Please could one of you lovely kind MNers review my birth plan? Thank you so much!

[LoveInAColdClimate]

Is there anything here that looks insane or that I don't need to say, or something else I should be including? I have a one-page bullet point version and a three page full version. Please see below. Thanks so much! Hugely appreciated.

Short version

? I would like to use the pool if at all possible for labour and delivery.

? I would like encouragement to use different positions, particularly upright. If I become too tired to remain upright, I would like to be encouraged to labour and deliver on my side and to avoid labouring and delivering on my back.

? Please offer me gas and air.

? Please do not offer me an epidural ? I will ask if I want this. I would prefer to avoid pethadine.

? I would prefer intermittent monitoring (to enable me to use the pool and labour as actively as possible).

? I would prefer to tear than to have an episiotomy, unless the midwife considers that I am likely to tear particularly badly without an episiotomy. I do NOT want to be offered an episiotomy just to speed up delivery unless this is necessary for the baby?s safety.

? Please do not use Keillands forceps on me ? please proceed to a Caesarean instead should their use be indicated.

? In the event that the use of low forceps is required, if you are not 100% confident that they will succeed, please do not try them but please let me have a Caesarean instead.

? Immediate skin to skin please ? with my husband if not possible with me.

? Please offer me encouragement to breastfeed immediately. If for any reason I am unable to breastfeed immediately, I do NOT want the baby to be given a bottle. Please give him milk from a cup instead.

? If I require stitches, I would like them to be administered (with pain relief) by the most experienced person available.

? I am happy for my baby to be given vitamin K.

Long version

Where to give birth
I would like to labour at home for as long as possible then transfer to [ ] to labour and preferably deliver in the pool in the Birthing Centre.

Companions
I would like my husband to be with me during labour and delivery, including if I require an instrumental delivery or a caesarean section.

Special facilities
I would like to use the birthing pool if possible, for both labour and delivery.

I would like to use the birthing centre's pool, birthing ball, wall bars, bean bags etc as appears appropriate and as I wish during labour and delivery.

If at all possible, I would like a private room for after the birth. I do NOT wish to be on a ward unless absolutely unavoidable.

I would like the lighting to be kept low and for quiet, calm voices to be used in the delivery room.

Monitoring during labour
I would like intermittent monitoring (to enable me to use the pool and labour as actively as possible) unless the midwife has reasons to believe that continuous monitoring is necessary.

Keeping active during labour and positions for labour and birth
I wish to remain active in labour and to be encouraged to find positions which are comfortable and helpful for me.

I wish to remain in an upright position as much as possible.

I wish to labour and deliver in the pool if possible. An alternative which I would like (if I find I do not like the pool) is to use a birthing ball.
If I become too tired to remain upright, I would like to be encouraged to labour and deliver on my side and to avoid labouring and delivering on my back.

Skin-to-skin contact with my baby
Skin-to-skin contact immediately after the birth is very important to me.

I would like the baby to be delivered straight onto my tummy.

I wish the baby to be given to me without being cleaned. I wish to put the baby straight to the breast.

In the event that I am unable to hold the baby, I would like him to be given to my husband so that he can have skin-to-skin contact.

I would like my husband to be given the opportunity to cut the cord.

I would like the three of us to be left alone after the birth to bond, so far as is possible.

Midwives, nurses and doctors in training
I wish for my labour and birth to be as quiet and private as possible. I do not wish for anyone other than my husband and the midwife to be present unless a doctor's presence is needed. However, I am prepared for a student midwife to be present, although I would like to be able to ask her to leave if at any point I feel uncomfortable with her presence.

Other issues
Please do not use Keillands forceps on me ? please proceed to a Caesarean instead should their use be indicated.

In the event that the use of low forceps is required, if you are not 100% confident that they will succeed, please do not try them but please let me have a Caesarean instead.

Pain relief options
I would like to use TENS in the early stages of labour, and then to use gas and air and the pool. I would prefer to manage with just gas and air and the pool but am aware that I may wish for an epidural. I do not wish to be offered an epidural, however - if I want one, I will ask for one. I would like the option to remain upright during labour and to use the pool so would prefer to avoid an epidural.

I would prefer to avoid pethadine.

I would like to be encouraged to move around and try different positions in labour. I would like this encouragement to come from both midwives and my husband, who has attended Active Birth classes with me. I would like my husband to remind me of the positions practiced in those classes, and to use the massage techniques learnt in those classes.

Having an episiotomy
I would prefer to tear than to have an episiotomy, unless the midwife considers that I am likely to tear particularly badly without an episiotomy.

I do not want to be offered an episiotomy unless the midwife thinks it is necessary for the baby's safety.

I do NOT want to be offered an episiotomy just to speed up delivery.

After the birth
I would like the syntometrine or syntocinon injection to avoid the risk of heavy bleeding.

If I require stitches, I would like to have local anaesthetic and gas and air.

If I require stitches, I would like them to be administered by the most experienced person available.

In the event that I need to be taken to theatre after delivery, and it is not possible for the baby to come with me, I would like my husband to stay with the baby and not go with me.

We would like a private room after the birth if at all possible (and are happy to pay for that).

Feeding my baby
I would like the baby to be encouraged to breastfeed immediately.

I plan to breastfeed exclusively and would like any help that can be offered to enable me to succeed in this.

If for any reason I am unable to breastfeed immediately, I do NOT want the baby to be given a bottle. Please give him milk from a cup instead.

Vitamin K for my baby
I am happy for my baby to be given vitamin K.

Oh god, that's so long . Sorry.

It seems to cover everything
My only thoughts are (and they may be wrong):

Vit K is either an injection or 2 sets of drops and you have not specified which.

I 'think' once you get to a point that low forceps can be used you are passed the point they will do a csection as the baby is too low and would have to be manouevered back up.

3rd Stage- do you want an injection to speed up delivery of the placenta?

Tbh though, I think with DS my birth plan never came out of the bag once I got to hospital. What happens just tends to happen so try and keep an open mind.

Wow, you do realise you will be able to talk to the midwife and your husband whilst you're in labour, don't you?
They might read the short version, they probably won't read the long one, particularly as it is 3 pages long! You might want make the short one a bit more concise, so they do.
And remember that if you decide you do want an epidural it can take some time, especially if the anaesthetist is busy.
Relax, you will be fine. You can't control exactly how it will all happen, have an open mind and trust those in whose care you'll be. They know what they're doing. Good luck.

With DS1 I didn't have a birth plan, with DS2 it stayed in the car boot with my labour bag as there was no time to get it.

It's a really good plan though, good luck.

TBH I would keep the long version for your husband. It is rather long and unlikely to be read in full. I would just transfer the stuff about students and managed third stage to the bullet points and give them that.

There's a lot in here the medical staff really don't need -e.g. you want to labour at home as long as possible. If you are at home, by definition you haven't passed them the birth plan yet, and believe me they won't hesitate to send you home if you've come in too early but all is well! Also, stuff like wanting private room, sticking it in the birth plan is unlikely to be much help. Much better to prime your DH to enquire verbally.

The short version is good though! Does that help?

Have you considered covering what your plan would be for a c/s? Although you are obviously keen to have a natural birth, a high proportion of women (up to 31% for a first birth) do end up with a c/s so it is worth putting something in about that eg: I would like the screen to be lowered when the baby is brought out, I would like to identify the sex, I would like the lights lowered, I would like skin-to-skin asap - if not poss with me then with husband/partner etc?

How far along are you?
Have you thought about having a home birth?
You can get a pool for your house, or use the bath (at mine, the MWs kept encouraging me to have a bath, but I didn't want to get wet. )

The reason I ask this, is because a lot of the interventions you prefer to avoid wouldn't even be an option at home birth.

I had a good labour - mainly tens, and gas and air until the pushing stage (i had to be reminded that the gas and air was available!)
I was able to be in whatever position i wanted to be (in the end, the baby wouldn't move down in any position except on my back - the MWs keep an eye out for this, and watch your progress in whichever position you want to be in)
And I was able to move around the house - I found that going upstairs at a fast pace felt great when I had a particularly bad contraction.

I had an episiotomy in the end because DD's hand was on her face, so she wasn't moving anywhere. IT was all that was needed, but they did have an ambulance on standby just in case.
oh, and if you have a prolonged labour (mine was 3 hours in the pushing stage in total - at 2 hours they started to discuss the need for interference - had i been in hospital, they would have only allowed me an hour before they got medical on me), it's a good idea to have your plan for the 3rd stage (placenta) written down too. I wanted a natural 3rd stage, but after the long labour and cut, i chose the injection. (apparently I didn't have much choice on this, but the decision had to be mine)

I think it is good that you have done the long birth plan so you and your DH have a really clear idea of what you want ideally (although the best laid plans...) but it won't be read by anyone else - it's too long! You want the short version to be as short as possible and really it's more likely to be just used as a memory check by your DH.

Most of your plan could be summed up by 'I want an active, natural birth using birth pool if possible' tbh.

Thanks so much, everyone - I really appreciate you spending time looking at this (especially as it's such an essay!). I have got the impression from NCT that I may be rendered incapable of expressing myself rationally and I'm worried about DH forgetting everything so I thought it best to be thorough! Perhaps I'll edit the short version to staple to my note and leave the long one in my bag so DH can refer to it if he wants.

Thanks for suggestions re c section plan, Stranded. Is it worth having a separate plan to be brought into play if that happens, to avoid making this plan even longer?

I have considered a home birth, Nickel, but am too much of a scaredycat (although I did very much admire your lengthy birth thread!).

I will play about a bit with it to include/exclude the issues raised above - thank you so, so much.

If this is your first my honest experience was it made no difference - I felt so strongly in advance but on the day I got exhausted after four days and had an epidural then just took advice from the midwife about things I'd ruled out before like managed third stage. It's fun planning but remember to chill and go with the flow instead of trying to stick to rules. That's my own advice for myself feel free to ignore

mainly because i was too much of a scaredy cat to go to hospital (during labour)!

"rendered incapable of expressing myself rationally" - yep, you'll be barking instructions instead and getting upset at small things like being offered a choice of juice and water instead of just being given a drink "i'm in labour here, can't you be a mind-reader?"

I'm with you on wanting low lighting and a private room instead of ward...I'm going to Kings College Hospital where my SiL also gave birth, and both times I remember her being in a private room afterwards, but am being told that's not an option now :(

(She had a CS both times, though, so perhaps people who've had CSs get the private rooms)

I think it's the luck of the draw private room wise. I was on a ward both times. If I had had a private room I may not have walked out two days later, or six hours later.

Thanks, everyone - all comments taken on board! I will tweak the plan.

Re private room, we have the option of paying for one if there is one available, and I am told by the midwife that there usually is... Fingers crossed!

Nothing to add, LoveInAColdClimate, as I'm in my first pregnancy, but just wanted to say thanks for sharing this, as it expresses very similar things to my own desires (which I haven't yet got around to putting on paper), and it's very helpful to see them in print.

General question to anyone reading, sparked off by NewYear's post - I dread internal examinations (childhood experience I really don't want to talk about). Is it possible/realistic to say I don't want them during labour? How can they determine dilation etc otherwise? Is this something I should talk to someone (my own midwife, my GP) about in advance, as it amounts almost to a phobia?

Glad my obsessiveness has been helpful, HardCheese . I'm sorry to hear about your childhood trauma. While I can't speak from experience as it's my first baby as well, at NCT we were told that an experienced midwife ought to be able to tell to a certain extent how far along you are without doing internals. I dont know how failsafe this is, though. I'm sure someone more experienced will be along shortly, but it certainly sounds like something that would be worth discussing with your midwife and including in your birth plan. My midwife has been very sympathetic with my plans to refuse Keilands - I know it's not exactly the same thing, but I'm sure you will be listened to.

It doesn't look like obsessiveness from here LoveIn - it looks admirably organised! I'm hoping this means you are simply a lot closer to your due date than I am to mine (almost 32 weeks), but I suspect you are simply more together. Thanks for response on internal exams.

runs off to look up Keilands in horror

Incidentally, as I've never even heard of K forceps, would you mind explaining your refusal, or pointing me to some information on their use?

I would also get rid of all "if at all possible", "please" and so on.

Did you consider asking to cut the cord after it seized pulsing?

Once forceps come into play it is very like that Cesarean is no longer an option.

i think it looks like a good birth plan, and quite open too. you haven't ruled out that things may need to change either, which is really sensible. at the risk of getting flamed, i am all for birth plans, mother's choice and control, but please remember that we can't always have the ideal births that we want so please don't be disappointed to the point of sadness if it doesn't happen as you imagine; healthy mum and baby are the most important outcome and the medics and midwives should will have that as first priority; if they deem it necessary to deviate from the plan, it is not just because they are taking things out of your control. it might not be the birth you want, but it will be the baby you want

I am 31+6, HardCheese - see, I said I was obsessive .

My Keillands refusal stems from my DM's awful experience with them - they are "high" forceps that are hardly ever used these days (and are banned in other places in Europe), but my hospital does occasionally use them. They are linked to a risk of serious maternal damage. My midwife has assured me that declining them should not be a problem.

beMybebe - good idea re cord and language changes - thanks. Re forceps, I have been told I can decline Keillands as if the baby's high enough to need those, he is high enough for a section. Re low forceps, I really want to avoid a "trial" of forceps, proceeding to a section when that fails (and thus ending up with two injuries from which to recover). I am comfortable that they may be needed when the baby is very low, but really don't want them "given a go" when doctors suspect they may well fail, as a friend discovered had been the case with her, resulting in her having an episiotomy then a section. Do you think this is unfeasible?

X posts with missing - I know it's more of a wish list than what will happen, but am being optimistic .

and to that end love, i hope those wishes come true

Thanks - me too!