Would you cast your eye over my birth plan please?

[NarcolepsyQueen]

Hi! I am due to give birth this week (I will be 38 weeks on Friday, but will be induced next Wednesday if I haven't gone into labour before then). Please would you look at my plan and see whether I have missed anything?

Birth Partner

Mr Narco. Please defer to him if I'm unable to communicate my wishes for any reason.

Medical Conditions

Severe SPD
Gestational diabetes (diet controlled)
Underactive thyroid
Allergic to Propofol

Labour

I would like to labour in water, with the possibility of giving birth in the pool.

I would like to remain free to move about as much as my SPD will allow during labour to find most comfortable positions as long as the midwife is happy with this, with monitoring only if required.

I am happy to have student midwives present.

Pain Relief

I intend to use TENS, Water and gas & air, but obviously I am flexible if, for example, an emergency situation were to arise or I decide I really need/want an epidural.

Delivery

I would like to avoid an episiotomy if at all possible, as my episiotomy was painful and slow to heal last time.

I would like Mr Narco to discover the gender of the baby and share the news with me.

Mr Narco would like to be offered the option of cutting the cord.

I would like my baby to be delivered straight onto my tummy for immediate skin-to-skin contact. I am hoping to breastfeed immediately after the birth.

I would like Mr Narco and I to be able to hold our baby for at least half an hour after birth.

I am happy for a vitamin K injection to be administered.

If a C-section is required, I would like to remain awake with Mr Narco attending. Mr Narco will hold the baby after C-section delivery and initiate bonding between the three of us.

Have I missed anything?

Thank you soooooo much!

Narco
The hospital I'm due to give birth at is very much in favour of active labour but I was told that if induced, I won't have the option of using the water pool and it's more likely that induced patients need an epidural (as the contractions are stronger.) I want to avoid an epidural for various reasons including pelvic girdle pain, so similar to you there. (Epidural = semirecumbent on bed = more likely to need an instrumental delivery.) It may be worth asking your hospital about their procedures so you can focus on what's likely to happen.

I have made out a detailed birth plan which covers all options: spontaneous vaginal delivery, induction, instrumental, caesarean. I have called it "childbirth preferences". It's done after reading the cochrane reports and other evidence-based resources and includes things I've been advised to include by my MW team so is reasonable. It sets out the sort of things I'd like, e.g. if Caesarean have skin to skin contact in theatre if space allows otherwise kept in line of sight at all times, with skin to skin once moved to recovery. If the baby goes to NICU that Mr Owlmaster can go too. It includes:

• specific notes about what positions my hips can be put in, that they require frequent change of position, how to move my pelvis (knees together)
• general notes on labour (active birth, pool, calm and quiet environment, response to pain e.g. keep qs for between contractions, VEs (no students), no acceleration of labour unless medically indicated (not accelerated just to fit average timescales or to fit with the MW's desire for a tea break, ha ha)
• specific notes on 2nd stage (spontaneous vs directed pushing)
• newborn checks done while baby in skin to skin contact
• specific notes on 3rd stage (phys, so baby still attached)
• no episiotomy unless instrumental delivery . no suturing by a student

The important thing in my mind is that my birth partner understands the reasons behind all these things and is prepared to step in and ask qs or do whatever's needed on the day.

I would just say that as a midwife I DO read birth plans and try to follow them as much as is possible.

The only thing I think you have missed out on is management of the third stage of labour. Do you want syntometrine or natural third stage.

They will probably recommend continuous fetal monitoring in view of the gestational diabetes although I would question how necessary this is if it has been very well controlled.

For those who suggest babies having skin to skin in theatre it is usually very cold in theatres and difficult to get baby in a comfortable position for mum so although possible it would be like lying flat with baby right under your chin and a load of towels on top of baby so it doesnt get cold. Not all that comfy!

I do like your birth plan, up to the point I have actually 'borrowed' some of your points for mine! Hope you don't mind - they do say that imitation is a form of flattery...

I think it sounds great.

I had a birth plan for DD - it WAS read, in fact the MW read through it with me as I was being admitted.

They did make sure they paid attention to what it had said.

For eg: I have hearing problems. So my major thing was essentially "you must make sure I have actually heard what you've said, because sometimes I can't and people assume I have because of what I say next."

Even when I was quite out of on G&A they got my attention and stayed really close to me so I could see their lips and hear properly.

I can't recommend birth plans highly enough if you have any kind of genuine extra concerns.