Sticking to birth plans regardless - yes or no?

[Restrainedrabbit]

After the furore on the OBEM thread last night about the hypnobirthing girl begging for pain relief despite specifying that she wanted a completely 'natural' (whatever that means!) birth and not getting it, do you think birth plans are worth anything and how do birth partners/MWs know when to 'give in' and when to help the woman through?

I had 3 HBs and it really mattered to me that I didn't have anything stronger than G&A during my labours and would have been devastated if I had had something in the end. My DH and MWs knew this and helped me through despite begging for an epidural in transition with DC1 and begging for it to all be over in transition with DCs 2 and 3 So glad I didn't relent in the end but how would anyone know if I am serious about extra pain relief or not??

Not looking for a fight just interested in other experiences/viewpoints

I think you go in there with a birth plan, you try to stick to it as long as it's sensible to do so but know that so much isn't in your control. When you wish to deviate from it, perhaps make the decision to do so in between contractions, after a bit of calming down etc and with as clear a head as possible.

I went in with a rigid idea of what I wanted and in the end had the exact opposite. I wish I'd acknowledged before the birth that I wasn't failing and/or letting myself down by not being able to control the uncontrollable.

A birth plan is a good idea, to give you a chance to think things through beforehand and research what you would like to happen.

But you need to be prepared to rip it up (don't know if mine ever made it out of the bag) if events dictate otherwise.

The one thing I really did not want during my DD's birth was an episiotomy. I was 100% convinced of that. But DD had her hands tangled round her head and it was the only way she was getting out, so I had to have one. I was a bit upset/frustrated about it but it was the best thing in the circumstances.

Depends what sort of thing you mean. eg if I was a JW I would expect people to not try to encourage me to have blood. OTOH I would be furious if I was denied pain relief because I'd made a pre-labour decision to do it all on whale music and found on the day that that just didn't cut it.

Broadly I think that people should encourage you to stick to your plan (sometimes you just need to hear that you csan do it) but recognise when you need more than just support.

The thing for me is how do you know when a woman needs something more or just some encouragement, DH watched OBEM with me and said it is very hard watching your DP/DW labour and difficult to know when to help.

I appreciate that I was very lucky that things went smoothly with all three, perhaps if I had had an OP baby or some other issue then I may have wanted more pain relief and my supporters would have assisted me in getting it.

Gueas it would depend on the woman's response - eg if she asks for an epidural and you tell her she can do it without one (because you know she'd rather do without if poss) and she seems ok after that, then all well and good. If she keeps on asking for an epi then she clearly needs more than a morale boost.

Birthplan was for waterbirth and, in big bold letters "I do not want a Caesarean section under any circumstances".

DS was undiagnosed (until 8 cm dilated) back to back footling breech and was about and was no way going to deliver normally or safely. When I got to hospital I had an internal exam, was told "do not push whatever you do" and was in theatre within seconds.

A birthplan is an ideal, but the only person who had not read it was DS!

i think the problem with birth plans is that the baby hasn't read it.

I'm not sure why people don't just make a list of preferences rather than a plan as such? As you can't know what's going to happen and all that.

I wrote down pain relief in the order I wanted it offered (up to and including epidural - even though I planned a homebirth, I knew transfer was a possibility, and I'm not superwoman). I wrote preferences for the birth and placenta delivery, and I wrote preferences for instrumental delivery and for c-section just in case.

At least that way there's no throwing the whole plan out the window when you start to deviate from your plan A, as you've covered all the options, and the HCPs know what you would prefer to be offered at different points

Personally i think birth plans are a waste of time. You have no idea what is going to happen and obviously nobody wants to have epiosotemy/forceps etc unless necessary. But they would not do these things unless you really need them!!
Most people think they can do it"naturally" until they actually go into labour and realise how bloody painful it is. It is not a bravery contest and I think if someone asks for pain relief they obviously feel they can't cope at that moment, so have it.
From my own experiece things were going wrong at every stage and we had to just go with the advice of the MW's on what to try next, there and then in response to the situation.

I think any kind of birth plan which leads to you being devastated if you deviate from it is not really much use. Having pain relief you hadn't planned on is a particularly silly reason to be devastated. There are so many ways childbirth can go that frankly you cannot plan for or control all of them. A sensible guide is a much better option than a plan - CalmInsomniac's suggestion of preferences is a better idea.

I had extremely flexible birthplans each time, and even with that amount of flexibility neither birth went according to plan, as such. I was disappointed with my first birth, although the situation that arose meant my baby and I were both lucky to come through it alive. I wasn't devastated though that my birth did not go to plan - devastated is a word I reserve for far worse things than a long and tricky birth but ultimately a healthy baby and mother. My second birth went so far off the scale of anything that could be described as a plan, noone saw it coming. Having planned a hospital VBAC with preferences for labour and preferences for if a second CS was necessary, we were all surprised I had an unplanned home birth in superfast time - there was nothing in my plan for that! My chosen methods of pain relief were not available to me, and I used different alternatives. There were some complications which required surgery after the birth for me. Was I devastated? No, I had to be peeled of the ceiling with elation!

Birth cannot be planned so precisely that a simple document should be adhered to at all costs.

I wrote a birth plan (a bit early really) then tearfully binned it when I was booked in for a section. Rotten at the time but I got over it. Anyway, when I showed it to my husband the thing that he noticed the most was that if anything had been suggested (episiotomy, drugs etc) that I ask if it can wait half an hour, if yes the need may pass or not, if no (ie emergency) then I will just go along with it.

So in that way it was helpful to him, I hadn't realised at the time that this was the way I was hoping to go.

I didn't have birth plans for either of my labours. It was an active decision not to. For me it was more important to have the fluidity of NOT commiting preferences to paper, IYSWIM. As it happens, both were very easy labours, perhaps in part because I hadn't put any additional pressure on myself.

My first time we had no plan as babies were premies and we had to wing it.

This time we have discussed the various options and have a decided again to plan to wing it . Joking aside we are aware of all the options and we are planning to adapt as we go along. I am lucky (or unlucky) as due to medical problems DH has seen me in pain before and knows what to do and when I have had enough, which I think helps.

As was said on OBEM how someone has coped through the entire labour can change completely when you hit transition by which time is a bit late for most forms of pain relief.

First time I was fine until transition at which point I had a period of blind panic when I needed reassurance not pain relief! DH is aware that that is his cue to be all strong and calming regardless of how scared he is!!!

On OBEM we watch everything from the outside and only see the "dramatic" snippets and not the bits in the middle!

Agree with CalmInsomniac in general.

I think birth plans are a good idea for thinking thoroughly through birth options, possibilities and preferences. As much as you can, it's best to make important decisions in advance of labour because you may not be able to think clearly at the time.

For example, your preference may be to avoid an episiotomy but you would agree to one in the case that the baby was in distress and needed to be delivered v. quickly. If you've already made this decision in advance, it's easier to convey it during the birth.

I didn't have a birth plan because I had an independent midwive whose views were closely aligned with mine on when specific interventions were useful or necessary. I was confident that she could advocate for me if I had needed to transfer to hospital from home. Without my MW I would definitely have written a 1-2 para "birth plan", setting out my main preferences and making clear that I would consider evidence-based interventions as needed but not just "to speed things up a bit".

Agree with Jess. I think birth plans are a waste of time and mainly designed to give an illusion of 'choice' which is very misleading. I think there are key things you need to decide, hospital / home location, equipment to buy, birth partners and a few technical choices e.g. vit K injection but writing out a plan as if you were selecting items from a menu is pointless.

Birth is a process and the main influences on the outcome (where you give birth / the type of body you have / the position and health of the baby) are things over which you have no control. You can read as much as you can but what is the point of making decisions about epidural etc until you are in the course of labour and the factors and circumstances are known?

I know so many women (including myself in a way) whose birth did not go to 'plan' and who felt guilty, disappointed and devastated by this. I think setting expectations too high is a problem.

I think the birth plan isn't really the issue, it's the attitude behind it. It's no harm to know your options beforehand and what everything entails and to have a rough idea of how things might go. But that woman on OBEM was quite adamant about her desire for a "natural" birth and had convinced herself beforehand that she should be able to do it without drugs. Her mum then believed that she would feel terrible if she did have pain relief as it was clear she was very negative about it, so that's why she was pushing for her not to have it. I think it's a shame when women feel like this - that having pain relief means you're a failure and that you should avoid it even if means you're scared shitless like that poor woman was.

My birth plan was a few lines - would like to try the pool, would like to avoid epidural if possible, no forceps to be used (the last is something I would never move on - my sister was permanently damaged by forceps).
I told my DH that I would try it with gas and air and then go up the scale if necessary. I told him that if I asked for pethidine/epidural he was to encourage me not to have them and if I asked again that was the time to take me seriously.

I thought the gas and air would do nothing for me but as it turned out it was fantastic. Up until I had g+a I was considering asking for an epidural but after my first whiff of the good stuff I knew I could do without it. After I got the g+a I didn't even think of any other pain relief at all. It just shows you that you don't know how it's going to go and how you're going to respond to things. I'd heard before that g+a was a bit rubbish so I wasn't expecting it to be the wonderstuff that it was! You just can't know how labour's going to be and having completely fixed ideas beforehand isn't detrimental I think as it is bound to cause you stress which is the one thing you really want to avoid.

sorry that should be is detrimental

What's the OBEM thread? Link?

www.mumsnet.com/Talk/telly_addicts/1150512-One-Born-Every-Minute-14-2

Birth plans are a waste of time. I tore mine up after bringing baby home, everything and I mean everything went the opposite way. First time mothers need to be told that anything CAN happen.

By DC 5 by birth plan was

I DO NOT want to go to hosptial unless absolutly necessary.

I DO NOT want a blood transfusion unless absolutly necessary.

If you MUST give me an IE you have to stop if I ask scream at you to.

I want my baby handed to me first.

I think that was reasonable and pretty easy to stick to.

I dont agree BPs are usless. I think you just need to know anything can happen during labour and you may change your mind or be forced to.

If there's one thing I'm grateful for, it's that I didn't have a plan.
Yes, I went into hospital thinking it would be all whalesong and a recreational whiff of g&a, but when things started going wrong, I at least hadn't put my romantic naivity put into writing.

Still, having read so much about natural birth I was terrified of allowing pain relief too early and resisted pain relief way too long (in retrospective)

Women say things in transition they don't really mean. Ideally they and their partners should be made aware this could happen. Then the birthplan can say "dont make decisions when I am in transition", if they can wait 10 mins, they can deal with it on a clear head and not make a decision they might be unhappy about later.
I don't think women choose a drug free birth for showing off or heroic bravado. They have genuine reasons which mean a lot to them, if a woman's carers understand and respect that, it might mean having to help her be strong when the chaos of transition tests her resolve.
I guess what it comes down to is that a woman's right to not have pain relief is as valid as her right to have it.

Does this mean that transition possibly really really hurts, so it's not wrong to actually take something against the pain?

I find the whole idea that you can't take a woman in transition seriously when she wants painkillers, because the pain stops her from thinking clearly quite disturbing.