Vincent Family Birth Plan
MAHEC Midwives       Pediatrician- Dr. Haaksma (Community Family Practice)
Labor and Delivery Support – Sally Robinson & Dana Nagle

Thank you so much for being a part of this special day!
We appreciate everything you are doing to help us.
April & Mike have prepared by taking the Bradley method childbirth classes. This pregnancy has been free of complications and we are striving for a completely natural childbirth.

Labor
-We would like to request a “water world” room if available
-April does best with direct straight forward communication
-After initial fetal monitoring, April prefers not to be “hooked up” to equipment
-Encourage freedom of movement and various positions
-Sally Robinson will provide massage of pressure points for pain management
-Access to fluids rather than IV
-If possible, we prefer dimmer lighting
-April tends to urinate frequently and does not want a catheter
-Please allow bag of waters to rupture naturally
-We recognize that this process may take time, and feel no need to rush it
-Please do not offer April pain management medication unless as a last resort
-April generally has no problem being touched, and will let you know if otherwise

Delivery
-Please allow freedom to push at own pace (but would appreciate coaching)
-Slight tear preferable to episiotomy
-Mike would like to cut the cord

After Care
-We would like immediate contact with our baby
-Hepatitis B shot will be administered at a later date in our doctor’s office
-No circumcision
-April plans to breastfeed only, access to lactation consultant requested

Emergency
-Please clearly explain the benefits and risks of any proposed intervention
-Allow Mike to speak on April’s behalf if distressed
-In the event of a C-section, please allow Mike to stay with April at all times

Nathaniel August’s Birth Story

          Our baby boy was officially due on July, 22nd. Almost a week earlier, on the 16th I officially decided that I was ready for the birth experience. I tried to put forth that intention clearly to the universe in the hopes that he’d hear. We had realized that with the impending new school year and Mike’s return to work for Buncombe County schools, that if our little fellow were two weeks late that there’d be very little time for our new family to bond all together at home.
On Saturday the 19th we went to see the newly released Batman, the Dark Knight movie in a jam packed theater. The film was rather intense and scary. At one point there was a sudden loud noise and the baby jolted with extreme force inside me, I’d never felt him move like that before.
Back at home we stayed up working on pregnancy pages for the baby‘s scrapbook and didn’t go to bed until a little after midnight. A couple of hours later I awoke to what felt like mild twinges of menstrual cramps. I lay in bed for a while until I realized that I probably would not be able to fall back asleep and got up from bed, noting that the time was 2:30. I found myself sitting in the future breastfeeding glider perusing the LL Bean sale catalogue. When a contraction came I’d just glide through without too much discomfort.
Around 4:00 I decided to get in the shower. Mike must have heard my movements and got up to see if something was going on. After the hot shower Mike began to time my contractions. They seemed to be 6 or 7 minutes apart. We talked about going on a walk once the light came. I knew that Ann was the midwife on call and considered calling to check in. I decided that 7am would be the earliest possible time to disturb her with a Sunday morning phone call but later would be better. Mike drifted back to sleep. I lay next to him, willing my mind and body to relax (as had been pounded into us at Bradley Method childbirth education classes). The rhythmic pains were getting more intense. I was able to snuggle next to Mike until dawn’s first light. Mike got up and tried to time the contractions again but it was confusing- not the punctual exact rhythm that I had expected.
Eventually we set out for a walk. At first I thought that we should stick to our block, but the walking felt good and we ventured out a mile or so into our West Asheville neighborhood. Mike asked how it felt to walk and talk through a contraction. Walking was not too much of a problem but it was difficult to maintain a coherent conversation, though I could answer straight forward questions. Mike revealed that while perusing the pregnancy books just before our walk, he had read that being able to walk and talk through a contraction meant prelabor or very early stages. I gathered that I was not very far along in the process.
Back on the home front I made some phone calls. We had invited two dear friends to be present with us at the birth. Dana would be coming from Hot Springs, almost an hour from Asheville. I called her first and indicated that “something might be happening” I advised Dana to proceed with the day’s plans (which involved rehabbing an old airstream trailer for her primary residence). A contraction came along and I paused in my chatter, asking Dana to talk to me.
Still, I wanted to check in with Ann but felt like if I was going to call I needed some kind of concrete information to report. Again Mike tried to time the contractions. After a great deal of effort we determined that they were about six minutes apart, lasting about a minute, with a shorter less painful twinge in between.
Around 10:00 am I called Ann on her cell phone and reported the contractions including the confusing strong/weak pattern. Ann remarked that if it was during the week she would ask me to come into the office for an examination. She told me that she was on her way into church, and then would be doing her rounds at Mission hospital. She suggested that I could come in to Mission outpatient for a cervical examination. At that point I could be either admitted or sent home with some meds to help me rest. I was very leery of putting myself in a situation where I would get stuck in the hospital really early in the process. We had recently heard many stories from friends about hours and hours, even days of labor pains.  Here I was at the very beginning of labor and was not thrilled about relinquishing myself to hospital policy and procedure so soon.
I believe that I was relatively coherent on the phone with Ann. I didn’t want to commit to going to in to outpatient but appreciated that Ann had offered. We agreed that I would think about it and call her back at 11:15. I got off the phone and made the proposal to Mike who immediately stated that we should take the opportunity to go in to outpatient and take advantage of Ann’s professional expertise.
I felt the need for a hot bath- even though it was already in the 80’s! Mike decided to whip up some food but I was not interested. I asked Mike to call Sally, our other sweet friend who was to attend the birth. Sally happened to be at Green life grocery when Mike called and asked if we needed anything. I requested a variety of fruit juices. That was the very last item I had meant to procure for stuffed hospital suitcase.
Also in the suitcase was a loose easy access outfit to labor in and an iPod that Mike had purchased especially for the birth. He had spent hours putting together birth mixes. I envisioned a musical mix of our favorites for labor, perhaps switching to hard rock for the pushing (A key element being Guns and Roses’ Welcome to the Jungle). For the final stage, the baby’s entrance into the world, I had requested some really sweet folk music, like Joni Mitchell and Crosby Stills Nash and Young.
Some additional birth paraphernalia was in Sally’s possession. I had requested a “small, not too weird” birth altar with some inspirational things to look at and give the space a personal feel despite being in the hospital. Sally had also developed a special birth blend of essential oils. We had also spent a lot of time writing and typing up a birth plan that focused on having as a natural a childbirth process as possible while maintaining flexibility. All in all I felt very prepared for the birth experience.
Back in the bath tub things were feeling more intense and painful. By the end of the bath I felt the urge to gyrate my hips like I was hula hoping. I had intended to fix my hair and put on a nice outfit to enter the hospital. That did not seem to be in the cards as I seemed to be having a lot of difficulty getting ready. I ended up putting on whatever clothing g was most easily in reach and getting my hair brushed but not arranged.
I didn’t think that I could deal with getting directions to outpatient over the phone. I called Ann back around 11:20 and after saying hello immediately handed the phone to Mike to make the arrangements.
I told Mike that we definitely needed to have the suitcase with us in case I was admitted. As generally is the case when we go anywhere, Mike was ready before I was. Time was passing quickly and we didn’t want to keep Ann waiting so off we went. The five minute drive to the hospital was exciting wondering what would happen when we arrived.
Mission hospital was a mess of construction but we were able to find a parking space in the outpatient lot without stress.  We parked near the staircase/ elevator and I elected to take the stairs. We left my massive suitcase in the car since we didn’t know if we’d be admitted. Mike or one of our friends could come back and get it later if need be.
At the front desk I felt like all eyes were on me. Mike told the receptionist where we were going and she offered a wheelchair which I refused. We were escorted up the elevator by some sort of orderly. In the outpatient area I was directed to a little cubicle and a woman introduced herself to me as Tipper, my nurse. I felt irritated to be assigned a nurse when we didn’t even know if we were there to stay! With distinct effort, I remained polite to Tipper but wasn’t exactly friendly either. I was directed to remove my shorts and climb up on the table and Ann was soon on her way in to see me.
The next moments will stand out forever in my mind. Without much ado Ann checked my cervix. “April,” she said, “Do you feel the urge to push.   .   .   .  because you’re nine centimeters dilated!!” I imagine that the next few minutes were akin to what it might be like to win the lottery. There was a flurry of activity and excitement all centered around me!
Tipper was shoving forms at me giving permission for the baby to be delivered at Mission Hospital. Someone grabbed a wheelchair. Of course I wanted it! Call Dana and Sally I hollered to Mike. I was whisked down the hallway to one of the labor and delivery rooms. I had wanted to labor in the nice big birthing tub in one of the hospital’s four “water world” rooms, but none were available. This room did offer a very serene window view of the mountains.
I had heard that women often have a b.m. while pushing and felt the urge to get that out of the way before hand. I went into the bathroom by myself and while hovering over the toilet, POP, my water bag broke with the juices conveniently gushing into the toilet. I heard Sally arriving through the cracked door. Ann came in and I told her that I felt like screaming for drugs. Ann reminded me that I didn’t really want that and that it was too late for that anyway. Thank you Ann!
From somewhere a contraption called a birth stool materialized. I don’t remember what it looked like but hanging onto it felt really good. I think I was making the hula hoop motions again. Perhaps if there is ever a second birth for me I can have a hoop on hand!
I remember Sally repeatedly telling me how good I was doing. Sally is a licensed acupuncturist and we had talked a lot about using acupuncture as a means of pain management during the birth. I had run this by each of the midwives with conflicting responses. It seemed like two of them were supportive but felt like it would not be cool with the hospital institution and we’d better not.  The other two midwives seemed excited about the opportunity to get acupuncture and didn’t have an issue with doing it at the hospital. Sally and I had discussed that in any case she could come work on me while still laboring at home and that we’d play it by ear at the hospital. In any case, we thought that acupressure should be ok.
Ann told me that it was time to push and that the stool would not be good because the positioning tended to promote more tearing. Where did I want to have the baby? Since the bed was right there I climbed up and on. I was making some really weird noises! Ann told me to pull my legs up behind me, like a squat but lying down.
This final phase was incredibly intense, but serene too. Mike was on my left holding my hand and looking at me sweetly. Sally was next to Mike, very interested in the action between my legs but attentive to me as well. Intermittently, she was exerting pressure on points in my hand. I’m not sure exactly what effect the acupuncture had on my pain, but psychologically it felt good to be doing something. Ann was standing next to Sally, occasionally commenting on what was happening, On the other side of Ann, by my right side was Jan, my nurse for real. She had a very calm supportive energy and I felt glad that she was there sharing this intimate experience even though we had just met!
I could see another nurse scurrying about, preparing the heat lamp and other things for the baby. I had learned in childbirth class that when you see this equipment being prepared you can be sure the baby is very close. That was a comforting thought.
I continued to make strange noise and Ann told me to go deeper with them. I needed frequent reminders to keep my legs held up; apparently I kept dropping my left leg and sighing! The sensations were intense, painful and primal. Apparently the baby was coming right along and his head was visible. I could have easily looked down at all the action but for some reason didn’t. I think that I thought that it might be so intense that I would impede my own progress. Somebody positioned my hand and told me that I was touching the tip of the baby’s head! It seemed like only minutes before Ann said, “Now for the ring of fire”.
Despite its name, the ring of fire phase actually felt better. Things were a little slower, thought still painful, and I felt more aware of what was happening. The one thing I would have done differently in retrospect would have been to slow down at this part and perhaps the baby would have eased out gently. As it was he came out rapidly and there were several tears on the way, though I couldn’t even feel them happening.
Suddenly Jan was handing me my baby, wrapping him in a blanket as she passed him up to me. I was in utter awe. I don’t know how many many times I said, “I can’t believe it, I just had a baby! Really, I am still awe inspired, just like that, I had a son! Just then Dana walked in.                                                                     
As I held the baby boy the placenta slithered right out. Apparently my copious bleeding was of concern and Ann administered pitossin to slow it down, or something. At this point I could have cared less about any procedures being done to me. I just held that baby, and remained in awe while Ann stitched me up. Sally seemed interested in all of the technicalities and Ann explained as she worked.
Probably the reason that Ann hung out in the room for a while was to keep an eye on my bleeding that it didn’t feel that way. Sally, Dan and Ann chatted merrily and the mood felt very celebratory. Dana whipped out the camera, something that wouldn’t even have thought of. Eventually Jan got around to completing all of the paperwork needed to admit me to the hospital. All in all I was not subject to any invasive procedures, had a completely natural birth, and followed our birth plan to a tee even though there was not a copy of it in the room. Initially, in early pregnancy, I had some reservations about giving birth in the hospital. The experience far exceeded my expectations and was in fact blissful. I attribute this to the incredible supportive attitude of my wonderful midwife, Ann Brown, my husband Mike and sweet friends Sally and Dana, as well as my own willingness to go with the flow!