negative midwife / birth plans

[user1465146157]

Hi all, wanted some feedback on my midwife appointment today to check if i'm being sensitive (I'm 37 weeks so it's possible!)

I was told to bring in a birth plan for this appointment so I typed up some notes about my ideal situation, and stated very clearly that I KNOW my plan is a best case scenario and I understand things may not go the way i want on the day. I'm very open to pain relief if I need it and have no problem taking something to help me through - i just don't know what to expect or what it will be like.

I've been REALLY trying to be positive about the birth even though I obviously have natural fears and its my first one.

I kind of got the feeling the midwife was smirking at the plan - even though I kept saying, i know things may not go the way i want.

The plan mentions Hypnobirthing and I ask for support in using breathing techniques to try and get through.

I also said that unless necessary i'd prefer not to use forceps or ventouse - understanding i might have to so will be open to it.

The midwife was very adamant that they may well have to use these in case theres a danger to the baby - she kept talking about the baby's heart rate. I get that she's right and of course I'll do whats best for the baby - but i can't understand why she'd phrase it the way she did given we don't know what will happen. She made it sound like they definitely will be using forceps / ventouse.

Then she said that once I'm 10cm, they would expect the birth to be done in 2 hours. I feel like thats a bit rushed, and made me feel worried that if i'm not done in 2 hours then they will pressure me to use forceps or other things to quicken the process.

I've never heard a time limit like this before - have you?

Then, lastly we talked about episiotomy which I've said - i'd prefer not to but if necessary then I'd have to. She said that it sometimes helps to do the cut as you may tear anyway, and it may be likely we'd do that.

I understand she has to be realistic, and I am really being realistic too, i just feel like a lot of what she said is based on the worst case, but she was talking as if these things WILL happen. They may well do, just felt a bit like i was made to feel scared instead of reassured.

anyone else had similar experience? Shall i stop worrying given that no one knows what will happen?

thanks in advance.

[Trifleorbust]

You have every right to refuse forceps or ventouse. However, it is absolutely true that labour has 'expected' time limits before midwives begin to suggest interventions. This is because the process of contracting causes the baby to lose oxygen (baby gets no oxygen during contractions) and so a very long pushing phase can be risky for the baby. I pushed for two hours with my first and they were going to move me from a midwife led unit to the delivery suite for a forceps delivery, precisely because 'baby was getting tired' - I asked what this meant and was told it meant her heart rate was slowing. I would have accepted forceps delivery rather than risk her safety.

So you are not unreasonable to feel that your midwife is being a bit negative but she is probably just trying to give you advice that keeps you and your baby as safe as possible.

[Lules]

She does sound a bit negative but it's hard to strike a balance between scaring people when it may well go fine and not giving them information. The 2 hour thing I think is standard. 2 hours is a long time to be pushing - it's exhausting particularly if you've had a long labour already and of course there's the danger to your baby too. You sound like you have a good attitude to birth though

[TiltedNewt]

So your birth plan says "I don't want X... unless necessary"? In my experience (limited, I know) they don't do X unless necessary. Could your midwife have been pointing this out, as in "I know you'd rather not, but these are the reasons X may be necessary"?

[Mrscrabtree]

Hiya, that sounds a bit stressful and like she might mean well but just doesn't have the best manner? (Im trying to be charitable...) Don't know if this is helpful but I read in the book Expecting Better that episiotomy is associated with worse outcomes than just tearing so best avoided. I haven't looked into this any further myself yet (only 7 weeks!) but you might want to. Good luck and I'm sure it'll all be fine xx

[TiltedNewt]

Also, I had an assisted delivery after 2+ hours of pushing. I believe it is standard.

[Trifleorbust]

TiltedNewt: 'Necessary' is a very subjective decision in medical terms. Everything is about risk. Forceps may be 'necessary' to avoid a certain level of risk, but not 'necessary' if you are willing to accept a greater level of risk.

[littleducks]

Sounds a bit negative.

You don't need to consent to vaginal examinations, forceps or ventouse. It is better to be open to the idea they may be necessary and be flexible until the actual time.

I learnt about all these in NHS antenatal classes but a MW never discussed with me in terms of me needing these, surely nobody can predict the labour?

[Trifleorbust]

I also wonder whether some midwives are sceptical about hypnobirthing and if this comes across in their interactions with mothers-to-be? Most women will require some form of pain relief in labour (it bloody hurts!) so she may be trying to manage your expectations.

[SellMySoulForSomeSleep]

I was allowed to push for 4 hours. So sometimes they don't follow their own rules.
I suppose she is trying to make you understand issues that may occur but not in the best way.

Just go with the flow. The midwives explain what, why and how with you during the birth and include you in all the decisions

[Trifleorbust]

The midwives explain what, why and how with you during the birth and include you in all the decisions

I think it's really important for an expectant mum to understand that the midwives aren't making the decisions - she is. Midwives and doctors offer advice but the decision about what interventions to accept rests with the mother to be.

[TiltedNewt]

Trifleorbust, that was kind of my point. I think I am bad at explaining myself though.

To put in a birth plan no X unless necessary leaves it for the person reading the plan/delivering the baby to decide if a thing is necessary or not. Which means it may as well not be included because that person will decide what they think is best is necessary, where as a different midwife/doctor may have made a different call because they perceive the risk levels differently. And it is better to talk through these reasons before hand, so the term has a bit more meaning.

Or she could just be a miserable midwife.

[Sploozle]

I don't wish to sound rude, but I've never thought birth plans are overly helpful. No one wants to have an assisted delivery - not least the obstetricians who would much prefer women to have normal deliveries without them getting involved. However realistically around 15% of first time mums might need this sort of help. If that situation occurs then it will be discussed and explained at the time. The fact that you've written you'd prefer not to have something on a birth plan will not make any difference to if it's considered to be the safest thing for both of you.

The 2 hour thing again isn't an absolute deadline, but is part of the national guidelines of safe practice. (NICE guidelines)

[haveacupoftea]

It sounds like she has had a lot of mums insisting they won't have this or that and was nearly prepared for you to fight with her! I imagine all goes out the window when you get into the delivery suite anyway.

[PotteringAlong]

I agree that the time limit is completely standard. I also had an episiotomy with my first to reduce the risk of tearing - a back to back baby and they wanted a controlled cut not an uncontrolled tear.

[Trifleorbust]

TiltedNewt: But of course it is sensible to make it clear that you would like minimal intervention, as some HCPs will take this into account in making their recommendation.

[LaraG13]

I was very fearful about a forceps delivery, and when I said this to my midwife, she told me it was my body and i could always say no. When it comes to it, if your delivery doesn't go as hoped and they recommend assistance, you can ask what your options are and make a decision based on the options available and likely risks. There are different ways for HCPs to approach the same scenario, and your preferences can influence this. For example, I would have preferred to have a c section if the delivery was stalling, assistance was looking likely, and c section was still a viable option. My midwife told me this was a perfectly valid decision to make if it came to it. Others may want to avoid a c section unless it's the only option. So there are choices that can be made along the way. I think your midwife has done you a disservice by totally disempowering you. You sound very realistic. Don't let her make you feel you don't have any control or choice because you do. Of course in a medical emergency your choices will become more limited and you may be forced to take certain decisions for the safety of you or your baby, under the guidance of your HCPs, but you know this. You are right to think about what you'd like and what you wouldn't like, and have every right to express this to those who deliver your baby. It's your body, your baby, your pregnancy, your birth. Good luck and I hope it goes the way you'd like it to - of course many births don't go to plan, but many do as well.

[TiltedNewt]

Trifleorbust, Definitely. But I just don't see how putting "unless necessary" is making it clear you want minimal intervention. It reads as giving permission more than declining. No one wants an episiotomy, but some people are willing to have one and some people aren't.

I just wondered if the midwife spent more time focusing on the negatives because of this permission if necessary, I know you don't want it but these are the reasons it may be necessary type thing, rather than being miserable. Or, again, she could just be miserable.

I will add I am waiting for a consultants appointment to discuss my son's birth as I was told what was happening and not given any options or explanations and I am now having panic attacks about my next, so maybe you have more faith in HCPs than I do.

[Imstickingwiththisone]

OP use the last of your pregnancy to decide what you would like to happen if assistance is required during the labour. As a PP has said if you would prefer to go straight to c section then you need to make this clear and that you do not want forceps / ventouse at all.

As has been said, they don't intervene unless they feel it is necessary anyway so there's no need to put it on your birth plan anyway. Unfortunately it is up to you to try to get more knowledge on whether you think their interpretation of necessary is the same as yours. All decisions will be run by you during the birth regardless of your plan anyway. Obviously they are medically qualified but a lot of decision making is policy based and there are different opinions on the methods used out there. For example I actually thought episiotomies were discouraged now unless forceps / ventouse was being used - not just as a standard!

It's probable that most first time mums have a birth plan similar to yours. I know I did and with hindsight I would've clued myself up more on why forceps are used, what alternatives are, what the risks are etc. And for a kick off I wouldn't have been really excited about the prospect of being induced just because I wanted to meet my baby.

[LBOCS2]

The thing that I found most useful was to think that 'if x happens then I'd like y'. Think it through. You'll have lots of ideals - everyone does - and all going well, you'll get your ideal birth. But the best way to keep feeling in control when it doesn't go to plan is to try and plan for the less than ideal situation.

I wanted a water birth, MLU, minimal intervention birth the first time around. What I GOT was preeclampsia, induced a bit early, epidural, labouring on my back, instruments-ready-to-use, extremely high blood pressure and needing monitoring birth. But it was ok, because I'd thought about what I wanted if I couldn't have my ideal, and I got that. So we still did delayed cord clamping, baby was delivered onto my stomach, I chose which assistance I wanted, whether I'd have an assisted placenta delivery, what form baby was having vit K in. And it ended up as a positive experience - not just because I got a baby at the end of it either.

(I got my ideal birth second time around, and it was also a very positive experience).

[Anywhichway123]

Hi OP my midwife told me not to bother even writing a birth plan and so did my sister who's a mum of three and a theatre nurse.

I was very worried before my first DD was born and spoke to several midwives and had long conversations with the midwives in the birth choice clinic. I was told the reason they're sceptical about birth plans is because it gives women false hope they will have the 'ideal' birth of their choice and for many women it causes a lot of disappointment and even PND if they don't.

I can understand you feeling your midwife was negative but having met several I've found them to be very matter of fact. Their aim, as I was told, is to keep you both safe, that is their priority and they will do whatever is necessary.

When I had my DD, I wrote a really comprehensive birth plan. I wanted a water birth, I wanted to keep it as natural as possible, I didn't want an epidural or forceps, I didn't want to be induced and I was open to all pain relief :) I ended up being induced so no water birth and having an episiotomy because baby's heartbeat plummeted and they needed to get her out. After the birth, the fact i didn't have the birth I wanted didn't matter, my baby had been delivered safely.

Ir's a really good idea to have a plan so you can try and have the birth experience you would like but do stay open minded in case things change. The main thing is your little one gets here safely.

Good luck! x

[Bellaposy]

It's her job to give you the benefit of her experience and the reality is that births don't often go to plan. I had a very loose idea of what I wanted for when I had my daughter last year (pool, no pain relief, please not forceps). I got the the hospital 8cm dilated with my daughter in distress - pool out the window and ventouse delivery. They did take my request for no foreceps into consideration. I can imagine if I'd had a more fixed idea of what I'd wanted, it would have been traumatic and upsetting when it didn't happen. IMO the midwife was trying to help you make sure that didn't happen.

FWIW I highly doubt you'll be lock watching at 10cm dilated. You won't notice the passage of time. And two hours is a very long time when you're pushing.

[Bellaposy]

*clock watching God I hate autocorrect.

[Stylingwax]

2 hours of pushing!! I pushed for 10 minutes and that was more than enough!

[sj257]

It took me 2 and a half hours to push my daughter out. They got a doctor towards the end because she was getting distressed, he decided her birth was imminent though so no intervention needed, but if it had have been I would have welcomed it because I was exhausted.

I personally don't see the need for such a detailed birth plan. Things go how they go when you are in labour, you are still able to communicate what you do and don't want during it.

[toomuchtimereadingthreads2016]

I was told to fill in a form for my birth plan and it was very detailed, pages long. Was given the form at my first hospital information chat. After I had filled it out noone ever read it. When I asked the midwife at my induction if I should give it to her she said "can't you just tell me what it says?" I mentioned that I didn't want to be offered pain relief, would ask if I wanted it. Was encouraged to have a epidural three times, the last being by the anaethetist who was already getting ready to give me one. I was grateful at the time, but it went completely against what I had asked, as did everything else re. interventions during labour.

Am not going to write a birth plan this time. Just the after birth care. Skin to skin, delayed cord clamping, any necessary initial tests to be done bedside. For the rest am planning a "what will be will be" approach this time around.