Birth plans - do you think they're a good idea?

[Twinklemegan]

I'm interested in other people's experiences of birth plans, particularly for first births. For example

1. Did you feel you had enough knowledge to make an informed birth plan?
   
2. Did your labour and birth follow the plan. If not, why not and was it your choice?
   
3. Were there any consequences of your birth plan which you didn't anticipate?
   
4. What would you do differently next time?
   
   I'm not doing any formal research, I'm just interested in other's experiences. I for one feel that, in hindsight, I didn't have enough information about the various pain relief options to make an informed choice. My birth plan affected the way my labour and pain relief was handled. For example, I had no idea that by asking not to be offered meptid or an epidural (but for them to wait for me to ask) I was condemning myself to labour without any pain relief whatsoever, gas and air only being available in the late stages.
   
   Anyone else?

[ruddynorah]

i did a birth plan mainly so i could discuss what i wanted with dh. i did feel very prepared and had read a heck of a lot. dh was then able to speak on my behalf and encourage me to have what i wanted whilst i was in the throws of a very very long labour. i too 'condemned myself' to a labour with only gas and air...but that was what i wanted.

[whomovedmychocolate]

I had two - one for the birth I wanted at the midwife unit, another for a surgical birth, to wrest some control just in case it all went tits up. Guess which one I used

My next birth plan will be: have baby, both of us survive, tea and toast afterwards (the only bit of my birth plan that happened last time).

[Twinklemegan]

You see, I didn't realise I wouldn't be able to have gas and air until much later on. So when I asked for it and it was refused without explanation other than it's too early I panicked big time. I thought that meant I should be coping with the pain, and I really wasn't, and that it would get loads worse, which it really didn't.

I read loads and loads about natural, active labour, but I didn't feel the information out there about medical pain relief was that good really. My perception was an upwards sliding scale of gas and air, meptid/pethidine, epidural. ie you try the gas and air, if that's no good you have meptid, etc. That just isn't how it works. Perhaps I was just being dense.

Sorry to everyone who's seen all this before. It's just I saw my consultant today to talk it through and these issues arose, which I thought were very interesting. She took on board my concerns entirely.

[Kathyis6incheshigh]

I had one for my first birth but while the process of writing it was useful, the actual document wasn't necessary at all. Firstly because they had a checklist to ask me about most of the items on it (eg bf/ff), secondly because most of the conclusions I had come to after lots of reading were actually the default position in the hospital I was at (eg they don't do routine episiotomies, they encourage labour in whatever position you want).

Didn't bother second time round.

But I would encourage anyone else to do one because their hospital/mw may not be the same as mine was.

[Twinklemegan]

Yes I think you're right Kathy. My hospital was pretty non-interventionist in attitude anyway as it turned out (although the stats didn't suggest it - just shows how misleading statistics can be).

I should add though that my consultant did say that the MW let me go for longer in the 2nd stage than she "should" have done. I am very grateful to the MW for that, because I finally gave birth without intervention (apart from an epiosotomy) and I know that was down to my birth plan, so it was a very good thing in that respect.

[Kathyis6incheshigh]

Twinkle - i didn't see there as being an upwards sliding scale. What I reckoned was that pethidine etc had lots of negative effects that epidurals didn't have, so I went straight from g&a to epi.

I read lots about chemical pain relief, didn't go to antenatal classes.

[Kathyis6incheshigh]

That's interesting Twinkle - it sounds like you thought yours was really worth having then.

[Kathyis6incheshigh]

Good point about stats not telling you much. It probably comes down a lot to which actual midwife you get on the day, as well.

[Twinklemegan]

Yes, maybe the sliding scale thing was in my head. ie gas and air - not scary; meptid - a little scary (hospital doesn't offer pethidine); epidural - very scary. So a scale of desperation I guess.

Sadly it turns out if I hadn't asked not to be offered anything except gas and air, I could have had meptid in the early stages when I really needed help.

Isn't hindsight wonderful?

[Twinklemegan]

Yes in part Kathy. But I wish I'd left out the bit about pain relief and gone with the flow. It's that bit that haunts me you see. The hours and hours of agony with only paracetemol on offer

[Twinklemegan]

Anyway, I should shut up and let other people post.

[SlightlyMadStar]

I think that is an important point. The birth plan can be seen as a contract and I have heard that some hospitals will stick rigidly to it, arguing that they are protecting themselves for being sued. For that reason, I felt wording (and not closing doors) was important - and I tell anyone who starts a thread about birth plans the same.

So for pain relief I wrote something along the lines of
"I would prefer to manage pain by staing active during labour and the use of G&E. I do not want to be offered pethidine (I knew I didn't want pethidine), but will consider an epidural if labour seems prolonged or I feel that I am not managing with the G&A."

[Twinklemegan]

Oh god I can't help myself...

Yes, SMS the consultant said as much. She said the MWs may have been afraid of discussing pain relief with me because I had asked not to be offered it. But if only, if only I had known that gas and air would not be available to me until late on in labour, I'd have written my plan very differently.

Incidentally, the hospital was also really busy and the MWs were away from me for up to an hour at a time. They couldn't observe my reaction to my contractions at all really, so they underestimated the pain I was actually in, and I was in no fit state to stand up for myself (literally) That same hospital has now had it's MW quota cut by half incidentally.

[SlightlyMadStar]

How early was too early for G&A?

I was offered it almost as soon as I got to hospital (4cm).

I know you can't have pethidine if they expect you to give birth within 4hrs, and I think you have to be 3cm before you can have a epidural (and I think most hospitals won't give them after 7cm). Having said that - this may be totally inaccurate and may be an example of the poor information thats out there.

[Twinklemegan]

I was somewhere between 2-3cm and 6 cm dilated when I asked for it (ie it was between examinations). The consultant said you should only have g&a for about 2 hours, so normally it's given in the late stages only (at this hospital). She said I could have had meptid if I had asked. I told her, and she agreed, that the offer of paracetemol was completely unhelpful as that made me believe it was only the beginning of the pain (which wasn't at all true) and I absolutely flipped.

[SlightlyMadStar]

I had G&A more or less constantly for approx 4 hours. No-one even suggested taking it off me (although I did stop using it for a bit as I was in a bad position ot use it and concentrate on the contractions).

Even tho it wasn't on my birth plan I was offered and given Paracetamol and codeine when I first arrived at hospital.

Sounds like I was fortunate. for you.

I have to say I have never seen anything that says you can only have G&A for 2hrs and/or in late labour, so if this is true nationally, or even policy at your hospital it is certainly not helpful for people thinking they have there plans all decided based on inaccurate info.

[Twinklemegan]

Thanks SMS. Anyway enough about me. I'm still interested in other people's experiences and I promise to shut up, honest.

[lulumama]

a client gave me the idea of calling it 'birth preferences', as it is more flexible, and gives more room for manouevre

i think that whatever plan you have , or don;t have, educating yourself about birth, what your rights are, opposed to what the hospital will 'allow', is a huge benefit

[SlightlyMadStar]

I suppose I should tell you about my experiences then...

DTDs - didn't have a birth plan. Unexpectedly arrived at 27wks.

DD3
I thought I had enough info (but maye not reading your story).
My labour and birth followed my plan (apart from the bit where I asked the MW to ensure I didn't tear too much .
No unanticipated conseqeunces
Wouldn't do anything differently

I have to say that only about 30% of my birth plan considered pre-birth options. I had more about placenta delivery/cord cutting/placing baby on tummy straight after delivery/initiation of bf.

[tryingtoleave]

I was quite against birth plans with my first birth. I didn't want to think too much about the birth, I didn't know what it was going to be like and I was prepared to go with the flow and put myself in the hands of the mws. I was probably lucky but I had a positive experience.

I do think though that not knowing too much might have helped me. Now I've spent too much time on mumsnet and I've read so many scary things. For instance, why is everyone so against pethidine? I was offered g&a at 2 cm when I already had an urge to push (that was the worst, scariest bit of labour)and needed some help to relax. I asked for pethidine instead because I didn't want anything in my mouth (my issue). The mw was surprised, I think, but agreed and it was very helpful. I dilated very quickly after that and was allowed to push just at the point where I was starting to think I would need an epidural. So, I think pethidine allowed me to avoid an epidural and a cs (I was told if I couldn't stop pushing that's what would happen).

Next time though, I might have a plan just to avoid continuous monitoring, which meant I had to lie in the most painful position or they couldn't hear baby. I didn't realise I had a choice about that.

[1dilemma]

Birth plans are not for me I'm afraid so sorry not much help but I thought I should say that. Sorry it was not how you'd hoped hopefully it will be better next time.

[Mumpbump]

Tryingtoleave - I think people are anti pethidrine because of the fact it is communicated to the baby and can make them drowsy for a couple of days after the birth. I also had the urge to push before time and upon refusing pethidrine was offered an epidural instead - at about 9cm dilated. They didn't do an exam before they administered the epidural though.

I agree with what others have said. It should be carefully worded so that it is flexible, ie. state preferences and be qualified. Mine said that I would prefer not to have a c-section unless there were concerns about my/ds' condition. There was always an out and I delegated responsibility to dh to make any decisions if I was unable to.

I also think they are helpful because they provide discussion points for you and your partner so that your partner can understand where you're coming from and can provide any necessary support during labour...

[MuffinMclay]

I think they are utterly pointless, but that it is down to personal choice. If someone finds it helpful to do one, because they help clarify thoughts or because they have strong views on what should or shouldn't happen during birth, then they should go for it.

I found that I had no idea at all about labour would be like for me or what it would feel like, so I couldn't possibly stipulate what I did or didn't want until it happened. I wanted to avoid a cs if possible, and was happy for as any med students to attend, but that was as far as it went. I wasn't planning to lose my voice during the process, so could just agree (or otherwise) as issues like that came along.

I was induced, and the sister on the ward told me off - talked to me like I was a naughty teenager who hadn't done her homework - and said I should use the time after the gel was applied to come up with my birth plan. I just nodded and decided to ignore her. This time I'd have the confidence to tell her that they're not my thing.

[SlightlyMadStar]

I think the most important thing about a birth plan is that it makes you think about the options.
Thinking about the options makes you realise there are options.
Realising there are options helps you to realise that it is your body, your birth and it is not something that has to be controlled by the medics (if you don't want it to).

Don't just think about a birth plan as being about pain relief options. There is so much more to it than that.
Do you want to find out sex of baby yourself?
Do you want baby to be cleaned and wrapped before handing him/her over?
HOw do you want to deliver the placenta?
Do you want to use any birthing aids?
Do you want to have help breastfeeding straight after birth?
Do you want baby to have Vit K? How?

Only about 30% of my birth plan considered pain relief, and only about 50% of my birth plan considered 'medical procedures'. The rest was about me and bonding/contact with baby after birth.

[MaeWest]

Hi Twinkle - glad your appointment went well yesterday. I wrote quite a simple birthplan. As you know, things went fairly smoothly for me. Right at the beginning I wrote something like "I would prefer to labour with minimum intervention and for medical staff to explain stuff to me if they think they need to do something" (it was a bit more eloquent than that... ) This was more important than any discussion of pain relief for me. All language was couched in 'prefer' rather than must/will etc. Also used the plan to explain who else would be there and their names (mum & DH). Also what I wanted to happen afterwards, max time for me & DH to hold/bond with baby, encouraged to bf etc. Only thing I would change is the bit about bf actually, MWs were a teensy bit grabby with the old tit and baby's mouth... but details, details. Also maybe mention that DH/other birth partner could act as advocate for me if I wasn't in a state to speak for myself.

HTH and that you have a better time next time