Is this a good enough Birth Plan?

[ALovelyBunchOfCoconuts]

Hi there, am preparing all the necessaries for having my second baby and have just written my birth plan.

Could you possibly read it and advise on anything unecessary or if I have missed something out?

Many thanks :)

Birth Plan.

• DH to be present at all times. I would like him to take an active role during the labour, rubbing my back if required and offering me drinks etc.

If the midwife feels there is something extra he can do she can feel free to suggest it.

• I would like to remian active for the labour as much as possible. I would like to be able to use a birthing ball if one is available and also would like advice on comfortable and effective positions from the midwife.

• I would like to use Gas and Air if I request it (I would like to try without in the beginning). No Pethidine. No epidural unless medically advised or necessary. I am aware that my pain relief requirements may change as labour establishes so please expect this to change!

• Midwife to monitor me and baby as much as she needs to. I will be fully cooperative with her duties.

• I would prefer to deliver in any position that I am finding comfortable at the time and would like midwife to suggest effective birthing positions as I do not want to deliver on my back, if avoidable.

• If assisted delivery is required, I am open to episiotomy and I would prefer Ventouse if necessary. No forceps please.

• I would like skin to skin contact with baby as soon as possible after delivery. If I am too medically unwell for this then DH must do skin to skin. I would prefer baby to be passed to me as he comes out, minimal cleaning. And I would like the sex revealed ASAP.

• If anything occurs where I am separated from DH and baby ie emergency surgery, then DH is to stay with baby. He must not come with me.

• Happy for baby to have Vit-K.

• Midwife to cut cord.

• I would like to go home ASAP, if all is well. Is it possible to avoid postnatal ward?

I didn't write a birth-plan for any of my 3, believing that I had discussed things enough with DH and my midwife.

After ds2 was born I had to go straight to theatre. I wish with all my heart I had put the bit that you have about skin-to-skin with dh and dh staying with baby. Poor ds2 was dumped in the horrible fish tank. It makes me cry to this day to think about his little button eyes staring around the room while nobody held him. I have even been known in my less rational moments to attribute his autism to this happening. ( I do know really this can't be the case)

I think it's a really well thought out birth plan, but maybe someone will come along in a minute who has had an experience they wish they could have planned ahead for so they can warn you to put it in there!

Sounds well thought out. Perhaps include your feeding preference. I had an emercency csection and not long after ds1 was screaming for a fed but I was still unconscious. Mw saw from birth plan that I waned to bf, she checked with hubby and dm to latch ds1 on whilst still unconscious. They said yes I would want that. She turned me on my side and latched him on. The only other choice would of been to give him a bottle but that may of coursed problems with him latching on. It was very sad to have missed his first bf but would have rather had that than he have a bottle then not want to latch on.
Good luck with the birth

Thanks both :)

I should have said in my OP that I am undecided on feeding prefernce yet so will add that bit in when I have reached a decision.

Carey - :( that you have sad memories of your birth

Orange - That was really intuitive of the MW :)

I think its a really good plan but you don't mention anything about the 3rd stage. Do you know what options there are and if you have a preference?

Losiintransition - I knew there was something... Thanks. I have no idea what I would prefer or what is best. it's either wait naturally or have a jab isn't it? Is the jab best? I can't remember anything about DDs birth so have no idea what I did then.

I would change the "i would like to" to "I plan to" as, to paraphrase Mary Cronk, I would like to go on a cruise round the Med but I am planning on going to Salcombe.

I would always do natural third stage & cut cord only after it has stopped pulsating so that the baby gets all its blood back.

Does something bad happen if you cut it too soon then? I'm sure the cord was cut pretty much straight away with DD. I have no idea if I had the jab. I was so spaced out and dazed from things.

This is something I seem to have completely overlooked. Am now trying to cram my head with info and coming across things I've never even heard of! Argh!

www.thirdstageoflabour.org/thirdstagechoice.html That might help with the third stage.

If you can, I would try to make it more concise, bullet points, so it is easy to read at a glance, maybe make clear subheadings (pain relief, intervention, feeding). For a start I don't think you need to explain what DH will do to the MW, he can take care of that (write him out a reminder flash card if you like, maybe with some encouraging phrases/affirmations on the back), you could just say: "Birth partner: DH present, Can MW give advice on how to support me best"

Okay, thank you. I did think it might be a bit waffly and too paragraph-y so will condense it a bit better :)

And will look at that link also. Thank you.

Oh that link was just what I needed thank you so much.

"If the cord is clamped early the baby does not receive enough blood through the cord. In some circumstances it is possible to delay cord clamping with a managed third stage which significantly increases the amount of the baby's blood volume"

This is what I would prefer I think. To still have the third stage medically managed but with a delay to enhance blood flow. I had a ventouse delivery last time and baby is big so risk of intervention quite high so I definitely think this will be best for me and baby.

This what I added in:

Delayed medical management of third stage until cord has stopped pulsating to encourage blood flow to baby, then happy to clamp and cut and have the jab.

coconuts it is fab that you are thinking about all this stuff, because it means I can just come along and glean all the info off your threads instead of having to think too hard for myself!

One of us has to be prepared LOL x

I understand your preferring not to have forceps. However just sometimes they save a life and avoid an EMCS. I would say something about only consenting to the use of forceps if unavoidable. And that is probably the only reason they'd be used anyway.
My plan was simply "minimal intervention for the safest possible outcome" it ended in an EMCS that almost certainly save DSs life. Very happy with that!

sprinkles Really, I do not want forceps. I think I'd rather have EMCS and skip trying forceps. It is just barbaric to me. That is why I have said if intervention is required then to use ventouse (I've had that before) and I am ok with that. I just would not agree to forceps.

There is a whole forceps thread here on Pregnancy which reinforces my opinion on forceps. Although I can see if it was an emergency that it may be the only option but I'll cross that bridge if I come to it.

You know there are different types of forceps? I can understand you refusing keillands, but if your baby is almost out and vonteuse doesn't work (didn't with mine - too hairy to get good suction I think!) then a gentle pull with wrigleys forceps would be far less traumatic for everybody than an EMCS with the baby pulled back up the birth canal (don't even know if they would do this).

Can I specify on my birth plan which I want and which I don't? Is there a way to find out which my hospital use without looking a little deranged!!? I definitely agree that it would be better than an EMCS pulling the baby back up but I didn't know there would be a reason as to why a ventouse wouldn't work. So thanks for that :) Sometimes it is just a bit too daunting to google these things...

Ok thanks, I'll tweak that bit then. :)

Doctors will use forceps when they believe it will cause less damage/ risk than a c/s. You can tell a doctor to go against his or her clinical judgement but you have to accept responsibility for what happens afterwards. I'd suggest you research outcomes for emergency c/s done in late second stage. Doesn't make happy reading.

spudulika I've had a look, and maybe I haven't found the right research yet, but it looks like the comparative outcomes of an emergency CS compared to a forceps delivery entirely depend on the skill of the doctor that attends the birth. Which is quite scary since I have no knowledge or control over that

I found this article very interesting, especially this part:

Outcomes
Vacuum-assisted delivery has a lower rate of successful delivery, but is less likely to lead to Caesarean section than the use of forceps.
Vacuum-assisted delivery is also associated with less use of anaesthesia and fewer severe maternal injuries.
However, use of forceps following failed vacuum extraction can lead to a high level of damage to the mother. Adverse symptoms such as urinary and faecal incontinence are common in mothers with both forms of assisted delivery.
Cephalhaematomas and retinal haemorrhages are well recognised sequelae of vacuum extraction, but usually have no long-term adverse effects.