Writing a birth plan

[Izzy82]

This is probably a stupid question but I'm 38 weeks pregnant and have no idea how to go about writing a birth plan.
the midwife has never mentioned writing one and my next appointment with her isn't for another fortnight so there is a chance I'll have given birth before then.
So a) where do I write it
B) what do I put on it
C) what do I do with it once it's written
D) does anyone have one I could look at

Thank you
Xxx

[ohthegoats]

I wasn't going to bother, since they seem to go out the window, but the woman who runs my aquanatal class said to go for it. As far as I've been told, you write it and attach it to the front of your notes. Make sure your birth partner/s know what's in it.

I've just started putting mine together, but will discuss it with my doula nearer the time. Currently it looks like this - bullet pointed (which won't show up on here) - I have no idea if this is any good by the way, and I'm taking away bits/adding bits as I go!

Birth Partner
My partner, K
Our doula, E

Positions for labour and birth
To stay mobile
Use of birthing pool if available for both labour and birth
Minimal monitoring, not continuous
Position for birth ideally to be squatting/standing or on all fours

Pain Relief
Will discuss any pain relief options but scared of not being able to move legs
In order: G&A, pethidin, epidural

Issues
Prefer no syntocin
No consent for Keillands forceps – ideally no forceps at all (ventouse preference, if not then CS)
No cutting or stitching without local

Afterwards
K to tell me gender
Cord to be allowed to finish pulsating
K to be asked if he wants to cut the cord
Skin to skin immediately (either with me or K)
Managed placenta delivery/third stage is fine
Vitamin K is fine
Want to breast feed, no formula ideally

Other
If there is a medical reason for me to be separated from the baby, K to stay with him/her rather than with me

[ohthegoats]

I didn't call it my birth plan either, I just put 'Birth Preferences' at the top - I imagine a lot of it will go out of the window, and we'll just go along with what is recommended. Who knows. I have no idea how I'll act in the moment.

[SouthDerbyshireMamma]

I didn't bother. My only request was to try for a water birth if possible. When I got to MLU it was full so I had to go to consultant lead and birth on a bed. Everything else I was prepared to go with the flow

[PenguinsHatchedAnEgg]

Just to say Goats that many areas won't plan for a managed third stage if you have waited for the cord to stop pulsating . Might want to check and think about which bit is more important to you.

I think birth preferences can be brilliant where they act as a map through various scenarios. And a bit pointless if they are just a wish list. Try to think through lots of 'what if' for things like instrumental delivery, section, etc.

[Marnierose]

Mine is very short. Main things to include

Preferences for labour and pain relief - I haven't bothered. It's all out of my control until the time

Third stage (placenta) - natural or with help of injection.

Vitamin k - oral or injection or not at

Feeding baby - I have specified no formula without my permission

Skin to skin or whether baby should be cleaned first

Students yes or no

Who will tell you the sex and cut cord.

[RedPony]

I didn't bother writing one and im so glad I didn't as my birth was completely different to what I was expecting! The only thing I did was to inform DP that under no circumstances was he to let anyone near me with any forceps and if I needed intervention then they could do a cs. Fortunately I didn't need any intervention as Ds shot out so quickly but it was far from the relaxed calm water birth I was planning.

[Cobo]

I've just dug out mine, pasted below. Can't remember for the life of me where I got some of the items from - probably they were mentioned in an NCT class. I printed it out and put it in my notes, and told the midwives it was there when I got to hospital. Most of it went out of the window - emergency C section and an epidural in the end!

BIRTH PLAN

• I would like to try a water birth if possible

• I would prefer not to have an epidural

• I am happy to have gas and air as pain relief

• I would prefer not to take Meptid

• I would appreciate help and advice on using breathing and positioning to cope with contractions.

• I would like the option to move around during labour, as I suspect this will be my preferred way of dealing with pain.

• I am nervous about the use of forceps.

• I would like to hold the baby, skin to skin, straight away, or as soon as possible, before the baby is cleaned or weighed

• I have taken an NCT antenatal course

• I’m happy for the midwife to tell me the sex of the baby

• I’m happy for the baby to have a vitamin K injection

• I’m happy to be given Syntometrine, but I would like to delay cutting the umbilical cord for 3-4 minutes after the birth

[marrappa]

ive done mine...... if u go on the nhs pregnancy website they have a bit for writing a birth plan it asks u loads o questions and you just answer them then ive just printed it of

was very easy to do and everything in it.....

prob wont go to plan but hey ho

[ohthegoats]

Penguins - ha, that's funny - it's the only part of the 'thing' that's been dictated to me in advance. I've got a blood condition that might give me a higher chance of PPH, so sort of 'have' to have the managed third stage. But I've also been told I'm 'allowed' to do the thing with the cord.

Who knows... like I say, it's all a bit wishful thinking isn't it really...

[Pregnantberry]

The midwife said she found the way I structured my birth plan very helpful. I did it by stage, so that it was easy for the professional reading it to follow. So:

In the first stage and throughout labour:
-Who is your birth partner?
-Do you want students allowed in?
-General things, like "for the midwives to take a minimal approach to intervention" etc.

In the second stage:
-Thoughts on atmosphere like lighting and music
-Thoughts on positions (mine was just that I wanted to feel free to choose whatever felt most comfortable at the time)
-Thoughts on pain relief
-Thoughts on monitoring (look up electronic, pinard, and doppler/sonicaid and decide what you would feel comfortable with)
-I also wrote "if labour takes longer than the usual protocol, to not feel pressurised to "get on with it" if both the baby and myself are doing fine". I wrote this because I had heard horror stories about this happening so it was on my mind. I think if you have any fears like this, about anything, make sure you include them even if they sound silly, so that you have peace of mind that the doctors/midwives are aware of your wishes.
-How do you feel about being given stimulants to speed up labour (look up syntocinon)?
-How do you feel about having your membranes ruptured to hurry things up? Put it in there because I have heard women say that their waters were broken without their consent.
-How do you feel about being hooked up to an IV drip?
-how do you feel about an instrumental delivery? Forceps/Ventouse.

The third stage (my midwife friend said lots of people didn't bother writing about this, but that it was important):
Skin to skin? I was fussy about having my baby plonked on me immediately unless there was a problem.
Breastfeeding?
Do you want to deliver the placenta naturally or be given injections to speed it up? Research this.
Look up delayed cord clamping - do you want it?
Do you/your partner want to cut the cord?
Do you want injected or oral vitamin k (or vitamin k at all)?
How do you feel about salespeople (such as bounty reps) approaching you on the ward? I banned them.

Then I had a section for 'In the event that complications arise'
C-section - Last resort, or to be done at the first sign that something might be wrong? Do you want your partner present still?
If your baby goes into the special care unit,I put that if it was medically feasible I would want to hold or touch him first, and for him to receive my pumped milk when possible.

[PenguinsHatchedAnEgg]

Ah, ok. Overriding medical reasons for the jab. They don't like planning to give the jab late because it increases the risk of retained placenta. But they will if there is a medical reason - in my case simply that it would not budge on its own.

[yakiudon]

The length and complexity of a birth plan is directly proportional to the length and complexity of a delivery. Mine was 2 lines:

Live Baby
Live Mother

COI - previous obstetric trainee.

[squizita]

Yaki genuine question... Is your assertion that a birth preference plan will lead to a long/complex birth something you have observed happening, or a figure of speech in frustration at people's hubris if they think they can "birth to order"?
Apart from maybe someone very anxious being stressed, I can't see how it would change physical/clinical things.
My notes already have bullet points on the front, put there by HCP. I hope they won't annoy anyone.

Also if I had to put keeping me/my baby alive as something that needed to be on a plan... I might not choose that hospital!

[ohthegoats]

Yep, live baby, live mother are two things I'd prefer to not have to actually write down as a preference!

Medical types seem to spend quite a lot of time telling pregnant women what they are 'allowed' and 'not allowed' to do. I think a birth plan reminds them of the adult brains that exist behind the piece of meat.

I'm not scared of giving birth, but I am scared of hospitals, metalic medical instruments and bossy health care professionals. Writing things down gives me a feeling (however hopeless), of control.

[PenguinsHatchedAnEgg]

yakiudon - superior "I know best" attitude from medical professionals is precisely why my birth plan got longer with each delivery (oh, and the labour got a hell of a lot shorter and more straightforward too).

I can understand your point if you are trying (rather indirectly) to say that a birth plan focused on essential oils, whale music and how you will breathe the baby out is no use to anyone. Life so very often doesn't work out that way.

But there are valid choices to make, and preferences to express. For example, I am awful at communicating during labour. If I don't tell you in my birth plan that I am one of the very small percentage of women who find internals terribly painful and will only agree with gas and air, how do you know? If I don't tell you that I will freak the fuck out if you don't give a running commentary during any procedure like epidural, how do you know?

Oh, and it never occurred to me that I'd need to mention that I'd like both of us alive at the end, I took that as a given as objectives go. So I assume that was a poor joke.

[yakiudon]

Live baby, live mother might seem like a flippant statement for a birth plan, but from my experience, there are sometimes some rather terrifying prescriptive and restrictive requests.

squizita I am only commenting on what I noticed anecdotally but I would say yes to both your points. For whatever reason, women with more unrealistic expectations and rigid, lengthy, prescriptive plans tended to have a higher likelihood of instrumental delivery. But again, to reiterate, that's just what my colleagues and I observed. I doubt there's been any study on it!

[PenguinsHatchedAnEgg]

I can imagine that those with rigid expectations of birth would struggle. Because once they have moved off that rigid path they have no coping mechanisms.

Also, those with long plans and rigid expectations tend to be aiming for the no drugs/calm/tranquil birth. It doesn't take many words to say "I'd really like an early epidural please".

My plan was long, but it wasn't rigid and it wasn't unrealistic. It was long because, for example, it had sections on homebirth, hospital, instrumental and C-section. Things that mattered to me and were perfectly possible to arrange - like if I need a section please bear in mind that I will utterly freak out if you don't explain what is happening as you go along.

[yakiudon]

Penguins yes, yes your first sentence is exactly my experience! Put much more eloquently than I could.

[PenguinsHatchedAnEgg]

Fair enough. I do think that all those people who say that a birth plan is a 'wish list' have kind of missed what I see as the point.

I see the point as being that, even if it all goes a bit/ utterly tits up, there are things I can request. Like I can say that, in a section, I'd still like DH to tell me the sex of the baby. Or that, if baby and I are very unwell, they should remind DH that I want him to go with the baby. Or if things are going well, things like knowing I find internals very painful can help minimise them.

There were also things I learned from previous births - like that I need to have a commentary on procedures.

But all of it was about helping me cope best whatever happened. Not about planning for a dream birth.

[PenguinsHatchedAnEgg]

So to go back to the OP, I think the most useful stuff is around what happens if it isn't going quite to plan. Because it's great to say that you'd prefer to start with gas and air, but to be frank that's what they are likely to offer you first anyway. And it's great to say that you'd like to avoid syntocin, but unless you mean you'd prefer a section to syntocin, it isn't really adding much to what will happen automatically. And stuff like playlists and essential oils should definitely stay between you and your birth partners.

What is helpful for the medical professionals is stuff you know that makes you different from most women (e.g. I've had diamorphine in the past and it made me vomit and vomit and feel awful. Please don't offer it to me). And things where there is an active choice - e.g. vitamin K, presence or otherwise of students.

[Izzy82]

Thank you everyone that has posted a reply. You've all been very helpful
Xxx

[MultipleMama]

I'm having a homebirth but if that changed I've wrote a quick one with the main priorities.

Birth Partners:
Husband, D
Brother-in-Law, P
Doula/Brother, I

No students or staff wondering in and out without knocking or permission. Privacy at all times.

Birth:
My permission is needed for all procedures including examinations, forceps and episiotomy.
Water birth if possible i.e bathtub or waterpool.
No pain relief to be given without permission and double checking.
Prefer to stay active throughout and choice own position for pushing - no continuous monitoring unless necessary.
Do not induce me without permission and valid cause.
Third stage to be delivered naturally.
Express during labour in case of unexpected circumstances.

After Delivery:
Wait until cord has stopped pulsating.
DH is to cut the cord.
Placenta and cord to be saved for collection.
Skin to skin to be established before cleaning.
Establish breastfeeding within first hour.
No formula without parental permission.
Do not circumcise.
If I am unable, D is to remain with baby at all times, have first hold, feed expressed milk etc.
Remain in the same room as baby at all times.

If EMCS:
To hold or be shown baby right after birth.
D is to remain with baby at all times.
Begin expressing right after birth if unable to breastfeed.
Not to be seperated from baby unless necessary.

Simple and basic, nothing outlandish or 'hard' to achieve. I know not everything may go as planned but at least my birth plan is there as a guideline. Basically my permission (or DH if I am unable) is to be given on everything and when in doubt as me again. .

[PenguinsHatchedAnEgg]

Are you outside the UK Multiple? I can't imagine it being an issue in the UK to express not circumcising?

[MultipleMama]

I live in Germany and many are against it here, I think it was even illegal at some point, but DH wanted it included to cover all bases so I just wrote it down for his sake.

[WhyOWhyWouldYou]

I think penguins got the right attitude - a birth plan should be more about your choices if something goes wrong.

In my first pregnancy i was being encouraged by others to write a "wish list" style birth plan. It would only have increased my stress and anxiety when things went tits up. I had to have continual fetal monitoring (he was showing signs of distress before establised labour), i had to lay on my back far far more than i would have hoped but it was noones fault, it was just bad luck.

Also worth pointing out is hospitals are extremely reluctant to give out epidurals unless you have said your willing to consider one prior to labour (in fact the hospital im using for this pregnancy even has a special section in youe notes that must be signed prior to labour, or they will not give an epidural for pain relief purposes at all). So if youve never laboured before i would write something along the lines of "if the pain is bad enough, i am willing to consider an epidural".