I like birth plans but I wish I could tell all first-time Moms who come in with long, intricately specific birth plans to save them for their second birth. Second labors are usually easier, faster and more suited to a birth plan than a first. This is, of course, a generalization but one that is pretty consistent. Second babies are easier to deliver than first babies. Why? Lots of reasons: Our uteruses get smarter and figure out how to do the job. All the muscles, tissues and bones have already stretched out making it easier for the baby to descend. The trail has already been blazed and is easier to travel than one you have to create from scratch.
Moms of first babies are birth-virgins. They've never done it before. They don't know yet if their anatomy and their babies are compatible for a vaginal birth. Most of the time they are. She doesn't know yet how long it will take for her uterus to contract enough to dilate her cervix and push that kiddo out. There's a lot of literature that says the average first labor is 12 hours but if I've said it once … babies never read that literature. Some take longer than others. A lot longer.
ON FIT PREGNANCY: The Truth About Pain
There's always some debate as to when labor actually starts. The official word is labor starts when strong, regular contractions cause cervical change. It's not always possible to determine that exact moment. Lots of moms have strong, regular contractions for hours (days, weeks by some stories) that don't cause significant change. Try telling them they're not in labor. Most moms will argue, "I don't care what you say, labor started at 3:00 this morning." I'm going with Mom's story. My first took 30 hours—no matter how the obstetrician timed it. I went with my birth plan for the first 25. Once I finally tried some stuff that was "off plan," labor progressed rapidly and my daughter was born 5 hours later. The point is, first labors take a long time. A lot of thought and planning for exactly how you want your labor to go is a good idea, but keep in mind that as the hours drag out and progress is slower than you hoped for, birth plans frequently have to change.
Second labors, however, are perfect for birth plans. If you've already successfully delivered a baby vaginally, you most likely will again. Your labor will be shorter (usually) and it's way easier to deal with contractions when your cervix is dilating quickly and the finish line is in sight.
Let me get specific here. One of the most common items on a birth plan is "no pain medication or epidural under any circumstances." OK, that's not so tough with a second labor that's likely to be over fairly quickly (anywhere from 1-12 hours). That's a tougher target to hit when you've been contracting forever, have run out of coping mechanisms and are still only 3 centimeters dilated.
ON FIT PREGNANCY: When Push Comes to Shove
Another popular item: "No pitocin to augment labor under any circumstances." With a second labor, there's frequently no need. They're way more efficient and don't tend to need much encouragement to keep the ball rolling. Item: Want to labor in the tub? Perfect! This works beautifully with firsts too but second labors are so much smoother that frequently, a little time in the tub is all the pain management needed before complete dilation. Heck, I've had seconds go so fast in the tub the water didn't have time to cool down. Item: Want to wait until you feel the urge before you push? No problem. If you've followed your birth plan request for no pain management, you probably don't have an epidural. Believe me, once you have that urge to push, no one's going to stop you. You won't have to wait for it either. Once the baby is on her way through the birth canal, your urge to push will be so strong, it's irresistable. Remember those two long hours of pushing with the first? Thing of the past. Seconds pop right out. I've delivered seconds myself when they came so quickly, they shot out like cannon balls. I was grateful there was a wall behind me for support. Doctor? Midwife? No time. Just snap on the gloves and catch. That hardly ever happens with a first.
MORE ON FIT PREGNANCY: OB or Midwife?
Some birth planning with the first is an important part of preparing for labor along with prenatal classes and a healthy dose of reading. Just please, remember that you're a birth-virgin and plan for flexibility. We're going to do everything in our power to help you achieve the birth of your dreams. We're all for birth plans but those of us who've been doing this for a while are more realistic than some first time parents. We know that plans sometimes have to change. It's an important first step in parenting. You'll raise the child you deliver, not the one you planned on. They might, or might not, be the same child. Most of the time, the child you birth is far and away better than anyone you've ever dreamed of. Best laid plans…
Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.
