To put that I don’t want to be treated by PAs in my ELCS birth plan?

No one is going to look at your birth plan. There's highly unlikely to be a choice of staff anyway. Just be glad if they actually do your c section on the day it's planned for and don't send you home again because they are too busy.
The aftercare is similarly shockingly and dangerously lacking. I would just be grateful to have someone providing some care. It's not like you can turn the person away and get someone else of your choice. A more likely scenario is no one turns up at all other than a healthcare assistant taking your obs, despite said obs declining.

Birth plans are good for you educating yourself about pain relief options, vitamin k, skin to skin etc. You get to choose who cuts the cord maybe. But once it all starts happening it's largely either protocol driven or down to pot luck.

So what?

Unlike nursing and medicine (doctor) the requirements for PA's are such that someone can become qualified with very little training and experience. Your friend being overqualified doesn't change the fact that many others are the opposite.

Patients aren't going to be interrogating the staff on their qualifications during labour so how are they supposed to know who's who?

Depends on what and how you write it.

You can have consent based printed birth plan signed by you and whitnes and no hospital will skip reading it.

During childbirth woman is in situation where she can have limited ability to speak or advocate for herself. Birthplan is document written to show your wishes where your thinking was not "obstructed by pain and emotions". If you are in situation to have PALS or court involved, a fact that you had birthplan in place can be great help as no one can claim they "did not hear her" or that you said something else.

Midwife will go through it and if anything is possibly problematic flag it up. I know as I refused consent for specific thing and was informed that in case I become unconscious they would not be able to proceed with that even if it is to save my life. Same way you can opt out from transfusion.

So yeah, birth plan is not "just a paper".

Thst was definitely not a thing at my 2 sections.

A PA did our 6 week postnatal check and she was excellent.

@s4usagefingers Same here. I think there’s a huge misconception about birth plans, that it’s all about ‘whale music’ and unrealistic expectations. Although I suspect that myth will always be peddled as some people undoubtedly don’t like women having control and autonomy over their bodies.

I believed the whole ‘birth plans go out the window!’ with my first labour and ended up with a negative experience and some injuries/side effects. When I looked back at my labour and birth I realised decisions had been made on my behalf that I wouldn’t have made myself if I’d known the risks and benefits. But I was young and amazingly wasn’t even particularly aware of the fact you have to consent and you don’t have to ‘be allowed’ to do things by the doctors! Once I was a bit older and educated it seemed mad to me to go into a situation not knowing about the options and the risks… you would want to in any other medicinal situation or procedure wouldn’t you? So why not birth.

Second pregnancy, was a lot more educated and had a birth plan. Way better experience and felt so much more in control.

I had my blood taken by a PA in gynae assessment when I had a miscarriage. She had apparently done the extra training for more difficult veins. When I had my baby 18 months later I never saw any PAs in maternity throughout pregnancy, none around when I had my planned c section (everyone introduces themselves in theatre), and none on the post natal ward.

If you're having a planned c section the Consultant comes to see you beforehand and so does the anaesthetist. You can ask them any questions, so that would probably be a good time to ask if a PA will be assisting and confirm you wouldn't give consent.

I know it’s quite off topic but I did a birth plan purely to educate myself on the possibilities and potential choices that comes with childbirth and I’m so glad that I did. I wasn’t in the position to take on any information during labour so decisions came from what I already understood. It didn’t actually get looked at by the midwives that I know of.

My friend is a PA. She has a nursing degree, about 12 years experience then did the two year course. She's currently studying for a Masters.

She's bloody awesome and I would choose her over a junior doctor any day.

Not all PAs are the same.

I think birth plans are worth doing 🤷‍♀️

Given that you literally have to give your permission and consent for any decision and procedure made, it’s a really good idea to actually be informed so you know what you are happy to consent to, and what pathway you’d want to take should certain situations arise (especially since labour and birth can be quite unpredictable!)

@BPquestion there is actually. You have to have a life or health sciences degree.

Do you mean the Trust where you work?

We absolutely have them in Obs where I work.

You can consent or not to certain things in your birth plan but it does depend on what constitutes your birth plan 1) yes to vitamin K etc and no physician associates or 2) fairy lights, nice music and a water birth. They take notice of number 1 not number 2.
I had an early unplanned vbac and the student midwife was having to try and go through the birth plan for the important bits in between my contractions!

I don’t know why the government are pushing PAs when nurses, paramedics, physiotherapists and pharmacists who have all done more than two years initial training, then practiced for a number of years and reached a certain level can do a masters and yet more training to do Junior doctor type role. It is only certain health trusts that offer these roles but they are very experienced and don’t do surgery.

I don't think you're wrong in your concerns, but can it work on a practical level?

If the particular "thing" you need has a PA scheduled to do that task on that day, would there be a doctor available to do it?

I'm not sure birth plans are ever really adhered to? Mine never made it out of the bag.

I don't know, they do need to have a 3 year science degree and then do the msc to get the pa degree. Whilst this is 2 years on paper, it is 3 years in reality as it is an intensive full time course with no summer break. So they spend at least 5 years at uni training.

PAs tend to specialise in one area and remain in that area so they do become an expert in one small part. Whereas junior doctors are constantly rotating so they may not have as much experience in that particular area.
But what I would say is that all health care professionals can and do make mistakes, no matter how senior they are.
I am speaking as someone who had a bodged c section performed by a junior doctor.

Not true.

I have worked in maternity a long time and have never seen a PA. You’re reading made up stories designed to stir up anger.

Don't blame you. Think the whole concept of these roles is deeply troubling.

Really? I work in this field and haven't come across any?

BIRTH PLAN not a birthday plan, stupid autocorrect. Why can't I edit my post on my phone?

I'm sure you already know that your birthday plan is not worth the paper it's written on? It's just a ruse to make you think you have an element of control.

You might as well write that you want your baby to be delivered by a unicorn while you listen to an angel playing the harp.

The best you can hope for is that you are given some form of pain relief and end up with a healthy child

I had a PA involved in my pregnancy (not the CS, thankfully) and it was an awful experience. I will never be treated by one again.