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.

Gosh you are well prepared!

I'm on dc3 and the birth plan reads somethng like "I have a pool. Bring some gas and we'll take it from there!"

loveinacoldclimate,your plan seems fine,and keep an open mind.

hardcheese please speak to a midwife you feel comfortable with.midwives can only examine you with your consent.examinations in labour are to assess progress.if labour is progressing and you decline to be examined then the baby will come anyway!

Jezzo my birth plan is 'get baby out safe do what ever you think is needed i'm not a doctor i don't know whats best' might go have a wee look see if i can add to it lol

I didn't have a birth plan with DS1. I had a better idea with DS2 as to what I would rather have.

NewYear, it isn't unrealistic to refuse internals. My birth plan stated I wasn't to be touched at all, and neither was the baby. Delivered her myself.

HardCheese (confusingly, I am a different NewYear to NewYearEverything!). Some people would argue that routine internals (e.g. when you get to hospital, after X hours, etc) are counter productive. Many women dilate irregularly - e.g. take ages to get to 4cm and then go from that to 10cm in half an hour. The temptation amongst medical staff is, if you are not going 1cm an hour, they feel they need to augment, which can be a bit of a slippery slope. It's what happened to me with DD1.

With DD2 I planned to say no unless I expressly agreed it would be helpful. For example, if there was concern I was pushing against a cervical lip I may have agreed. Actually, for various reasons, I had none. It was an amazing home birth. I think I probably dilated irregularly this time and many things would have been negative had I been checked. I may have been encouraged not to get in the pool. I may have been told I was in early labour when I was an hour away from giving birth, which would have screwed with my mental ability to cope...

If there is every a DC3, I would also refuse most internals.

However, refusing all internals can be tricky, in that some midwives will put pressure on you (though others won't. Bit luck of the draw). You would want to fully brief your birth partner to stand up for you. It does pay to have researched your position, so you can quickly convince them it's an educated choice on your part.

I would also suggest talking to your midwife in advance. There may be situations where you agree that an internal is a good idea, and you want arrangements in place which enable you to cope the best way possible if you make that decision. For example, you could request gas and air. You could request certain lighting, positions, staff, etc.

Good luck!

NewYearsRevolution, thanks so much - that kind of information is just the kind of thing I need to think about. It's helpful to know what comes under the heading of Absolutely Necessary, and what can be refused - I do worry about my partner folding under pressure if a medical professional says 'We need to do this or Bad Thing X will happen. More research needed, clearly.

OP, apologies for the hi-jack.

No worries, if you want to start your own thread once you've had a think there are loads of people on here who will be helpful .

The BRAIN acronym can be useful for partners: benefits, risks, alternatives, intuition, nothing (what happens if we do nothing0. You can also add a T - do we have time to talk about this. If they say no (i.e. baby at serious risk), it would put everything else in perspective.

OP - you didn't mention ventouse at all - do you have any view on that?

Also in your long version I think you need to be clear that you expect to pay for the single room when you first mention it under special facilities. The way it reads atm sounds a bit like you insist on a NHS single room - may not get you off on the best foot with the staff Obviously the bit further down makes that clear.

I agree you need a c-section plan.

Generally yes upright is better for many women but you may find that you like being on your back. Some women labour that way. What you really want is for the midwife to follow your cues for position and to support you in that.

Personally I had a rough birth plan for my first which worked out ok and after that I just tended to say 'this is what works for me' for the other two. Until you're there doing it you won't know 100% what you'll want so I would be clear with dh that actually yes he can look at the plan and refer to it BUT if you are sayng very clearly that you want/need something else then he must listen to you. A couple of examples - you don't want an epidural, fine. But if you change your mind you need him on your team not saying 'no you don't want that, you really don't'. Another example - like most mums you're saying 'don't bother about me, take care of the baby' with regard to if you need theatre to send you by yourself and him stay with baby. Just keep the door open on that one and if you need his support he should know that baby will be exceptionally well cared for and his place might be with you. Do you see what I mean? There's lots in your plan about ensuring the baby's wellbeing and about managing the type of birth you want but there's maybe not as much about taking care of you. Don't forget yourself in all this - they can't run this show without you. Good Luck.

kiki - regarding childbirth, Doctors don't know best either.
Remember that doctors who deal with babies only ever =see abnormal births - the ones that have gone wrong. So they always view it from a "worst case scenario" point of view.
I would definitely add to your birth plan, and remove the doctor reference.

For a "primip" (first baby), the target for dilation is ½ cm per hour.
It's 1cm for the next ones.
So, if you are 3cm at 9am, then it's likely that you will be 5cm at 1pm, and then fully dilated (10cm) at 11pm.
If you don't want to be examined internally, then bear these times in mind.
Then if you feel worried, you can ask them to examine you.
I did allow examinations, and mine were textbook in timing, but I was only examined 3 times in total, i think.

My cousin is a mw and says that women who refuse internals get more attention as the mws have to spending longer with them to assess where they are.

She also says that crap mws can refuse pain relief on the basis of not knowing how many cm dilated you are and bully you into internals but this is rare.

Blimey! How much time on their hands do you think they have!

As for the private room, at my hospital there was an option to book and pay for one although no absolute guarentee that it would be available due to others possibly having a more pressing need. Everyone would like a private room, you don't get one just because you say you want one. The "I would like a private room please" makes you sound like you think you're the queen.

Also your plans give me the impression that you have a very idiolised view of how your labour is going to be, in my opinion you are setting yourself up for disappointment. A lot of women become very despressed when labour doesn't go exactly how they expected so it's best to be as flexible as you can in your mind.

Things such as not giving birth on your back go out the window if the baby gets stuck. Also low voices won't happen if there is a problem. The midwives are there to do a job not to worry about if the volume of their voices is going to upset you.

I also think you are being unreasonable and unrealistic to expect each of your midwives to read your birth plan as they enter the room so that they are aware that you don't want them to mention that "epidural" word. Seriously how much time do you think they have?! They are there to get your baby out safely not to act as your puppets!

If you are that specific about how you want things perhaps you should look into going private/hiring your own team of previously briefed midwives and doctors etc.

I suspect there is a new PFB mum on the way!

"They are there to get your baby out safely not to act as your puppets!

...I suspect there is a new PFB mum on the way! "

Wow, harsh AND unfair.
I wonder if you are one of the minority midwives that think a woman is a piece of meat that just needs to lie back quietly whilst they "get the baby out safely".

Actually, no, you are probably a blast from the 60s that think nowadays everyone one is treated with the kid gloves and shaving, enema and conveyor belt treatment of women in labour was the right way to go.

Gluesticks, are you a man? Perhaps you aspire to be one.

The OPs birth plan is no where near as detailed and prescripted as mine and I didn't come away depressed. I did however suffer PND and ptsd after a category of errors during my first birth due to the mws not knowing me or how I would react. My BAD birth required considerably more time and resources than my second which went smoothly due to careful planning and everyone knowing what to do in EVERY eventuality.

And actually I think the OPs birth plan is pretty open and flexible. Mine was literally PAGES long.

GlueSticks - your post really is unfair.
She's not being PFB or precious by wanting to have a plan of how the ideal birth should be.
Nowhere along the line has she said that she won't accept medical intervention if necessary - but has stated quite clearly, and fairly, that she would like the birth to progress naturally as far as possible.
That's not an out-of-this-world request.
Birth is natural,and should be treated as such until or if there is a problem.
Which in the majority of cases there isn't.

It's a lovely birth plan and there is nothing wrong with planning what you would like to happen as long as you are realistic that it won't always go that way - as much as anything because of the way our maternity services work. I think someone lower down mentioned home birth - I don't know if that is an option for you OP but it would certainly be one way to help you achieve the birth you want.
And yes I do think you should have a separate c/s plan. Unless it is a real "crash" section you will have time to get it out and discuss it with the mw/surgeon if things look like they might be heading that way - eg if they start talking about intervention like forceps.
Good luck!

What a lovely post, Gluesticks .

Thanks to everyone else, I will respond properly when not trying to eat lunch with one hand and do some work at the same time!

Oh, and as I have said several times, I am happy to pay for a private room and am amending the plan to make that clearer (although it does already say that).

LoveInAColdClimate
What a lovely post, Gluesticks
Thanks to everyone else, I will respond properly when not trying to eat lunch with one hand and do some work at the same time!

But not thanks to me? You asked for opinions and you got mine, but you only say thank you only to the ones whose opinions you like.

You asked for opinions and you got my blunt and rather honest one. Perhaps you would only like responses from those who tiptoe around you and [whispers] don't talk too loudly

StarlightMcKenzie And actually I think the OPs birth plan is pretty open and flexible. Mine was literally PAGES long.

And did anyone actually read it? How many pages? 10? So it was actually an essay? I am sure the busy, likely understaffed midwives have nothing better to do then read an essay on how you want to give birth whilst listenening to jon bon jovi or whatever.

Birth plans are a good idea but they need to be short and concise. Flexible and realistic. Most importantly the parents need to be aware that there is a good chance that not one single thing in the birth plan might go to plan. They also need to be aware that the understaffed medical staff won't be able to memorise every pages long birth plan and so may well walk into rooms talking too loudly/wearing pink lipstick/humming the wrong song or whatever else it is the parents don't want at their babies birth.

I just had another look at the Midwives, nurses and doctors in training "section".

You want it to be as private and quiet as possible with only your husband and midwife present. You don't want the doctor there but are happy for the dr to be there if needed (they wouldn't be there otherwise). You don't really want a student in the room but will put up with them but might ask for them to leave bla bla bla

Perhaps the problem is that you have made it so bloody longwinded.

Gluesticks, I'm afraid I'm not going to engage with you.

Revised short version below (I won't bore you with the long one again!):

? I would like to use the pool for labour and delivery.

? I would like encouragement to use different positions, particularly upright. If I become too tired to remain upright or find it uncomfortable, 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 like to avoid continuous monitoring (to enable me to use the pool and labour as actively as possible) unless the midwife has reasons to believe that it is necessary.

? 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 Keilands forceps on me ? please proceed to a Caesarean instead should their use be indicated.

? In the event that the use of low forceps or ventouse 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. I do not want a ?trial? of forceps/ventouse if they are not guaranteed to succeed.

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

? I would like my husband to be given the opportunity to cut the cord, preferably after it has stopped pulsing.

? 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 the vitamin K injection.

In the event that I need a Caesarean

? I would like the screen to be lowered when the baby is brought out.

? I would like the lights lowered.

? I would still like skin to skin ? if not with me, then with my husband.

Thank you everyone! Your help is very much appreciated. I have left out whether I want a managed 3rd stage as I don't feel that bothered about it, really, and thought it might be something that could be decided depending on how the birth has gone (i.e. if I'm exhausted after a very long labour and need a load of stitches then managed might look better, or if he has just popped out (hahaha) then natural might be nice. Does that sound sensible?

Thanks again.

You know what though GlueSticks - it is disrespectful to walk into a room talking loudly and/or humming. I wouldn't walk into a meeting doing that. I wouldn't even walk in a colleague's office or up to their desk doing that. So why on earth a medical professional would walk into a labouring woman's room doing that is beyond me.

Similarly, I would expect the main midwife caring for you to read your birth plan (and the new one on shift changes). If someone is going to actively suggest pain relief or whatever, it should be that person, or the midwife in charge after speaking with that person. So it's not unreasonable.

That aside, I would agree with one point you've made - which I think Love has already taken on board- that the shorter plan and bullet points are more likely to get read. I don't think there is anything wrong with the content of that plan, it all sounds sensible to me.

Do you work in a hospital by the way? It sounds like maybe you do?

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

Oh and if you take out all the obvious statements like the one above (how the hell else do you think they do stitches?!) you will reduce it by about half.