advice on wording/tone of birth plan

[qqquavers]

I know that everyone recommends a polite and friendly birth plan, and I agree that they should be. But how can you make it clear that what's on there is not just a minor preference for one thing or another, but that you feel strongly about something? I plan on leaving irrelevancies off my plan and trying to make it brief, that might be a start. Or should I start with a few sentences about how important that everything is discussed with me first being done, that informed consent is important to me?

I don't want it to be so friendly and lovely that it makes me sound like some pushover and accepting of anything. How can you say things without sounding hostile? or sound like you are telling them how to do their job? I want them to respect my plan and know that I mean what is in it, sounds assertive but at the same time respectful of the people reading them. I've heard midwives are accepting of birth plans but what about OB's if I need them? I know they all try to do what in your best interest, but obviously medicine is as much and art as a science and different training/experiences lead many midwives/obs with different opinions of what is 'best' and what if I get someone who isn't a 'match' for my preferences. I'm worried in what seem to be understaffed wards I'll get somone who is very intervention happy and there not always an alternative.

Know what i mean? Any examples?

i had my birth plan and then a sheet of notes for my DH - we stuck a copy on the fridge so he re-read it lots.

lovebeingknockedup - just be careful on that one. There are circumstances where trying to change to a c-section isn't actually safe (others with more knowledge than me have posted on this in the past). Not saying you can't express a strong preference, but be aware that the issues may change on the day.

starlight I am stunned at the detail you have gone into! Can I ask why you wanted a running commentary on the state of the placenta? And how it all panned out? I didn't bother with a plan. I knew it would hurt. I had an open mind about pain relief.

On some on the other plans I think, if I was a midwife, I would be a bit [skeptical] at the 'I was a natural birth but will consider an epidural'. To me that reads 'I will attempt natural labour but will be screaming for an epidural when 2cm'.

lovebeingknockedup NO FORCEPS was the one point I absolutely hammered into my DH before DD was born, having read the Ragged Bits thread. They could do a c-s, but there was NO WAY anyone was to come at me with forceps of any kind.

When it came to it, after 2 hours of pushing and still no baby, I nearly kissed the registrar when he came brandishing the salad tongs. DH kept asking me 'are you sure?!' and at that point I just needed DD out. I knew theatre was already in use so I'd have been waiting to go in, and there is a point where it's not possible to do a c-section when baby is too far down.

Starlight,

I'm really interested in your requests about internal exams - were they okay about this?

I was induced at term + 13 (after waters broke at + 12 but labour did not commence).

I took the epidural at about 4-5 centimetres precisely because I couldn't hack the idea of a VE after a horrendous one where 5 different midwives tried at about 2cm. I was managing the labour pain fine but I knew I couldn't be able to focus and manage the pain while having a VE so when it came time for the second one I just asked for the epi.

Of course, then came the "cascade of intervention" ending in a very dicey forceps delivery with high forceps where they were all shouting around me because a few of them were disagreeing and saying I needed to be sectioned. Ds didn't cry for more than a minute and had an Apgar of 5 and it took me more than 8 months to recover from quite severe pelvic pain.

I think next time (if and when there is a next time!) avoiding VEs would be key.. do you know what the potential objections are? Did having a doula help a lot?

Did you have to argue much for it?

Mine last time (DC4) said

• (Note about my allergies)
• (Note about my birth partners)
• I don't want a medical student present. I am happy with a midwifery student only if they are present for the whole thing, not just 2nd stage.
• No internals please. I will tell you when I have the urge to push.
• Gas & Air for pain relief; this does not stop me being able to push, and I'll also need it for delivering the placenta.
• Please do not cut the cord until it has stopped pulsating.
• I would like to try for a natural 3rd stage, unless I bleed excessively.
• Skin to skin instantly.

This was adhered to brilliantly by the midwife (who I'd never met before) in the large teaching hospital. She LOVED it that I didn't want internals, and kept telling the midwifery student who was also there that it was her favourite kind of birth.

The only bad points occoured when she went off shift (she'd already worked an extra 20 mins to stay for 2nd stage). A much more old fashioned mw came on. She kept trying to cut the cord, but I'd feel it and it was clearly still pulsating (took 20 minutes to stop). Then she just left me to it with trying to get the placenta out, and saying "Ready for the injection yet?" Which in the end I had to have, as I couldn't get it out lying prone on the bed.

This time, the only change will be that I will add a line asking for mw to help me to be upright and active to try to birth the placenta without the injection.

And I will try to give birth before the 8pm shiftchange!

working9while5

• after a first delivery similar to yours (only the traumatising factor with VE's was a consultant with HUGE hands and long fingernails) I have had all 3 of my later babies with no VE's. I'm fairly high risk (always slightly premature) and one of these later births was also an induction. But even so, I've had no trouble at all with mw's respecting this, they actually seem to like it, depsite being in a consultant-led teaching hospital where they are meant to log them.

I totally changed my mind about the episiotomy after dd's head had been stuck halfway out of my fanjo for the last hour and I could feel myself about to tear in all sorts of interesting ways. In the event I wish I had been a bit quicker in asking for it as the tear was very jagged and took a long time to heal.

working9while5 - You do not have to request internal exams. The MW's have to request permission to give you an internal exam. If they give you one without your express consent, it is assault. Likewise, if they do not stop in the middle of one when asked - it is assault.

DD1 was a planned HB with IMs, where my birth plan read "to have this baby as quickly and easily as possible". Because they'd done all my antenatal care (with longer and more frequent appointments than with the NHS) we'd already covered most of the points. They knew I didn't want VE's, they knew I wanted a physiological 3rd stage, they knew I wanted skin to skin, they knew me well enough to read how I was labouring.

DD2 was an unplanned hospital birth after I needed to be induced at 36 weeks. Our IM was there as support (not insured to act in an NHS hospital), which was invaluable, but I did feel that VE's were a good idea to check how the induction was progressing, and the MW I had was very gentle. But I didn't enjoy them and wouldn't choose them.

If we have a DC3 then I will be very clear that I will only consent to VE's if/when I understand and agree that there is valuable information to be gained. I will not agree to a VE purely because it is 4 hours since the last one. I will not agree to a VE to check I'm fully dilated (unless there doesn't seem to be progress in descent). I might write this as a friendly "I'd like to avoid", but the intent will be much stronger. If the MW doesn't like it then DH will request a different one!

Getting back to the original point if I have a DC3 then I will write a fairly detailed birth plan - with both my previous labours I've gone very quiet and very "into" myself. I found it much easier to go with the flow with DC1, partly because I didn't need to think or talk. With DC2 the MWs were as discreet as possible, but they still needed to talk to me and for me to talk to them from time to time. My hope would be that by putting sufficient detail into the birth plan they'll be able to leave me alone much more easily.

Sorry :

You do not have to request no internal exams

Love, I agree with Mother, if you feel so strongly about forceps, write/draw/sing it in any way possible to get the point across!

Concise (no more than 2 lines) bullet points is what I used. I also didn't want to add too many details as it's clear so much is unpredictable. Mostly highlighted skin-to-skin, bf-ing, and open communication at all times.

I'm having an elective C-section unless the baby comes earlier, so I listed my preferences for both CS and vaginal delivery, though kept my wish list brief(ish) for both.

At the end I wrote a sentence thanking everyone in advance in case I'm too out of it to do so at the time! :)

I agree Starlight. Lack of VEs has helped my deliveries immensely. I wish more women knew that they are not mandatory...

I didn't find VE's painful at all and in fact wanted to know how i was progressing! everyone is different i suppose.

You have to be careful not to be too defensive and detailed. Starlights birthplan - way over the top. Do you really think you can resuscitate a baby with the cord still attached????? Get real!!

Surely saving a baby's life is more important than whether the cord has stopped pulsating!!

Poppyella - why do you think you can't resuscitate a baby with the cord still attached? If the equipment required can be brought to the baby, why not? If the baby's struggling to start breathing, isn't there an argument for leaving it attached to a source of oxygenated blood for as long as possible?

Everyone is different. I think the more trust you have in MWs and Drs the less important a detailed birth plan is. I had a huge amount of trust in my IMs as I'd got to know them - hence my birth plan was 1 line. I won't have the opportunity to develop that trust if I plan a hospital birth - so I'll use a detailed birth plan instead. For me that will be the appropriate choice, even if that birth plan only serves as an aide memoire for DH.

This was my birth plan Hipp birthplan

Although I was at a private hospital and trusted them to stick to the plan I did include a section at the end where I pointed out that transgressions from certain marked sections would be without my consent and they would render themselves liable to legal action for assault - just to be sure. ( I was a lawyer at this time)