...to say that birth plans contribute to womens unhappiness around labour?

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Ive read a lot of threads and a great deal of women seem to be unhappy because they didnt get to stick to their birth plan, for many reasons spanning from medical to facilities not available etc. Should women be encouraged to have a loose plan of how they want their labour but also encouraged not to set their heart on it?

Im 23 weeks pregnant and I know ill be asked about my birth plan soon by my midwife. Just gathering opinion! Thanks for reading

Not a single thing on my birth plan (though I did call it preferences) came to pass, but I was really glad I had it as it made me think things through in advance.

For some of it, I was in too much pain to talk, so it was good DH knew what I would like to ask.

At one point, when they said we were moving to theatre to try a forceps delivery and do a c-section if that didn't work, I asked if they'd be able to try a ventouse delivery instead, and they paused and said 'well it might not work but if you're ok with being moved at that point, we'll give it one push and re-assess then.' And it did work, and so I was able to give birth vaginally without forceps which was a preference, and I don't think I'd have thought to ask if I hadn't thought it through in advance.

I think it's very fashionable to dismiss women for wanting control over the process, see the negative comments about candles and music. I listened to hypnobirthing tracks for the start of my labour and it really helped me stay in control, there are lots of lessons from sports psychology about how the body deals with pain and it's limits that can really help women having a normal healthy labour.

At almost every stage my 'option 1' didn't work out, so having looked at the evidence and thought about what I wanted really helped me in being able to ask for my option 2- in some cases, that wasn't possible, but where it was it was really good. I had an induction, an epidural, an assisted delivery and a third degree tear, none of which were things I wanted, but on the whole I feel positive about my birth because I felt I was respected and listened to by all the medical professionals involved. For me, having a plan helped with that.

I thought this was already the case. All my antenatal classes and midwife appointments they made it quite clear that you may not be able to stick to the birth plan. However evidently this isnt universal. I think the idea of "preferences" rather than a "plan" is a great idea.

Also more emphasis that it's not your fault if the birth doesnt go the way you expected and you arent a failure if you end up having a epidural/c section/ other intervention which you didnt anticipate.

I wrote my birth preferences the day before I was induced as it was all a rush. It wasn't worth my time! No one asked about it once and everything happened so quickly anyway. Wasn't worth doing!

I can’t really remember what I wrote. But I remember it made me feel more secure. Not because I thought I was in control of the process itself, but because it reminded me that nobody was in control of me. That I was the patient and had the overriding choice.

I don’t think I wrote one but I was better at 2nd and 3rd birth at knowing what I wanted and asking for it

I think its awful that women feel a failure if they have intervention. The poster that commented on the NCT group saying 'oh well' to those that had an intervention enrages me.

It seems from reading the comments here theres so much variation on 'plans' and how much detail they go into. I am slightly concerned that some werent even asked about a plan/preferences.

I agree birth preferences might be more realistic. I knew plans sometimes have to change so although I had my preference I didn't want to rule anything else out! In some birth groups I was in I was amazed at how detailed and fixed some plans were. Mine was just let's try a water birth if we can and ideally just gas and air but we'll see how we go.

Should women be encouraged to have a loose plan of how they want their labour but also encouraged not to set their heart on it?

I don’t know of any women who have genuinely believed their plan is what is guaranteed to happen. It’s just what women would ideally like at the time of writing (many women then go on to change their minds mid labour - eg with epidurals etc). Remember, it’s not just about the baby arriving but the request to have vitamin k injected or administered orally, skin to skin, breastfeeding etc afterwards.

For a situation women rarely have full control over, this is a way some women like to to think they face planned for their best scenario.

I didn't make a birth plan with my first. It was horrific. I don't consider myself to have given birth to dc1 and almost 5 years later still have nightmares about it.

With dc2, my consultant wrote plans for me. One for an elective section which was my choice. One for a vaginal birth if I went into labour before hand and things were at a stage where that was safer. I did go into labour early and the amazing overnight team who eventually delivered my dd2 followed it to the letter, watching, delayed cord clamping, immediate skin to skin, no separation and actually made me feel part of it.

I think having an idea of what you want/don't want for all possible outcomes is a very sensible idea.

Actually the data seem to suggest ‘going with the flow’ and not making a birth plan tends to raise the risk of both ptsd and pnd after birth. That is part of the reason why the NHS recommends you make a plan — because you are more likely to be informed and force your medical team to communicate with you (even when they disagree) about the various birth options and procedures.

Yes, I agree. In my area, women are encouraged to make birth plans by the hospital. To be honest I think that’s just to give us some illusion of control over the process. I’m not sure I think that it’s helpful to give women the idea that they have more control over labour than they do.

Despite the fact that women in my trust are encouraged to strongly to make birth plans, mine never even made it out of my bag. There wasn’t time and the midwives never asked for it.

Each pregnancy the community midwife forced me to write a birth plan and each time when in labour the midwives sort of chuckled and didn't read it! I had no birth problems so it wasn't like there was anything on there that was difficult to achieve!

I've seen lots of women recently been disappointed by the way their labour/deliveries planned out, especially the caesareans. They all had birth plans/preferences, and all said clearly prior to it that they knew it might not go their ideal way etc etc... but we're still disappointed. They had pinned so much hope on a birth with no intervention it was upsetting for them when it happened that way and overshadowed their joy at having their child. More needs to be done around the way we speak about how we give birth, so we don't pull out the pity-face when a woman has an instrumental delivery and praise the woman who has a simple vaginal delivery.

NCT groups can be a mixed bag. You can get ones led by retired local midwives who have also taken additional qualifications like I did and have them be some of the most enlightening sessions you have ever done. Or you can get ones led by recent 19 yo graduates of their educational programme who may or may not have given birth.

Our trust have a section for birth preferences. It's clear that they are preferences but I think it's better to have it written down in case you're not in the position to say at the time. As previous posters have mentioned it can cover after the birth as well (cord / vit k) not just labour.

I think it's also important to talk through it with your birth partner if you have one as well, then they can highlight things on your behalf and you aren't reliant on the midwives having to read it.

My NCT leader was very pro-intervention where necessary and gave us a lot of information about the different assisted and c-section birth options available at our local hospitals.

Have preferences rather than a plan. Consider different situations that deviate from your ideal and how you would like your environment to be in that situation then you can have something in mind to improve all situations, even if it's something as simple as keeping lighting or voices low or who you would like to be in the room.

I barely made a birth plan, because tbh I was fairly baffled by the idea that I could possibly be more knowledgeable than experienced midwives and doctors about what would be best for me and my baby. My preferences were basically 'please do whatever is safest and most conducive to a non-traumatic birth'. I hadn't a clue what I would or would not want once I was in labour, because you can't know what it's like until it happens.

I hate the phrase "birth plan" because it suggests a list of how you want things to go when what it actually means doing your research in advance and being prepared.

If you were doing anything else risky and unpredictable and set off saying "well, I'll just see what happens and trust the experts", people would say you were crazy.

It's not being inflexible or setting yourself up for disappointment to find out out about what problems are likely to lie ahead and to take steps to avoid those problems if possible and make contingency plans for how to deal with those problems if they do occur.

The poster that commented on the NCT group saying 'oh well' to those that had an intervention enrages me.

In fairness, OP, she was an old-school hippie of a somewhat tiresome self-righteous type, who wore patchwork trousers and handknitted kneesocks, and from what I remember, she'd been drafted in at the last minute because the scheduled teacher dropped out. I would hope she was unrepresentative of the NCT.

And she was so nakedly 'Oh, no the Cascade of Intervention means YOU LOST at birth!' about it all at the reunion she was literally walking around with a clipboard asking people how they'd given birth that she pissed everyone off and we had a rare moment of total esprit de corps, where even the people who had breathed their babies out on half a paracetamol were joining in and inventing various interventions and drugs out of fellow-feeling.

Preferences is a much better word. I'm constantly disappointed in myself for giving in to the drugs even tho a MW friend told me that she did a study of 1000 women who had the induction drip as part of her dissertation and 100% had an epidural or pethidine. I hate it though 😕

I think that's a fair point, @BroomstickOfLove. I sometimes feel there's a mean-spirited edge to threads (not this one, but others I've seen on here and elsewhere) that come down to saying 'silly little first-timers, imagining that they have any agency in their own labour'.

My birth plan for my second baby was a lot bolshier than the one for my first, honestly.

First birth plan: "I would prefer not to lie down to labour so that I can stay mobile but I understand this might not be possible and really whatever will be will be on the day, I am happy that medical professionals know best" etc etc etc.

Second birth plan: "I am NOT lying down in labour." Underlined.

My birth plan contained what I wanted if things went pear shaped. It had nothing idealistic on it!!

The very last item was that if I was unconscious during or after birth the first person to hold the baby was to be my husband and that I wanted it to be my husband to tell me boy or girl. (Plus a note to husband that no one was to be informed of the birth before I got told).

This is how it ended up - so I was very glad I had a birth plan!!!

Couldn't disagree more from my own personal experience. I did not have a birth plan/preferences written for dc2. I have really fast labours, and had barely half an hour in the delivery suite. I was so annoyed that the midwives couldn't read my mind. They kept asking me bloody questions when I was about to give birth at any moment and didn't have any capacity for thinking about or answering anything. I remember one of them kept trying to literally push the gas and air yoke in my face even though I hadn't asked for it and it was the last thing I wanted at that moment. Baby was born less than 5 mins later. I still get the rage thinking about how frustrating it was trying to communicate during that half an hour.

Next time I wrote a birth plan - the first thing it said was that I have really fast labours just so they'd know. And it was the best thing I ever did. The midwives gave it a quick read and knew how to deal with me without having to ask me loads of questions. And they appreciated the note about fast labour. I was so impressed with them. One of them even suggested I get up and move around because I was totally floundering after my waters broke. I think I was going through transition and I didn't know what I wanted to do, but she reminded me that I thought I'd like to be upright. I tried it and felt much better. I am so grateful to her for making me feel listened to. It made such a difference to me.

But, of course every person's experience is different.