After all your careful preparation,
the day finally arrives. It's going to pass too quickly and too
slowly, much as the pregnancy has passed. Your chief concern
on the day should be your baby, but also on the future: you will
want to minimize your regrets, and you will want to remember
as much as possible. How to accomplish this will differ for every
set of parents, but I offer the following thoughts...
Have A Birth Plan
A birth plan doesn't mean you're scripting
the action, and those who think they can script even a normal
low-risk birth are laughably naive. (I can say this because I
used to be laughably naive. We won't discuss my first birth experience.)
Some prefer to call it a wish list. In our cases, what we're
trying to do is create a best-case scenario for what is already
a worst-case scenario.
Every mother ought to have an idea of
the type of birth she wants and why she would choose certain
options over others. The best kind of birth plan would be useful
as a guideline for the doctor or midwife in the case of an unexpected
situation where more than one approach is possible. If your general
preferences are understood, the doctors can act with this in
mind. Of course, if you have stated that you don't want a cesarean
and your life would be in jeopardy without one, expect to have
a c-section. Your birth attendant will make medically responsible
decisions. However, your birth plan can be a paper-advocate for
your wishes at a time when you may not be able to advocate for
yourself.
When I wrote my birth plan, I tried
not to dictate too much (except for issues I would not relent
on, like rooming-in). I explained my reasons for wanting certain
procedures and not wanting others; I tried to phrase it as "we
would prefer" rather than "you will" and this
was well-received by the midwives. They all looked it over in
the seventh month, sent me home with edits, and then I returned
with a final version. I made sure a copy was on file with the
hospital, a few copies in my medical records with the midwives,
one on my person, and two in my suitcase for the hospital. Yes,
I am overly cautious, but being the suspicious sort, I didn't
trust the hospital that had so mismanaged my first delivery to
keep track of a single piece of paper. It was important to me;
it was not so important to them.
What sort of things ought to be covered
in a birth plan? Anything you feel you couldn't live without,
of course. But you also might want to mention what measures of
pain relief you will consider (and in what order); whether you
want your partner with you in case of a c-section; if you would
rather tear than have an episiotomy or vice-versa... As the parent
of a baby who may well not survive the birth, you also have a
second set of considerations: whether you want extraordinary
measures to save the baby's life; that you want them to delay
routine procedures until after you've held your baby for a little
while; whether you want a chance to hold the baby in the case
of a still birth (here's my biased opinion: YES you do. Don't
let anyone tell you it's abnormal to want to hold your baby under
any circumstances); what provisions you want made for the baby's
nutritional needs; what assistance you will require of the staff
in gathering mementos and taking pictures. Demand rooming-in.
If you decide later to place your baby in the nursery, that's
fine, but make sure the baby isn't whisked away because of 1950s
hospital policy. Call as many doctors as you must to secure this
right. It wasn't until I contacted my son's pediatrician that
I finally found a doctor who would take authority and say, "They
damn well better let her stay in the room with you! If they don't,
tell them to call me--immediately! Even if it's two in the morning!"
[That's practically verbatim. I love my son's pediatrician.]
Once she took that stand, everyone else behaved.
I've included as many birth plans as
I could find, and I would appreciate more, especially concerning
twins. I compiled bits and pieces of any birth plan I could locate
online and took the bits most appropriate to myself. Parents
who are composing their own are invited to do the same. This
is not a copyright issue unless you are planning on making money.
In writing your birth plan, try to keep it on two pages. Short
paragraphs/sentences that get right to the point are good. Elaborate
graphics are not recommended. Consider it a medical document
which may need to be referenced in a hurry without a lot of distractions.
I recommend printing them all out so
you have everything before you when you write your own. Many
of these borrow from one another: we're not going for originality,
but for a satisfying birth and time with our babies. You'll also
notice that many of them contradict one another: many women,
many preferences, many different birth experiences. As always,
discard any notions you dislike.
These are located on other sites, so please hit your "back"
button after you visit because I don't want to lose any readers.
(Yes, I'm totally shameless.)
C-Section
This is a very touchy subject. Some
mothers feel their baby has a better chance of being born alive
by cesarean than by vaginal delivery. You'll have to discuss
this with your doctor, since obviously it requires your doctor's
cooperation. If your doctor objects to discussing a section on
the grounds that "the baby will die anyhow," you have
the right to fight him/her. It matters to you whether
your baby is born alive. If you're willing to endure the longer
recovery period, what right does the doctor have to say you really
don't want to? Offer to sign waivers, explain that you know the
risks, and explain that it will be a lot easier for your emotional
recovery if the baby is born alive and lives for even a short
while in your arms. Then discuss how to best raise your child's
odds of a live birth.You'll have to take into account previous
deliveries and how many more children you expect to have. It's
best to get this resolved right up-front so there are no regrets
later. And remember, a c-section is not a guarantee of a live
birth.
The Birth Center
If you can, tour the birth center first
and try to speak to the director of the maternity unit. Explain
your situation and ask what accommodations they can make for
you. Ask if a private room is possible. Ask if you may have a
room relatively isolated from mothers with healthy babies (I
joked that they stuck me in the leper-section, but I never heard
another baby cry). Ask about early release from the hospital.
Find out if they will mark your door to alert staff to your loss
or impending loss (I found out they do mark the doors at my hospital,
but I forgot to ask how, so I never found it on the door to take
it home with me!) Request nurses specially trained in bereavement
if possible. Ask about your options for recovery outside the
maternity unit. This is not always the best option (a post-partum
woman needs to be treated by nurses familiar with post-partum
needs) but you may be comforted to know if it's available to
you. If someone assures you a certain request will be granted,
be sure to take his or her name so you can say, "Judy Smith
authorized rooming-in," which will carry more weight in
a crisis than "But someone said--"
Siblings
Beyond a certain age, siblings seem to appreciate the time
spent with the baby. However, they may be very nervous and apprehensive
about holding a baby who seems very fragile or that they're afraid
will die in their arms. As with the funeral afterward, ask what
the child wants to do at every step of the way. Children will
generally know what they can handle. Some will want to look at
the baby; others will not. Some will want to hold the baby; others
will be content to sit beside the baby while you hold the baby.
Virtually anything is acceptable. My son was not frightened of
Emily's appearance or her impending death. Provided with an opportunity
to hold her (while seated in my lap) he did, and ever afterward,
when talking about Emily, he says, "I held my sister."
And he says it with a smile.
My son was not present at my daughter's birth, but some feel
that's an important part of bonding, and they may be right. That
is a decision to be made within the family itself, and in accordance
with your birth attendant's practices.
Relatives and Other Visitors
To a point, you may want them there, and some will arguably
have a right to visit. Make sure the hospital will allow them
to enter immediately after the birth, no matter what time it
is, since your baby may not wait around for visiting hours. Some
things to consider: the number of people you want crowded into
a hospital room with you; the length of time you want them to
stay (we allowed the grandparents to stay until after Emily died;
in retrospect, we ought to have considered sending them away
so we could have some time alone with her); and how soon after
the birth you want them invited in (we waited until Emily and
I were cleaned up, which was about as long as it took them to
make the drive to the hospital). Do try to make sure everyone
maintains the solemnity of the event. If Uncle Fred is going
to yack on and on about his car's transmission problems, someone
needs to be instructed ahead of time to tell him to keep quiet.
But nicely.
Religious Observances
If you want a religious ceremony to mark the child's life,
such as a baptism or a dedication, speak ahead of time to the
hospital chaplain and your clergy. Find out what you can do yourself
in case time is of the essence. Some opt against any particular
rite, feeling that they are "for the living" and therefore
their baby will not need it.
A special note for Catholics:
any person can baptize someone into the Catholic faith (non-Catholics,
non-Christians...) using any water, by dipping a finger in water
and making the sign of the cross on the baby while saying "I
baptize you in the name of the Father, and of the Son, and of
the Holy Spirit." In case the baby is stillborn, a baptism
can be performed anyhow; in that case, it is called a conditional
baptism, and the procedure is the same except for the wording:
"If you are able to be baptized, I baptize you in the name
of the Father, and of the Son, and of the Holy Spirit."
Catholics also can request that their baby be confirmed, but
that must be performed by a priest. We requested confirmation,
and although we had to work harder than we ought to have, we
were able to obtain that sacrament for Emily as well.
My friend Scott, who has studied for the Catholic priesthood,
writes, Any priest may confirm in case of danger of death
(Canon 883-3 of the Code of Canon Law) and even in the Latin
right any baptized person may be confirmed in danger of death
(Canons 889 and 891). The Character conferred by Confirmation
will endure unto eternity and conform your baby more to Christ
forever. At any rate it was drummed into me in theology that
it was a priest's duty to confirm in such circumstances.He
adds, The relevant canons for confirmation of infants are
883-3; 889 and 891. By canon law Baptism, Confirmation, and the
Funeral are a parish priest's responsibility: Canon 530 begins:
"The functions especially entrusted to the parish priest
are as follows:
1) the administration of baptism; 2) the administration
of the sacrament of confirmation to those in danger of death
in accordance with can. 883 n.3; [...]5) the conduct of funerals.
Photographs and Videos
Take photos. Take lots of photos. I would recommend video
too, but it's very hard for me to watch the video, and on the
video I noticed some aggravating things I hadn't noticed at the
time. (In the time it took you to read that sentence, someone
ought to have taken three pictures, by the way.) Make sure you
have at least two cameras working. We had four cameras for Emily's
birth, and one of those didn't get any pictures because of a
malfunction. (Take another photo--it's been too long.) Ask the
nurses to help you take photos, and designate one of your visitors
as the photographer after he or she has had a chance to visit
with the baby. My brother took over as videographer and did an
excellent job. My mother took many many photos on my camera after
hers had problems. (Take another photo.)
Remember, if you take the photos and you hate them, you can
always discard them later. But you'll only have one chance to
get them.
Note for those as clueless as I was: many hospitals dim the
lights for the birth. Remember to turn them up a bit before you
start taking photographs. We didn't, and some of the photos are
very dark.
A few other tips:
- Make sure to get a lot of face-forward shots. Afterward,
you'll want to remember your baby's face most of all.
- Take pictures of the whole baby: hands, feet, whole body.
Most of Emily's photos have her wrapped tight in a blanket and
wearing a hat on her head. We were keeping her warm, of course,
but after she died I made sure to get those other pictures.
- Have two cameras, one with black-and-white film and one with
color. Babies with discoloration from birth will look very normal
in black and white prints; if you take only color photos, most
camera stores will be able to develop black and white prints
from color negatives.
- If your baby has a visible deformity, as with anencephaly,
don't shy away from taking photographs of that part. Keeping
it covered over may be preferable for the shots you will show
other people, but you will have some parent-only shots too. We
took only one picture of Emily's uncovered head, but it was from
a distance, and now I don't have a good picture of how plum-shaped
her little head was. Again, if you don't like it afterward, you
can discard it.
- After your baby dies, do continue to take pictures, but I
caution against leaving the baby in the basinette to take them.
Babies belong in someone's arms. They look better snuggled.
- Be prepared for the photos to make your baby look darker
and more beat-up than she looked at the time. The better photo
shops can accommodate for that, and you may need to spend some
money getting photos enlarged and color-adjusted.
- Hey, it's been too long since you took a picture.
Afterward you may well ask, as I did, how can one life be
boiled down to a hundred crappy photos? The answer my friend
gave was, "It can't," but at least we have that many.
If you can get even more, that may be a comfort. Snap away.
Things to Say, Sing and Do
I found it helpful to "rehearse" the scene ahead
of time in my mind to determine what was important to me to say
and do with Emily in however long we had with her. That helped
me remember when the time came. I forgot the things I had wanted
to do that I didn't rehearse. I remembered the ones I did (call
it self-programming). Some things are simply natural and will
come on cue, like snuggling your baby or rocking your baby. Others
have told me they sang lullabies or read books. When the time
came, I said to Emily, "It's okay if you have to leave us.
It's okay if you have to let go." And she did. It makes
me feel marginally better to know she left with my blessing.
If regret can enter heaven, she at least won't feel torn.
Some things are definites: give your baby lots of cuddles
and kisses. Touch and talk are always good. If you have special
outfits for your baby to wear, bring them and ask for help dressing
her. If you want to bathe your baby, make sure you get the chance
to do so. If your baby is born alive, encourage her to hold your
finger (I don't remember doing that) and even try nursing or
feeding colostrum from a spoon. If you want the baby to stay
in your room for several hours after the death, demand that right.
The baby is your baby, not the hospital's baby, and you have
the right to stay with your baby.
Nursing Staff
And that brings us to another type of potentially clueless
individual: the nursing staff. If you've toured the birth center
in advance and explained your situation, you may well get bereavement-trained
nurses who won't pop in full of joy as they ask with delight,
"So, what are you having?" ("A baby. Now leave
and return without that fake smile.") Find out in advance
if your door will be marked, and if you can keep the marker.
Even the most sensitive nurse may not know how to handle your
situation, however, since you knew in advance that your baby
wouldn't survive. Several staff members tried to impart to me
their philosophy about neonatal death, all of which I took with
"Uh-huh" and a bland smile. They'll expect you to be
hysterical, and if you're not, you may feel abnormal. You're
not. You just knew in advance and did some of the hard work up-front.
But as long as they're there, make them take photos. They'll
like it better to think they've been helpful.
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