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...

The doctor's job is to advise you of the options in any situation, and give you the benefit of her medical expertise to tell you what she believes is the best course of action. It's up to you what you consent to - it's your body. Maybe it's worth reminding your doctor of that.

doctors understand common law and its application is hammered home by gmc,and nhs trusts

marzipan

Your poor friend.

Scottish - if that's what you meant, I'm sorry I got the wrong end of the stick. It was the 'that's a wish list for 1:1 care at the Portland' that made me respond to you specifically, as well as terming this sort of birth plan as 'ethereal'.

I really don't believe that having a firm grasp of what you want means you need private care and are completely unrealistic, though agree that a good rapport with caregivers and an understanding that situations can change is also very important.

I do think that women have a tendency to come down hard on other women's choices - especially if they see them as 'tree-huggery/lentil-weavery' when they've had what they feel is a wake-up call to reality.

A birth that sticks to your plans IS possible and happens often - having a positive view, being confident in your body and feeling supported in your choices is a big part of that. That's why I get het up about this subject!

yes rebecca, I shall do that and speak to her.

I understand that a medical situation may require a totally new outlook on the whole birth. All I want is a healthy baby and live, but I also don't think that not wanting to be traumatised is a wish too far.

I was simply v freaked when the doctor said she once threatened to hand over a woman to a doctor the lady didn't know as her sister had voiced her concerns over deviation of birth plan. I'm in a foreign country already, I could end up with a total monkey botching me. And all that because I didn't consent to something.

Thanks Kitty - it sounds like it has been difficult to be heard where you are. I hope you get it how you want it in the end and are able to get your voice heard.

Still a little confused about the instrumental thing - will talk it through with the midwife i think and the consultant when I see him next week. there seems to be a few of us who have had failed instrumentals and then CS despite others saying that wouldn't happen. I know i had a 5 1/2 hour second stage which led to failed instrumental (could see dd's head like marzipan's friend) before CS but in fairness to the staff, think they were following my birth plan which indicated that a CS was to be final option.

Will be following Rebeccacad's list as it seems v sensible!

It doesn't sound as if your doctor has the best grasp on how to make you feel relaxed and you are right - not being traumatised is not a wish too far.

Call your doula up tonight - she won't mind one bit - talk all of this through with her and she (knowing the situation in dubai better than me) will be able to help.

You don't have to have that doctor if you don't trust her and your doula will help you work through all of this.

If you have any trouble getting hold of your doula I have CAT messaged you my email address - feel free to get in touch.

rebecca, I will also use part of your list. Many thanks for posting it! Very kind of you to CAT me, I will most definitely get in touch. Must sleep now as I'm 3h ahead of you guys and my dd has nursery in the morning.

Thank you ginger, I wish the same to you. See you in postnatal and hope it will all go well.

Very interesting to read the contributions re physicality of birth and instrumental delivery. I will definitely speak to my midwife about this.

Goodnight for now ladies.

The list was Titty's - I just annotated! But do get in touch if you want to.

Sleep well.

To respond to the questin about instrumental deliveries / CS

A CS is always an option. However as the baby progresses down the birth canal you get to a point where an instrumental delivery becomes much safer for the baby, as a CS will mean pushing the baby back up the way again.
So the instrumental is far safer.

If the instrumental is not successful, then the CS becomes the only option, even though it is more dangerous than an instrumental would have been, had that been possible.

It isnt that a CS is completely impossible past a certain point, just that at that point no-one would try it before an instrumental delivery because of the higher risk.

Thank you tiger. Does that mean therefore, that i shouldn't refuse instrumental intervention and ask for a CS at that point instead?

You could ask about the relative safety of both options for the point that you are at, and then make a judgement from there, though may have to be a quick decision depending on how the baby is coping.

Or explain beforehand that you only want an instrumental delivery to be offered if it is the safest thing at that point, and that all other things being equal you would prefer a CS to an instrumental?

Thanks zapostrophe I'm sure this has really helped Kitty in her decision making at a time when she's clearly feeling stressed and anxious. You guys are so supportive and helpful it makes me feel all warm and fuzzy.

Let me translate your post in to human for you.

'You may find that, despite everything you say in your birth plan, things come up that you aren't expecting. That's when your doc should let you know that she advises another course of action such as an episiotomy. You may want to ask her what the benefits, risks, alternatives are and what happens if you do nothing and give it 10 mins. You can then decide what you want.

All that being said, it's worth stating a preference as that way your doc will know that you'd prefer to tear rather than have an episiotomy and should act accordingly'.

kitty if you are overseas its a very different thing, I read OP and assumed you in the UK

can you speak with other expats who have given birth, it might not be all that bad? I think 2nd birth, plus doula, means you might be onto a winner!

I can see why you'd veer towards ECS

good luck

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

I usually suggest people choose no more than 5 items on the list - as a full A4 sheet tends to make tired staff go cross-eyed! (and occasionally antagonistic - not a good thing obviously!)

Got my ideas for some of these 'preferences' from the Royal College of Midwives "10 tips to help mothers have a normal birth" site.

It's really about how you want to be looked after, not necessarily about your 'plan' for the birth.

Really it shouldn't be necessary to say any of these things as they should all be part of normal good midwifery practice. Sadly normal good practice isn't what people always get when it comes to maternity care, as anyone who's spent time reading the posts on this board will know!

As a midwife I can say that tittybangbang's labour preferences suggestions are not unrealistic. Midwives should not find such a plan difficult to follow as it is essentially highlighting the preference for a natural, intervention free labour.
The forcep/ventouse decision is not straight forward. There are different reasons for either of these instruments are to be used. If the decision is a 'trial of forecps' because the baby has not descended well, then it is not unreasonable to request straight CS. However, if the baby's head is seen really easily when pushing, but the woman just does not have the ability to get the baby 'round the final bend', then ventouse/forceps is safer than CS. As a midwife I help women who are at the latter stage and need a 'lift out'. That means that I can use a ventouse (preferably) or forceps (if ventouse pops off) to help guide the baby out as the woman pushes.
Sometimes the swelling on the baby's head (caput) is seen but the actual head itself is still fairly high. THis is probably what happened to those who didn't understand why CS could be done when baby's head could be seen. There are very many variables when it comes to making a decision about a safe delivery. These should be discussed fully with the couple so that they understand the options.

Mears - thank you so much for clearing up the forceps/ventouse thing. It sounds like that was definately the case for me as I had been in labour for so long that I think I just didn't have it in me to push the baby out despite her head being seen. Maybe this time, it will be different! Fingers crossed.

Thanks again,

I liked your annotations rebecca and I copied the whole of titty's list so I can go through it and tweek what needs customizing

The reason why I'm afraid of forceps is the potential damage to the baby, wrong grip, the turning, damage to myself of course. I mean I want to literally walk away from this birth IYSWIM.

Oh rebecca I just had to laugh out loud and snort into my tea "You guys are so supportive and helpful it makes me feel all warm and fuzzy.

Let me translate your post in to human for you."

Tis okay, I have never experienced labour so I may well be uninformed and naive as of now, but I'm prepared to change my view if things go wrong and the baby's life is in danger. All I want is a healthy baby but I also would like not to be traumatized by it all. I'd prefer a GA and CS if it all becomes too much.

Thanks porca. I think I'm being churlish when I say Oh well, then I'll have a CS. I'm normally not the type to give in so quickly. I have sent a text to my doula and made an appointment tomorrow with my lovely caring midwife here so I'll be armed with questions.

titty, thank you for your input, I will look up the website you mentioned.

Mears, thank you for clarifying the instrument question. I just wish I was in the UK with good midwives trained like you. The ones here are not a patch on you.

Well I have experienced labour (and not just my own) and I don't think you are being uninformed and naive!

It would be worth asking your doula about planning a positive c-section in the event that an EMCS is necessary. A good proportion EMCS aren't actually that much of an emergency, in that there's time for you to ask for a quietish room, lower screen when baby's born, skin on skin immediately after birth if baby is doing well.

They won't be keen on a GA unless it's a dire emergency and they have to get the baby out at the speed of light because of the added risks to you and the baby.

I think the biggest issue is that you look into the options properly and understand them, so if the doctor starts talking about, e.g. forceps, you (and your birth partners) know enough to say, for example, "can we try ventouse first?".

FWIW, having a CS under spinal/epidural has less risks than a CS under GA so if there is time, they are likely to try that option first.

You need to be properly informed of why things might be used when and what might be riskier or impossible. Asking for something unrealistic is more likely to get the doctor's back up then informed suggestions.

There's list somewhere, suggested by a midwife I believe (anyone know what I'm talking about?) with a short list of things to ask in any situation. The first, if I remember rightly, is something along the lines of "is the baby in immediate danger or do we have 5-10 minutes to discuss this?".

Kitty

I think that the doctor sounds awful but bear in mind ( not to dismiss your concerns but as a way of feeling reassured) that the cultural and language difference may partly explain it. Many Scandinavians I meet are quite blunt and at least while travelling in Norway their perfect English sounded rude when they left out the pleasantries. As I don't know norwegian/ Swedish I can't say for sure but bear it in mind.

If she comes highly recommended she should be a good professional. If so, she will try to do the best for you and baby. The three doctors in my family would all probably risk a lawsuit if they thought they were saving a patients life. Also bear in mind UAE law is probably different from uk. It may even be that if sth happen to a national woman/ child as a result of sticking to what the patients requested she could end up in jail or worse.

My consultant (private) is v dismissive of birth plans too. That said his Wife had one. He jokes about them a bit but is happy to go through one with us. I think he is occasionally quite blunt but thats becauae he sees some women arrive with rigid expectations. His main points are always that labour is unpredictable and that intelligent and informed as I am I should know that I may be unable to speak / understand what is going on. And even dh may lose it.

We decided against a doula as we didn't want conflicting input during labour itself. We already get 1;1 care from midwife and consultant. But perhaps the doula will help - she may even know the doctor in question. She may know other doctors in the hospital.

Ps

I think that all the ladies who point out that the plan is a preferences list and is meant to prepare you and help the medics have it just right.

Perhaps if you're lucky all you need to do is point out to doc that you are not saying you know better than her and neither you nor your doula will be preventing her from doing her job. In an ideal world she will say she understands and will bear your wishes in mind but will need to do what needs to be done for you and baby. I so hope for you that's this is what she meant all along.

In any case it's possible instrumental delivery never becomes an issue.

Please take care and try to relax.