Let's talk Birth Plans for pregnant folx.
Why is this even remotely related to mental health?
In quite a few ways, it's actually very pertinent to mental health.
If you have a history of trauma - especially sexual trauma or domestic violence - it is very possible that a bunch of people up in your genitalia isn't going to be the most relaxing experience. It may be triggering, and cause feelings of helplessness. If your provider isn't aware, they might not realize their actions are causing distress.
Then there's the possibility of birth as a trauma. Birth can certainly be traumatic - not just because it is painful..but because as pregnant people, we may have expectations, dreams and preferences surrounding our birthing experience that 1) may not be honored 2) may not be possible 3) may not come to fruition for whatever reason. There is the possibility of pain we didn't anticipate, near-death or actual death experiences..endless amounts of things can happen that could be traumatic.
So what are your options if you're pregnant?
Helpful Birthing Options
A Doula. A doula is a person who is present with you throughout your birthing experience, and is able to help advocate for you. They can help explain processes, your choices, design a birth plan, manage your pain without medication, help you connect with your partner, give your partner a break, etc etc. Doula's are really freaking work it.
Exploring your options. Birthing can be done with the assistance of a certified nurse midwife, an OBGYN, or a certified professional midwife. It can be done at home, a birthing center or a hospital. You have choices. Interview your providers. Make a list of questions and ask them. Some providers are really fuckin' weird about psych medications. If you take Lamictal or another medication (managed by us maybe yay!), and your birthing provider is not cool with it, you might need another birthing provider.
I'm currently pregnant (again, blah), and I had an interview with a fantastic midwife early on in my pregnancy. One of my top questions was, "how do you feel about your patients taking mental health medications? I'm on Wellbutrin, Lexapro and Adderall." She was cool with it, and we bonded.
Creating the plan. Wtf is a birth plan and why should you have one?
A birth plan is your list of preferences in a written form you can provide a copy to your nurse, midwife, doula and/or OBGYN. Your birthing team will now be fully aware of your preferences. This includes things such as:
Your preferred name and pronouns
Birthing positions and tools you are interested in: birthing ball, water, peanut, in bed, standing, kneeling, etc.
Who you would like to be present?
How would you like the room to be? Dark, bright, ice chips available, snacks?
Cervical checks? You have the option to opt out.
Pain relief you are okay with, and in what circumstances to advance to further pain management: TENS units, laughing gas, alternatives, epidurals or perhaps "I would like to avoid epidural unless I ask ten times in a row, or use a safe word" or "Do not give me an epidural in any circumstance"
Episiotomy - would you avoid and rather tear naturally, go with it immediately if suggested?
C-section - OK at first recommendation or try EVERYTHING else first?
Pitocin? Low and slow? Absolutely not?
Avoid forceps/vacuum no matter what or OK if recommended?
Do you want to catch the baby, your partner, the provider?
Umbilical cord cutting - who is doing it? Are you allowing the blood to drain a few minutes first? Would you like to keep it connected?
Baby clean up asap? Baby straight to your chest? Golden hour?
Feeding preferences - breast, bottle, mix?
Antibiotics for Strep B?
The list goes on and can include everything and anything.
Specific Options to PTSD and Birth
One important thing to keep in mind is being out of control and feeling helpless is something that can trigger PTSD. If you have birth expectations and an experience that do not line up, this could also increase the risk of the development of postnatal PTSD. This is why a birth plan can be so important - it allows you say in so many difference places - and your choices are written at a point where you may not be able to speak or think clearly.
Considerations for PTSD
An Epidural could either be very triggering or the pain itself could be very triggering. Sometimes for those with PTSD, the idea of being bound to a bed unable to move is so horrifying, they would rather endure contractions epidural-free.
Certain birthing positions may be triggering such as hands and knees. It may also be very triggering if you are approached from behind and/or touched without warning.
C-section - if you have a history of sexual assault, consider asking them to not restrain your arms during the procedure.
Being coached to push may be triggering. You can opt in your birth plan for nurses or the doctors to let you push as your body allows you, and not to be coached.
Have extra clothing if possible to cover up. If you birth in a hospital, the gowns can be very revealing.
Chestfeeding may be a trigger. If you are not interested in breastfeeding/chestfeeding, let your team know that you would prefer to have a bottle ready.
Lactation counselors and others on the team may also just go forward and grab your nipples to squeeze them or demonstrate techniques. You can request for them to not do this and/or use their own body to demonstrate.
Be open about your feelings throughout the experience and if you worry about a fight/flight/freeze response, make sure to tell your partner or team what nonverbal cues to look for and how to interact with you in these moments (give you space, simple choices w/ yes/no nod etc).
Thinking Forward to Postpartum
One of the things that happen after someone gives birth is that people want to visit and see the baby. Everyone checks on the baby. Usually this goes on for the first few weeks until the novelty of a new life wears off.
The postpartum period can be extremely difficult (and that is an understatement) to the birthing parent. Discuss with your partner and family prior to the birth any limitations you may have on visitors, people holding your child, kissing the baby, etc.
Also think forward to further postpartum.
It doesn't necessary just get easier. Sometimes it gets more lonely.
Have a therapist on hand. Have other parent friends you can connect with - even via text or social media community. Force yourself to go out once every couple weeks just to take a drive and get some air.
The baby will come, and things will be really beautiful at times. Things can also be frustrating, scary and overwhelming.
It can be lonely.
At the end of the day, make sure you have a team who has your back to help you through.
