Doctor said she thinks Birth Plan unnecessary

[kittyonthebeam]

I went to see her yday for scan at 36+2. All good, baby has dropped and might be less than 3 weeks from now.

I am going for a VBAC after an ELCS. I wrote a birth plan but Dr. said she feels at liberty to ignore stray from it.

My main concerns are I do not want forceps but would rather have a CS then. I do not wish to have ventouse either but it sems medically a CS is no longer possible in that case as baby in birth canal. (Is that correct.)

I do not want an episiotomy but would prefer to tear naturally. I want body contact straight after delivery and no tugging on placenta until painkiller is working.

I don't think I am being unreasonable but she said her main duty is to make sure the baby is born healthy and I am healthy, too.

Basically, MY wishes don't matter, she'll do it as she sees fit and I am and I'm scared of the birth now.

I toured the hospital today but I feel like caving in and having another ELCS. I'm so scared of the unknown...

Gosh, she sounds lovely! not

i agree that the main thing is baby is born safely. but that doesn't mean you shouldn't have a birth plan and that she shouldn't try and stick to it, and consult you/your birth partner if she needs to stray from it

i would seriously consider asking for a different doctor if this one is not taking your wishes and concerns seriously.

remember that they cannot actually do ANYTHING without your permission. that goes for forceps, ventouse, episiotomy, the lot. they HAVE to ask you, unless of course it really is a matter of life and death
you may well find that in the event it all goes ok. i would still do the birth plan, and also make sure whoever will be with you during labour knows precisely what you do and don't want so they can speak on your behalf if necessary

I think that is correct about sometimes the ventouse / forceps being the only way rather than a c section.

However, you do have a right to a birth plan, even for things such as do you want a managed 3rd stage / do you want baby to have vitamin k injection etc etc etc?

I would call your community midwife and talk it over with her. Fwiw I am 38+2 and already have one ds, neither time has anyone even asked to see my birth plan.

If the baby is stuck and low down in the birth canal then ventouse/forceps is generally safer than pushing the baby back up.

I had an ELCS partly because I wouldn't consent to another instrumental delivery and they could not guarantee they wouldn't perform one.

I would def want a birth plan though.

I think there is all the more reason to do a birth plan here. this is yesterday is quite right that they cannot do anything without your permission. It is illegal for the medical profession to do anything without your consent unless you've been sectioned or they have a court order.

I'd be tempted to write your birth plan and also a covering letter explaining that you feel strongly that you would like this plan to be adhered to and that you are aware that legally the staff will need informed consent from you to waver from it. I would send a copy of this by post to your doctor, your midwife and the supervisor of midwives explaining that you have felt compelled to put this in writing formally because you are anxious about your choices not being supported and your wishes ignored.

Of course there may be instances where they feel they need to do something different and this is where you can ask for an explanation before making a decision.

If you feel anxious about this doctor you can request another.

It is your body, your baby and your choice - as soon as you've put something in writing so strongly they will be very careful not to do anything without your permission in case of legal reprisals later.

I'd also be tempted in the letter to request another appointment with doctor to go through your plan again as you didn't feel you were listened to last time and also talk over with your midwife.

Have you got a DP or friend you can take with you to another meeting?

The doctor is medically correct: when the baby has travelled down into the vagina you can no longer have a c-section as pulling the baby back up through the cervix would cause you permanent damage. If this happened to you, then instruments really are the safest option. You might just manage to avoid episiotomy with ventouse, but not with forceps. Also, with instrumental delivery, you've interrupted the natural process to such an extent that natural third stage isn't an option either.

So, even though her communication skills sound dire, what she's telling you is grounded in medical realities: you can never guarantee that instruments will not be indicated as the safest option.

she is a tad charm free, but essentially she is telling the truth. when it comes to some situations they have to get the baby out!
noone wants episiotomy, noone "chooses" to have ventouse but the curcumstances occur and at the end of the day the baby is more important than a birth plan

i can completely see both sides here
we write birth plans to express our wishes
but imo they are only wishes, desires, and we do have to trust the doctor/midwife to make fast decisions to ensure the safety and wellbeing of us and the baby.

You saying that you will not have forceps, ventouse or an episiotomy, well what is she supposed to do if these are needed? a CS isn't an option by this stage, she may indeed have to "ignore" your birth plan and get on with getting the baby out the fastest and safest way possible.

but she was v insensitive, but maybe you were coming across so forcefully that she felt you needed a reality check?

She was being honest & truthful, if insensitive. Birth plans are fine, but a doctor's primary concern is to deliver a healthy baby & to make sure the mother is healthy too. If it comes to that kind of decision-making, the birth plan will and should be ignored.

Birth plans are there to express your wishes. If what you are wishing for is medically impossible/unsafe/inadvisable, it's going to get ignored.

Saying that you would like ventouse to be tried before forceps should be fine. Saying that you don't want instruments and would prefer a C-section is less fine because it may not be possible.

Saying no episotomy if instruments not needed should be fine as this is supported by the current evidence base. But if forceps are needed, an episotomy may be essential.

Saying you want skin-to-skin contact straight after birth should be fine, but be aware that if baby needs medical attention, this may not be possible (some people use a phrase like "unless this isn't possible for medical reasons").

Re. the 3rd stage, are you definitely having a managed 3rd stage? They may not be able to wait for painkillers in that case - my understanding is that they only have a certain amount of time to safely get the placenta out.

While the doctor was definitely insensitive, it does sound like you're setting yourself up for disappointment by writing an unrealistic birth plan atm.

birth plan is a wish list,statement of preference.but the can be deviated from and are not always possible to implement.clinical decisions may necessitate that plan isnt possible

I agree that birth plans need caveats - but there are very few situations where you don't have time to say 'In know you wanted X but we now think Y because of Z. Do you consent?'

I doubt Kitty would ever put her baby in danger - but you are right that she should understand that there are situations in which the doc may want and need to deviate so she isn't disappointed.

This is why it's sometimes a good idea to call your birth plan 'birth preferences' instead.

But, if you don't have faith that your wishes are being listened to, that can really be frightening and it doesn't sound like this doc was supportive of kitty's choices in advance which is making her fearful. This isn't good enough.

There are cases where alternatives can be explored, when a doc wants to do one thing and the mother had wanted to do something else. e.g. Doc:'You aren't pushing baby out quickly enough, we need to use instruments'

'Is baby in distress at the moment'

'no'

'Could we try a change of position for 10 mins - e.g. squatting and see if that helps and then reassess, or is my baby in immediate danger'

'We'll monitor heartrate during that 10 mins and if baby shows signs of distress we'll need to use instruments,but otherwuse let's try other position'

If women feel they have to do blindly what medical staff say, without information to support that course of action, we will never see an improvement in maternity services.

The key word here is blindly - there are lots of instances where a course of action is necessary and a few words of explanation and consent from mother can turn a traumatic negative experience in to a positive one.

But a 'Doctor knows best, silly mummy for wanting it a certain way, I'll do what I think on the day' attitude is not acceptable and Kitty shouldn't be made to feel unreasonable for not being happy with her care.

Kitty, whereabouts are you? Am thinking where you might be able to get some additional support.

Some other suggestions for a 'birth preferences' sheet:

My birth preferences

I want an active labour so please encourage me to move around if I?m not too tired.

I?d like to be left to get on with doing things in my own way as much as possible.

No internal exams unless clinically indicated/ until I feel ready to push/ unless I request one.

If I have to be continuously monitored could you help me to maintain as much mobility as possible.

If I need interventions could you please explain very clearly what you want to do and why ? to me if I?m able to listen, or to my partner if I?m unable to listen or speak coherently.

I?d prefer to get through the labour without pain relief and would like lots of encouragement and support to achieve this.

If I?m not coping I will request pain relief, but I would prefer you not to offer it to me.
OR
If you think that I need pain relief ? I look like I?m not coping - could you offer it to me?
OR
I?d like an epidural /pethidine as soon as I?m in active labour.

If changing position in second stage will help me get my baby out more easily, could you strongly encourage me to do this?

No directed pushing unless absolutely necessary.

I?d like to use the pool for pain relief if it?s available.

I would like/don?t want to deliver my baby in the pool if possible.

I would like a natural third stage if it?s clinically appropriate.

I would like my partner to cut the cord/my partner does not wish to cut the cord.

I don?t want the cord to be cut straight away if possible.

I?d like my partner to catch the baby if the birth is straightforward and the midwife is happy for him to do this.

I would like a managed third stage.

No medical students/I don?t mind if a medical student is present.

I?m happy/not happy to have a student midwife assisting my birth.

I intend to breastfeed and would like to hold my baby straight away. If it?s not possible for me to do this straight away and my baby is well, could my partner be encouraged to have skin to skin contact with my baby instead?

My birth partner is squeamish/anxious/wants to be fully involved.

If I need a c-section I don?t want/I want my baby cleaned up before I hold him or her in recovery.

If I need a c-section could the screen be lowered as my baby is lifted out?

We don?t know the sex of our baby and would like to discover it ourselves rather than be told.

tbh,dont get so hung up on a plan.be aware situation can and will change - be able to articulate yourself without being too rigid.sometimes mums write very specific unrealistic and ethereal plans that bear no relation to birth

Tittybangbang: this all sounds great (in an ideal, a-bit-rose-tinted world). But how on earth will the midwife / midwives / doctors remember all this? They'll have to be checking the birth plan before they make any move / say anything. The mind boggles .

titty,that is a wish list for 1;1 care at the portland.nor representative of most busy labour wds at all

of course they won't remember every detail, unless they've got photographic memory but it gives them an idea, they can refer back and of course they should be checking with mother or birth partner before doing anything major.

At a birth i attended a week ago they had a 5 page preferences sheet which even i had reservations about. they highlighted key things in bold, i talked it through with midwives when they arrived. They said it was a great plan and they'd do their best to stick by it. They had to deviate twice, but let mum know in advance, had a discussion and she was happy.

sorry no caps, bf-ing as i type.

consider the big what ifs,and overall try get good rapport with staff,open and frank discussion and dont fret about a bloody long wish list

Scottish - I'm afraid that's just not true. Hospitals have a commitment to supporting women's choices in labour.

Of course wards are busy, but that's no reason you shouldn't have good care. If you don't ask, you don't get and, in a situation where MW is looking after lots of patients she is, unfortunately much more likely to listen to the person who states wishes clearly and consistently that someone who is too afraid of being a bother to request anything.

If you were having an operation for a heart defect, would it be acceptable for them to chose to operate in a faster way that would give you a bigger scar even though you had discussed in advance that you wanted to have a longer procedure that would give you a neat scar across your chest?

Of course they could see more patients this way, but it would leave you with something you would carry around with you for the rest of your life that could have been avoided.

Just because we have a national health service does not mean corners can be cut. Asking for your wishes to be respected is empowering and necessary and not something anyone should be made to feel silly for.

My birthplan was never read and the situation I found myself in changed the possibilities beyond belief (had to be induced, different hospital due to change in risk, monitoring etc) but I'm still glad I wrote it. I had my DH and Mum with me and I spent ages discussing it with them both beforehand so they were well prepared to voice my wishes.

The birth I had was as near to the plan we had made as it could have been under the circumstances.

Rebecca, you're right about all this on principle, but really, can't all this be discussed during labour, as things unfold? Surely things may change so much that some/lots of the items on the list may be irrelevant in the end?

I feel that it's much preferable to have an advocate (eg husband / doula etc) than to have a super long birth plan that, to be honest, will only irritate people & will be seen as an expression of being precious.

i THOUGHT my birthplans were neverr read

i was wrong

when i had ds2 i didn't even think they HAD my birthplan, but they did things i had specifically written down, without asking me. and when i was talking to one of the midwives afterwards she confirmed she had read it

so even if you don't think your plan has been read, it may have been!

i agree with rebecca 100%

maria obviously there are situations where it all goes out of the window

but to be honest even a quick glance through a birth plan lets a midwife know what sort of a birth you would like

no, she won't remmeber every little thing, but she can see if you're a no pain relief, baby straight on you, breastfeeding mum for example, or whether you would like to be offered pain relief asap, have baby wrapped up and then help with breastfeeding

it gives them an "idea" of what you want. I don't think anyone is suggesting that it's set in stone or that it shouldn't be changed.

and yes, i agree too that it's really important that whoever is supporting you knws what you want (as I said in my first reply)

Is that right re CS - my friend had a trial by foceps but ended up with a CS so it must be possible?

thisisyesterday, yes of course I agree that a birth plan may give an idea to the midwife reading it what sort of birth one would ideally like.

It's just that I think lots of times women / their partners have unrealistic ideas of what birth will be like, and how much they will be able to control events, and birth plans can (sometimes) create an illusion of control when there is little we can control in labour/birth (be it homebirth or hospital delivery)

Totally agree Maria, an advocate is the best thing to have, but having a birth plan and an advocate is even better ! That way, everyone knows (or should know) what you prefer in advance - can refer to plan without bothering you if you're concentrating on labour and your advocate is supporting you.

As things change, progress, need to be discussed that's where your advocate pops up to remind of birth plan and help you understand a new situation if there is one.

Each method of informing them of your wishes works in a different way and is complementary.

I really believe that good health care professionals welcome a birth plan.