C-Sections: Should we all do 2 birth plans, just in case?

[Mazzletov]

I've just posted a thread asking for your views on what factors make an emergency c-section traumatic, and what factors make a planned c-section less so.

I've had another thought which I'd like to assess general opinion on.

Having found out, too late, that there are apparently certain "options" available during a c-section that women can request (but like me, don't necessarily know about in an emergency situation), I wonder if they should get us to do two birth plans: one for the straightforward birth (at home in water, in my case) we're anticipating and one for the appalling surgical delivery which we're not?

I was so confident of avoiding hospital that I didn't even pack a bag, and so would probably have laughed in the face of any midwife asking what my preferences would be in the event of an emergency C-section. (I might have asked, "what could cause that then?" and she might have answered, "nobody realising your baby's upside down til your waters finally break 15 hours into labour," and I might have said, "golly, if that could happen, how's about a 38 week scan just to be on the safe side?" ...) But it might have alerted me to the fact that REALLY AND TRULY, you sometimes don't know what might happen, and at least you can feel a teeny bit in control and "own" the experience if the worst should happen.

I wonder if our local Trust should insist on it since they've got such shockingly high c-sect rates. But would such a practice just be pandering to this awful state of affairs? Would a routine gathering of info on women's c-sect preferences almost justify their continued over-use of the procedure?

I'd rather they hadn't cut me open. But failing that, I'd rather they'd given me the opportunity to express my preference to have their pop music turned off, for example...

My birth plan said absolutey nothing. I had implicit trust in my midwife. I understood that all the community midwives routinely let the cord stop pulsating so I didn't even need to specify that. All it said was that I wanted a very clear explanation of anything that might be untoward. I think that once you're in the ambulance, and they know you'd been a candidate for a home water birth, the birth plan goes in the bin anyway. It might be a good idea to have a back-up. What do you think?

[ShowOfHands]

I had planned a home water birth (posted on your other thread) and had an em cs. I didn't write a birth plan either way as I knew my mw team and the home water birth was rather indicative of my wants/needs. They had already asked all about managed/natural 3rd stages etc and it was in my notes.

I should, I absolutely should have written down or even had in my head what I would do if I ended up in hospital. I had a bag packed but stupidly didn't think about what I would ask for if a cs became necessary. I should have considered it. It would have helped manage the aching chasm between what I envisaged and what happened. You know what, I should have told dh who could have shouted for me when I was too demoralised and upset to speak.

[titmouse]

My birth plan is in 3 parts - the first part is for HB as that is what I am planning, part two is 'plans for what happens if I have to be transferred to hospital' and part 3 is 'what happens if I have to have an unplanned CS' - got everything covered in case of all outcomes and makes me feel like I will have some control over what happens if things don't go as planned.

[cory]

I didn't have a separate plan for emergency caesarian, but found what I would have put on it happened anyway: the operating team spoke to me, everything was explained to me, ds was put straight onto my chest. It was a really good day. Probably helped that my expectations were not high: I had been quite unwell beforehand and ds was IUGR, so my highest hopes were to get him out alive-anything else had to be a bonus.

[fuzzybunny]

I am due in 2 weeks with my first and am hoping for a home birth, however I have written a 3 part plan very similar to titmouse with 1) a perfect home birth, 2) having to be transfered to hospital and 3) induction or c-section.
I'm not happy when I think about the possibility of being induced or having a c-section, but am pleased the medical staff will have my notes to make it work for me if they can.

[clubfoot]

Yes, I had a CS Plan despite booking into a Birth Centre. Same this time.

I found the book Blooming Birth really helped me understand CS options and helped me understand that despite my best efforts it might happen.

[titmouse]

fuzzybunny - good point about induction, I hadn't considered that possibility. It seems that however organised I am there's always something! Thanks for the prompt I'll give it some thought.

[Wheelybug]

First time round, I had to be induced/csec early and I hadn't written a birth plan. Probably a good job as it would have been the complete opposite of what I got.

Second time round, I was hoping for VBAC, but wrote 2 birth plans - a c-sec plan which also covered going to SCBU if necessary (thankfully not this time) and a VBAC birth plan. These were discussed with my midwifery team at about 37 weeks. I ended up with a c-sec and my plan was pretty much adhered to although not read before the c-sec but I told them what I wanted.

[MrsJoeMcIntyre]

I didn't have a birth plan for my elective cs as such, I just tried to think of what would make me more comfortable, and when I met with the surgeon, he took all my views on board.

The atmosphere and environment was much more calm than I could have anticipated, but I am glad I thought (albeit didn't write it down) beforehand.

If I do opt for a cs again, with the benefit of hindsight, there are things I would want to do a little differently, and once again, I would be vocal about them.

[Mummyfor3]

I did not have a birth plan for any of my deliveries, but had the advantage of being a HCP myself and understanding what choices I had and, crucially, that there are a lot of things I would not have control/choice over.

Reading all these answers on this and Mazzletov's other thread it really saddens me that so many woman are so traumatised by their birth experiences. I feel v strongly that being well informed is so important and takes so much anxiety/guilt away. Obviously the question is whose responsibility it is to achieve well informed woman: HCPs or ourselves, and personally I think it should be both.
A bit of me wonders how much trauma is caused by the maybe subconcious idea that because a birth plan has been made, that is how delivery is going to pan out? And deviation from this plan is seen as "failure" or ill-will/ignorance/incompetence by HCP.

Personally it helped me to at some point of my 7 week hospital stay with DS2 to v deliberately put control firmly into my consultant's/midwive's hand and reliquish any idea that this baby was going to arrive how I wanted it to. Admittedly, I had 7 weeks time to prepare myself for the inevitable (Grad 4 Placenta Praevia, he was never going to be delivered vaginally) and I was so relieved that he was not delivered at 25 weeks that anything that followed was fine.

Please, everybody, do not flame me too much, I am truly saddened by other's pain and by how long it is affecting them. but I cannot help wondering whether a detailed birth plan or in a way even worse, several birth plans give the illusion of a degree of control that quite often just does not exist.

[cory]

I think it might work differently for different people, mummyfor3. For some people it may be that the birth plan becomes a kind of test they set themselves so anything that falls below that becomes a disappointment. For others it may be that the mere fact of writing out a birth plan gives them an opportunity of informing themselves and understanding the birth process.

For me too, the thing that helped me most was having spent several weeks on the ante-natal ward in both pregnancies. The hospital no longer seemed a strange and alien environment (even the cleaners took an interest when the time came for me to be induced ) and I had a very clear idea of what different births might be like from talking to other mums.

[PrettyCandles]

I've always written two birthplans - on the same sheet. Top one was my ideal, bottom one was my alternative. OK, I didn't plan for C-section, but I thought about what I wanted to do if I didn't get what I wanted, IYSWIM.

With dc3 I did discuss C-section options with dh, because I was getting a lot of "this baby is going to be too big for you to deliver vaginally" messages, so I thought I'd better be prepared in case of ECS. But I deliberately did not put it on my birhtplan. I think that putting CS into the birthplan would have made it more likely to happen, as the message would have been that I am open to the ulimate in medicalised birth - which I am not. I wanted to do it myself if at all possible.

[Mummyfor3]

Fair point, cory.
My comment is not so much due to my own personal experience but from speaking to woman in my professional capacity (GP) who did genuinely believe that what they put in their birth plan is what would happen; I suppose much like you can expect your house to look like your architect's plans, IYKWIM.
Maybe the message to HCP needs to be: communicate, communicate, communicate, explain, LISTEN, and explain again. There are obvious time/money/resource implications in this.
Or are we all getting too precious about it all?? Just out of interest, who here has ever witnessed a vaginal birth before they gave birth themselves - and I include ANY vag birth, ie dog, rabbits, pigs etc etc all count ?

[titmouse]

I'm not expecting my birth plan to be adhered to word for word, but writing it was an important exercise for me. My birth partner, a very good friend who has had 3 births (this is my first) went through it with me and helped me write it and if she hadn't I would be completely clueless about what was even possible/normal/expected. I also talked to other friends about their experiences. And sure, it may not work out like that, but to answer your very valid point about whose responsbility it is to make the woman well-informed, mummyfor3: my ante-natal care has been pretty hit and miss, no continuity whatsoever and I have felt quite let down. Even if my plan doesn't get looked at I learnt enough through writing it to feel like I've actually done something to help shape my birth experience cos relying on MW and GP has not been possible.

[sachertorte]

I´m with Mummyfor3 on this one and am shocked at the idea of producing TWO birth plans!

I can understand their use as a tool to prepare yourself for birth and to become more informed, but think anything more than a very brief birthplan is pointless. Does a midwife have time to read a seven page plan? I don´t think so! Do you put your trust in the people who are there to care for you? If you don´t then I think you are more likely to be tense and to have a more unpleasant experience. When you´re pregnant you can not envision a thousand different scenarios but have to have faith in medical staff to do what is right. Sometimes you just have to relinquish control.

Ime, the best way through labour is to stay at home as long as possible, hovering around the maternity ward for long periods seems to be asking for trouble when you could be more comfortable and relaxed at home. My labours in hospital were not longer than 4 hours and am sure went relatively well because I didn´t spend too much time there. When is a woman expected in the maternity suite normally?

[Mummyfor3]

Just got back to this (am lone parent tonight: how anybody does this mothering lark on their own every day is beyond me, respect!):
I do not think that anybody sensible can have a problem with a birth plan as a starting point to think about options, get information etc etc I think is a Very Good Thing, so IMO Titmouse's attitude towards it seems to me v sensible and realistic.

Starlight, I really do not think that a well informed woman who knows what she would like and, crucially, what she would NOT like, can be considered a PITA. Does it not come down to, again, communicating why for instance an intervention is recommended? Also, there are plenty of women around, on this site and in RL, who in their heads fully understand that their crash section saved their life/their baby's life, but still cannot help but feel terribly traumatised by their experience. Equally, I know of lots of woman who had "normal" deliveries and cannot recover from the experience. Also, what is different for those, who have horrible birth stories, but do seem to be able to put it behind them and count their blessings, rather than replay in their minds what happened to them?

I am really interested by this, and do not intend to cause any offense to anybody, but I am wondering whether some of it boils down to personalities dealing with similar situations differently. Will a "glass half full" person recover better from a traumatic experience than a "glass half empty" person? I do not know.
And anyway, Starlight, I would NEVER have been patient or organised enough for a long birth plan . Also, hate to admit it, I cannot admit many MWs actually reading it like Sachertorte said.

[Mummyfor3]

Oh, and I think it is terrible if woman have to go through pregnancy/labour/delivery if they do not trust those looking after them.
I count myself v lucky on that count (all care in local NHS hospital). And I hope we are not talking about individual a**holes one unfortunately meets in any walk of life.
Do we all feels so very vulnerable in the throws of childbirth that everything becomes more scarey and threatening?

BTW, have been itching to answer this earlier: pressure on neck during crash induction of GA is allow for quicker and easier intubation by slightly changing the shape of the windpipe. V unpleasant, but there you go...

[Mazzletov]

Hi everybody and thanks so much for joining in.

My original idea about 2 birth plans came from the fact that I went into labour quite well informed (by lots of reading, talking to other people, attending the NHS classes as well as a couple of alternative ones, and of course my midwife)about the many and varied aspects of natural delivery. Because that's what I had been told I could expect to have.

After the CS, I happened across an article in a magazine suggesting "options" you could "request" in the event of a cs (very VERY few of which are done as genuine "emergencies" with no time to spare for a chat). These included: Seeing the baby immediately; Your voice being heard by the baby first; The baby not being cleaned before you held it. I sobbed my heart out because it was EXACTLY THESE THINGS that I felt so sad about not having, and nobody had told me I could have asked.

It's absoutley right that different experiences affect different people with different personalities in different ways. I am proposing some sort of consistency in practice to protect those who might, unexpectedly, turn out to be sensitive souls in ways not hitherto imagined. I have a good friend who also had an emergency cs (there are LOTS of us in Swansea, where VB is the exception, I understand), who says she had no preconceptions about what the birth experience would be like, whereas it was my expectations that led to heartbreak.

But I must say that I'm not generally a "planner". I do tend to take life as it comes. I hadn't even written a birth plan. I did trust my midwife to tell me what was going on and advise me appropriately. And when she said the baby was breech and we had to go to hospital, that's what happened. And I entered a situation I was completely unprepared for. Because with her encouragement, I'd been being positive, and put thought into creating a calm, intimate environment to greet my baby in. I could have taken a similar approach to dealing with the (albeit disappointing) eventuality of a cs, had anyone told me that there were things I could "opt for" in what I had thought was a totally choiceless situation.

The birth planning process is partly a prompt for a midwife to go through some of the options and make the woman aware of pros and cons. Nobody spent the merest moment educating me about cs situations... because I wasn't having one. That was what my midwife told me, and I didn't have any reason to disbelieve her. I thought she knew which way up the baby was. More fool me!

[Mummyfor3]

For what it is worth, Mazzletov, I think you are doing a very important thing, obviously for yourself, but also getting some of us thinking about these things.
I am glad you are back. Hope your meeting will be a productive one.
"..in ways not hitherto imagined": is this not the problem, that some problems you cannot plan for because you do not consider them before they actually happen?
After my 1st MC apart from grief, I felt so shocked and astonished that this should happen to ME, and I really struggled with the unjustness of it, until it occured to me: why NOT me?? What makes me so special? (apart from that I am quite fabulous )
Anyway, I am going to bed now. It has been v enlightening and thought provoking, so thanks for that .

[MrsTittleMouse]

I am a planner.

First time around, I was told by my midwife not to write down my birthplan as it would give me "unrealistic expectation". When things went wrong, I was treated like a small child, as it was assumed that my requests were the result of extreme pain and exhaustion and not rational thought. I was given treatment that was completely contrary to my wishes and, it turns out, that was completely wrong for my medical circumstances (a senior midwife shown the notes after the effect told me that I was a very poor candidate for an instrumental delivery). I have no idea whether writing it down to show the HCPs would have helped (as the OB was a complete misogynist arse), but it certainly couldn't have hurt.

Second time around I had the same birth plan. I discussed it with the senior midwife, who wrote it in my notes and signed it. Luckily I didn't need it that time around, but at least I knew that it had been "sanctioned" by the hospital.

I had birth trauma after the first delivery, and it was in no way down to wanting a magical fairy delivery with no pain and wonderful instant bonding. It was down to being treated like a piece of meat by the most senior HCPs and being physically damaged by what they did. I have never been raped, but I imagine that I had some similar feelings as rape victims - my vagina had been sliced open against my express wishes, then they lied to me about it ("just a small graze"), and then I was sewn so badly that sex was impossible. Try feeling "glass half full" about that delivery!

[MrsTittleMouse]

PS Like starlight I had imagined pretty much every senario. That's the only way that I could go into a second vaginal delivery with my sanity intact (sadly not an exageration - I needed counselling throughout the (planned) pregnancy to help me cope with the fact that I was carrying a baby and would need to get it out at some point!).

PPS There is a happy ending to all this, as I now have two lovely DDs, I (eventually) found a sympathetic gynae who has helped repair the worst of the damage, and I am now officially bored of my first birth story and don't want to repeat it to DH every night.

[titmouse]

mazzeltov I think it is a shame you were 'told' to 'expect' a natural home birth because I don't see how anybody can predict any outcome in labour, it seems to me like you had a false expectation built up, and it is understandable that you now feel let down by it.

I guess I am somewhat protected against this, not by having a multi-part birth plan, but by never imagining that it will be stuck to and having no real expectations, only hopes. Maybe this is down to personality, I tihnk in my case it is down to being helped through this by somebody who ended up not having the birth she planned who wants to ensure I am not caught unaware like she was. In this sense I am very lucky, I know.

I do believe the woman has a responsiblity to think outside of medical advice and to at least consider every eventuality, not to be demanding or paranoid but to empower themselves. I wouldn't be able to just accept that my birth will be exactly as I have planned for because this forum is full of people who started home birthing with all the right intentions, but it didn't always work out as hoped.

It feels when reading your posts like you trusted your MW and now feel let down by her, which is a real shame. How long ago was this?