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

Same here WidowWadman. Women have the right to make their own decision in labour - but not at certain times when they can't be trusted

If the decision would be to have an epidural it takes a lot more than 10 minutes to get hold of the anaesthetist and get it set up IME anyway.

I didn't bother with a written birth plan. I knew in my mind that I would start off with TENS and use stronger painkillers if I wanted to, and that was my "birth plan". I went in with an open mind and managed nicely on TENS and after a straightforward 6 hour labour out popped my daughter who was immediately laid on to my tummy.

I was well looked after, monitored at times, was allowed tro walk about, get on all fours etc - in the end I found lying on the bed the most comfortable.

What do so many women have against being monitored? I found it quite reassuring. Also, I took the view that the midwives were far more experienced than me, a first time mother. So I was happy to follow their professional advice.

I guess the monitoring problem is, that not many trust have ambulatory monitors, which don't restrict movement.

I would have been much more open towards the idea of a trial of labour if my trust would have ambulatory monitors. The fact that they don't was on my long list of reasons why I want an ELCS. Thankfully my consultant agreed.

I do remember the MW saying with DC1 wait ten minutes and see how you feel, she also talked me through several contractions when I was wavering. I guess that is the advantage of HBs, you havesomeome with you the whole way through and thus they can 'read' you better for it?

I agree that it is worrying the attitude that women can't be trusted to know their own mind in transition and thus should be ignored but, personally I did go a bit loopy during that time

Bunbaker, most women have nothing at all against intelligent monitoring. However not all monitoring is intelligent. There is plenty of clinical evidence in well-respected journals (eg BMJ and The Lancet) that continuous foetal monitoring (ie the kind where you are strapped to a monitor that requires you to lie motionless on your back on a bed) encourages women into a less than favourable position for labour and birth. It has been shown that being hooked up to CFM creates unnecessary focus on a machine when medical staff should be focussing on the labouring woman and her as-yet unborn baby. The machine can create a false sense of security. Often women are left on the machine and the MW has failed to grasp the concept that machinery is only as good as the person operating and monitoring it - so if she is out of the room it is a bit pointless. It's no good realising there was a problem after the event. CFM which requires the woman to be confined to a bed has been proven to be one step on the cascade of intervention. It has a place in some births, but should not be used as routine. Many hospitals use it as routine even in low risk labours.

There are many other ways of monitoring a woman and baby that let the woman move around and not be on her back, that require the MW to check the woman and not a machine, such as use of a handheld doppler. So many women are against monitoring that restricts their ability to give birth efficiently, not against the most effective non-invasive monitoring.

Widowadman -

It's not just a pain issue. In transition there is a rush of adrenaline. This causes the pain to become more intense because it counters all the lovey hormones and endorphins that have been cushioning it, but it also cause fear, anxiety and confusion. A woman who has been zoned out in birthing land may suddenly come back to earth with a bump, feeling very lucid and wondering WTF is happening. In this panic she may decide she can't cope, then change her mind very quickly as it eases.

It is transitory , and knowing that it is brief helps a lot of women through it. Also, pain relief requested in transition often won't take effect until it's over, so the woman has done the hardest bit (transition) without pain relief, then gets it as she goes into 2nd stage which she might have done fine without. It's that in particular, which some women feel disappointed about in the aftermath.

Maybe some women are 'disappointed' because there is a culture (an industry even) that promotes the idea that non-interventioned births are superior.

Ton, like I said in my earlier post, I think it is unfair to judge women who want drug-free births as trying to be fashionable or show how brave they are. There are genuine concerns about the effects of these drugs (and other interventions) and it is up to the woman to weigh up the pros and cons and make her own informed choice. It is up to her carers to respect and support that.

I'm not judging women who want and have drug-free births - I recognise that there are serious reasons for not wanting certain procedures and that there are risks / benefits of all interventions (and non-intervention) that need to be considered.

I would consider judgmental language to be things like
"Women say things in transition they don't really mean"

" help her be strong when the chaos of transition tests her resolve "

"Some women feel disappointed in the aftermath"

If you had said - in the chaos of transition a woman might decide to have pain relief which left the baby sleepy at birth and breastfeeding slower to establish OR a woman decided to have an epidural that meant her positions were restricted and labour was slower - then I would buy your claim to be not making a judgment but you use emotional language about the woman's feelings about labour and her failure to be strong and have resolve

Birth plans are a good idea as they make you think through the actual process.

However, if I had insisted on sticking to mine with DD1, we would both be dead. I could see as labour went on and on and on, that things weren't going the way I would have wanted. But when a consultant says, "this baby needs to be delivered now, you need an cs" I wasn't about to say "excuse me but that doesn't fit in with my birthplan".

I think anyone who goes in with the idea they will 100% follow the birthplan, no matter what, is a bit stupid naive.

Ton, I didn't want to bring up the specific pros and cons because the thread isn't about that, and because I don't want to be down on those choosing pain relief. If a woman knows the side effects and feels the need for pain relief is greater, then she should have that choice, I don't judge because I made that choice when after 2 days of contractions, 4 hours on synto with an OP baby and still only 4cm, I was throwing up with the pain of every contraction. I've been there, so I can't judge.

I'm sorry if my turn of phrase seems judgemental, it's not meant that way at all.

I acknowledge that a woman without pain relief may need support to help her through the hardest parts, I know labouring, with or without drugs takes strength and resolve. I also know that the right support and encouragement can really take the edge off. I certainly would never, ever use "failure" to describe any kind of labour. The process should not, IMO, be judged against any external yardstick.

Women in transition do say things they don't mean, won't remember and allsorts. "I don't want this baby", "I want to go home" are fairly common. That doesn't mean she should be completely ignored, but it should be understood that she may prefer to not be taken at face value, for that little while (a choice that she needs to make in advance and put on her birth plan).

I don't really think disappointed is too strong a word when some women who's choices in labour are disregarded and the most "trivial" expectations broken end up with PND as a result. I have a fairly healthy attitude to my birth, if I had the birth I planned neither of us would have survived, but I am still saddened by the effect the opiates given during my EMCS had on my baby in the first precious days, so I am sure I would feel at least that disappointed if I had been given drugs that I requested in a confused moment of panic, that I ultimately could have done without.

Surely the point of a birth plan is to work through what your preferances would be in a variety of circumstances.

This is how my MW explained it to me.

SUrely people don't think that they can just write a list and it will happen like that?

Moonface's Life Plan

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I was given pain relief during transition against my birth notes. Half a dose of pethadine after 23 1/2 hours pain relief free op birth, which made my baby sleepy and could have been much worse, considering a MW knows many women panic in transition and pain relief so late can cause complications I think as they know it is bad should not give it the same as a csec is offered if complications may arise without. I am annoyed I was given it considering DS was born 30 minutes later.

My second birth MW looked at my plan calmy explained I was in transition and I was not going to be in pain much longer. I calmed down the pain eased, and I actually thanked her for that decision with a card and chocolates.

I put on my birth notes that procedures I didnt want were only to be carried out if my babies or my life was at risk. I see no problem with pain relief but if a woman has got to transition without asking then as transition only lasts a short period of time and is the only reason she wants it I think you should instead calmy talk to her.

And I dont think drug free births are superior, but I have a phobia of drugs and was more scared of drugs than labor.

I remember I spent ages researching and writing up my birth plan and in the end it wasn't needed at all.

The problem with childbirth is that it doesn't go according to plan and you can spend hours writing the perfect plan and circumstances change.