Once the cervix has dilated to 10 centimeters, many women begin to feel an urge to push. Some do not feel it right away. At times, labor slows or even stops after dilation is complete and the woman is given a natural "rest." Resist the urge or the instruction to push before the urge to push is present. Occasionally women never feel one at all, and in this case if contractions are still coming on regularly, pushing is still very effective when done during contractions. If an epidural is in place, the urge to push will not be present and some guidance will be necessary in the timing of pushing, but again it can be quite effective for some women even under complete numbness. For others, epidurals make it very difficult to help a baby out.
Episiotomy
An episiotomy is an incision made to the perineum during pushing, that enlarges the opening of the vagina. Many obstetricians do episiotomies routinely, or nearly routinely. Ask yours what their rate is. Anything over 25% is quite high. For many midwives, episiotomy is quite uncommon. For Midwives Care, Inc., the rate is under 1%. With warm compresses, vitamin E or olive oil, and calm coaching through pushing, there is almost never a need for a woman's genitals to be cut. If the baby is showing signs of distress, exceptions should of course be made. At times, women will have perineal tears when an episiotomy isn't given. Many times, there is no injury whatsoever to the perineum. Some doctors believe that a straight cut will heal more quickly and with less discomfort. Others say that with careful stitching (necessary for large tears and for all episiotomies) and proper postpartum care, tears and straight cuts heal similarly.
Cleaning, Weighing, Warming, Noise, Light, Examining and Other Pokes and Prods of Varying Necessity
After delivery, the warmest place for a baby to be while adjusting to the cooler environment is under a blanket, skin-to-skin with Mother. Many women specifically ask that the lights be low and the noise be minimal, so that the drastically heightened stimuli don't overwhelm or frighten the baby. Weighing can be delayed for as long as the family would like � an hour or two is fine. The baby can be gently wiped in Mother's arms, although the vernix need not be removed. It can be rubbed in instead, as it is very good for newborn skin.
Some hospitals and doctors perform a blood test on babies routinely to check for iron and glucose levels. The American Academy of Pediatrics and the American College of Obstetrics and Gynecology now recommend against these routine tests. Just after birth, the babies' blood levels can vary widely due to any number of factors (particularly if the labor and delivery involved medications) and will usually regulate themselves within the early hours.
Vitamin K Shot
The vitamin K shot is given to aid in blood clotting. If your newborn is going to be circumcised, the mother may consider this shot a good precaution. Furthermore, if the birth was not smooth, and there is any chance of internal bleeding, it is a good precaution. However, with a normal birth and a healthy newborn, severe blood loss is an unlikely risk and the vitamin K present in colostrum suffices nicely.
Antibiotic Ointment
Antibiotic eye ointment is used to protect babies from infection during birth, should the mother have contracted a venereal disease during pregnancy (a test for VD is routine in early prenatal care). If a woman has been monogamous and her partner has been as well, there is no risk of such infection, and the ointment is unnecessary. Overuse of antibiotics is becoming a serious problem, as many bacteria are forming resistance to the drugs, making them ineffective. It is socially responsible to use them only when necessary, and sensible to not give unnecessary drugs to a newborn baby. This antibiotic ointment is required by law, but waivers are available to sign. It is typically necessary to ask for these specifically.
Circumcision
Routine circumcision is medically unnecessary. It is a very painful procedure, with psychological risks as well as the same physical risks of any other surgical procedure. It is important to be educated about this issue before deciding to alter the genitals of a baby. Further reading is listed at the end of this article.
Vaccinations
Making decisions about vaccination can be a very complicated task. Some vaccines are basically safe and effective; others commonly produce mild to severe reactions in infants and should be seriously examined. The effectiveness of certain vaccines is questionable. Pharmaceutical companies profit immensely from vaccines, as does the entire medical community. In short, vaccines have usefulness, but also risks. It is wise to read and ask questions of many people, including individuals who have nothing to gain or lose by vaccines being used routinely. There is a very thorough and evenly represented set of writings in an issue of Mothering magazine, referenced below.
Separation
If a woman wants to be sure her baby is responded to and cared for promptly, it is wise to keep the baby near. Newborns in some hospital nurseries are allowed to cry for long periods, given bottles of formula and pacifiers, given vaccines without notification, and even circumcised without asking! Of course, administering vaccines and performing circumcisions without notification are rare mistakes, but they do occur. Nursing staff will allow babies to cry and offer formula and pacifiers less rarely. Some women consider it important for their newborns' cries to be met with their loving arms instantly. Furthermore, offering new babies artificial nipples can result in "nipple confusion," a term used by lactation consultants and breast-feeding counselors to describe a troublesome condition that leaves the newborn unable to coordinate a proper latch and suck on a human breast.
A Few Tips on Style
Some experts recommend a short, concise birth plan, outline style. The advantages to this are that many people get a feel for your wishes easily, and a caregiver who is hesitant to cooperate with special requests won't be irritated by a lot of reading. However, for many obstetricians and most midwives, a more personal and thorough written description is helpful. Based on conversations throughout pregnancy, both mother and caregiver should already be familiar in a general way with the plan. Some details, however, may have never been discussed and the written birth plan can finalize these. There is no need to include issues that are certain to be irrelevant. For example, most hospitals no longer do routine enemas and pubic shaves; therefore, there is no need to write a request that it not be done. These sorts of written requests can be seen by some hospital personnel as insulting.
A birth plan should include issues that are most crucial to the mother, those which will go against what is routine at the place of birth, and those about which the mother and caregiver may not be already aware.
Some believe the short, concise style to be outdated. Crick says, "Birth plans are so individual that there isn't anything that has to be on it� The old traditional bullet point birth plan is perhaps not the most effective thing. Write a more essay style birth plan. Simply, a letter to the various people at the birth, visualizing how you want the birth to go."
According to Terhune, "The parents' attitude toward the whole process is so important. If you are planningnatural childbirth � the requirement is to trust birth. But it doesn't mean that birth is always perfect. If a couple takes on self-responsibility and understands the risk, and they�believe that the safest place is out of hospital, we honor that decision. 'Trust in birth' doesn't mean 'I know nothing will go wrong.'"
Many women have unspoken and unconscious fears, doubts or simple concerns about labor and delivery that can come out during the course of writing such a letter. The birth plan is one tool for preparing the heart and mind for the glorious process of childbirth. It is an experience worth entering with our eyes open, aware of our options, our risks, and our maternal power.
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