21 Weeks Pregnant - my birth preparation protocol
Weekly pregnancy updates from a childbirth educator, doula and mum to 2 little girls. Come and join me on my journey as I share how I’m feeling, how baby is developing, what I’m doing to prepare, and some favourite resources!
You may have heard the saying, “if you fail to prepare, you prepare to fail”. I feel this applies to birth as much as anything else. Now clearly, I don’t mean we can “fail” at giving birth! That baby is going to come out! However, if we have a particular plan for how we would like the birth to occur, we need to prepare for it. This applies whether you are planning a vaginal birth or a Caesarean birth. There are always preparations you can make to give yourself the best chance possible of having a great birth experience. It’s a pretty long post this week, but I’ve put in plenty of sub-headings to hopefully make it easy to follow!
Preparing for a planned Caesarean birth
Since I’m going to talk mostly about vaginal birth, I’ll just go quickly first into why you might want to prepare for a planned Caesarean birth, though some of the points below for vaginal birth apply too. With Caesarean, they just open you up, take the baby out, and stitch you up again, right? Well...yes. But... choose a provider who is on board with your reasons for planning a Caesarean birth, that way you will feel you have their full support. Look into ways you can individualise your experience. For example, perhaps you want to plan a music playlist that you can listen to during the surgery and as you meet your baby! Perhaps you want to find a surgeon who’s on board with a maternal-assisted Caesarean (where you take your baby out). Look into the ways that baby/breastfeeding/bonding might be affected by a Caesarean birth, and plan what you will do to mitigate any potential issues. Plan for a supported postpartum. Caesarean is not “the easy way out”! The birth process may be significantly quicker than a vaginal birth (not always!), but it is major abdominal surgery, and you don’t just get to recover from surgery. You have to recover from surgery WHILE caring for a brand new baby AND going through all the postpartum hormonal swings. It is a lot to have on your plate, and you need all the support you can get from family, friends, doulas, support workers, you name it!
Preparing for a planned vaginal birth - the foundations
While there are medical reasons to plan a Caesarean birth, whether physical or mental/psychological, the majority of women don’t have a need for this kind of intervention at birth. Unfortunately, the way the maternity care system is set up in Australia, many women who thought they were going to have a vaginal birth end up with a cascade of interventions which all too often lead to Caesarean. But does that mean we just have to cross our fingers and hope for the best? No way! There are so many things you can do to maximise your chance of having a vaginal birth, even in a public hospital setting. A great resource is The Great Birth Rebellion podcast episode 149 titled "Increase your chance of vaginal birth in hospital with these strategies". I never want women to feel it’s impossible to have a great vaginal birth in hospital. It’s totally possible, with the right preparation and support.
Place of birth
Sometimes we don't get a lot of choice here - we’re stuck with whatever is locally available. Ideally women with low-risk pregnancies would have access to midwife support for home birth, if they choose that over hospital birth, but this isn’t always the case. The hospital-run home birth programs are few and far between, and places are limited. Private midwives are available in some areas, but they are also limited in how many clients they can take, and sometimes just the cost of going private is prohibitive. So sometimes we don’t even get an option on place of birth: if we want medical support available, we are obliged to go to hospital. However, if you do have options around your place of birth, look into them and see which one best aligns with your birth goals and your own family situation and circumstances. While I have had home births myself, I am never going to say that is the right choice for everyone! Birth where you feel safest.
Healthcare providers
When it comes to providers, the gold standard is continuity of midwifery care throughout your pregnancy and birth. That is, you see the same midwife throughout your pregnancy and she attends your birth too. This should be available across the board, with the addition of obstetric care as required for mothers with high-risk pregnancies. Unfortunately, Australia still hasn’t caught up here, and many mothers don’t have a chance of getting into the continuity of care midwifery programs at public hospitals and can’t afford a private midwife. And so they end up in the unenviable situation of going to hospital for their appointments, waiting sometimes for hours to see a midwife, probably seeing a different midwife every time and having to explain their history all over again, and then most likely seeing completely different midwives when they go in to give birth. Once again, if you have options around your care, do what you can to get continuity of care with a midwife!
Support team
Your husband/partner is usually a key person on your support team. They should spend time along with you in learning about labour and birth, and learn how they can best support you. You may want to have your mother, sister, another relative or friend. Make sure that everyone on your team shares your vision for birth and is ready to support you through it, calmly and steadily, even if the going gets tough.
Doula support can make a massive difference to how your birth goes, especially if you expect to give birth in hospital. Having a doula for pregnancy and birth is like having a GPS when you drive somewhere you’ve never been, or a Sherpa when you climb Mt Everest. We’re not saying you couldn’t do it on your own, but if you have the extra support, you will most likely have a more satisfactory experience with fewer bumps along the way!
My birth preparation protocol
I would consider planning all of the above (place of birth, provider, support team) as absolutely fundamental, and things to consider early on in pregnancy. Besides that, my way of approaching labour and birth preparation through my pregnancies has been pretty simple:
Conception to 20 weeks
Get through the fatigue, morning sickness, or whatever other major challenges you may face, usually in first trimester but sometimes beyond. Meanwhile keep as nourished and hydrated as possible, and keep active or at least do a minimum of walking/light exercise if you are able.
Besides that, focus on informing and educating yourself about birth. Take an independent childbirth class (along with your partner). Listen to podcasts. Read books. Learn about the physiology of birth and how you can best support your body and baby in the birthing process.
While I emphasise the importance of focusing on the positives, and not listening to negative birth stories or opinions, I don't think it's wise to pretend that complications never happen. Now is the time to inform yourself on some of the more common complications in pregnancy and birth. That way if any of those come up for you, you already have some knowledge. Knowledge goes a long way towards reducing anxiety and stress later on. You understand the issue, you know the options for dealing with it, and you know the likely outcomes. However don’t dwell too much on these potential complications. They’re not likely to happen to you, and if one of them does, you will be prepared. Once you’ve looked into them briefly, set them aside and maintain your focus on enjoying a smooth, positive experience!
21 weeks to birth
Physical prep: Now is the time to get into the physical and mental preparation that will serve you so well when it comes to childbirth! Do the recommended Spinning Babies daily activities, daily if you can, or as close as possible. Besides the walking component, the rest of the exercises take only 20mins or so, and you can split them up throughout the day if that works better for you. And if I’m being honest I have never achieved their walking recommendation on a daily basis through my pregnancies! Though I do try to substitute with a brief indoor walking workout if I am not getting out for walks at least kind of regularly.
Mental prep: Aim to listen to a positive birth affirmations audio track daily. Listen to guided relaxations and/or visualisations for birth, once again daily or as close as possible. I am hooked on the ones my midwife recommended while I was preparing for my first birth. It’s the Ultimate Birth Relaxation series, aka “Colour and Calmness” from KG Hypnobirthing, which is included free when you get their book (which I also recommend). (Note that this series also includes an affirmations track.) It’s kind of funny because when my midwife first mentioned the audios I was pretty reluctant to give it a go, feeling it wasn’t really my thing. It felt weird listening to them the first few times. But after having listened through them for the rest of that pregnancy, all I need to do now is start the audio and close my eyes and my body and mind sink into relaxation. So they work! But they work if you listen to them regularly, not just once in a while or cram-listen at 39 weeks!
Practice breathing. There are so many techniques suggested, but the key thing is that your exhale is longer than your inhale. That’s what tells your body to relax. Also practice “horse lips”! Relaxed jaw equals relaxed pelvic floor! Relaxation during labour is fundamental for allowing your uterus to function optimally.
See a pelvic floor physio from 26 weeks for individualised guidance on preparing your pelvic floor for birth. Also see physio/chiro/osteo etc. throughout pregnancy as required. If you can, get a massage every now and then from a qualified prenatal massage therapist!
Part of my personal protocol includes the consumption of red raspberry leaf tea and dates in third trimester. This might not be for everyone, but I figure if it might help and it won’t do any harm I'm going for it! (You can listen to the Great Birth Rebellion podcast episode 172 on this topic.)
If you’re interested, look into other complementary therapies available such as acupuncture and aromatherapy.
Make sure you know who your local lactation consultant is so you can call on them if you need to, and if it’s your first baby definitely plan to take a class. Yes, this applies even if you’re not planning to breastfeed, since you have things to learn about bottle feeding and about how to deal with drying up your milk production.
Last but not least... prepare for postpartum! Be aware that postpartum is physically, mentally, psychologically and emotionally demanding! Surround yourself with people who will truly support you; take time away from those who won’t. The 5-5-5 “rule” for postpartum suggests 5 days in bed, 5 days on the bed, 5 days near the bed (and that’s just to get you started!). Prep freezer meals in advance, get help with cooking cleaning, laundry and older kids. You won’t “bounce back” in 2 weeks, nor even in 6. Take the time you need, get all the support you can, whether that’s from family, friends, or a postpartum doula.
And meanwhile... keep listening to podcasts, reading books, and reading/watching positive birth stories!
Disclaimer
I am by no means saying a positive birth experience depends on you following my protocol for my own pregnancies. This is what has worked for me, and I’m glad if there are ideas here that are helpful for you 😊
What symptoms am I feeling this week?
I’m feeling stronger kicks this week which is pretty exciting 🥰
How has baby been developing this week?
At around 27cm long and weighing 400g, baby’s skin is now covered with vernix, a white, waxy substance which provides protection for the skin during pregnancy and in the immediate postpartum period. It helps prevent the skin from becoming chapped or wrinkled in the amniotic fluid and has antimicrobial properties that protect against infections. So don’t rub your baby down straight after birth! Leave the vernix to give them a better defence against infection!
What am I doing to prepare?
Well, since I am now in the “21 weeks to birth” phase, I have started my Spinning Babies exercises, hypnobirthing tracks and breathing exercises! So thankful that we are over our super busy season of travelling and back into a home routine now, since it makes all of this so much easier!
And that’s it for this week! 🌿💛
[Photo: snuggles with my first baby after a smooth and perfectly manageable labour & birth - having followed the above protocol throughout my pregnancy!]