ARTICLEPREGNANCY

Ruscha’s Birth Plan Helped Her Advocate for Herself and Her Baby

By Stacey Feintuch

December 12, 2023

Ruscha Hillman, 25, of Baltimore, wanted to avoid giving birth at a hospital. She had read about the disparities that affect Black mothers and knew that Black women have a higher risk of dying during childbirth at hospitals. She thought she would feel safer having the baby at home and more likely to have the childbirth experience that she wished for. But in the end, she had to set aside her desire for a home birth for the safety of her baby.

Here’s how Ruscha created her birth plan for delivering at home—and what happened when she found out she needed to go to the hospital instead.

Why Ruscha Wrote a Birth Plan

During the first six months of her pregnancy, Ruscha went to ob-gyn appointments. She met with a different provider each time.

During one visit, she asked if she’d be able to labor on all fours, move around the room, or do other practices to make herself comfortable during the birth. “I was told ‘No, that’s not what we do here,’” Ruscha says.

That’s how she knew that her traditional ob-gyn practice wouldn’t work for the type of childbirth she wanted to experience. So she found a midwife and decided she wanted to give birth at home. She wanted as few interventions as possible.

At the midwifery practice, “the care was more warm, the visits were slightly longer, and the certainty of having my chosen birth attendant was comforting,” Ruscha says.

Preparing for Birth

Ruscha began to prepare for a home birth by seeing a chiropractor, hiring a doula, learning breathing techniques, and practicing hypnobirthing. Hypnobirthing is a set of pain management techniques that can be used during birth that includes visualizations and affirmations.

Ruscha told her doula LaTory all her preferences for the birth. “We were on the exact same page.”

She also wrote her thoughts on a piece of notebook paper—a written birth plan just in case she had to go to the hospital. “I wanted it written down so I didn’t have to advocate or argue for myself while I was in labor.”

Ruscha’s Birth Plan

The birth plan included aspects of labor, birth, and post-delivery that were important to Ruscha.

During labor, she wanted:

No fetal monitors on her baby
No epidural. She wanted to try to labor without medication as much as possible.
The ability to shower during labor if needed to help with pain management

After she delivered, she wanted:

Skin-to-skin contact with the baby immediately after birth
Delayed cord clamping, which means waiting to cut the cord until one minute after the birth or until the cord has stopped pulsating
Encapsulation of her placenta. She wanted to save it for steaming, dehydrating, and grinding to later put into pills.

Ruscha’s Birth Story

Ruscha labored for two days at home. Contractions started on a Saturday and lasted until Tuesday. She managed pain by sitting in the tub and practicing her breathing.

But labor wasn’t progressing as quickly as expected. “I had contractions but nothing was happening,” Ruscha says.

Jeni, her midwife, and LaTory told Rusha that she had to do what was necessary to give birth. “After hours of laboring at home without success, I knew I finally had to go to the hospital,” she says.

Changes in Plans

Right after arriving at the hospital, Ruscha’s cervix was checked, and her membranes were stripped, a procedure meant to help labor progress. LaTory was there the whole time. She knew Rouscha’s birth plan and advocated for her.

“I had to have a snowball of interventions,” Ruscha says. She labored for a while, and they gave her Pitocin, a medication that activates the uterine muscles to start or boost contractions.

Ruscha was exhausted from laboring at home and being in pain for so long. She knew she had to labor more and deliver her baby. So, she decided to get an epidural, which would help reduce the pain.

Once she got the epidural, she couldn’t feel her legs and wasn’t moving as much. Labor slowed down and still wasn’t progressing.

Speeding Things Up

The medical staff broke Ruscha’s water, another intervention to help labor progress. She was told they only had 24 hours to deliver the baby after the water was broken.

After a while, the baby’s heart rate was dropping with every contraction, according to the band around her belly that was monitoring the baby’s heart rate. (For most of labor, she insisted on not having a fetal heart monitor on the baby, since she didn’t want anything attached to his head. But she did allow it towards the end of labor for the baby’s safety.)

“They told me if I didn’t have a c-section my baby would die,” Ruscha says. That was because of how long she’d been in labor, the baby’s decelerating heart rate, and the fact that her water had been broken for 24 hours. “It was rough to hear. I was trying to do what was best for the baby. So, I ended up having an emergency c-section.”

Meeting Baby Gabe

It had been a long wait to meet baby Gabe—from starting labor at home on Saturday until the following Friday afternoon, when he was delivered via c-section. ”When he came out, I was in awe of how beautiful he was,” Ruscha says. “It was a mix of emotions. I was so happy to meet him.”

She had some difficult feelings too. “I had a lot of medicine, so I felt a little loopy after delivery,” Ruscha says. “I was heartbroken about not having the birth I wanted and felt physically broken.”

Her expectation was that Gabe would come out and her husband, Caleb, would catch him, and she would hold him. But medical students and doctors touched him first. “I was overwhelmed by how many people got to hold and touch my baby before I did.”

Once she did get to hold him, they had skin-to-skin contact. “It was wonderful to hold him and know that he is the person who has been living in my body this whole time,” says Ruscha. “I was mostly in shock. But I also felt strong and told him, ‘I fought for you to be here.’”

Making New Plans

Ruscha’s birth didn’t go exactly as she had planned. Still, the experience made her realize that sometimes you have to change course for the sake of your health and the baby’s health.

She and Caleb hope to have another child, and there are some things Ruscha says she’ll do differently next time. She says she would create a birth plan for her next child, but that she’d be flexible with the plan. “I know that the baby has their own plan.”

She also wants to be healthier before her next pregnancy. She would like to lose some weight and get more exercise in preparation for birth. She’d also seek midwifery care immediately next time.

Ruscha was inspired by LaTory, her doula, to start a new career. “Because of her, I’m now going to be a certified doula,” she says. “She changed me as a person. Birth is so special, and a woman should be supported. I want to support the next generation of people in the world.”

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