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.

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

No I don't. I have given birth twice though so am aware of the realities.

Looks good Love a couple of thoughts.

You might want to change the word 'guarantee' when talking about forceps/ventouse and say something like "if the relevant doctor has any reason to suspect they would not be successful" (or something. That perhaps isn't quite the right wording). Nothing is ever guaranteed with medicine...

Re managed third stage, they'll probably assume you want managed unless you say otherwise, so I'd stick in "I may wish to have a natural third stage if possible, but will make the final decision on the day." They stick you with that needle fairly fast and you might not be concentrating on making the decision IYSWIM. If it's in the plan, they'll probably ask you earlier - say as you are pushing.

On milk from a cup I'd say "If necessary" somewhere. Even if you can't breastfeed immediately, most babies will happily wait. Neither of mine were remotely interested in feeding until at least a few hours old.

Any help?

Glue - ok, just wondering. Me too .

NewYears - I do not think s/he does, at least not in the clinical role.

^ You say^ that Glue but I can recount many many stories of women NOT being anaesthetised for stitches. I had to write it in HUGE CAPITALS at the bottom of my birth plan.

NewYearsRevolution [knowing smile]

Mine had a contents page, and yes it was read. And yes it went to plan because EVERYTHING that coukd possibly happen was written in it.

Contents page? Wow, that's hardcore! I've seen you post in the past and can understand it though.

Starlight, I have always found your story of your second (I think) birth very inspirational. Thank you for sharing it.

LoveInAColdClimate My birth plan reads like a copy of War and Peace (and I'm only 29 weeks). In fairness, there are 3 versions - one for DH, one for the MWs (bullet points) and one for me to work through with the Supervisor of Midwives when she comes to see me in a couple of weeks to talk through my care plan (homebirth against medical advice) so that we both know that I've thought about and understood the implications of each of my choices.

Even if the short version isn't read by the MWs in attendance on the day, it has given me the chance to work through what I am and am not comfortable with, my reasons for making certain choices and the opportunity to make DH aware of my preferences so that he can be my advocate if I am not able to speak for myself for swearing and demanding everyone fuck off because I've changed my mind about having a baby.

Last time round it didn't even come out of my bag (shame, it would have made a handy fan), but even so when it came to things like being offered an epidural, and later on, forceps, it meant that rather than making an 'on the spot' decision we knew that I'd already weighed up the pros and cons of any offer of assistance. It was also reassuring knowing that it was there just in case DH wanted to refer to anything in it at any time.

Well you have to get the essential things in like:

I DO NOT CONSENT UNDER ANY CIRCUMSTANCES TO THE ADDMITANCE OF THE BOUNTY LADY!!!

Incidentally nothing in it was about music, candles or lentil flapjacks.

Love Thank you for your kind words. I wish everyone coukd have a birth like my second one.

Sorry but whole op and thread has had me laughing :)

I think it's an excellent birth plan in the revised second version. A birth plan is never more than a guideline anyway - we all know things might go very differently, but at the same time if you're well prepared and want to do active birth it could all go as described. My two births were pretty much as you describe (except no gas and air or any other pain relief) - upright (actually all fours), lots of walking around, use of pool, mobile heart monitoring, skin to skin, immediate BF. You've made it clear by discussing use of forceps and CS that you realise intervention might be medically necessary and are thus not in 'natural birth la-la land'. Your plan is short and clear enough for midwives to read in your notes when they come in at shift changes etc. You've taken the private room thing out of the short version, which is good - that will come long enough after the birth for you to discuss it rationally.

One thing though - when I had my two in a birthing centre (not a hospital) it was usual to be sent home three hours after the birth - if your birth is as unproblematic as planned and the baby is healthy, why would you need to even stay overnight in hospital? It's MUCH quieter and more private at home.

I think the OP's birthplan is great and am cribbing busily from the revised version nd various helpful comments, though now feeling inadequate that mine is no War and Peace and doesn't have a table of contents .

I get impatient with medical professionals who scoff at reasonable birth plans, as if they're the equivalent of a greedy, over-imaginative child writing a letter to Santa Claus. Why on earth wouldn't a woman pregnant for the first time do her research on a life-changing and potentially dangerous event, and keep a note of her preferences for when she's not capable of expressing them? For a while I was dithering between giving birth in two countries, and the choice I finally made (UK) was based on how badly several different medical professionals in the other country responded to evidence that I'd been reading and wasn't going to passively accept medical pronouncements.

nickelhasababy i can guarentee you the doctor will know more than me about complications in child birth i am not qualified in the slightest to decide if i need forceps / c sections or anything else so will happily take MW and doctors advice.

This is my plan

Pain relief - as little as possible but whatever i need at the time

Complications - Do whatever you need to to get baby out safely, if you need to cut me cut me, same for forceps and c section.

Internal exams - If i need one i need one

Additional notes -Please don't lie me on my back, skin to skin straight away with one of us, clean me up quickly.

I will be able to talk to the midwife and think it's more likely she'll remember me asking for certain things that reading it i also have complete confidence that DP will be able to make any decision on my behalf if i'm unable. The hospital where i'm giving birth is a huge city one and from friends and relatives experiences there they don't bother reading your birth plan anyway so will just tell them what i want.

i have to say that every MW who looked after me during DS's labour/delivery read my birth notes (which were different to a birth plan i have to admit - i had several unusual complications/history). i don't understand the sneery tone a few posters seem to be taking about having this kind of stuff written down.

my only comment about your C/S stuff in your revised plan is that if it is an emergency C/S then they won't necessarily have time to do any of that (at mine the anaesthetist was telling the consultant not to cut yet while i was vomiting in a bowl having been whisked round corridors and in and out of rooms). might be worth having the C/S-specific stuff on a separate sheet for your husband to produce if you are having a non-emergency C/S??

other than that i think your revised one looks good.

oh, and for the poster concerned about internals i think the view on them may have changed - i had several when i was labouring with DD (12 years ago) whereas with DS i had very few and in fact was fully dilated and complaining about the pain when someone finally had the wit to look at me and realise that i'd gone from 3cm to 10cm in an hour...

To be fair, my 'table of contents' was pretty much a one page bullet-point summary with a reference to where the mw could find out more if she wanted an explanation of the rationale or more information about the detail iyswim.

i.e.

• vit K - none (page 6),

• Physiological 3rd stage, cord cut after placenta delivered (Page 5)

• Birthing pool even if water contraindicated (Page 4)

That kind of thing.

Skrumie - I think it's very dependent on the hospital and the midwife. I was quite pressured into regular ones with DD1 and that was only 2.5 years ago .

Starlight - I've read your story too and was very impressed. You said some lovely things to me (under an old name) when I was preparing for DD2.

The midwife I had in 1998 maybe wasn't too up to speed on 'birth plans' but she certainly asked what I wanted. I was concerned about a managed third stage and she noted that but then in the event it was medically required so we went with it. In 2001 and 2007 they certainly were expecting a plan - seemed disppointed when I had nothing written down. Yes a plan must be flexible and it's good to get other's feedback on it. No reason for the OP to be clobbered for this. Some things you get, some you don't and some you realise you don't want - but just thinking it through is helpful.

Erm it is a bit detailed to be honest - no one can guarantee forceps working either, as there are a lot of variables and depends how far down and position of the baby and turning down the lights for a caesarian?

I have managed to have 4 babies (expecting 5th) without ever having a birth plan! To be fair I am not a very organised person..... my birth plan this time was, me to Midwife ' ooh I fancy a birth pool what do you think?' Midwife to me' yes, brilliant, you will love it'

Really does it need to be that detailed?

I worked on a labour ward once and a primip came in with laminated copies of her birth plan, one for everyone and also for her husband (his had post it notes too) - she asked for us all to come in and 'briefed' us which was bad enough as she had the long version on a clip board which if our short version was not clear we had to refer to - even bought her own candles, instructed when and how to light them etc, Head Midwife fretting about fire safety quite amusing in itself. Within an hour all abandoned, shouting swearing and slapping her husband - really really shockingly foul mouthed. Anyway the upshot was the only thing adhered to in 'the plan' was delivery of placenta and vit k for the babba - we did laugh, it is cruel but we did laugh.

Also episiotomy is not done to speed up delivery unless the baby needs to get out quickly through distress etc - you might risk sounding if you are teaching them to suck eggs and alienating the Midwives

Thanks, everyone. I do very much hope not to have to stay in, but I understand that whether or not I get to go home the same day depends on how the baby and I are and also what time he makes his appearance - apparently it's hard to get signed out in the evenings.

I have heard otherwise about episiotomies being done to speed things up - a friend was offered one to speed delivery, said "yes" because she wanted the baby out and the ring of fire to end, but found it hard to heal and regretted it. But perhaps there was more to the story than she told me and the baby was in distress (in which case I would of course have one if it was needed).

I have removed the word "guaranteed" and "100%" from the forceps but and toned it down a bit. I do totally see what you mean - I also won't give clients "guarantees" that something will work, I should have thought it through a bit more (as I have now!).

I feel a bit at the idea of medical professionals laughing at a labouring mother behind her back for failing to follow her birth plan. It doesn't seem very... well... professional or compassionate.

HardCheese - glad you're finding it helpful and I hope you have a lovely birth.

This has been really useful even if it stays in my bag - I like the idea of having thought through the options in advance and understanding the pros and cons of any choices I have to make, even if some choices may end up being made for me by how things pan out.

I don't know if you'll read as far as my comment but are you expecting to be unable to speak in labour?

it took me about 5 minutes to read that birth plan, her MW will have more time than that whilst the op is in labour by a very long chalk. (if the baby comes in 5mins, they just need to read the end bit!)

AND I WAS UNABLE TO SPEAK IN LABOUR.