan for the necessary things. Likewise, before giving birth, you should ask yourself several important questions about the event that awaits you. It turns out to be useful to have a birth plan that will allow you to get to know yourself, your needs and requests, fears and doubts. It may also be an inspiration to talk to your husband or other family members who will accompany you during childbirth, so that they too understand your plans. A birth plan also allows you to compare your own expectations with what the hospital where you will give birth offers.

When to make a birth plan?

If yours runs smoothly, you can start drawing up outlines of your birth plan at 7-8 months of pregnancy.

What should a birth plan include?

The finished plan contains a list of things and procedures that you consider necessary to do at the birth of your baby. It's worth really thinking it through and discussing everything with someone experienced (a friend who has already given birth, your doctor or the midwife you chose). Remember that after the start of labor you will forget about half of the essential things, and the prepared document will be of considerable help. The birth plan should be drawn up so that the midwife does not think that her hands are tied. If a situation arises that may pose a threat to your health or the baby, the birth plan will not play a big role. Then you will need to apply solutions that will protect both of you from danger.

Here are some suggestions for creating a birth plan:

1. Your first and last name are required information.
2. Details of the doctor managing the pregnancy.
3. Details of the person accompanying you during childbirth - if you want this person to be with you until the end of the birth, write down this information. If you wish to be involved in some procedures yourself, you can also indicate this. Anyone's company during the birth process, outside the presence of a midwife, depends only on your decision.
4. Positions in the first and second stages of labor - determine in which positions you are going to give birth. If you are interested in an active birth, remember the vertical positions. The position taken during the pressing phase sometimes depends on the customs of a given hospital. If you get a choice of positions, don't forget about gravity and vertical positions to help dilate the cervix.
5. Medical interventions - think about which ones you might approve of and why, and which ones you would like to avoid.
6. Accessible non-medical care - Consider whether you want to use alternative forms of care that are soothing and relieve pain: exercise ball, ladders, handkerchief, bath/birthing pool, aromatherapy, massage.
7. Presence of interns - if you do not want their presence, you have the right. Sometimes it happens that students are very helpful and support the woman in labor and her partner.
8. Cutting the umbilical cord - who should do it? If the course of labor and the condition of the child allow it, the baby's father can cut the umbilical cord. In some hospitals, the midwife does this due to reluctance on the part of the child's father or habit.
9. The first hours after giving birth - you must be bathed, decide what clothes you should wear, you are thinking about breastfeeding already in the delivery room - think about it.
10. Baby's first vaccinations - You may not agree to have your baby vaccinated immediately after birth. If you refuse, you must submit a statement in which you write that you refuse to vaccinate your child and understand the consequences of this decision.
11. When you are admitted to the hospital, take your birth plan with you. The plan will help the staff understand your wishes and needs for the birth.

A very important and exciting moment in the life of every expectant mother is childbirth. In order not to forget anything and not get confused at the most fussy moment, make a birth plan. In addition, it will help you tune in to the fact that the baby's arrival is close.

In this article, we will help expectant mothers create a birth plan and explain what mandatory items should be included in your plan.

Preparing for childbirth requires a special plan that will help you understand how you manage your birth, what your needs are, what you are afraid of, etc. With the help of a plan, you can compare your needs with the capabilities of the maternity hospital that you have chosen. A birth plan can organize not only you, but also your family members.

So how and when should you make a birth plan?

If the pregnancy is progressing normally, you can safely start working on a birth plan at 6-7 months of pregnancy, or when you feel the need to sort everything out.

The birth plan must include all the procedures and things that you think need to be done at the birth of the child. Consider each point carefully, if the need arises, consult with a friend who has already given birth, and best of all with a midwife or doctor.

Such a plan is very useful when labor begins, because gathering your thoughts at this moment will not be easy, but every woman wants the birth to go as well as possible.

You shouldn't leave your birth plan in such a way that the obstetrician thinks her hands are tied. Remember that your plan will be considered in case of a normal birth, but if there are any complications, it will no longer be relevant.

What must-have items should you consider in your birth plan?

First, write all the necessary information about yourself, starting with your last name, first name and medical information - this is very important.
If you decide that someone will be present with you during the birth, be sure to enter the details of this person. Also, you can note at what stages of the birth this person will be present. Indicate all the nuances.

Write down the position you would like to take during the first and second stages of labor; you can discuss these positions in advance with your doctor and midwife. And if you also write down these positions, then no one will forget about your preferences.

Probably the most important point in your birth plan will be the point about medical intervention. Think about what you agree to and what you don't agree to. Write down why you would like to avoid certain procedures.

If you have special preferences, such as using alternative forms of care - massage, aromatherapy, bath or birthing pool, exercise ball - please indicate this as well.

Sometimes it is possible that interns will be present during childbirth; if you do not want to see them, you can safely refuse them. By the way, sometimes they can be very useful as additional moral support, not only for you, but also for your birth partner.

If everything goes well, you can even prescribe a condition that the child’s father, for example, will cut the umbilical cord.

Everything you want to do after giving birth should also be included in your plan. Write what the baby should wear after he is bathed.

If you refuse vaccinations for your baby in the first days of his life, also write this down.

Take care of a special statement refusing vaccination - this is necessary for your wish to be fulfilled.

The plan you create will help the maternity hospital staff understand what you want and what you don’t. It will become an assistant for you; a birth plan will help you focus on the process and not think that you might have forgotten something. This is additional peace of mind for you at such an important and exciting moment.

- important points that I have compiled to follow during the birth of our son and which can help you in drawing up your plan.

I dreamed and dreamed of natural childbirth. But when I was diagnosed with ICN and stitches were placed on my cervix, I realized that giving birth at home was out of the question. At that time, we attended courses for pregnant women and there they explained to us how important it is, not only for the pregnant woman herself, but also for her team, to have a clear Childbirth Plan. It is clear that childbirth is an unpredictable thing and you need to be prepared for anything. That’s why we need this plan, which will clearly describe what and how to do if something happens.

These people should have an idea of ​​what you want from your Childbirth. Let me give you an example. When I got stitches, the doctor who did it asked where I planned to give birth. I said that I wanted a natural birth as much as possible, to which he said that, of course, it could happen here too. Then I asked one question - how much time do you give before cutting the umbilical cord. The answer put everything in its place - “well, 2-3 minutes is enough.” Therefore, it is very important to know in advance and let the doctor understand what you expect and want from your Childbirth.

I drew up the plan for a long time, based on my wishes. It was compiled 2 months before the birth.

I printed it out in 5 copies and put it in a ready-made bag for the maternity hospital. Before that, of course, I let my husband read it :)

So here it is.

Childbirth

1. I can move freely and walk around the room

I didn't want to be tied to the bed and lie on my back during contractions and pushing. For me, as well as for the process itself, it is very important to be in motion.

2. There should be dim, dim light in my room.

That is, natural light from the window during the day or, as in my case, candles at night.

3. My music inside the ward

This aspect was very important to me. I initially planned to listen to traditional Celtic music, but ended up listening to relaxing yoga music. We even bought a special speaker, but since everything was not planned, we forgot it at home. We ended up playing music from our midwife's iPad (which was great that she had it!).

4. Giving birth in your own clothes

I wanted as few associations with the hospital as possible, so it was important for me to give birth in my own personal clothes. I was wearing a simple elastic bandeau dress. In the end, of course, I took it off.

5. Do not offer painkillers/epidurals

I wanted the most natural birth possible, so I only considered non-drug methods of pain relief. During childbirth, there comes a time when you begin to feel that you cannot cope and many begin to require anesthesia. It is very important at this time to have someone next to you who can bring you to your senses.

6. Do not puncture the amniotic sac

That is, wait until it bursts on its own. Piercing stimulates very strong and painful contractions - this is considered stimulation of the birth process. In addition, sometimes babies are born “in a shirt” - that is, in a bubble. In my case, we went to the maternity hospital because my bladder burst, so it was irrelevant.

7. Minimum gynecological examinations

Watching the disclosure every time the bubble has already burst can at least introduce an infection, and does not carry much information. I was watched 4 times during the entire Childbirth period.

8. IV only for medical reasons

I was against installing a catheter on my arm. Again, because I wanted to minimize the hospital mood. In the end, of course, they put a catheter in me only because it was necessary for medical reasons - bleeding began.

9. Offer me food and water between contractions.

Yes, I ate and drank during Childbirth. And I think everyone should do this. It takes so much strength and energy to bring a baby into the world. In general, all the fuss about the ban on food and drink came from the fact that surgical intervention could potentially be required. I drank red wine (with doctor's permission) and water. I ate bananas, apples, cheese, dark chocolate.

10. Offer me new positions

During childbirth, there always comes a time when you have to change positions in order to find the right one, in which it seems to be easier for you. For example, I couldn’t lie on my back at all. I was in unbearable pain. During contractions, I walked, lay in the bathtub, and sat on the birthing chair. While pushing, she hung on the bed handle. And she gave birth on a birthing chair.

11. Massage my lower back during contractions

This helped a lot with the pain. When a contraction came, I would first tell my doula “contraction” and she would begin to massage my lower back. Then even words were no longer required. My husband was also a great help with the massage.

12. Lying in the bathtub during contractions

When labor was in full progress, I climbed into the bathtub. Warm water relaxes and helps you get through contractions easier.

12. Use natural methods of stimulation if labor stops

Sometimes they stop. And I did not want to resume the labor process medicinally with the help of the synthetic hormone Pitocin. Natural methods include nipple stimulation, walking, changing positions, and so on.

13. No Episiotomy

I am opposed to episio - or perineal incision, which is practiced in almost all childbirths. And without any meaning. Many doctors say this is necessary to prevent rupture. But even studies already say that natural tears heal much faster and more painlessly than incisions.

14. Physiological birth of the placenta

This means that the placenta should be delivered on its own, without prescribed Pitocin or tugging on the umbilical cord. The exception is the placenta not expelling within 60 minutes or bleeding!

15. Natural relaxation methods

This includes breathing, acupuncture, massage, rebozo, pressure. For example, it helped me a lot when they breathed through each contraction with me and massaged my lower back.

After Childbirth

1. No Pitocin

This synthetic hormone oxytocin is often given immediately to prevent bleeding. I see no reason to do this without strict medical indications. That is, if the birth was normal and physiological.

2. Immediate skin-to-skin contact

Place the baby on my stomach immediately after he is born. This is important not only from a psychological point of view, but also from a physiological one. Children should receive microflora from the skin of their mother (or father), and not from the hospital table. Plus, it stimulates the separation of the placenta! Well, the “plus” is that it even helps children breathe, as they feel your breathing and heartbeat.

3. Clamp the umbilical cord only after the placenta is born

Or at least let it pulsate. Blood and oxygen are still supplied to the baby, so it is important to let him get enough of it. In our case, unfortunately, this did not work out because I started bleeding.

4. The husband cuts the umbilical cord

It was important for me from an emotional point of view.

5. Save the placenta for encapsulation

This requires a separate post. But the point is to dry the placenta, chop it up and then consume it. Yes, you heard correctly - eat your placenta. All females in the animal kingdom do this. The placenta contains numerous hormones and bioactive substances. Its use improves milk flow, reduces the risk of postpartum depression, and gives more energy. Unfortunately, we were unable to use this service because I had partial placenta accreta. But next time, if possible, I’ll definitely use it!

6. Examine the baby on my chest

This is where it should be. And all manipulations (of course, if everything is fine) can be carried out on my chest. Or wait a few hours - for example, measuring weight and height. They examined Emelya and listened to me on my chest and only then measured his height and weight.

7. Avoiding eye drops

It is still standard practice in many maternity hospitals to instill antibiotics into children's eyes. This is done to prevent infections that can be transmitted to them from their mother. I’m completely clear about this, so I didn’t see the point in completely unnecessary antibiotic therapy.

8. Refusal of vaccinations

We wrote a refusal of all vaccinations. It would take a long time to explain; I have already written my point of view on this matter.

9. Don't bathe your baby

Babies are born covered with a special protective lubricant, which, in my opinion, is simply unnatural to wash off. Moreover, with the use of all kinds of chemical agents. We didn’t bathe Emelya, we just dried him off.

10. Consultation with a breastfeeding specialist

No matter how rich a theory I had on breastfeeding, I still had no idea how to breastfeed. Therefore, a knowledgeable person who showed me how to properly apply to the breast came in very handy. But my husband also helped me a lot. It was he who helped put Emelyan to the chest and insisted on trying new positions if Emelyan refused to take the breast.

11. The baby is always with me or with dad

My birth ended with heavy bleeding, where I lost 1.5 liters of blood. It’s clear that I spent the first 12 hours in intensive care. At this time, our baby was with his dad. It lay on his bare chest and was “enriched” with his microflora. In addition, my husband brought Emelya to me for feeding until I was transferred to our shared ward. If this point had not been in my plan, Emelyan would have gone to the nursery and lay there alone, which in my opinion is absolutely unnatural.

Just in case

1. Do not accelerate/provoke labor

Only if there is a real threat to my life or the life of the baby.

2. Explain any interference to me first and then give time to discuss it with your team

In my case, the moment came when the progress of labor stopped. The baby was premature (I gave birth at 35 weeks) and he was not lying as it should, so I could not relax and the dilation was 8 cm, but during contractions no more than 6. In a normal “full-term” case, I would have been given Pitocin, but since it was a premature birth - there were two ways out. Either a cesarean section or try an epidural, which will help dilate up to 10 cm, and then give birth without it. When the doctor told me about this, I couldn't believe it. In my eyes, this was the collapse of my dream of natural Childbirth. But my midwife and doula agreed with the epidural as a necessary part of my Labor and helped me understand and accept it. As a result, she helped me dilate to 10 cm, and I was already experiencing all the delights of the birth process!

C-section

1. Only strictly for medical reasons

In cases of threat to my life or the life of the baby.

2. “Soft” CS

In Russia, this type of operation has only recently begun to be practiced. I will definitely write a separate post about this. It is called “soft” for many reasons. Below are some of them:

• Before the operation, insert a sterile bandage into the vagina and then wipe the baby’s mouth, face and body with this bandage in the first 2 minutes after Birth (when he lies on my chest). This is necessary in order to give the baby the mother’s microflora, which he is deprived of because he did not pass through the birth canal.
• My team (husband, doula and midwife) with me in the operating room
• I want to see the birth of my baby (that is, not put up a barrier)
• If possible, let the umbilical cord pulsate
• Husband cuts the umbilical cord
• Leave my one hand free so I can hold the baby
• Immediately put the baby to my chest, if not, then to my husband

All points were fulfilled in my situation. Because I knew what I wanted. Because I had a plan. And of course, because we gave birth under a contract with the “right” doctor in the “right” maternity hospital, who shared our views on natural childbirth. And most importantly, we gave birth with the “correct” midwife, not a hospital one, but her own, who taught courses for us. Which we knew personally. And I know that I would give birth again there, with these same people!

* I am now actively mastering Instagram, my thoughts about pressing problems and more are on evgenia_happynatural

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