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.

brandy, I'm afraid with my first they were about to give me an episiotomy to speed up delivery as I had been pushing for over 2 hours on my back.

Whoops unintentional caps lock, but seriously - it can be very hard to articulate your preferences whilst you are in labour. i found i went into a little bubble and didn't want to talk.

if the OP finishes her labour unconscious, how are they to know to give baby to her husband for skin-to-skin and all that? He may need prodding at that point as birth can be very overwhelming for all concerned.

Tigeress, I couldn't speak during either of my labours due to the pain. It is possible. And it is possible to be too drugged to speak too.

Also, you can't talk to midwives that AREN'T THERE!

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.

Yes well actually to be honest she was very rude and a bit of an arse, everyone took very good care of her but she was insulting and patronising to the staff, spoke to everyone as if they had never delivered a baby before. No one was spiteful to her face at all but after everyone being lectured and talked down too it was funny. I know it is horrible but actually nothing at all went wrong with her labour, it was genuinely text book and not too long but she just could not handle the lack of control! surprise surprise!

BrandySoaked - so really a bit like most of us complain about 'nightmare clients' in our jobs from time to time! I'd hope that if you're nice, and polite, even if it turns out your birth plan is a bit unrealistic it would be rather different.

My midwife laughed to my face about one aspect of my birth plan, but to be fair it WAS funny, and I knew it.

I wanted to labour in the birth pool even if there were good medical reasons not to fill it with water. I knew I would feel safe there and no-one could touch me without express consent.

I asked for no episiotomy after my NCT class and ended up with a 3rd degree tear that took MONTHS to heal. My only advice would be to do a bit more research about the pros and cons of both to be absolutely sure about your decision.

I know all births are different, but I wish I had explored further before making my decision.

That's fantastic Starlight. You're right, it is quite funny.

You know what, Starlight, that's a really great idea!

We'll see.

I will report back in due course after I have demanded an epidural after the first contraction and begged them to turn up the lights and lever him out with forceps just to get him out of my pelvis .

can i add 'check for tongue tie' to your birth plan?

DSIS has just had 3 weeks of hell before someone looked properly at her babies tongue.

Not sure what you mean tigress.

another option to high forceps is continuing to labour to get the baby to descend further (if no foetal distress obviously)

and yes, i think it is worth putting in a plan if that is your preference - the HCP will not necc. outline all options..

and i suggest briefing your DP/DH in detail on whatever you decide so that he gets a good understanding of it.

Edless - definitely agree with that one - I can't believe how many people I've heard of in real life whose babies had tongue-tie and they were forced into FF because no one told them how easy it was to fix. (or that it could be overcome)

Tigress - Being unable to speak in labour is not what a birth plan is about!
when I was in labour, I wanted everyone to be a mind-reader, and told them so, because it was too much bloody effort having to tell everyone what I wanted

That's why you have a birth plan - I was sooo pissed off every time someone asked me a question, even as simple as which drink I wanted: why should I have to think and worry and make decisions while I'm in this much pain (sorry to mention the pain - it's not that noticable when you get there, but it does take a lot of your thought and energy)?

Thanks for tips re tongue tie - will add that.

Didn't realise they might use high forceps even if I still stood a chance of pushing him out myself - yikes! Thanks, Edless.

As well as what Nickel says re not necessarily wanting to articulate detailed ideas during labour (or indeed actually being unable to speak, as others have said), I like the idea of knowing what I would like to happen in various scenarios (a bit like a Choose Your Own Adventure but with more pushing and poo ), even if that's not what happens when push comes to shove (or indeed when push comes to hacking at my perenium and yanking with forceps...).

Ok, I think I may be there! The C section bit will be overleaf, rather than on the same page as the rest.

? 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 Keillands 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 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 extremely likely 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 necessary. Please check for tongue tie.

? I may wish have a natural third stage if possible, but will make the final decision on the day.

? 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.

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

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 after the baby is delivered.

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

your DH will be encouraged to support you if you get tired

Good luck with that as the midwifes and doctors didn't even read my birth plan. And the midwife didn't even write it down properly or ask me all the questions. xx

Just something to bear in mind re stitches.... The community midwife explained to me that they will always administer local anaesthetic..... Whether they've given enough or put it in the right place is a different matter. She advised me I must speak up if I felt pain rather than just unpleasant tugging.

This is exactly what happened.... The dr just got started and didn't check like they do at the dentist and I did say I wanted more and it was forthcoming!

Just something i hope you remember. Its my 'top tip'!

brandysoakedbitch 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 hmm - even bought her own candles, instructed when and how to light them etc . . .

Blimey!

. . .you might risk sounding if you are teaching them to suck eggs and alienating the Midwives

I agree

OP I am still not sure why you don't want anyone to mention epidural. You just have to say no or shake your head (if that's all you can manage) if you don't want it.

I'm afraid the lowered lights in theatre just won't be happening if you have a CS. You might feel like that's the important stuff done, but the operation isn't finished yet and there's important things like making sure the placenta is intact on removal, various layers of stitching etc that the obstetrician needs to be able to see properly while you're getting on with skin to skin etc.