| Sample
Birth Plan (click to download)
A
positive birth experience can mean very
different things to different couples. Each
person views “favourable outcome”
and “risk management” differently,
and this will impact how they approach the
birth experience: where they choose to give
birth, who they choose as their primary
caregiver, how active they choose to be
in the decision-making process, etc. It
is important for you to have a clear understanding
of the many choices that can and will need
to be made during your labour and birth,
and that your caregiver(s) be informed of
your values and choices so that they may
be respected. This is the primary goal of
preparing a birth plan.
Natural
birth requires a true commitment and continuous,
skilled support. This is especially true
in our current health care system where
natural birth is the exception rather than
the norm. Consider that most physicians
and nurses practicing in a hospital setting
have no training or experience in continuous
labour support and may never have witnessed
a truly natural (undisturbed) birth. If
your desire is to birth naturally, preparing
a birth plan can be an invaluable tool towards
fulfilling it.
It
has been demonstrated that these four factors
make the greatest contribution to women's
satisfaction in childbirth:
- having good support from caregivers
- having a high-quality relationship with
caregivers
- being involved in decision-making about
care
- having better-than-expected experiences,
or having high expectations.
Pain relief only becomes important for satisfaction
in childbirth when expectations are not
met.
The
mere continuous presence of a woman who
has given birth and who shares your values
has a beneficial effect on the mother‘s
confidence and birth outcome. There are
additional benefits when the person is specifically
trained to support mothers in labour and
childbirth, as is the case of a doula.
The special relationship, trust and continuity
of care that exist between a mother, her
partner and their doula have an important
positive impact on the experiences of pregnancy,
labour, birth and breastfeeding. Some of
the proven benefits of having a doula include:
Birth outcomes:
25%
shorter labour
50% fewer cesareans
40% reduction in oxytocin use to speed up
labour
less use of forceps and vacuum extraction
30-60% fewer requests for pain medication/epidurals
fewer complications
For Mom:
less
fever and infection; reduced bleeding after
birth
more positive birth experience; more secure,
confident
less anxiety and postpartum depression
enhanced bonding with baby
For Baby:
shorter
hospital stay
fewer admissions to special care nurseries
easier start to breastfeeding
For healthcare system:
dramatically
reduced costs of obstetrical care
If
you have chosen to hire a professional
labour support person (doula), having
a birth plan can help her advocate for your
choices at times when you may not be able
to speak for yourself. Before labour begins,
you should discuss with your doula under
which circumstances, if any, you wish her
to speak on your behalf.
Please
remember that informed choice means knowledge
of alternatives along with the benefits
and risks of each available option, including
doing nothing. A choice, by definition,
implies more than one option. Parents as
well as their caregivers share responsibilities
in the process of informed consent.
The
following is a non-exhaustive list of points
for you to become informed about and include
in your birth plan. You may omit or add
items depending on your personal priorities.
Depending on your choice of birth location,
primary caregiver, and previous experience
(if any) your birth plan may be more or
less detailed.
If
you wish, you may include an introduction
to your birth plan. Here are some suggestions
to get you started:
As
parents, we acknowledge that we are ultimately
responsible for our own health and that
of our baby. We know that birth is a normal
process that a mother and her baby are capable
of carrying out without intervention, in
the vast majority of cases. We know that
discomfort and pain are part of this process,
and we expect to be allowed and encouraged
to labour in a way that is most beneficial
to us, even if this is in conflict with
routines or protocols. We have made efforts
to seek out the knowledge, resources and
support to make informed decisions. After
careful consideration of this knowledge,
and in accordance with our values and priorities,
we have put together this birth plan to
help you care for us in a way that will
not only ensure the safety of both mother
and baby, but honour and respect our values
and needs regarding this birth.
...
Who
would you like to have present during labour
and birth? Do you want to place a limit
on the number of people caring for you?
If you are giving birth in a teaching hospital
or birth center, are you comfortable having
interns present? If you have older children,
would you like them to be present during
part or all of the birth process?
- Clinical experience
is crucial to interns. While this is true,
their learning process can have a great
impact on your birth outcome. This also
adds to the number of unfamiliar people
who are present at your birth. Consider
accepting the presence of interns as long
as you are assured that supervision is
adequate.
- Birth can be an amazing
experience for older siblings to witness.
In many cultures, children of all ages
witness labour and birth. This experience
can be very positive and even facilitate
adaptation to and bonding with the new
sibling. The child should be prepared
for the events, sounds and atmosphere
of birth and cared for by a person familiar
to them (ideally whose sole responsibility
during the birth is to care for the child).
The child should know that he/she is free
to be present (or not) according to his/her
own comfort level.
What
is your top priority during labour?
How
would you like decisions regarding your
care to be made? Do you want your caregiver
to make decisions unreservedly on your behalf,
or do you want to be kept fully informed
and share in any discussions and decisions
made?
- Protocols and routines
are guidelines which you are not obliged
to submit to. Being aware of what they
entail, along with their possible drawbacks
and benefits, will allow you to understand
what is being proposed and choose accordingly.
To ensure no decisions are made hastily,
consider requesting a few minutes in private
to regroup and discuss with your support
person when anything is proposed to you
during labour. There is always time to
take a few minutes to make an informed
decision, and you should never feel rushed
to make a decision on the spot, in front
of nurses, doctors, or interns. True
emergencies are rare.
What
is your preferred approach to pain management
during labour? Do you want to be offered
alternative measures only, pharmacological
measures only, or both? Do you want to be
offered medications, or do you prefer that
this option be reserved for a moment of
your choosing? Become informed on the different
methods that are available in your place
of birth, and on their respective benefits
and risks. Any medication has potential
risks for you, your baby, and the birth
process, and you must understand these before
labour begins in order to make an informed
choice.
- Examples of effective
alternative (non-interventive) measures
to cope with pain: hydrotherapy, upright
positions, remaining mobile, exercise
ball, pelvic rocking, intradermal injections
of sterile water (may not be available
everywhere), acupuncture, acupressure,
transcutaneous nerve stimulation (TENS),
massage, hypnosis, music, relaxation,
visualisation, vocalisation. Pharmacologic
measures include narcotics, gas anesthetics,
local anesthetics, epidural analgesia.
Common
procedures used during labour:
Unless you express a clear desire otherwise,
many procedures will most likely be routinely
carried out if you give birth in a hospital
setting. It is wise to know what they entail
and understand their benefits/drawbacks
before labour begins so you will not be
subject to procedures that you do not want.
The following is a list of the most common
routine interventions carried out during
labour, a short explanation, as well as
a summary of the pros and cons according
to the most recently available medical research.
As you will notice, hospital routines and
protocols are not always evidence-based.
1st
stage labour (effacement and dilation of
cervix to 10 cm)
“Nothing
by mouth”
The tradition of withholding food and drink
from labouring mothers dates back from the
time when women were “delivered”
from their babies under general anesthesia.
Although obviously this is no longer how
women give birth today, many hospitals still
have a policy that forbids labouring women
to eat or drink anything but water or ice
chips. The principal arguments for fasting
are to prevent aspiration if emergency cesarean
should be required, and to prevent nausea
and vomiting during labour. These arguments
are outdated. We know that the risks of
fasting are far more likely to occur than
the need for emergency cesarean. Furthermore,
nowadays, even emergency cesareans are done
under spinal anesthesia. General anesthesia
is very rare in modern obstetrics; aspiration
is extremely rare in modern anesthesia,
so aspiration is not an issue (even if it
was, fasting during labour does not guarantee
an empty stomach, and the most dangerous
fluid to the lungs is undiluted stomach
acid!). As for nausea and vomiting, fasting
does not prevent these.
Pros: None. There is no evidence
to justify withholding food from the mother,
at any stage of labour. Birth is the most
demanding physical workout a woman’s
body will ever go through, and her body
requires food and drink to enable it to
work efficiently.
Cons: Medical research does not
support this practice. Hunger and thirst
cause significant discomfort; associated
with longer labour; increased use of synthetic
hormones to stimulate labour; increased
forceps/vacuum assisted delivery; dehydration
may cause fever.
Routine
IVs
Most hospital protocols include the routine
use of IV fluids during labour. However,
IV fluids are not the solution to the “nothing
by mouth” rule discussed earlier,
since they do not provide the nutrition
or energy offered by food and fluids, do
not prevent the feeling of hunger or thirst,
and may negatively disrupt the normal physiology
of both mother and baby. Other than replacing
fluids, another reason for routine IVs is
to have a vein open “just in case”
an emergency should occur. However, life-threatening
emergencies are rare in low-risk labouring
women (over 90% of pregnant women). Nevertheless,
if you feel this is truly necessary, you
may wish to consider a heparin/saline lock
instead of an IV. A heparin/saline lock
is an IV that is attached to a little chamber
on your hand filled with either saline or
heparin, which keeps your vein open and
provides quick access to your venous system.
It allows more freedom of movement than
a conventional IV, which is attached to
a tube that leads to a solution bag hanging
on a pole.
Pros: None
Cons: Medical research does not
support this practice. Discomfort;
inflammation; bruising; inhibit mobility;
fluid overload is common; abnormal blood
sugar levels in baby; may exaggerate baby’s
birth weight and initial weight loss following
birth, which causes unnecessary stress and
may prompt interventions which can interfere
with breastfeeding; may cause severe breast
engorgement.
Fetal
monitoring
Intermittent fetal monitoring enables
the caregiver to assess the baby’s
well-being in a non-interventive manner
by listening to the baby’s heartbeat
with a hand-held device during and after
a few contractions, which is sufficient
to ensure a safe journey through birth for
both mother and baby.
Continuous electronic fetal monitoring
is often part of routine protocol in hospitals.
It enables limited nursing staff to monitor
several labouring mothers at a time, yet
without requiring their presence. However,
convenience for the staff is where the benefits
begin and end. Continuous electronic fetal
monitoring does not result in better outcomes.
In fact, it does quite the opposite: it
significantly increases the risk of cesarean
section without any benefits to the baby.
It has a profound effect on the way the
mother experiences labour, limiting her
freedom to move around, and her choice of
measures to cope with pain (exposing her
to the potential cascade of interventions
that can ensue), and increasing the mother’s
anxiety (which also has an impact on pain).
Medical research does not support this practice,
unless there is a specific medical reason
(use of pitocin, suspected problem in the
baby, or VBAC).
Internal fetal monitoring is accomplished
using an internal sensor with a needle that
is fixed on your baby’s scalp and
another sensor introduced into the uterus
to monitor the contractions. The membranes
(bag of waters) must be ruptured and the
cervix dilated at least 2 cm for internal
monitoring to be possible. It is more accurate
than external monitoring, however it is
invasive and increases the risk of infection
significantly. It should not be used unless
there is a good medical reason.
Cervical checks
The cervical check is the most used method
to evaluate the progress of labour. It provides
information on effacement and dilation of
the cervix, as well as the baby’s
station and presentation relative to the
mother’s pelvis. Although it is rarely
essential, in the hospital setting, it is
performed regularly and frequently throughout
labour. However, there are several good
reasons to limit these exams to a strict
minimum. First, most of the time, it requires
that the mother lie flat on her back, which
is disruptive and uncomfortable, even painful.
Second, this constant monitoring creates
expectations of “regular progress”,
according to “standards”, even
though we know that the physiological process
of labour does not follow any established
parameters. Even if all is going well, “results”
may be discouraging or disappointing for
the mother and this can negatively influence
the evolution of her labour. Finally, cervical
checks significantly increase the risk of
infection (especially when the membranes
are ruptured), which can lead to further
intervention and have negative consequences
on the health of the mother and baby. It
is also important to remember that cervical
checks are a subjective assessment; therefore,
the same person should perform all exams,
to ensure the most consistent interpretation
possible.
Restricting
positions/movements
Freedom of movement is crucial to the normal
birthing process. It permits gravity to
help your baby come down and engage correctly
as well as increase the size and shape of
your pelvis. It allows you to actively manage
the pain of contractions, and may help relax
tense muscles, making birth easier. Last
but not least, it can actually speed up
labour, or stimulate a slow progressing
labour. Although most birth settings will
not specifically restrict your movements
during labour, many routine interventions
directly result in limited movement (eg.
IVs, continuous fetal monitoring, rupture
of membranes, epidural analgesia, etc).
This, in turn, can make birth more difficult
and lead to yet more intervention. Labouring
while lying down on your back can be more
painful and increase the likelihood of the
baby entering your pelvis in an unfavourable
position, making the baby’s descent
into the birth canal longer and more difficult.
When
the time comes for you to push your baby
out into the world, you should be encouraged
to adopt the position that is most comfortable
to you and most facilitates the birthing
process. In most cases, this is not the
“typical”, on your back position
with legs lifted up high and spread widely
apart. Side-lying or gravity assisted positions
are most often instinctively adopted when
women are allowed to chose, and a woman
can give also birth squatting, on all fours,
kneeling, or even move between different
positions as the birthing progresses. This
facilitates the mother’s pushing efforts,
and may help reduce perineal trauma.
Artificial
rupture of membranes (AROM or breaking the
bag of waters)
Although it was thought that breaking the
bag of waters shortens labour and prevents/corrects
poor progress, scientific evidence does
not support these reasons. Another reason
some practitioners perform this procedure
is to assess fetal well-being by the presence
or absence of meconium in the amniotic fluid.
Meconium in the amniotic fluid is a sign
of fetal distress. However, this is another
instance where the risks far outweigh the
benefits.
Pros: None
Cons: Medical research does not
support this practice in early labour.
This seemingly benign procedure can significantly
affect the mother and baby’s well-being
by:
- May precipitate umbilical
cord prolapse, which is an indication
for emergency cesarean
- increasing the intensity
of the contractions (thereby increasing
pain)
- may cause distress in
the baby
- may open the door to
infection
- leads to more interventions
(such as medication to deal with increased
pain and use of synthetic hormones (pitocin)
to speed labour for fear of infection,
antibiotics, forceps/vacuum assisted delivery)
- increases the
risk of cesarean section
Labour
induction (artificially starting labour)
Due dates are estimates that serve to guide.
They are imprecise, and fewer than 5% of
women will actually give birth on their
due date. The average length of a first
pregnancy is 41 weeks from the last menstrual
period. The decision to artificially start
labour should be made on a case-by-case
basis, evaluating medical considerations,
such as signs that the baby is no longer
growing adequately or his/her well-being
in the womb is deteriorating. It should
not be made for convenience reasons or simply
because a given date has come and gone.
Interventions to start labour include stripping
the membranes (manually pushing the membranes
away from the cervix while leaving them
intact), various methods of ripening the
cervix (hormones that will make the cervix
ready for labour), AROM, and synthetic IV
oxytocin. As with any other intervention,
induction of labour carries some risks,
such as increased medication use, increased
forceps/vacuum assisted delivery, and increased
cesarean. There are several alternative
methods which have been proven effective
in some cases and do not carry with them
the increased risks mentioned above.
Labour
augmentation (speeding up labour and/or
shortening the 2nd stage)
Giving birth is a process that cannot be
measured by the clock. The accepted “standards”
for the length of labour are based on faulty
assumptions or arbitrary guidelines. This
means many women are subjected to unnecessary
interventions to correct a problem that
is not a problem to begin with, and all
these interventions pose real risks to mothers
and babies. The procedures which can be
used to speed up labour or shorten the 2nd
stage (pushing the baby out) include AROM,
IV synthetic oxytocin, vacuum/forceps extraction
and cesarean section. Here again, if there
is a need to stimulate or speed up the labour
progress, there are several alternative
methods which have been proven effective
in some cases and do not carry with them
any risks.
2nd
stage labour (pushing the baby out)
Protecting
the perineum
Your perineum is designed to fan out and
stretch considerably to allow for the passage
of your baby’s head, which is the
biggest part to accommodate. An intact perineum
is one that does not require suturing; a
first-degree tear involves the skin of the
perineum and vaginal mucosa; a second-degree
tear involves deeper layers of perineal
muscle; a third-degree tear involves the
anus; and a fourth-degree tear involves
the anus and rectal mucosa. You can prevent
or reduce the likelihood of perineal tearing
in several ways: instinctive/physiologic
pushing (as opposed to “block and
push” as described above); hands-and-knees
and side-lying (gravity neutral) positions
to birth the baby; slow, controlled birth
of the head (most often this will require
you NOT to push when the baby’s head
crowns, and breathe while your uterus does
the job); and perineal massage and compresses
during the pushing phase (this can be done
by your doctor or midwife, and has been
shown to significantly reduce the incidence
of 3rd degree tears). Perineal massage during
the last trimester of pregnancy may also
help prevent tearing and reduce the risk
of 3rd degree tears, especially in first-time
mothers.
Episiotomy (a surgical incision to
widen the vaginal opening) does not prevent
tearing. On the contrary, it often makes
tearing much worse, significantly increasing
the risk of 3rd and 4th degree tears. Another
outdated belief is that an episiotomy is
less painful and easier to heal than a tear.
Medical research has shown consistently
the opposite: episiotomies are more painful,
take longer to heal, and are more prone
to infection than a natural tear, should
it occur. Medical evidence shows there
is no benefit to episiotomy. The
only medical indication to perform an episiotomy
is when there is severe fetal distress requiring
a quick delivery, while the birth is not
imminent (in the next few minutes).
Instinctive
as opposed to directed pushing
The uterus is a powerful muscle and its
coordinated efforts do the majority of the
pushing work, with no assistance or voluntary
effort from the mother. In fact, most of
the time, no additional, voluntary force
is needed for the baby to be born. However,
the dominant approach to birth in our culture
is for the woman to contribute with deliberate
pushing efforts. When a woman pushes instinctively
in response to her natural urge to push,
she rarely holds her breath for more than
five or six seconds. There is usually grunting,
groaning or exhaling to decrease the strain
on her heart and circulation. The mother
may breathe deeply several times between
pushes. This naturally provides continued
oxygenation to the baby as well as to her
uterus and perineum. This allows the perineum
to stretch and fan out gradually for a slow,
controlled birth of the baby’s head
and shoulders, thereby preventing tears.
In contrast, when a woman is directed to
push, as is often done, especially when
the mother is under epidural or other pain
medication, she is instructed to push on
cue, to hold her breath for at least ten
seconds and to not make noise or exhale
during pushing. She must then quickly take
another breath and push again, often 3 or
more times within one contraction. This
decreases oxygen supply to the baby, the
uterus and the perineum, which can lead
to dizziness, exhaustion, fetal distress
and perineal trauma (tearing) and hemorrhoids.
Signs of distress in the baby will prompt
physicians to intervene to speed up the
birth of the baby with forceps, vacuum and/or
episiotomy. In addition, directed pushing
may increase the incidence of postpartum
urinary incontinence.
How
would like the baby to be born? Would you
like to have a mirror so you can see the
baby be born? Would you like to lift the
baby out yourself, or for the father to
catch the baby and place him/her on you
(with help)? Do you prefer the doctor /midwife
to be the one to catch the baby?
3rd
stage labour (placenta or afterbirth)
Clamping
and cutting the umbilical cord
When your baby is born he or she still has
a lifeline in the umbilical cord still attached
to the placenta which allows him or her
to gradually begin breathing on his/her
own, without emergency. Between 25-60% of
the baby’s total blood volume is in
the placenta, and this rich placental blood
contains stores of iron (among other important
elements) that can be transferred from the
placenta to the baby if the cord is left
unclamped until it stops pulsating (usually
a few minutes). This results in improved
iron stores, and a reduced risk of anemia
extending into the first year of life. Under
usual circumstances, there is no rush to
clamp and cut the cord. On the other hand,
clamping the cord immediately after the
baby is born increases the risk of a retained
placenta and hemorrhage.
Active
management with pitocin, kneading and/or
controlled cord traction
Once the baby is born, there is a natural
rush of oxytocin. This causes the uterus
to keep contracting to separate the placenta
from its wall, so that you can push it out.
This may take from a few minutes to an hour
or so. There is no reason to hasten this
process, except for convenience. Again,
unless you clearly indicate otherwise, active
management of the 3rd stage of labour with
synthetic oxytocin (pitocin), uterine kneading
and controlled cord traction (physician
gently pulling on the umbilical cord to
separate it from the wall of the uterus)
is done routinely.
- Unless there is an emergency,
there is no medical indication to speed
up the process of the delivery of the
placenta. On the contrary, unnecessarily
interfering with the physiological process
can increase the likelihood of placental
retention and hemorrhage.
Welcoming
baby
Do you have any special requests
about the hour or so following birth? For
example, keeping baby skin-to-skin, being
left alone with your partner and baby, postponing
routine interventions such as cleaning,
weighing, administration of antibiotic ointment
in the eyes, Vitamin K injection. Would
you like Apgar scores and pediatrician examinations
to be done in your presence, with your baby
in your arms (or your partner’s) as
much as possible?
- Immediately after
birth, if both mother and baby are doing
well, baby should be placed skin to skin
on his/her mother and they should not
be separated.
Routine
interventions for the baby
As long as both you and your baby are doing
well, most interventions for your baby can
and should be postponed until at least a
few hours after birth. This is because during
the first hours of life, you and your baby
will be alert and primed to bond and imprint
to each other, and go to the breast for
the first time. For all this to happen,
you must not be separated and left undisturbed,
preferably skin to skin. Only absolutely
essential medical care should be given at
this time. After the first few hours, your
baby will most likely sleep for a longer
period, and this will not be conducive to
a first contact if the opportunity was missed
or disturbed by unnecessary routine interventions.
Apgar
scores
Immediately after the birth, at one minute,
five minutes, and 10 minutes, your doctor
or midwife will assess your baby’s
vitality according to the Apgar scale. This
is done by observing your baby’s breathing,
skin color, muscle tone, heart rate and
reflexes. Unless there is a problem, there
is no need to take the baby away to do this,
and this should be done while you hold your
baby.
Evaluation
by a pediatrician; weight/length measurement;
washing
This is usually done shortly after birth,
but can be postponed for a while so that
you are not disturbed. It can and should
be done in your presence, and the physician
can assess your baby while you hold him/her.
Prophylactic
antibiotic eye ointment and Vitamin K injection
Unless you clearly state otherwise, these
are routinely done immediately after birth.
Prophylactic antibiotic eye ointment is
given to all newborns to prevent congenital
conjunctivitis caused by sexually transmitted
bacteria such as chlamydia and/or gonorrhea.
However, not all newborns are at risk for
this, depending on the parents’ sexual
history. Also, the ointment itself can cause
a chemical conjunctivitis in your newborn,
which some studies suggest is far more likely
than the conjunctivitis the ointment is
intended to prevent. Bacterial conjunctivitis,
when it occurs, is obvious and easily treated
today, and is no longer considered to be
significant risk. Discuss with your caregiver
whether this prophylactic treatment is appropriate
for your baby. If you choose to give the
ointment, it is preferable to postpone it
to a time when your baby will be less alert,
so it does not impede on your first contact
with each other, because it will blur your
baby’s vision.
Vitamin
K injections are also given routinely to
increase clotting factors in the baby in
order to prevent hemorrhagic disease of
the newborn (HDN). HDN is very serious but
very rare (2 per 100,000 babies per year),
and not all forms of the disease are prevented
by Vitamin K prophylaxis. If there were
absolutely no risks or costs associated
with vitamin K administration, nobody would
argue against it, but in fact this is not
the case. There are known risks of giving
Vitamin K, and some possible risks which
we do not yet know about. For example, we
do not know the impact of giving babies
up to 10,000 times the dose that naturally
occurs in their bodies (which is what they
receive with a 1 mg intramuscular injection).
We know that colostrum contains large amounts
of Vitamin K - nature’s own Vitamin
K shot. Colostrum, and allowing the baby
to receive as much blood from the placenta
as possible offer many more benefits to
the baby than Vitamin K injections were
ever alleged to do. There may be some medical
indications to give Vitamin K to your baby,
such as increased risk of bleeding from
vacuum/forceps delivery or birth trauma
such as hematoma. Vitamin K prophylaxis
is a complex issue, and a controversial
topic to discuss, since most parents are
not even aware they have a choice in the
matter. Talk to your doctor or midwife about
the potential benefits and risks of this
intervention and whether it is appropriate
and necessary for your baby.
Glucose
monitoring
An abnormal blood sugar level is more than
a single arbitrary value: it is a continuum
of abnormal levels associated with specific
symptoms. There is no medical indication
to routinely test all babies’ blood
sugar during the days following birth. The
procedure (heal prick) is invasive and painful,
and only babies exhibiting symptoms of abnormal
blood sugar levels should be subject to
it. Most hospitals no longer do this routinely,
but you should nevertheless be aware of
this possibility (especially if you had
gestational diabetes, you are diabetic or
you or your baby have other risk factors).
Incidentally, the first treatment for a
baby who exhibits signs of hypoglycemia
(low blood sugar) is to breastfeed more
frequently, so by breastfeeding on demand
(which for most babies is frequently...)
you will be naturally preventing and/or
treating this problem.
Early
Supplementation for Breastfed Babies
Newborn babies should receive only colostrum
and breastmilk for the first 6 months of
life. However, in spite of this widely-accepted
recommendation, a large percentage of newborns
are given supplements of artificial baby
milk during their hospital stay, for reasons
other than medical necessity. Early supplementation
interferes with the establishment of breastfeeding
by causing problems such as the baby refusing
the breast, nipple soreness, and decreased
milk production. It directly impacts infant
health by reducing the intake of protective
antibodies from breastmilk as well as exposing
babies to the risks of formula itself, and
is associated with early weaning. Early,
skilled support is key to a smooth start
to the breastfeeding relationship. Unfortunately,
advice and assistance with breastfeeding
is still inconsistent in most birth settings
in Quebec, with basic, effective training
only recently becoming widespread among
maternity staff. This can be frustrating
and confusing for new parents. This is yet
another aspect of life with your new baby
which you will benefit from being well informed
about. Peer
breastfeeding support groups are known
to greatly improve breastfeeding success,
and when specific issues arise, access to
a Certified
Lactation Consultant can make the difference
between an issue that is simply resolved
and one that progressively becomes more
complicated, jeopardising the breastfeeding
relationship.
Sources / Further reading:
A
Guide to Effective Care in Pregnancy and
Childbirth (Murray Enkin et al.)
Ina May's Guide to Childbirth (Ina May Gaskin)
Spiritual
Midwifery (Ina May Gaskin)
Obstetrical Myths versus Research Realities:
A Guide to the Medical Literature (Henci
Goer)
The Thinking Woman’s Guide to a Better
Birth (Henci Goer)
Gentle Birth Choices (Barbara Harper)
Birth Your Way (Sheila Kitzinger)
The Complete Book of Pregnancy and Childbirth
(Sheila Kitzinger)
The Doula Book: How a Trained Labour Companion
can help you have a Shorter, Easier and
Healthier Birth (Marshall H. Klaus, John
H. Kennell, and Phyllis H. Klaus)
Lamaze International: Care Practices that
Support Normal Birth. www.lamaze.org
Birth and Breastfeeding (Michel Odent)
Maternity
Center Association’s Maternity
Wise www.maternitywise.org
Vitamin
K and the Newborn (Association for Improvements
in the Maternity Services www.aims.org.uk)
Creating
your Birth Plan (Marsden Wagner, MD)
Sample
Birth Plan (click to download) |
