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Writing a birth plan(112 Posts)
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
Looking back my birthplan was a bit, well silly. "I would prefer not to have an episiotomy", "I would rather avoid being induced", "I want to be free to move". These are all things that all women want. My next one will be shorter and much more specific;
- If I have to be induced on a synto drip I want an epidural beforehand.
- I want a cs before forceps.
- I don't want to go more than an hour without seeing a mw.
-In the late stages it might look like I've gone "into myself" and want quiet.I don't I'm terrified and need you to talk to me.
It's also worth thinking about what you're really like. I sort of got sold the MLU and very limited mw involvement but in reality I wanted to be told how things were going and hated going a long time without seeing my mw.
Squizita- I know the women you're referring to. I spoke to a lady who had had a "textbook NCT" delivery- waterbirth, no drugs, no interventions, no tearing- and said that she'd had that birth because she'd had her heart set on it and was very strong willed . My waters broke and were bloody so I had to labour in hospital. After 24 hours I'd got to contraction every 5-6 minutes but only 4 cm so had to go on a drip to be induced. I've been told that if I'd been "more active, relaxed and positive" during the early phase the drip wouldn't have been necessary. Again-rubbish!!
It was terrifying especially as DC1 had breathing trouble and kept needing to be touched/stimulated to take a breath while we waited for ambulance however it was one of the most intense, liberating bonding moments DH and I had ever shared. That's why we had a homebirth with DC2
I never wrote any birth plans for any of my three babies. I couldn't see the point of planning out something I knew I could neither predict or control. I am the sort of person who can get rather stressed when any plans I make do not work out, so it was just better to go with the flow.
I am very much with those posters who said simply "live baby" and "live mother", and I am not even a health professional. If I had been pushed to give a birth plan then that is what mine would have been, pretty much word for word.
All of my births were totally different. My first one (long, and a difficult ventouse delivery), was certainly not a means to predict how the birth of my second 3 years later (much faster, near textbook labour/delivery, though some high blood pressure in the run-up). My third delivery was nothing like either of them - waters broke 5 weeks early, baby became distressed and could not tolerate any attempt at artificially inducing labour, so I needed an emergency c-section.
* I ended up giving birth to a breech baby in the bath with DH going on the very limited information he researched on homebirth and breech baby.*
well that's a hell of a birth! And I imagine must have been utterly terrifying. I want to just feel relaxed and put myself in the hands of people who'll tell me what to do, but I know that I also need to think for myself and make my own choices... It's difficult! Fingers crossed it will all go well and straightforward and I get what I need when I need it. It's all any of us can hope for.
Redling - I understand where you're coming from. During my first time I looked up everything, prepared as much as I could and had this wild birth plan on things that I had no actual experience with. I know I didn't want pai relief but that was due to my choosen lifestyle but despite all my research I was still clueless about everything, so how could DH know what I wanted if I didn't. In the end I had an unassisted birth (BBA). I was terrified not of the birth or the contractions etc but because I had no medical proffession who could tell me what was normal and what wasn't and look out for warning signs. I ended up giving birth to a breech baby in the bath with DH going on the very limited information he researched on homebirth and breech baby. So in that respect, I completely understand the point you're trying to make.
Tried to see if I could find mine for you OP, but must have deleted it - it went on the front of my notes and was looked at on admission to the MLU. Everything went a bit wrong and ended up with EMCS...however the birthplan was helpful (a) for me in the run up to consider what might happen and how I might deal with it and (b) because it reinforced some of the things that were very important to me. From memory the main points were:
- No pethidine (I was still offered it but in the sense "it says you don't want it are you sure as you might get some sleep" - didn't accept)
- DH to tell me the sex of the baby (this was kept to and in the EMCS baby was held up for us to see for ourselves)
- Want to use birth pool (got it)
- Help me stay active and upright, minimal exams/touching etc (MLU great at this - then transferred to delivery suite and had epidural)
I guess the thing I would want next time is better explanation of what is happening - e.g. I recall my mum (who was birth partner) being extremely cross that they'd shown me some card with the risks of epidural and asked me to consent mid-contraction...could this not have waited a minute?!
Mine was literally as follows:
If I call for drugs and an epidural I mean get them fast.
Vitamin K injection for the baby.
If a c-section was necessary do it fast.
Blood transfusion if required.
Someone told me if you want something be insistent and make a big racket so they can't ignore you. Good advice imho.
Ah, I understand what you meant. I think the BRAINS acronym is quite good for that:
Nothing (i.e what happens if you wait?)
I do believe in natural births to a point but I wouldn't ever go as far as saying that one is better than the other, or that women should feel less for themselves for not doing it. A mother has no right to judge another on what is best, only the labouring mother knows what's best in her situation. I think people go overboard and start preaching. I think labour can be various spouts of pain but even I don't believe it can be pain-free (not without drugs at least ).
penguins I know there are things that we can influence and that DH can be of help to communicate for me. My point was more that as first time parents how are we supposed to know when we are being assertive and when we are needlessly delaying the inevitable and causing more problems? I agree with what you say about the pressure of feeling that I should have 'learned' to give birth by now, that we should always know when something is necessary and when there are other options, but that is a big ask on my DH in what will be a fraught situation even if things went routinely. I don't know how I'll cope with the pain, and I don't know how I'll know or how I'll if something suggested to me isn't necessary as I imagine I'll just want the baby out as soon as possible and will try anything. I just feel pressured sometimes by the 'you know your own body better than a doctor' idea of childbirth.
Multiple a slang term used for women who have and strongly advocate a very natural birth. Used nicely, its kudos to them. They're tough women who have done amazingly.
However with a different tone its those women who smugly tell others their births weren't as "good" and what they should/shouldn't do with their bodies. Before the usual MN hands-in-the-air 'these women don't exist' ... Try being lower middle class in posh west London... Plenty such stories/comments for the NHS chav with her medical pregnancy if you wander into the wrong clique of mummies at the wrong time.
But half the time I wonder are they even telling the truth.
Squizita- I totally agree with you about a balanced view. I had DC2 and 3 at home. And after a rubbish first birth read Ina May as a way of balancing my feelings about that and putting them in perspective. Not because I believed that all births go smoothly.
Actually what was rubbish about my first birth wasn't forceps (ok, those aren't ideal, but the registrar was kind and compassionate and it was fine). What was hard is that I had a very long and very intense latent stage, and was treated like a silly girl who wasn't coping with minor discomfort (I can confirm from my later, unmedicated birth that the pain I was feeling at that point was as bad as it got. I literally wanted to march back to hospital and tell the patronising "some of us have low pain thresholds" mw that she had been talking bollocks). I had been sold the idea that I could just distract myself through that latent bit. And that, by the time the pain got really bad, I would have pain relief options. To basically be told first "stay at home and stop whining" and then "stay in that room, lie on your back for some monitoring and stop whining" was really tough and I was pretty traumatised afterwards.
So I can imagine how, if you have believed that the whole of birth is going to be find if only you do the prep, it could seriously damage your mental health.
Redling - I think maybe you've misunderstood what people mean when they talk about people advocating for them if you think it means disagreeing with medical advice about your/your baby's safety.
For example: in my first labour I was told that I should have a routine period of continuous monitoring for about half an hour on admission (though was left for closer to an hour. Belts went on, mw wandered off). Told to lie down and have belt strapped up. I was in agony on my back. This happened a few times. E.g. when they broke my waters, half an hour on my back to check that my baby was happy. It was only afterwards that I discovered that it would have been perfectly possible to do the monitoring in the kneeling up position that I found far more comfortable. Just a bit more bother for the midwife, and I might have needed to lie down if that position didn't get a decent reading. Or in some of the situations, she could have used the handheld Doppler - she basically just didn't want to crouch down and was keen to have a print out for her file.
I was too exhausted and in too much pain to argue, but I really could have done with an advocate who, after the first time, said "Penguins is finding it really difficult to be in this position. Is there any way we can do it differently". By my second and third births, DH was well briefed to look out for things I was finding particularly hard going and find out if there were ways to make them better.
Or another example, lots of units will have expectations about how fast you 'should' progress. However, if everyone is ok and wants to wait, you don't need to necessarily go down the route of augmenting the labour. If you are too 'in the zone' or in too much pain to hold a discussion on that, having your DH 'advocate' for you on that can be useful - whether you eventually decide to hold off or whether there are strong reasons for augmenting.
In my third labour, I had an amazing, amazing midwife .I can't praise her enough. I certainly didn't need an advocate. But, like any profession, there are better and worse mw's (and more and less observant and/or compassionate ones).
What exactly is a birth warrior? I've never even heard that term before...
My DH made the point when told he was my 'advocate' during birth and to make sure I got what I wanted, that why would he go against what a medical professional was telling him was best. Seriously, I can read all I like about the birth process, it doesn't make me better at it than anyone else. And if something goes wrong and a midwife or Doctor says I need something, I'm most likely going to go with it. I don't think anyone's out to sadistically hurt me for no reason. Childbirth is still a hard, painful, messy and dangerous business at times, and I've known people who have had a hard time healing afterwards, not because they were 'violated', but because that's what can happen when an infant comes out a vagina. No one seems to go into hospital for an operation and expect to tell the Doctors what to do. I'm all for having a go at the natural birth, I'm going into the MLU, hoping to use the birth pool and G&A, but if I have a long labour, if I get exhausted, if baby gets stuck, I'm happy to be whisked away to a bed and an epidural because I can't control what happens.
That's a good last line Katherine - when I interviewed my doula, the main thing I had that I wanted assistance with was 'Three healthy people leave hospital, ideally without PTSD."
I have a SIL who is a proper warrior. But that's in every aspect of her life, her birth circumstances didn't surprise me at all.
On the other hand I've got a partner who reckons you should just go for an epidural straight away - "Why the hell wouldn't you?" Then he heard about the post forceps/theatre/every drug going birth, 6 months later no sex issues that some friends of his are having, and sort of changed his mind. Haha.
I've hired a doula. I expect I'll be somewhere in the middle - like most women are. I just hope I don't find the hospital element of it all incredibly stressful. Erk. I'm scared of hospitals, and slightly of the unknown. Not of pain.
I have a birth preferences list for DC2 due in 4 weeks. I had birth trauma from DC1's birth and I want to avoid things that I feel will be triggers (e.g. my SPD was so so painful I had to have my legs physically held open on the bed by mw and DH, lost consciousness due to PPH and had memory gaps, DS needing resus and not understanding what was happening. I laboured fast and furious and was not able to express myself at all).
My preferences this time are active labour positions, minimal VEs in current labouring position, don't want to get on the bed, monitoring in active position, deliver kneeling if poss to protect pelvis, immediate skin to skin (with cs too if have one), will ask for pain relief as needed pls don't offer. I have also explained my previous birth & listed relevant medical info and that I've been using natal hypnotherapy, and asked for someone to go over the details of birth 2 with me afterwards. I've also included BF preferences. Thankfully SPD is nowhere near as bad this time.
The main purpose for me with writing the list was thinking about what things I might have options for, and discussing these with DH, my doula and my mw.
Obviously my main aim is healthy baby, healthy mum; but if this can also be achieved while protecting my mental health as far as possible then that would be good!
In my pregnancy record book there's a section with questions on preferences (it says you can alternatively attach your own birth plan) and it gives examples. A lot of it is about how you feel about things or concerns you may have rather than out right demands or refusals.
Splendide My circle of friends are a combination ... the example I gave was extreme. Most of my friends talk more openly about how it is tough but not impossible.
Of those who have had kids recently 4 it was what's considered straightforward: pushing, G&A, shot of pethadine (2 more had births like that but with epidural and monitoring).
6 had "interventions" (though of those, several expected it in advance).
2 C-sections (1 planned, one emergency).
It kind of matches the average stats for my local places.
So you might well be lucky!
One of my friends who was in early labour for a WEEK rolled her eyes about interventions and epidurals and said "I f**ing wish... it was the daily grind got to me... the big contractions bloody hurt but I was so relieved it was nearly over" which just goes to show I suppose that we cannot even predict what part will feel like a problem! Birth warriors would applaud her birth: she feels she was a bit of a mug and should have used some pethadine to get a nap in!
You could start by using the template on the NHS choices website, here: www.nhs.uk/Conditions/pregnancy-and-baby/pages/birth-plan.aspx#close
It gives you a good idea about what kinds of things you should mention.
Really interesting post Squiz. I'm 30 weeks with my first and have read Ina May and Juju Thingy and about four million hours' worth of online blogs. I do pregnancy yoga and will be doing the NCT course next month.
Honestly, probably all distraction techniques than feeling they'll be actually that useful. I sort of feel like the more info the better but that might be wrong. Definitely recognise the JUST TRY HARD ENOUGH message and in fact I worry I've conveyed that to my DH. He's not even slightly pushy but I do think he thinks that it'll be fine as I get loads of exercise, do yoga and understand the process.
But I look around at the women I know who have given birth and the odds are way against me!
...her intervention was stitches after (as 60% of women have) and some pelvic floor help afterwards (not having done any before because she hasn't had any conventional prep).
It was purely the idea that if there were no interventions, birth would be "nice" that threw her.
How much worse would a vonteuse or emc be with that mindset?
I bet there are women who have experienced that.
Goats I wonder about the internet... Things I have read on MN and Baby centre boards from either people who birth easily or angry people after intervrntion (let alone elsewhere):
- if you rest up before labour you won't feel as much pain
- stay away from hospital! If you choose a HB it will be intervention free
- intervention is always a problem and you should ask for a debrief
- Ina May's book shows birth as it really is (as if it is a bible not an edited book promoting her methods) - don't read any negative stories
- if you say NO to interventions most likely it will be OK (IMO bloody dangerous. Also of you then say 'yes' you'll feel a failure).
- DRs and MWs don't understand birth.
- it is relatively easy to learn to 'breathe out' baby and not push.
Some pretty extreme views... And most with the idea if you JUST TRY HARD ENOUGH you can have a perfect birth. My mum also cites expectations of birth 'damage' (e.g. incontinence) have changed: so women want a traditional birth but without the damage her/my grans generation took as a risk. Like a sanitised version. Ask a British woman about fistulas... Many will be clueless...
There are so many "aggressively rose tinted" opinions online that if you were the kind of person who wanted to read the positives, it might be easy to create the image of every intervention a failure, violation, problem ... Not just ones resulting in issues/pain, but anything.
I know a woman who paid for masses of rather woo (and v v expensive) alternative birth prep, but refused hospital ante natal because she said it was the "system" brainwashing you. Thankfully her birth went well clinically: but she developed real trauma about how painful/primal it was. She thought before that the "system" lied and babies were breathed out- they just wanted to cut women willy nilly. She has therapy to this day, doesn't trust herself, all sorts of issues.
That was mine, ontobeanonymous. A pointless exercise because the baby doesn't read it!
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