Birthing Plan?

[Renaissance227]

I know this is probably a silly question but what is a birthing plan and how do you write one? I haven't got a clue and everyone else seems very clued up!
When should I write it?

[rooks14]

I didn't write one until I went for my 40wk app with the midwife when she went thorugh some stuff wiht me. She said basically everyone writes this massive thing like NO FORCEPS, AVOID C-SECTION etc etc. But they don't do that sort of stuff for fun! She said things like that get done if they need to and you'll be talked through it before hand if the time comes. So there's no point writing that.

She just went through some things like do mind students being there? There spoke a bit about whether you want the baby to have vitamin k after birth and the risks/advantages, and whether you want to deliver the placenta naturally or have the injection to encourage it and stop more pushing. That was it really! Just sort of make decisions in your head rather than storming in with a list of do's and don'ts! They know what they're doing and won't force you into anything without being able to make an informed choice! :)

[Renaissance227]

So you don't have to have it written down on a piece of paper to give to someone?!

[rooks14]

I haven't! As long as whoever's going with you DP/Mum etc knows what you want they can make sure you get it! If there's any big things like you have a name that's difficult to pronounce and you want to make sure that it doesn't annoy you in labour put a sticky note of it spelt out phoentically (?) on the front of your notes! :)

Then again I think some people do have a full written list of instructions but so far the midwives barely glance at my notes anyway so I doubt they'll spend time reading over your list!

[AchtungBaby]

I wrote a birth plan, and gave a copy to the midwife when we arrived in the labour ward. DH also had a copy.

I outlined my preferences under these headings:
Birth partner
Pain relief
Monitoring baby
1st stage of labour
2nd stage of labour
3rd stage of labour
Interventions
After the birth

I'd definitely do the same again.

[Tangle]

I tend to think that a birth plan isn't nearly so much use as the process of writing a birth plan. To me, the process of writing a birth plan gives you a chance to think through various scenarios and various procedures that are often considered standard and decide how you feel about them while you've got a clear head. It also gives you a framework around which to talk to your birth partner so that they understand what you're hoping to achieve and why some aspects of your plan are very important to you (or not - we're all different). For me that means including things like VEs (I won't accept them just because the clock says I ought to have one) and the 3rd stage (I'll plan a physiological 3rd stage unless there are signs of PPH - I had one with DD1 and there was very little pushing involved, it just took a bit longer).

Technically, yes - they cannot perform any intervention without your informed consent. However, my personal experience is that labour is quite intense and distracting - I can and have had a discussion with HCP's whilst in labour, but it took a lot more mental effort to assimilate information and make decisions than it would at other times, and I'm really not sure it helped the labour continue smoothly. I was very glad that I had spent quite a bit of time considering different possible scenario's and consequences so that when the time came I didn't have to start from scratch. I also think its a time when its very easy to put emotional pressure on women at a time when they are least able to withstand it, so that women tend to make the decisions that the HCP's are recommending - at what point does that become coercion rather than informed consent?

Writing a birth plan and expecting that to become the way your birth will progress is creating a situation where you are very open to feelings of disappointment and/or failure if the birth doesn't pan out that way. Writing a birth plan so that you've considered a whole host of "what ifs" is a very useful exercise :)

[AchtungBaby]

Well said, Tangle .

[Renaissance227]

Thank you Tangle.
Don't the HCPs know best in a certain situation though? and wouldn't they only suggest something needed doing/using if the situation really called for it? OR am I being naiive and HCPs want to use/do stuff for their ease and not your's and your baby's?

[Renaissance227]

Not sure if I've worded that correctly but I'm sure you get where I'm coming from.
I just tend to think the experts kknow best in that situation and as long as you know what things are/mean then you can't prejudge whether you'd want it.

[Tangle]

It depends how cynical you are :o

IMO, a lot of hospital policy has been necessitated by the staffing levels currently in place. In an ideal world (IMO), MWs would be able to provide one to one care to each woman in labour - they'd be able to observe how the woman's behaviour changed and monitor progress without needing to do routine VE's. But we're not in an ideal world and few hospitals are able to provide that level of support - at which point the argument for routine becomes stronger as it provides some indication that progress is being made for minimum staffing levels.

When it comes to more serious intervention, there usually is an indication of a problem - but every situation will be unique, and every HCP will make recommendations based partly on their training, partly on the policy of the hospital they are working in and partly on the back of their personal experience (or lack of) in similar cases. I've heard of a lady who was scanned in early labour as part of a trial and was found to be carrying a breech baby - she was told "we have to do a CS or your baby will die." That's blatantly false - the risks of a vaginal breech birth may be higher than those for a cephalic baby, but that's very different to saying they have no chance of surviving the experience! If you were that woman, though, would you question such a bald statement or would you be asking for the consent form and asking how quickly they can get you to theatre?

I don't think that most HCP's are "out to get" the women under their care - whenever I hear what hospital MWs achieve in the face of staffing constraints I'm in awe of them - but I do think that some HCP's can have a tendency to slip into "me Dr : me God" mode and present information in a way that does not invite or allow discussion. They may very well be recommending the course of action that has the lowest risk of mortality, but there may also be an alternative course of action that has a different set of risks that this individual woman might prefer (even though this individual consultant does not!). I tend to take the view that as I'm the one who'll be living with the consequences I'd quite like a say in what risks I'm exposed to - but that's me

One of the most useful things that I got out of NCT classes was the advice to "Remember to use your TBRAINS:"

Do we have Time to Talk about this?
What are the Benefits?
What are the Risks?
What are the Alternatives?
What does my Intuition or Instinct say?
What will happen if we do Nothing for 1/2 hour?
Smile!

For some women, accepting their HCP's advice is the right thing to do. For other women, questioning their HCP's advice is the right thing to do. I think its very useful to know that you can question their advice - whether or not you choose to do so at any given point is entirely up to you :)

[Tangle]

I completely agree you shouldn't prejudge whether you'd accept any particular intervention until you're there - but I do think its possible to decide that there are certain circumstances where a given intervention is often recommended, but in that particular situation you'd rather do something different. That's why, for me, I like to have run through a whole mass of ifs and buts and maybes so that I have a back up plan - if things go horribly pear shaped and you wind up with an emergency CS, would you still like skin to skin if its safe to do so? If its not because of your condition, would you like skin to skin with DH? Assuming baby is healthy, would you be happy for it to cleaned and weighed immediately or would you rather that waited? If the baby needs to go straight to SCBU, would your DH go with it or stay with you? Its a situation I hope never to be in - but, for me, having thought through some of those options and made some plans before hand would make it less stressful if it did come to pass. For me...

[fraktious]

I'm with tangle here. Yes they mostly do but opinion is divided on some things. I had a birth plan so I could avoid 'questions' like 'we'll just give you the injection to help deliver the placenta now, ok?'.

It's definitely the process which is important. If you cover the bases then should you need intervention it's not all out of control because you've given it some thought and premade decisions (all being well). Bear in mind, it's a

Plus it avoids unnecessary thought in labour. You or your birth partner can just say 'read the birth plan'.

I, however, appreciate I was lucky and my plan was respected.

[fraktious]

Random unfinished phrase

It's a plan. Plans change.

[Bunbaker]

"Don't the HCPs know best in a certain situation though? and wouldn't they only suggest something needed doing/using if the situation really called for it?"

I tend to take that view and didn't write a birth plan. I think that 11 years ago they weren't a big thing. I just knew that I would start with TENS and go down the pain relief ladder if necessary. I didn't have any strong views or feelings about my labour or any other procedures and went in with an open mind. Luckily I had an easy labour and everything went like clockwork.

My advice is that if you do write a birth plan bear in mind it is only a guideline and many birthplans just don't get followed at all - expect the unexpected and keep an open mind. Too many women expect to stick to their plan rigidly and then get very stressed as a result of something unexpected happening.

[nunnie]

I am on my 3rd and never had a plan for previous two. This one hopefully will be a VBAC and I am doing a plan but mainly due to the rigid nature of my hospital policy and timescales and me personally not wanting intervention until there is an obvious need and not because a policy dictates it.
If there is a problem then the intervention used I have a preference to but will under no circumstances demand it will only make it clear on my notes that I strongly wish it to be like this. If the Doctor making the choice advises against my preference then they know best.
Also included who will be present and if I prefer to/not have student present, injection etc.

Whether it gets read or even noticed I don't know but writing it made a difference to me coming to terms with issues surrounding my sons birth and that can only be a good thing in the process of mentally preparign myself for this birth.

[YBR]

I am writing a birth plan partly so that as I read/find out about various options my thoughts are all in one place, and I'll probably put something (edited version) in my notes.
The big thing for me is having things properly explained (to my DH if I'm not in a fit state) so it's our decision, so it'll emphasise that.
It might also have some other info in it like dietary stuff (I don't eat ....). I read somewhere it can be useful to add that to the birth plan.

At the moment it's brief statements under headings:
Environment (e.g. active/water birth, monitoring, students present)
Pain relief (preferences for each of TENS, drugs, epidural, etc)
Procedures/interventions
Post birth
Other

I also see it as a chance to communicate which things I generally think positively about and which I hate the idea of (e.g. epidural, because of aftermath of a lumbar puncture previously).

[kickassmunkiii]

Hi

Haven't read the thread (sorry) but thought I would link to this

birth plan

I printed this out and took it with me when I had my DD.

Good luck OP!

[Bunbaker]

I would also add to keep it brief and to the point. If you turn up with several sheets of closely typed A4 paper the chances are that it won't even get looked at.

[AchtungBaby]

That's a good point, Bunbaker. I think that 1 side of A4 is the right length.

[NewMummy5July2011]

I wrote a birth plan and all my preferences about interventions etc went out the window when I was actually in labour. I ended up with a very medicalised birth from start to finish and was exactly the opposite of what I wrote in my plan.

I agree with the other posters that the process however of writing the plan was really good, and I found that the doctors and midwives did everything they could in each of the various scenarios (i.e. I ended up with an emcs and in my birth plan I asked that everyone is very quiet so that the first voices the baby would hear would be ours). Even though it was an emergency situation they were very good at respecting this.

I think it's really useful writing the plan so you can go through the various scenarios in your head and try to prepare yourself. However I would say continue to stay open minded because when you are in the situation things can be very different to what you had in mind - things you think you might not want may change when you are in the situation. So I would say use it as a preparation exercise more than anything - and make sure your birthing partner knows how you feel about everything too. I found my husband had to relay things to me during the labour and in some cases take over decisions for me when I was no longer able to listen / understand.