Creating a Birth and Recovery Plan

A common recommendation for expecting mothers is to create a birth plan: a document that gives your caregivers (midwife, doctor, doula, partner) an outline of your choices, desires and ‘no thank you’s’ while in labour. This is designed so as not to take your attention away from the amazing process you are going through.

While it is great to have thought about things like birth positions, caregivers to be present, and heat therapy ahead of time, it is important to have a fluid list and an open mind. This will help to prevent fear and feelings of lack of control from taking over the mind and interfering with the unfolding of birth.  I prefer to suggest that expectant parents think of their birth document as a guide, rather than a plan, because birth is just not something that always goes as planned.  I also suggest that they consider recovery as well.  Most people focus solely on the birth, but there are a lot of things to remember in the early postpartum period. Think of your birth guide as your place to put on paper your gentle reminders about what is important to you in your recovery.

Here are my top recommendations for expecting parents to consider when creating their birth and recovery plan.

Birth team
By the time you are creating a birth and recovery plan, you will more than likely have chosen either a midwife or an OB/Dr as your primary caregiver.  Other choices may now be about adding a doula to the team, maybe an acupuncturist maybe a chiropractor?  Perhaps you chose a doctor but are now thinking you would like a midwife?  A final member of the birth team that is often overlooked is a pelvic floor physiotherapist. You can see them during your pregnancy to help optimize your pelvis and pelvic floor for birth and they will also be the person you see at 6 weeks postpartum after your final check in with the doctor or midwife.

Birth location
Home birth?  Hospital birth?  Birth centre?  You have the choice about where you give birth (provided you are not high risk) and where you choose will involve a different set of needs and things to plan for.  Your decision will also be dependent on who you choose for a primary caregiver as well.  My recommendation is to birth where you feel the safest.  For some, that will be in the hospital, and for others that will be at home.  There is no right or wrong, but rather what feels right for you.  Birthing where you feel safest will better enable you to relax and focus inwards during your labour and birth.

Lighting
This may seem like an odd thing to think about but the lighting in the environment where you give birth is very important.  Ideally, you want the room to be dimly lit which will allow you to connect with the process your body and babe are going through.  Bright lights, spotlights and fluorescent lights do not create a sense of comfort and relaxation, but instead may leave you feeling exposed, self-conscious and vulnerable. These can all interfere with the progression of birth.

Sound
Music?  Silence?  A water fountain?  For some, sound can be soothing and can help to achieve a meditative state, while others need silence to be able to focus.  Decide what you may like and plan to either have soothing sounds or to ensure your birth space is quiet and still. Headphones or an ipod deck?  Ear plugs and a ‘no talking’ sign? It is your birth, so it is up to you.

Interruptions
Who will be allowed in the birth room with you?  For some, the entire family may be there.  Some also invite a birth photographer to capture the event.  Others may want only their caregivers and partner.  Some will think they want the entire family there, but when they are actually in labour they feel differently and may want no one but the birth team there. That is ok – stay fluid and honour what you need in the moment.  Remember, this is a guide, not a rigid plan.  Having a doula is a great way to ensure you ideals and your ‘plan b’s’ are supported.

Birth positions
Word is getting out that birthing on your back is not ideal and the squat or side lying position seem to be popular alternatives women are choosing.  Remember though that birth is fluid and by having a number of positions in your mind, you will be ready to pull from the list, rather than feel like you need to choose one and stay there. Movement in labour is optimal so finding and practicing movements and positions during pregnancy is ideal.  Talk to your care provider during your pregnancy to see what positions he/she supports and remember, it is your birth so if they don’t support a position you are hoping for, perhaps you would like to find another caregiver? 

Pushing
Ideally, you will push for under an hour and at most under 2 hours.  Anything over that leaves you at greater risk of intervention and pelvic floor dysfunction.  Talk to your care provider about his/her beliefs around pushing.  Keep in mind that movement and gravity will work in your favour to help reduce pushing time, as will staying off of your back.  If you feel like things aren’t progressing, change things up – try a new position and if that doesn’t work go sit on the toilet.  Our bodies naturally relax and open for elimination when we sit on the toilet and often it can help you let go of tension in your pelvis to help with the birth.

Perineal care
The perineum will be stretched greatly during birth and different caregivers use different approaches for supporting the perineum.  Some will perform perineal massage during labour and as the head is crowning.  This is not something I recommend as it can be very distracting for you to feel fingers and pulling while you are trying to relax and allow your baby to emerge.  It can also increase blood flow to the area leading to increased swelling.  Some caregivers will use warm compresses to help soothe the area and encourage relaxation.  Again, this may be irritating to some or it can be very therapeutic and can allow the tissues to soften.  It is ideal to talk about the practices your caregiver chooses, and how those resonate with your choices beforehand.

As for recovery here are a few things to think about as you prepare to repair.

Healing Herbs
Peri bottles and baths will be your best friend in the early days postpartum.  The warm water soothes and when you add healing herbs it becomes a restorative therapy. Canadian Birth Products carries a wonderful blend and a brand available in many retailers is Earth Mama Angel Baby.  Steeped like a tea and then added to your peri bottles and baths, these herbs will help heal and calm the delicate tissues of the perineum.

Belly Wrap
Just as you would wrap an injured ankle to support it while it heals, so too should you wrap your abdomen to help the connective tissue heal and encourage the muscles to realign.  Traditional belly wraps are available and will do the job; however, they don’t promote movement.  While I am a big believer in rest with little movement in the first week, I do encourage gentle movement into week 2 and beyond.  I encourage my clients to wear a belly wrap for the first 8 weeks so I want one that doesn’t restrict movement.  The soon to be released After Baby AB tank from Bellies Inc is my first choice, but for now the Fitsplint or the Tupler Splint are decent alternatives.

Mother Warming
A beautiful tradition that has unfortunately been lost in the busy lives of North American women is that of Mother Warming or Mother Roasting.  The tradition believes in sealing up or closing the emotional, physical and spiritual pathways that have been opened by birth.  Warming the body with wraps and heat and nourishing soups helps the new mother heal.  Moxibustion and massage with warm oils are also seen and are beautiful therapies that the modern day mom needs to incorporate into her recovery.

Postpartum Doula
I love doulas for birth and I love doulas for postpartum support.  Even if you have a lot of family and friends, a doula can be a key resource and support person for you in the first six weeks postpartum.  If you can find a doula who attends birth and is trained in postpartum work as well, that is ideal. A strong bond will already be established and she will know you well.

Visitors
Everyone will want to see you and the new babe but it can be very overwhelming to both you and your little one to have too many visitors too soon.  Think about who and when you want to have people visit and limit the time they stay.  Make a suggestion that visitors must bring a frozen meal for you so you can forget about the need to cook, but also stay nourished.

Restorative Exercise
When your baby is born you will be excited to have your body back and many moms are very eager to get back to exercise.  The key to getting your body back is to take it slow.  Progressive exercise done slowly and purposefully during the first six to eight weeks is key.  Seeing a pelvic floor physiotherapist at six weeks post will give you a good idea of how your core is doing.  Running and other high impact activity is not recommended for four to six months postpartum, but if you are slow and respectful with your core restoration, you will be back to the activities you desire without all the common problems new moms face.

Remember, birth is dynamic and fluid and you need to be too.  Creating a structured, rigid plan can induce fear and angst if things don’t go as planned.  By thinking of ideals and listing them in a guide it can be helpful for your birth team as they support you and your babe in the miracle of birth.