Midwives Attitude to Birthplans

[Hermya321]

I went to my first antenatel class yesterday at my local birthing centre and it came round to discussing labour, all was going well until someone mentioned birth plans.

The Midwife started then talking about how pointless birth plans were and that she'd rather chat to people rather than get paper shoved in her face (now I can understand the bit about paper not being shoved in her face).

She then continued on her rant about how useless they were and that she wouldn't go to a mechanics and tell them how to do their jobs, and that she didn't appreaciate being told how to do hers.

I did find it a bit bizare to be honest, maybe I'm being naive but I thought the majority of midwives encouraged you to write a birth plan.

I thought the point of a birth plan was to note down the things that you would like where there are choices and decisions to be made, not to tell the midwife what to do. I would find another mechanic if I didn't agree with his recommendations for fixing my car...

Sounds like the midwife isn't very good at respecting a woman's choices.

next time ask her what are her views on home births. I can't see her liking those either.

Knowing what I know now, I'd be writing a letter of complaint to the supervisor of midwifery.

Foxy She did come off like that slightly, I don't think it helped that we were in a class of first timers as well. I'm so glad I'm taking in a doula, not that I think all midwives are the devil incarnate by any stretch. I just want to make sure there is an extra person in there with us to enable us to be able to make choices without feeling presured into them.

running Thats what I thought as well.

Birth plans pointless?

OK, so you arrive on the ward in well established labour, you're having difficulty communicating to the staff because of pain/distress, exactly how are they supposed to know that you do not consent to an actively managed third stage/have a phobia of needles and therefore are fearful of epidurals/want to find out the sex yourself?

Our CMW at the antenatal classes said that if nothing else could we please fill in the section about third stage labour and Vit K injections because the midwives need to have a reference and need you to have thought about these things. i would have thought a birth plan makes the MW's life easier because it shows that the woman has given prior consideration to some of the issues which may be difficult to explain fully in the throes of a fast labour. there are both choice and consent issues here.

I think her attitude sucks and I'd go with foxy's suggestion of writing a wee letter to make it clear to her superiors that she's not treating the women she's supposed to be caring for with very much respect.

I cover birth plans in my classes and tell my clients that they are a frame of reference for the partners as well. As TDD said, a woman cannot always put her feelings across in the throes of labour so its useful for the partner to act as an advocate for her and can make her wishes clear to the midwife.

I agree about her attitude problem, perhaps a letter or chat to Head of Midwives means they could have a word with her.

Reaading the birth plan helps the midwife to learn something about your hopes and fears for the birth so of course it's important. I didn't have one for either of my last two births but I didn't need one because my midwife had provided all my antenatal care and we'd had plenty of time to talk about these things. But in this day and age with NHS care when you're not likely to have ever seen your midwife before you turn up in advanced labour....?

OP - the birthcentre midwife sounds like an insensitive bully. If she'd done this to me as a first time mum it would have diminished my confidence and made me feel like a tit.

That does sound a bit harsh. Our midwife asked us to just put the main points in bullet points - if you have a lengthy essay and the staff are changing shifts/dealing with emergency situations it's probably difficult for them to keep ploughing through pages. I put my top 3 things, based on my experience first time around - I didn't want an epidural/I really really didn't want another section if at all possible and I wanted my DH to stay with me as much as possible.

But things can go out of the window in an emergency - its very hard to predict what might happen and I think you need to be open minded and flexibile otherwise you can set yourself up for a lot of disappointment - feeling you have somehow "failed" because you were so determined to avoid an epidural for instance.

In my experience midwives vary greatly. I know a couple of friends who assisted with births as medical students and they did have a lot of stories about complicated birth plans and how they just didn't have time to look at them. My advice would be - keep it as short as possible so it can be quickly scanned and try and be flexible.

She certainly didn't put it well, but I don't think her view is an unusual one, I wrote a birth plan, no great essay, just a few points regarding the parts of the birth we'd probably have some choice on, no one was remotely interested, and I was induced so didn't arrive in the throes of labour.

If there is more than one way of safely managing someone's labour (there usually is) then women have a right to have some input into how they are looked after. That's the bottom line with birthplans. Midwives are required to follow hospital protocols. Mothers aren't! A basic acknowledgement of this reality would go amiss with some midwives.....

Any midwife i've come across, including a friend who practises in another part of the country have told me not to bother as they don't read them anyway and will do whatever is clinically necessary in the circumstance.

As a Doula, I discuss birth plans with clients, accross all scenario's, not just their ideal.
There are choices that can be made, whatever occurs in a labour and its important to feel listened too, heard and understood.
I would make sure you're birth partners have read and understood your biorth plan and anything you really do or dont want to happen so they can make sure nothing is done without you're consent or understanding.
Selina

I never discussed any plans with midwives - it was my first and I kept waiting for a mw to bring it up and talk any options over with me, but it never happened. However, in labour I had an epidural so about 7-8 hours in (to pass the time I think) the mw talked about those things that, if you are not an emergency situation, can be accommodated such as who tells you the sex of the baby, cutting the cord etc

I think these are reasonable requests for a mother to make should there be an opportunity to see they are carried out, but to bear in mind the aforementioned emergency situation when it is not a possiblity as there are more pressing matters.

Having complained about my first midwife as her attiude sucked, I am now seen by a good midwife and have the supervisors of midwifery for my area over seeing my care.
As I have some strong views about what I will and won't accept (also when etc) they have said it is imperative that I do a birth plan and that they will be putting a copy in my file ready for people to read when I go into labour so there is no confusion or problems with any of the midwives (I think it helped that I'd complained to be honest as they now know if they even attempt to be disrespectful or undermind me when I'm supposed to be concentrating on giving birth and letting my body take over to do that I am even more likey to complain and potentially sue afterwards if they screw up)

One thing that I think is important to me and should be included on a birth plan if you feel the same is 'Please do NOT offer me any pain relief, if I require some I will ask for it'

This is because my doula said that is something she now tells everyone to put on their form as she has found that midwives often keep offering medication as pain relief and in the end women end up taking it then regreting it afterwards as they were so close that they didn't really need it and that it actually made some of them forget the birth itself, made them feel really sick and one lady felt so out of it she couldn't even hold the baby straight away :(
So as I feel that even in labour (especially in labour) if I really want pain medication or an epidural I am prob going to be very vocal about it, if I don't then having to keep answering someone No is going to be more distracting and I won't want to explain everything or be maybe even talked to alot either!

I think the issue is that people have NO IDEA what will happen, and this shows. for example

: no episiotomy, if people write that then often they end up tearing badly, much worse

: no forceps. so what are they to do if the baby gets stuck???? leave it there?

: no epidural, again what happens when first time birth is scream,inbg for one as she had no i9dea. say no?

: no monitoring, again what happens if the baby is showing signs of distress?

so I am kind of with the midwife on this, think its better to go with the flow and we all get the birth that we get at the end of the day. if you are informed enough that always helps

we seem to think we have a choice , and very often we dont, we get what mother nature gives us

Agree with some of the pp who noted that a birthplan is about stating preferences and making decisions at a time when you can think clearly about them (i.e. not during labour!).

I doubt that there are many people (at least not on MN) who regard birthplans as an instruction manual for medical staff or a self-fulfilling prophecy for a perfect birth.

I also doubt that there are many mothers or medical staff who would stick to the letter of a birthplan in a true emergency.

It's all about stacking the odds in favour of a healthy and happy birth. For some people, using a birthplan to state that they would prefer not to have any non-emergency interventions is part of minimising risks and giving themselves the best possible chance of a good birth outcome.

It's perfectly rational to state, for example, that you'd rather tear than have an episiotomy, especially given that recent research strongly suggests tears generally heal faster than episiotomies, and that episiotomies have no protective effect in terms of minimising further tearing. Yes, there are emergency cases where an episiotomy will be the best course of action but when lives are genuinely in danger no one is going to be re-reading the birthplan.

Maybe the wording is wrong. Porca makes some very good points. Perhaps if we called it "birth preferences" or something it would hold more water. There has to be some middle ground, surely. Very few women these days have completely unrealistic expectations due to antenatal education. And midwives should be aware of the extent and limitations of a labouring woman's knowledge. There is definitely good justification for a woman to document her wishes, and even more so for the attending staff to read such information.

Thatdamndog I think you're right, I think if it was marketed as birth preferences then a better balance may be struck with the whole thing. I am lucky my doula has from the start been very quick to point out that birth is a very unpredictable process and that all you can is hope for the best and plan for the worst (shes so lovely).

I didn't really feel angry about the midwives attitude, I just thought it was a bit odd and wondered if I'd been reading the wrong stuff about making one. But actually considering what others have said here, it's not the best in the world and I think I will be writing a letter just to raise the issue.

I'm glad to hear that Hermya, I'm really shocked about her attitude! Her theory about car mechanics makes no sense either unless shes suggesting that a car has feelings and needs to feel empowered and and in control and treated with dignity?!

Please ignore what she said and write a birth plan anyway, I didn't as I was naive and didn't know what to expect. The only things I felt strongly about were that I didn't want to lay on my back to push and I wanted dh to cut the cord and announce the sex, I thought they were pretty standard things which would be encouraged anyway and I thought I could just tell the mw when I arrived at hospital. In the end I was already pushing when I arrived there and they stuck me in stirrups and the mw shouted "its a boy!" and cut the cord straightaway without asking. Its very difficult to communicate in advanced labour, if I could go back in time I'd staple a birth plan in the front of my notes (and arrive an hour earlier).

The doula sounds like a great idea, I'm sure she'll be prepared to advocate for you anyway should the need arise. Good luck with the birth

I do hope you ask her about home births and come back and report to us. It may be interesting if she discusses home births before or after your letter to the head of midwifery arrives too.

I'm fairly shocked also to hear of midwives not even bothering to read them at all. The first thing the comunity midwife did at my homebirth was sit down and read my (very short) version.

Of course the midwife should read what the mother has written, and speak to her and of course treat her respectfully etc etc

But I can also see porca's point that some women may be really prescriptive in their plan, and almost militant about it, and then when it comes to actually giving birth, they may change their mind about certain aspects.

I'm not a midwife, but I work in a profession which involves dealing with people who may be feeling quite vulnerable, stressed etc, and I know how difficult it can be to get it 'right' sometimes. Actually, there often is no 'right'. People are individuals, and don't always want to be treated in one particular way. I would imagine midwifery can be similar. The rationale behind birth plans is entirely sound - handing back control to the woman. But I have known some women (in my antenatal class) who wrote extremely detailed and prescriptive plans (eg no pain relief, definitely no epidural, water birth etc) and then when it came to labour they changed their mind - which is entirely their right, but it's difficult for the midwives to then know how to respond. Is the mother going to turn around afterwards and say she really didn't want interventions, and the midwives should have ignored her screams for pain relief and stuck to the birth plan?

I think once again this thread points to the importance of knowing your midwife, which is really difficult if you give birth in a big hospital where there are dozens of midwives and you're likely to come across people you haven't met before when you go into labour.All they have to go on is your birth plan.

I like the idea of 'preferences' rather than plan, as plan suggests a schedule which will be stuck to.

It is a useful process to go through for your own sake and also useful for your birth partner/ doula so they can advocate for you at a time when you might not be in any fit state to speak up for yourself.

As long as it is flexible (ie, you state that your preferences are relevant in the case of a straightforward delivery and that you will cooperate if things change/ there is an emergency situation) and respectful of the expertise of those who look after you, then why wouldn't they be glad to know what you would prefer?

My MW was very keen to see my birth plan. I'm pg with number 2 so no rose tinted glasses about birth here but I still want whoever attends to get an idea of how I want to play it without me having to think about explaining it all during labour!

The MW in the class sounds awful- it is your body and your baby and you have every right to state what your preferences are, even if you change your mind about everything on the day. To say that how you feel about it doesn't matter is just so disrespectful.

I'm being taken care of by a team of midwives, I've seen this one twice throughout my entire pregnancy and am really hoping she isn't on duty when I do go into labour. Apart from this one, everyone else I've seen has been lovely.