Birth Plan: Do You Need One?

From detailed birth plans to none whatsoever — the pros and cons
By Erin Marsh

First-time mothers often have a meticulously devised birth plan, including what songs will be played during labor and delivery to birthing positions. But is that necessary?

Here are some pros and cons of birth plans and what you SHOULD make sure to consider before that momentous day.

What needs to be included?
If you are a planner, you may have a detailed birth plan created. Consider having multiple birth plans in case your ideal plan is not feasible. If the baby is in distress and you need an emergency c-section, which is often devastating for a mama who wants to deliver naturally, what can that situation look like to make it more bearable? Plan for the best case scenario but mentally prepare for alternatives. Then you can at least make the best of a less-than-ideal situation.

Who will be present?
Pregnancy and delivery can be beautiful experiences, but can also be difficult and unexpected. Consider who you want in the room with you to welcome the newest addition to your family. While your parents (or in-laws) may be an important part of your life, this is your moment with your expected child. The last thing you may want during those painful and/or exhilarating moments is the stressful energy of a loved one.

Or perhaps your family is perfect — supportive, loving, nonjudgmental — but you want to experience those precious moments with your significant other and newborn. Whatever you decide, is right for you and your family, and is absolutely the correct decision. Do not allow guilt or pressure to change what you want; those moments cannot be returned.

Visitors?
People love babies, and they will want to visit you in the hospital or those first few days at home to cuddle that perfect little bundle of joy. Figure out who you want to visit with and at what time, then task your significant other or a close family member or friend with enforcing those guidelines. If visitors, no matter how wonderful and supportive, cause you more stress than relief, avoid them. They will have plenty of time to cuddle that baby in the coming months.

Accept help
Some caring friends/family will want to help, let them. Make a list of small tasks that would help you while you recover, and when people ask if there is anything they can do, respond with something simple, such as “I’d love a meal that I don’t have to cook!” People who express love in the kitchen can make you a home-cooked meal, and those who would rather spend money than cook can give you a gift card or order a pizza.

Just be careful with your requests. When one woman asked her friend if there was anything she could do to help while the new mama recovered from a normal delivery, the new mother replied, “I never got around to painting the baby’s room. Could you do that?” Perhaps some friends would gladly do such a favor, but that’s asking a lot, and then you run the risk of losing a friend over lofty demands. On the flip side, the new mama got a freshly painted room with no effort on her part, so there’s that!

Other options
Depending on your familial and monetary situations, there are a plethora of resources to help you in the first few months. A family member may be able to stay with you to take some of the night shifts, and there are even “sleep nannies” you can hire to share the nighttime responsibilities. If you plan to nurse exclusively the first few months, this limits your options, but that’s yet another thing to consider.

Breastfeeding is admirable and beneficial for the baby, but not all mothers are capable of producing enough — or any — breast milk, and if it’s a fight between your sanity and breastfeeding, then don’t allow societal pressure to guilt you into thinking you are “less than” because you choose to supplement, pump, or use formula exclusively. Being a new mom is hard enough without the added pressure of society’s expectations.

Doula vs. Midwife: What’s the difference?

These two terms are tossed around frequently these days–is there a distinction?

Doula
The word “doula” is a Greek word meaning “woman’s servant.” A doula is essentially a labor support companion. They are professionally trained in childbirth to provide emotional, physical, and educational support to pregnant women throughout their journey. They are NOT medically trained; their purpose is to provide a positive, memorable, and empowering birthing experience, but they do not help with the physical birthing process.

Midwife
A midwife is a trained health professional, sometimes — but not always — a nurse, who helps healthy women during labor, delivery, and after the birth of their babies. Midwives can deliver babies at home, in birthing centers, or in a hospital.

Sara Linkey, CNM, MSN, RN at Henry County Hospital, explains, “Certified Nurse-Midwives (CNMs) partner with women to provide evidence-based women’s health care. Midwives provide gynecology services, pregnancy and postpartum care, and are qualified and trained in delivery. The Midwifery relationship can start in the teen years and continue all the way through menopause. Midwives are passionate about education, health promotion, and assisting women to make the best choices about their health. Midwifery is women caring for women!”

For those who are considering a midwife, it’s important to recognize that midwives can have different levels of training:

A certified nurse-midwife (CNM) is a registered nurse who has graduated from an accredited nurse-midwifery education program and passed the national exam. CNMs can practice in all 50 states.

A certified midwife (CM) is a midwife with a bachelor’s degree or higher in a health field but is NOT a nurse. To become a certified midwife, however, they must complete an accredited midwifery education program and pass the national exam. Only a handful of states allow CMs to practice.

A certified professional midwife (CPM) has training and clinical experience in childbirth, in and/or outside of the hospital setting and has passed the national exam. They are NOT nurses. Not all states permit CPMs to practice.

Are they right for you?
While anyone and everyone could use a doula, it is recommended to only use a midwife if you have a healthy pregnancy with no complications as midwives are not medically trained or equipped to deal with complications during delivery or medical issues that may arise with the newborn..

Midwives provide the same medical support and guidance during pregnancy as an OB/GYN, conducting prenatal exams and advising you during your pregnancy. They can deliver your baby and provide a doctor referral when necessary.

As with all decisions during pregnancy, the choice of a doula and/or midwife is a personal one.

Delivered…Now What?

What to expect the first 24 hours postpartum
by Christa Melnyk Hines

If you’re on the homestretch of your pregnancy, you’re probably anxiously awaiting the moment when you finally get to hold your newborn in your arms. But what should you expect in the whirlwind of minutes and hours following the much-anticipated arrival of your baby?

The first five minutes
During the first minute of life, healthcare providers will conduct an Apgar exam to evaluate your baby’s heart rate, respiratory rate, muscle tone, cry, reflexes and skin color. The screening will be repeated at five minutes after birth.

“The Apgar system helps us know if a baby is adapting to this huge transition from in-utero to life on the outside,” says ob/gyn Erin McNulty, MD. . A normal Apgar score ranges between 7 and 10. A score of 4 to 6 may mean that the baby requires oxygen and additional monitoring. Scores 3 and below demand emergency medical intervention.

Soon after delivery, babies receive Erythromycin eye ointment to prevent rare, but serious eye infections that can be passed from mom to baby during delivery. Newborns also receive Vitamin K, a vitamin that helps with blood clotting. Because they don’t produce enough of the vitamin on their own just yet, lack of the supplement puts infants at risk for anemia, excessive jaundice, or damage to internal organs, including the brain.

Meanwhile, if you’ve had a vaginal delivery, your ob/gyn team will oversee the delivery of the placenta and repair any tears to the perineum. Many hospitals also try to ensure mom and baby get skin-to-skin bonding time in the immediately post delivery, even if only for a few minutes in the operating room following a c-section.

The first hour
If you require a c-section, you’ll spend the first hour postpartum in the operating room where the OB team will suture the uterus and the abdominal skin before transferring you to the recovery room. Your baby will be most alert during the hour following delivery. You may be pleasantly surprised at how your newborn turns toward your voice and instinctively reaches to nurse.

“If you place a baby skin-to-skin on mom’s belly or chest, even right after delivery, the baby can usually get itself up to the breast to nurse,” says Lisa Cavin-Wainscott, APRN, clinical nurse specialist.

The first feeding will stimulate breast milk production and help the uterus contract, which can prevent excessive bleeding. Don’t expect you or your baby to get the hang of breastfeeding right away. “Be patient. It takes time-potentially four to six weeks-for mom and baby to get comfortable,” Cavin-Wainscott says.

Your breast milk won’t come in for another 48 to 72 hours, but don’t worry.

The colostrum that your breasts produce is usually enough for your newborn. After the first feeding, you and your baby will be tired and ready to sleep. Newborns typically sleep anywhere from 16 to 20 hours per day and may be need to be woken up for a feeding.

“Many new moms are surprised at just how often a newborn needs to eat,” Dr. McNulty says. “Their stomachs are the size of a pea so they are full quickly, but need to eat quickly too.” Baby will also pass her first stool called meconium, which will be sticky and dark green or black in color.

First four to 12 hours.
These days, most hospitals keep babies with their mothers rather than moving them to a nursery. The time together promotes mother-baby bonding, relaxation and healing. You’ll begin to learn your baby’s cries and recognize feeding cues like hand sucking.

While some hospitals will bathe the baby soon after delivery, others wait until four to 12 hours after birth. “The baby has a special coating on their skin that actually acts as a moisturizer so we don’t want to give the bath too soon,” says Dawn Cox, MSN, RNC-OB. A bath immediately postpartum can also stress a newborn because they get cold easily, Cox adds.

You may also notice your baby sneezing, but that doesn’t mean she’s sick. “Baby may be ‘spitty’ for several hours after birth as they get rid of blood and other fluids that may have been swallowed during the delivery process,” Cavin-Wainscott says. You may experience physical pain from the delivery and mixed emotions.

“During the first day following delivery, the hormones your body made during pregnancy start to come crashing down and mood swings and changes are the norm,” Dr. McNulty says.

Up to 24 hours
Your pediatrician or family care physician will conduct a complete physical assessment of your newborn, including blood type, bilirubin level, screening for rare genetic disorders, and a hearing screen.

Labor and delivery nurses, lactation consultants and other healthcare providers, will continue to provide you with support. A financial counselor, social worker and WIC nutrition consultant may also visit to provide resources that you might need before heading home. Of course, friends and family will be anxious to drop in too.

“I hear many new parents who wish they had slowed down and enjoyed more bonding time with their baby, rather than allowing family members and friends to visit right away,” Dr. McNulty says. If you’d prefer to wait to see visitors, ask them to visit after the first 24 hours or ask your nurses to advocate for you. “We are glad to step in and support the patient however we can. We just need to know ahead of time what you would like,” Cox says.

Guests should refrain from visiting if they are sick since babies don’t have well-developed immune systems and are more susceptible to infection. Be aware that different hospitals have different security measures in place to ensure the privacy and safety of their patients. If possible, advise your friends ahead of time of your hospital’s visitor policies.

Eight Gift Ideas for a Been-There-Done-That Mom

You’ll strike gold with these gifts
By Sandi Haustein

First-time moms ooh and aah over everything: stuffed animals, cute onesies, diaper pails, baby socks, receiving blankets, and yes, even wipe warmers. It takes a certain amount of creativity to find the perfect gift for second- (or third or fourth) time moms who already have all of the essentials. If you think a mom with multiple kids has everything she needs, try giving her one of these thoughtful gifts that she is sure to appreciate.

Diapers and wipes. While these necessities might seem boring, a mom who has more than one child appreciates not having to go to the store in those early postpartum weeks. If she has more than one in diapers, her wallet will appreciate the break, too. When friends threw a diaper shower for Dodi Hance, mother of six, she didn’t have to buy diapers and wipes for nine months afterwards. “It was so nice to go to my diaper closet and be able to pull out whatever size I needed,” she says.

Meals. Any mom with a newborn deserves a break from planning and preparing a well-balanced meal. Give the whole family a gift by bringing a warm meal. Before deciding on chicken casserole or the fixings for tacos, make sure they don’t have any food allergies, then package their meal in disposable containers so they don’t have to worry about returning them.

Tools for two. If your mom friend now has more than one child, she needs some new gadgets to keep up with her crew. Sara Keeth, a mother of two, says, “I never used a sling with my first child, but with my second, it was suddenly necessary since I needed my hands free to help out my older kid.” Similarly, a double stroller can come in handy when Mom takes multiple kids on outings to the zoo or the mall.

Anything personalized or homemade. When a baby’s closet is full of hand-me-downs, your friend will cherish gifts that were made specifically for her little one. Knit or crochet a blanket just for him or embroider the baby’s name on a burp cloth. Have her name engraved on a Christmas ornament. A personalized gift can become a keepsake for the family.

Playdates for her older kids. When you have multiple kids, it’s hard to find that one-on-one bonding time with a newborn that moms crave. Melissa Bates, a mom of three, didn’t realize how much she would appreciate concentrated time with her second baby until another friend offered to take her older daughter for the day. “Being able to spend uninterrupted time with just my baby for us to get to know each other was a blessing. Not only that, but I could actually sleep when he slept like everyone says you should do.” Even if it’s just for a couple of hours, offer to pick up your friend’s older children to take them to a park or back to your house to play. Your sleep-deprived mom friend will be able to enjoy the break guilt-free knowing that her older child is having fun with friends.

Gifts for the older siblings. Becoming a big brother or sister can be a hard transition, especially when baby is getting all the presents. Win Mom’s heart by buying something small for her older child, whether it’s a book, a dollar store toy, or a new stuffed animal. Bring a “busy box” full of things like coloring books, crayons, and stickers to give the child something to do while Mommy feeds the baby or changes a diaper.

Housecleaning. Want to make a friend for life? Pool your money with a large group of friends to buy a month or two of professional housecleaning. That way Mom can focus on her children in the first few postpartum weeks instead of looking around the house feeling guilty about all that needs to be done. If she’s a close friend, you might consider grabbing some cleaning supplies and doing some light housework yourself.

Self-care gifts for Mommy.
Give your friend a little something just for her. Think about lotion, a Starbucks gift card, a book for nighttime feedings, or a coupon for free babysitting so she and her husband can go out on a date. Becca Ross, a mom of three, received a gift certificate for a much-needed massage when she had her second baby. “Besides helping my aching back from nursing and carrying a baby and a toddler all day, the short alone time for me to relax and re-energize was helpful to everyone in my family,” she says.

The next time you’re scratching your head trying to decide what to get for your second-time mom friend, consider one of these practical gifts. Whether she’s breathing in the smell of a freshly-cleaned house, wrapping her baby in his own crocheted blanket, or watching her older child play with a new toy, she will know how much you care.

Advice for the partner

What new mom needs Supporting the transition
By Erin Marsh

Becoming parents can be a trying transition for all involved, and when you add physical/hormonal changes plus sleep deprivation, life can get crazy. One way to help navigate these challenging times is to discuss household duties and designate responsibilities during pregnancy. If you save this conversation for post-baby, when emotions are running high due to sleep deprivation and/or hormonal changes, the results may not be quite as rational…or calm.

If mama plans to breastfeed exclusively, that means she will do all of the nighttime feedings, and even if a partner wakes to change diapers before/after feedings, mama will get significantly less sleep.

House chores
If the non-nursing parent could take care of household duties–cleaning, cooking, doing laundry–then mama could at least nap when baby naps. That grandmotherly wisdom–”nap when baby naps”–makes sense in theory, but if household duties are still looming, those often take precedence over sleep. Help sleep-deprived mama keep her sanity by taking care of everything else so she can focus solely on baby…and a bit of shut-eye here and there.

Another supportive way to care for mama is to help with social and emotional duties. Find out what works best for both of you (are visitors helpful or do they bring more stress?), and then run interference with family and friends. Some new parents thrive on visitors; others see guests as another burden with added stress.

A pillar of support
The biggest thing you can do for mama is to provide unconditional support. Even if her requests are irrational and her emotions irregular, be her pillar. Some mamas bear motherhood with grace and ease, but most of us are sloppy, crazy messes thanks to hormones and sleep deprivation. Give us time–we’ll return to our pre-pregnancy state eventually…once we finally catch up on sleep and our hormones even out.

Hospital Bag Checklist
A handy list to help you pack

Prepping for your hospital stay and unsure of what to bring? Here are the must-haves:

• Toiletries, toothbrush and hair accessories
• Going-home clothes for you: choose something stretchy and comfortable
• Clothes for baby
• Baby blanket from home with the smells of your house/pets
• Pacifiers
• Carseat
• Chargers for electronics
• Entertainment: iPad, magazines, books, crossword puzzles, movies
• A pillow and/or blanket from home
• Slippers or grippy socks
• Loose-fitting nightgown (with nursing access if you plan to breastfeed)
• Nursing tank or bra if breastfeeding
• Chapstick (dry hospital air!)
• Lots of loose-fitting underwear that can fit large pads and a postpartum belly
• Face wash cloths and/or dry shampoo to make cleansing a little easier
• Cardigan or robe if you run cold or plan to wear nursing tanks
• Snacks for you and visitors
• Nipple cream
• Nursing pillow or boppy, whether you plan to nurse or not
• Bottles if you plan to formula-feed

But, remember: everything you pack you will also have
to bring home…along with your new bundle of joy!