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...

Maria - the thing about control is that it isn't usually about what actually happens but how involved we feel in decision making. So labour may go its own merry way, but if women feel they are participating in these changes they will be happier with the outcome.

People who report PTSD after birth are most commonly united by feeling that things were done to them, rather than them participating in a decision. A woman who has a EMCS and perceives that she had no choice in her care may feel deeply traumatised. If she trials a VBAC for her next birth, and gets in to an EMCS situation again but is informed throughout, explained risks and benefits and agrees to an EMCS is best option she will feel it a more positive experience even though outcome the same. This situation has played out several times with colleagues.

A birth plan is step 1 in feeling involved in your care and while I agree women should realise that it isn't written in stone I do think it's a key part of feeling positive about birth - especially for a VBAC.

Rebecca, makes sense what you say. I agree. However, for each person who creates a birth plan in order to feel involved & have a sense of control (very important thing), there's another person who creates a birth plan because they are expecting and assuming they'll have control. Very different situations, in my opinion.

Cosmosis: what's been discussed so far is use of forceps/ventouse when the baby has reached a point of no return and cannot go back up through the cervix. You can also use forceps higher up if the baby has stuck whilst the head is still passing the cervix, in which case the obstetrician's judgement which to try.

Ah ok, that makes sense, thanks :)

Ignore my last: it's inaccurate. Apologies, don't know what got into me.

Forceps should only be used when fully dilated, so the cervix has in effect disappeared.

Low forceps ("lift out") uses curved forceps and essentially eases a well positioned baby out, working with contractions to get additional movement. You would not c-section in these cases.

There is also "high forceps", which uses straight forceps and this is used when the baby needs turning as well as lifting out. If the baby cannot be turned, then c-section becomes the only option, though it's something they try to avoid so far down

I'm a bit confused about the forceps/ventouse thing happening and then it not being possible for a c-section as that is exactly what happened to me with dd. (sorry to hijack but I am also thinking things through as far as a birth plan for a VBAC in about 5 weeks time and like OP, would rather opt for a CS than forceps/ventouse again)

I was fully dilated, ventouse = total waste of time as couldn't get it on her head. Forceps - got a grip but no shifting her apparently. CS then done - she was born with a huge forceps mark across her face so presumably they did have to yank her back up the birth canal in order to deliver???

I can totally see that a birth plan has to be deviated from in certain situations but its hard after then event to understand what on earth actually happened to you!!

ginger yes I'm also confused about this as surely most women who get taken to theatre are prepped for possible c-section, given higher dose of epidural etc, and then ventouse/forceps are tried. If they don't work, then c-section is next step. Or not?

Some people further up the thread are mistaking their local NHS maternity unit for the Portland Hospital!

Tittybangbang's list is totally unrealistic unless the labour ward is half empty when you give birth or you are paying for private care.

Friends and relatives in the medical profession have told me that if you want staff to pay any attention to your birth plan on a busy NHS labour ward then you have to be realistic - this means keeping it to one side of A4 paper, with bullet points which are as short and simple as possible.

Your midwife may well be looking after at least one other labouring woman - she won't be able to remember pages and pages of individual preferences about things which aren't that important or which she can just ask you about at the time.
Also, nothing pisses the staff off more than a huge long list about what you insist on having. You should start any birth plan with a statement along the lines of "My first priority is to make sure my baby and I are safe. I am flexible and understand that everything listed below won't necessarily be possible depending on how things pan out". Then just do a few bullet points of the things that matter most to you.

Finally to respond to the OP - you can't specify that you want a CS instead of instrumental vaginal delivery - you can express that preference at the time if it arises, but only the clinicians examining you will be able to tell you whether the baby has to be delivered with forceps/ventouse or not. This will depend on the baby's position in the birth canal. You have to trust that the NHS staff looking after you will make this judgment correctly, or pay for private care. Even if you pay for private care, you will still have to trust the staff looking after you to do the right thing. The same goes for tearing/episiotomy - obviously no one wants an episiotomy but if the midwife or doctor delivering your baby can see that you are about to tear badly, and in their judgment you would be better with a neat and easily stitched episiotomy, if I was you I wouldn't be refusing to allow them to do it!

Perhaps if you actually read the list you'd see it is a selection of options to choose from rather than a very long list - you can't have a natural AND a managed third stage now can you?

I've actually looked Titty's list and none of the items actually take the midwife any more time - some actually create less work. To illustrate this I have annotated below.

The only difference is the midwife has to read the plan at some point (part of her job) and check with you/birth partner if she can't remember. This is her job. If she's too busy to read a birth plan and check on your preferences throughout labour you are in a dangerously understaffed hospital.

Unless you are suggesting all women should have labour induced, forceps used, CS if they don't progress within a few hours and a managed third stage for speed, your post makes no sense.

Telling medical staff what you want in advance saves them time. Of course there are situations where the plan needs to change. I refer you to my other posts on this thread about informed choice and feeling involved in your care.

I am indignant that so many people seem to think that expressing a list of preferences to do with you body, your baby and your birth at one of the most intense and sensitive times of your life is unreasonable and should be a requisite of highly expensive private care. I am sorry that your experiences of the NHS have made you feel like this but you are wrong.

I am bowing out of this thread as it is making me too cross and I always vow never to be cross on Mumsnet .

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

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

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

If I have to be continuously monitored could you help me to maintain as much mobility as possible. part of midwife's normal job

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. this is the law - you have to seek informed consent

I?d prefer to get through the labour without pain relief and would like lots of encouragement and support to achieve this. midwife's normal job.She should be encouraging and supporting a woman in labour

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.
helpful for midwife to know in advance pain relief preferences

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

No directed pushing unless absolutely necessary. again less work

I?d like to use the pool for pain relief if it?s available. woman's right to birth as she chooses.helpful for midwife to know in advance that pool might be requested.

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

I would like a natural third stage if it?s clinically appropriate. woman's right to choose and again useful info in advance

I would like my partner to cut the cord/my partner does not wish to cut the cord. helpful to know in advance so they don't assume and cut themselves

I don?t want the cord to be cut straight away if possible. again sueful in case they don't often to natural third stage and need to be reminded

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. useful factual info

No medical students/I don?t mind if a medical student is present. women's right to express this and saves midwife time in asking

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

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? very moderately expressed piece of essential info

My birth partner is squeamish/anxious/wants to be fully involved. again saves midwife time in the long run

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

If I need a c-section could the screen be lowered as my baby is lifted out? useful info, saves time on the day

We don?t know the sex of our baby and would like to discover it ourselves rather than be told. vital if you want this ot put it on the birth plan in bold. doesn't take the midwife any extra time at all

errrr.....I have read the list. I understand its a list of options. I'm not stupid - just trying to be realistic.

I just don't think any midwife with two or three labouring mothers could possibly be expected to simultaneously remember each item on the list above, as it relates to each woman she is looking after at any one time, which is why she will inevitable end up simply asking about the items on the list in any event!

If you have a short list of the really essential items, she might actually remember that. Believe me - most doctors and midwives will just be irritated by a list as long as the one you have posted above. Even if they aren't irritated, they won't remember it.

I won't bother responding in more detail since you are "bowing out" (aka not coming back to respond to sensible argument!).

However busy the NHS midwives and doctors are, surely there can be no excuse for what the OP reports her Dr said, i.e. that her wishes don't matter, that she (the Dr) will do to her whatever she sees fit, implying that she won't bother to ask for consent?

I'd be terrified and insisting on a homebirth (or more likely in my case spending my savings on going private) if any doctor had said that to me, it's just appalling.

I'm sure we all understand that a busy NHS ward probably isn't going to be able to accommodate all the little luxuries and preferences, and that sometimes there can be unexpected complications during a birth...but not being forced to submit to medical treatment or operated on without consent, surely that's a basic human right which shouldn't be reserved for those who can afford to pay £1000s for private care?

My birth plan would probably have one point only - no one as much as touches me without my explicit consent, but it's sad and upsetting that I should have to spell that out. I guess I'm more sensitive to these issues than most due to particular issues from my past, but even so, I feel sick with fear at the thought of giving birth on an NHS ward if that's what it's going to be like, and seemingly reasonable people will think that's perfectly OK...

doctors can't do anything to you without your consent - that's assault.
There is a difference between seeking your consent on a flexible basis as and when different situations arise, and you pitching up with a lengthy document spelling out all sort of contingencies which may well all go out the window anyway.
I don't think anyone on this thread is suggesting that doctors should be able to do what they want to you without asking first! The issue is about birth plans - not consent.

Ok, couldn't resist!

I agree that you need to be aware of what the most important things are to you, but not that a list as long as above will irritate most midwives/doctors.

I have been at births with a longer list and (though have asked couples to highlight the most important items in bold and have 'flagged' these with the clinicians myself) . I have been told how helpful they have found the info by midwives themselves. At a birth 8 days ago a midwife said afterwards how useful it was to have everything spelled out so clearly when she hadn't met the couple concerned before.

A birth plan isn't something midwives are expected to remember by rote , but it gives them an idea, something to refer to as they go between patients (a memory jog sometimes!) and they can of course check preferences with the mother and her birth partner throughout labour - having the plan just helps them from not asking unnecessary questions especially when shift changes happen.

Women in labour progress faster if their brains aren't stimulated too much by questions - of course the midwife is going to need to ask things, but if you have a particularly chatty one driving you mad your partner can quietly ask them if they would mind taking a good look at birth plan when they have a sec as Mrs X is trying not to talk too much.

Of course there are some professionals who'll find any active participation in care annoying, but it's quite good to have them sussed out early on and try and avoid them like the plague.

If you've had a bad experience before you probably have strong views on what you want and don't want and your preferences may be longer. If you don't ask you don't get!

I've read plenty of stories on here (and elsewhere, and heard in real life) of episiotomies, for example, being performed without consent, or without even telling the woman what was being done to her, never mind asking!

Agree this should be considered assault, but that doesn't seem to be a universally held view...

ILoveDonaldDraper you say "Finally to respond to the OP - you can't specify that you want a CS instead of instrumental vaginal delivery - you can express that preference at the time if it arises, but only the clinicians examining you will be able to tell you whether the baby has to be delivered with forceps/ventouse or not. This will depend on the baby's position in the birth canal."
I am due to be induced next week, my baby is back to back and they have said he is also large, I want specified on my birth plan that under no circumstances do I want a forceps delivery, and as they already know that he is not it a good position AND he is large, if for whatever reason things do not progress I would like a CS.
Do you think this is unreasonable or that they are likely to ignore and do what they like anyway?
If I have it explicitly specified that I do not want forceps used, could they just go ahead and use them anyway?

Thank you all for contributing and helping me to see this more clearly.

TBB, this is a bit how my birth plan looks and I'll take rebecca's advice on board to focus on the most important parts and leave the lesser items out. Thank you.

onimo, porca, maria and amidai, I think you hit the hammer on the nail. She comes highly recommended, very good track record but very blunt and as you so aptly described 'charm free'. She's Swedish, hence the bluntness I guess.

I'm in Dubai so not much choice re good doctors/hospitals. I have hired a lovely doula though and look forward to having her by my side.

I think just seeing that bed and picturing myself on it, writhing in pain scared me. I know it doesn't have to be that way but I have no concept of childbirth as last time it was an ELCS and none of my close friends have done it so I cannot ask. I'm aware that every woman experiences it differently. I think I'm just a chicken.

Mini, I hope you and your LO are okay now. I understand that I cannot control the situation and my body. Letting go will probably be the hardest bit for me.

I will go back to my plan and highlight a few important bits and focus on the baby, too. Must ask midwife and doula more about 3rd stage, not really given it a lot of thought.

They can't do a forceps without your consent. However if the Drs feel that a CS wouldn't be safe they don't have to do one.

Great you have a doula - talk through your concerns with her.

NW20: yes! Tell them you want to avoid an instrumental delivery if at all possible, and that you would prefer to go straight to c-section rather than attempt "high forceps" (the turning sort). Unless there is another compelling reason to avoid c-section, I think there's a very good chance they'll go with it as it's already known you have a large baby and a trickier presentation. [I think they might be less receptive, on medical grounds, for a "lift out"].

But hope it all goes well, and doesn't come to that.

Kitty, i was terrified too, i was the one at NCT classes who left before they played the birth video.

in reality, after 2 NHS births, i found the midwives great. i didn't write out a birth plan but had key things that were important. (i started writing it a few times, found it stressful and on the advice of my sister just spoke to the midwives). In early labour we talked about it and dh was aware of what we both wanted as he had been to the classes with me.

but i guess i was lucky, i had two easy straightforward births.

oh yes, one of my key things was "any sign of any problem then just do a CS. I have NO problem with a CS!"

also confused by what people are saying about CS. My friend had an emcs after they tried ventouse and forceps and could see the baby's head but couldn't get him out

Oh, I think I was a bit too slow. Only just caught up with the rest of posts. Many thanks again.

Yes Ephiny, that's exactly how I feel, that she will merrily do what she sees fit, without caring for what I want nor without giving me options. She said that there was once a woman who had her sister in with her and the sis said: we stated we didn't want this and then my doctor said if that's the case she'll hand the birth over to another hospital doctor.

I am terrified, absolutely terrified of her dropping the towel if I say NO to something and her leaving me to a doctor I do not know. For those who didn't see it: I am in Dubai, United Arab Emirates in a private care hospital. Medical care here is basically 3rd world standard if you don't get a good doctor and into a good hospital. The unknown is driving me crazy.

Ginger, I feel for you, I am still insisting I don't want forceps though.

onimolap thank you for that, I am definitely going to say that, I am just aware that they are reluctant to do CSs until it gets to an emergency situation which obv I would like to avoid.

My friend had the same situation as me and they let her go for hours pushing, before the baby became distressed and she was exhausted and then they took her for a CS. I would really like to just opt for a CS before it got to that stage.

rebecca,no you paraphrased me wrong. i didnt say hospitals dont have commitment to supporting women's choices - i said realistically dont get too het up on a wish list.and do form an honest ongoing rapport and dialogue with staff and be prepared for changes.clinically a situation can alter in minutes. the change ability to acomodate change is important too