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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

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

134 replies

CAG12 · 25/11/2019 15:42

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

OP posts:
Jeleste · 25/11/2019 18:53

I was really pushed for a birth plan by my midwife.
My best friend always told me her only advice about birth is dont make a birth plan.
So i was reluctant. I did make one in the end and of course nothing went according to the plan.
I wasnt too disappointed, because both my mum and my husband were terrific. Very supportive and reassuring. And the midwife who was there at the birth was amazing.
But for my second birth my plan included:
Go to the hospital.
Give birth.

stargirl1701 · 25/11/2019 19:44

I think it is helpful to decide what you will not consent to. I wrote that would not consent to high rotational forceps but that they should proceed to CS.

Hellofromtheotherside2020 · 25/11/2019 20:00

Mine went out the window!! I wanted to remain active but was so tired I just laboured on the bed!!!
I wanted all the drugs! I asked for an epidural in my birth plan but ended up not needing it during labour and survived on gas and air....a decision I regretted when they had to stick their whole arm up me to turn the second twin from breach position after the first was born!
I didn't even bother writing one with my third baby, just went with the flow.

I do know some poor women who've been upset theirs didn't go to plan.

pallisers · 25/11/2019 20:11

It’s a good time to state your preferences in black and white. For instance, I declined instrumental birth and indicated I wanted to go straight to Csection if things went pear-shaped (and that’s exactly what happened 🤷‍♀️)

I wish I had done this! I would have saved myself a near-death experience and a lot of pain and misery. it simply didn't occur to me that I might be advised to have a high forceps delivery or a massive tear or a pph. By the time the issue of the forceps came up I was in no position to think about it. I wish I had researched beforehand and made a plan.

BertieBotts · 25/11/2019 20:26

I think a helpful way to approach it is to start out with the mindset that there is a time and a place for every intervention in labour, whether we're talking emergency c-section under general anaesthetic or gas and air or candles or birth pools or episiotomy or induction. These are all useful things in different circumstances and it's simply a case of judging, partly by yourself, a huge part by the professionals supporting you, if and when a particuar tool will be needed. Women labour at different speeds and intensties. Your energy and hormone levels will not be the same as someone else. Your baby's position might be different. An emergency might occur. Particularly for your first baby, it's somewhat of an unknown quantity.

Nobody wants to have a crash section under general, but if the choice is that or one of you dying, obviously you'd choose the surgery every time. And while you might prefer not to be induced, if it comes up it's likely to be for a legitimate medical reason and you can ask why.

You can always ask about the risks, benefits, alternatives of any option you're being offered - if it's really life or death then obviously you won't be consulted, but they should debrief you afterwards so that you understand why the decision was made as it was. If this does not happen for whatever reason, you can absolutely request it and I believe it's a simple procedure to do so for up to six months after the birth.

Don't assume that you can "choose" a drug free, intervention free labour because you simply do not know what the circumstances will be. I think when women are sold a birth plan under these assumptions then you end up with the disappointment and feelings of failure, which is a huge shame as it can be such a positive tool.

So with your mindset about all interventions being useful in some way even though no intervention or coping method will be appropriate for every single birth, you can write your plan. I recommend being concise, and splitting into three sections. In the first section you include information about you which might be different from the norm, important for your caregivers to know or just useful during labour. For example, you could include any known allergies to drugs here (although they should be in your notes too) but also things like "I struggle to focus on sound if there is background noise" "It's OK to tell me directly what to do" "I have a fear of needles and would rather you don't tell me if you're about to cut/inject (etc)" "Due to an experience of sexual assault, it is very important that you ask me before examining me" - whatever works for you.

Second should be your preferences section. I'd include in this anything that it's fairly likely you'll have control over no matter what else goes on - for example, whether you consent to vitamin K at birth for your baby and which method (Injection or oral), whether you want active or physiological management of the placenta, whether you want to discover your baby's sex for yourself, want the baby to be towelled off/wrapped/left vernixy for your skin to skin.

Third should be an If....Then.... section, with specific requests for what to do (if possible) in certain scenarios. For example I always put that if the baby needs to go somewhere I can't follow, I absolutely want my partner there instead, and I'm happy for him to prioritise baby over me. (The baby, incidentally, does not know or care, so it's not wrong if your preference is different here :))

Keep each section to max about 6 items, so that it's short and punchy and easy to remember. This way your caregivers are likely to actually read it, not laugh at it (they will probably say it is more useful than a standard birth plan) and be able to implement it because it is clear and easy to remember. Don't include things like "I don't want to be induced/cut/have pain relief unless medically necessary" - those are things that first of all are probably already NHS policy, so you don't need to request them specifically, but also are things you will most likely be totally calm and not actually in a compromised state when they want to discuss with you, so you will be able to discuss it and decide based on their reasoning and your feelings at the time. If you know you want something very specific like an epidural ASAP or the use of a birth pool, put that in but if you're happy to go with the flow for pain relief and try what is available and see how you go, then just do it - there is no need to write that as that will be their approach anyway.

It can be worth having a separate sheet specifically for your birth partner(s) to refer to which lists ideas that you think will be particularly calming or helpful during labour, perhaps things you've read about or practised in antenatal classes.

Lastly, I don't think this is a thing in the UK because I don't remember it - but in Germany where I had my second, it's possible to make an appointment with the hospital and pre-fill-in all of the consent forms for things like epidural, c-section etc just in case you need them later so that you don't have to try and roar answers to questions you don't know through contractions when you just want them to get on and do it. So if that is possible, I highly recommend it, obviously giving consent doesn't mean you'll definitely have those things, but it means if you do need them you can skip that one step.

GrumpyHoonMain · 25/11/2019 21:03

I would suggest you use the NHS Choices template rather than create your own plan. They tend to get treated more seriously

paintedfences · 25/11/2019 23:02

I really strongly disagree. I think it's absolutely an excellent idea for people to have their birth preferences written out - just understand that it's not an actual 'plan' for the birth, but your preferences (and why why why were they ever called that?!) it is just a helpful way for the healthcare team to know your preferences quickly and easily, and adhere to them as much as possible depending on how the labour unfolds. my birth plan had a section for different scenarios, because it's so unpredictable - my one for if a c section was required for example said I'd prefer to know what was happening as they were doing it as I panic when I'm not told anything, whereas some people would rather not hear the nitty gritty and could reflect that in their birth plan.

You need to be educated about the choices you can make during your labour (of pain relief, positions, monitoring, whether you want vaginal examinations or not, whether you'd like help from the midwives on trying some different positions, even to mention on it if you are a survivor of sexual assault) to write your birth preferences, which can only ever be a good thing. I honestly think it's the bloody name that causes trouble!

When used as a helpful way to safeguard the individuality and respect for the person giving birth and encouraging the person who is about to give birth to know their various options and understand the BRAIN acronym used in birth, they're invaluable for the hcps, and for the women in my opinion.

It's just that fecking name!

Makinganewthinghappen · 25/11/2019 23:13

I have made a birth plan every time (six births) that said I wanted to have pain relief as soon as possible and as much as possible.

Every single time all that has been available is gas and air and even then only right at the end. In fact for 3 and 4 there wasn’t even gas and air - although I was helpfully allowed some paracetamol Hmm.

Birth plans are nice to make but in reality it seems to be a case of get what your given most of the time!

If I ever did (!) have another baby I would just write all over the notes in massive sharpie NO INDUCTION.

paintedfences · 25/11/2019 23:13

@CAG12 check out the positive birth company digital pack - it's amazing, I learned so much from it about the physiology of birth and how the midwifery system in hospitals works here. I was able to advocate for my wishes when speaking to hcps and taking their advice and that made the whole thing so much easier, just being able to understand my options and work from the situation I was in.

I heard about the pack on here and wave it at every pregnant woman I meet, including a lady at work who emailed me to say thank you - not because she had the perfect candlelit pool delivery, and neither did I, but because it gave us both the tools to navigate when we were in it, and kept us calm, which helps to increase the likelihood of having a positive feeling about the birth.

paintedfences · 25/11/2019 23:15

Jesus @Makinganewthinghappen that's appalling! What hospital was that if you don't mind me asking?

GrumpyHoonMain · 25/11/2019 23:30

@Makinganewthinghappen - that is awful. What was the reason why they couldn’t offer pain relief stronger than G&A? Was it because it was just a MLU?

RightYesButNo · 25/11/2019 23:37

Since you’re at 23 weeks and making these decisions soon, it may also help you to have the science.

In a study of 300 women in which 143 of them had birth plans, those with birth plans reported feeling “less satisfied and felt less in control of their birth experience than those without a birth plan.” Yet they were no more likely to have a Caesarean section, and in fact, were less likely to receive interventions such as rupture of membranes or oxytocin.
Here’s the study: onlinelibrary.wiley.com/doi/abs/10.1111/birt.12320

It seems that having a birth plan can affect point of view, maybe? I hate the idea of any mum feeling like she’s “failed;” it’s awful. I think calling them birth preferences could really help, because, while it may seem ridiculous, the word “plan” does have a lot of connotations. We have so many sayings about plans that indicate that one is losing control: “best-laid plans,” “not gone to plan,” “going off plan,” “not sticking to the plan,” “plan B” (indicating failure of plan A), and on.

I think answering questions, with your partner so they’re aware as well in case they need to advocate for you, about what you’d prefer, if you have an option, is a good idea, and that’s about it.

GrumpyHoonMain · 25/11/2019 23:50

I think a lot of women don’t realise they can say no to anything in childbirth, and when they do medical professionals either find another way to do what they need or try to explain why they want to do something.

In the case of forceps delivery, for example, if the baby is high then they are far less likely to work and you may need to be rushed into a emergency section anyway — so you then need to recover from a section and an episotomy and any damage the rotational forceps caused inside you. Plus the risk of blood clots (which are higher for assisted and c-sections) increases even more so. Remember forceps aren’t always used in life or death situations - they can often be used because of hospital policies regarding length of labour even if you and your baby are fine.

If you say no to forceps and your DP is aware too and can advocate for you then you will get an emergency section if it’s truly life or death so the recovery may be easier, or they will try other things to get the baby out or turn if possible.

Another example is an epiostomy - for example many midwives will offer one if you chose an epidural without offering to help you to a side lying position first (which can help things along). If you put on your birth plan that you want to side lie during an epidural they are aware and can try to make it happen.

Makinganewthinghappen · 26/11/2019 00:01

Grumpy and painted - I don’t really want to give the hospital but I am in the north west of England.

No one particular reason tbh - just constant “wait and see in half an hour” “try a bath” then “oh it’s too late for that!) .

I was u set consultant care for all deliveries because of another condition / 4 of them were induced at 40/41 weeks. The last one was the worst because they insisted on a drip induction rather than the gel (don’t know what this is called). Then gave me way too much - leading to one basically hour long contraction and a huge bleed. It was a total nightmare .dh and I asked repeatedly for pain relief but none came other than gas and air .

Ellisandra · 26/11/2019 00:01

I wrote “Birth Preferences” 12 years ago, because it was quite regularly discussed on forums that it was a preference not a plan. I was actually perfectly capable of making a plan without being so stupid as to think that guaranteed my wishes - but I used “preferences” as a way to signal to my midwife that I wasn’t stupid.

My midwife referred to it. I felt comfortable that I had expressed myself - I didn’t trust my now XH to help advocate for me at all, should I need it.

It went very close to plan, nice for me. I didn’t get a water birth which I would have loved - but just because it was on my plan didn’t mean I didn’t enjoy my birth experience without it.

@RightYesButNo I will look at your link when it’s not bedtime. I wonder if it’s just a correlation between birth plan writers and less satisfaction.
Women who prefer to feel more in control might be plan writers to exert control and more affected emotionally by variation from what they hope for.
I’d be surprised if there’s a strong causal link that it’s the act of creating a plan that leads to dissatisfaction.

GrumpyHoonMain · 26/11/2019 00:21

@Makinganewthinghappen - considering that happened in all of your births that suggests a systematic failing in your quality of care. Did you ever complain to PALS or get a debrief? I know some hospitals induce in ADAU or a general ward and then move you to the Labour Ward later but you still should have been offered something.

BubblesBuddy · 26/11/2019 00:34

I’m amazed at the detail people go into. I can see why busy midwives and doctors do not always comply with detailed plans. There are things mentioned on this thread I had never considered! I just wrote “Epidural” for both of my births and got one. I really didn’t care what they did as long as I was relaxed and the births were ok. I went to sleep with no 1 in labour and had to be woken up to give birth. Best non Plan ever!

My NCT Group really disapproved of interventions. I gave up listening as there was a hushed disapproval when I mentioned the E word. Years ago now but I really wouldn’t advise the NCT. I hadn’t realised it was so disapproving of certain views.

RightYesButNo · 26/11/2019 00:35

@Ellisandra I would agree that it’s not just the act of writing the plan that leads to dissatisfaction, and in the study they simply state the findings and then that more research needs to be done to improve satisfaction. However, what I think is most telling is that the “plan writers” are having less interventions and are still less satisfied than those having interventions. This seems to me to maybe coincide with the idea others have put forward that birth plans can increase the pressure to have either a “perfect” birth or a “completely natural” (ie any intervention at all is considered some kind of failure) birth.

I think it may be less about control and more about “natural” birth advocacy (I put natural in quotes because in my opinion, anything that gets the baby born safely is natural enough, unless you’re birthing a robot!!!).

Sleeplesssleepseeker · 26/11/2019 00:36

I used the birth "planning" process as an opportunity to explore my personal birth preferences. I found it a useful process and I think it should be seen as a tool for women in this way.

I did write a plan during both my pregnancies, but I was under no illusions that things would be likely to go to plan. First birth definitely didn't, second birth really followed plan to the letter!

I wasn't traumatised about my first birth going the way it did, but actually having a plan gave me a sense of power in a situation where I felt a lot of choices had been taken away. So for example I insisted on being as active as possible during labour, in a situation where generally most women would have ended up stuck in bed. The fact my birth plan said that keeping active was important to me was very helpful in kick-starting this conversation with the midwife and actually it turned out that a minor adjustment of thinking and a compromise on my behalf meant I was able to labour comfortably away from the bed.

So personally I wouldn't sack the process off altogether but perhaps redefine it slightly. And emphasis on the need to be flexible and adaptable.

Makinganewthinghappen · 26/11/2019 00:36

Grumpy I have never complained tbh it just felt like everything was great I have always had no issues (just normal births and healthy baby) so I felt a bit silly complaining.

After the last one I did ask about things just because they broke my waters about 16 hours before I gave birth and after about 8ish I was running a temp and needing paracetamol bring it down. I was never well after that just on and off unwell, with temps and little niggles until my daughter was 4 weeks old. I collapsed with pneumonia and sepsis suddenly, was rushed in extremely ill and in for a while separated from my baby.

I wanted to know if any part of that could be linked to care I had during birth since the temps and general ill feeling had started then. But was told no so that was that.

I still feel like it did but it was 4 years ago now!

Makinganewthinghappen · 26/11/2019 00:38

I think with the first I had the unfortunate combination of being a student and looking even younger, I was told I wasn’t on labour until I was pushing- and left on the ward.

With the last few I think it’s a case of “well you’ve done before a few times so suck it up!”

Countryescape · 26/11/2019 04:41

That’s why I never made a birth plan. If I had I would have been in an even worse state than I was. 30 hrs of labour, 3 1/2 hours of pushing, blood transfusion needed, forceps, episiotomy, injured baby, every imaginable intervention possible. The whole thing was horrific. My vagina never recovered and I had ptsd as well.

Fightingmycorner2019 · 26/11/2019 06:48

Birth plan = have a baby

I agree . How
Many times have i wryly smiled at first time mother waxing in about their planned natural births who end up with crash c section or forceps . Not because I am
Pleased they had a stressful birth but you have No choice , what happens

Anyway I Completely agree

NearlyOutedMyself · 26/11/2019 06:57

I had a birth plan which was essentially 'give birth', pain relief yes, no epidural. When I was admitted to the deliveryroom after induction, apparently this wasn't good enough so someone drew up a birth plan and told me to sign it. She made me feel like I'd not done my homework or had left it on the bus Hmm. Thankfully, she didn't deliver me.

my2bundles · 26/11/2019 07:01

I agree that birth plan =have a baby. Plus have it delivered safely following the medicall advice. I had a birth plan with my first, it was all calming music and water birth. The reality was completely different with lots of medical intervention to keep myself and my baby alive. With my second and had no plan and the whole birth was much more relaxed as a result.