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.

They lowered the lights when dd2 was born by c/s but did still have a small light on her - I'm sure they put the lights up again fairly quickly but it was all nice and calm and low lit when they actually brought her out.

I am another one who can't really talk in labour, I withdraw totally into myself, have a dim awareness of what's happening.

My birth plan is something like:

• Pool for labour/delivery if possible.
• NO vaginal exams during active labour. This led to me taking an epidural earlier than I wanted in my last delivery because I knew a VE would make me lose focus.
• NO Kielland?s forceps ? CS if this looks to be indicated please

And as I am giving birth at LGI most probably, if the blonde midwife from OBEM is on I need dh to somehow communicate the following to her:
.

• I don?t respond well to talk in labour, I prefer quiet. I would particularly like you to avoid trying to reassure me by saying how painful labour is/can be, how your labour was, how other people?s labours are/were or otherwise saying things about labour and birth that focus on the pain side of things. I appreciate some people think identifying with someone?s pain is helpful but I don?t find this kind of approach works well for me, it just makes me angry!

GlueSticks - I had that in my birth plan too. For me, it was because I knew that, if someone offered me an epidural at a 'low moment' I would likely say yes. However, I knew very strongly from my experience of epidural in my first labour that it wasn't what I wanted (I found epidural very unpleasant). I therefore wanted it to be something where I actively requested it. It's a bit like if I'm on a diet- if someone passes me the plate of chocolate biscuits I will probably take one, even though 10 minutes later I will be annoyed I did - but I wouldn't have walked across the room to pick one up.

NewYears - that's just how I feel. A friend's experience was that when she was offered an epidural she thought "oh, they must think I need one, I'd better have it", even though she actually felt she was coping ok. I'd rather not be offered it - I know it exists!

Thanks for all the advice - great tip re stitches, PastaBee, thanks.

To be fair on the epidural point - I wouldn't have asked for one, and was adamant in my birth plan that I didn't want to be offered one.

However (BP still in bag, unread) after 5 hours on the synto drip at full strength, having had G&A for about 3 of those and at a point where I was unable to articulate anything other than the odd word, the lovely, lovely MW asked me if I would like to consider one as she thought I would probably be another 12 hours or so with full strength contractions and in 'normal' labour she would not consider asking me as she would think I would manage without, but this was not 'normal' labour.

I could have kissed her.

And she was right. DD was born 12 hours later.

Just wanted to thank you for posting your birth plan, I'm a long way off (13+4) but it's reassuring to know that other people put in some of the things I am concerned about like skin to skin contact with partner if I'm unable to, minimal interventions etc.

I don't think you are being precious at all. We all know that things might take a different turn in an emergency, but that's no reason not to be clear about preferences in the event of healthy mum and baby. It would be awful to have a bad birth experience not because of an emergency, but because people just didn't know what you wanted.

Honestly, anything that makes a birthing mother feel more comfortable and confident, as long as it doesn't put the health of baby or mum at risk, has got to be a good thing for everyone involved.

Thanks, Flisspaps - I'll bear that in mind! Useful to know.

Spirited - no problem, glad it was useful. Quite agree that it would be crap to end up flat on my back in a brightly lit room with a monitor strapped on simply because I'd been too out of it to articulate that that wasn't what I wanted, rather than because it was necessary. I know things might change, but I also think it's really sensible to know what you would like to happen (just like life really!).

Hi there, sorry to give you more things to think about, but one thing that I don't think has been mentioned, and I didn't think about when I was writing my (admittedly rather vague and not very detailed) birthplan is your thoughts on interventions such as AROM and augmentation of labour on the drip. My labour was rather slow moving to say the least and I consented to AROM after being stuck at 4cms for at least 6 hours (although to be honest did feel rather bullied into it and kind of wish I'd not consented because I now always wonder if it contributed further to DS getting stuck in a bad position and eventual Kiellands delivery). I did stand my ground and didn't end up on the drip (had a totally irrational fear that the drip would be a one way ticket to EMCS) but had to have a right old battle about it with the MWs which I could have done without whilst in labour! I would just like to add that I'm no expert and really don't know enough about either of these procedures to tell you whether or not they are a good thing, but wish I'd been better informed beforehand about the risks and benefits of them. Good luck with your birth!

Short version is good. Long version is too long.

Episotomy's should only be cut to deliver the baby if the baby is distressed.

CTG montioring should only be used if there are risk factors which require its use. But do ask for a sonicaid to be used, not a ctg lead.

Thanks, RegLlama and Spatone.

Will read up on augmentation of labour as I don't know much about it - thanks.

The long version will be just for DH (unless the midwife gets very bored and fancies reading it ). Thanks re monitoring. A friend was offered an episiotomy to speed things up for her benefit, said "yes" as she just wanted to get through crowning and get the baby out, but then regretted it as she found it hard to heal. Who knows, different policies at different hospitals, although I think she was actually at home?

I had 2 episiotomies (2 different births, not both during one!) and it healed lovely both times. A friend of mine tore and it took ages to heal, got infected and all sorts. It depends. I think she wanted less intervention which of course is her choice, but regretted not agreeing to the episiotomy.

Glad you had a good experience, Gluesticks. It seems to vary so much, doesn't it? I have heard more "positive" stories about healing tears (in so far as one's fanjo having been injured at all can be seen as positive!) and more negative stories about episiotomies, but I know that either can heal well or badly. My personal preference, based on my own research, is that I would rather tear (well, obviously I'd rather neither happened!) but I know others feel differently.

I have noticed that pregnancy has definitely slowed my healing - little cuts or burns on my hands seem to hang around for ages, for example - I hope this is just a hormonal thing that resolves on birth or it doesn't bode well for healing any fanjo damage or a c section wound efficiently!

LoveIn, the tear vs episiotomy thing is something I'm also thinking about - could you point me to any useful source of research on it that has helped dictate your choices?

Mostly MN and stories from friends who are close enough to share information about their post-partum fanjos, HardCheese, to be honest! I think I recall that the MN pregnancy book was also good on the subject. The fact that episiotomies are no longer done as standard (which I think they used to be) seems to suggest that they are not, in most cases, preferable to tearing, although I know there are exceptions. And I assume that a small cut would be wildly preferable to a third degree tear, so I suppose there must be a huge variation in people's healing experiences depending on how bad the damage was.

Let's be honest, neither sounds exactly good, does it ?

Love - True, but having had both, absent complications the fear is usually worse than the reality!

Thanks, NewYears - everyone seems to say that, which is reassuring - that the idea of your fanjo being snipped or tearing is just appalling but that the reality in the midst of pushing a baby out is that you don't really notice it. Am hoping this is true...

Honestly, I had a second degree tear with DD2 (shot out like a speeding bullet, plus had scar line from episiotomy from DD1). I did not even know I had torn. Not only that, I did not feel any pain at all really during the pushing and had absolutely no experience of the 'ring of fire' everyone talks about. I was in the pool and had nothing, not even gas and air. Pushing was bloody brilliant. I loved it.

Early contractions hurt like buggery, but turns out I did the hard work at the start .

DD1 had epidural and forceps, so it was more the general bruising and soreness in the area than the episiotomy per se. My stitches were done by the registrar, who was apparently so neat that the midwife who did the postnatal visit asked if she could show her student. I was so blasé by this point I was fine with it .

Arf at fanjo display . I am hoping to skip the tricky first birth and skip straight to the shooting out like a greased fox in a birth pool one...

I will keep my fingers crossed for you.

What I'd wished I'd known for my first labour is that I react strongly to bright lights, loud noises and internals. I'm very animal - I like it dark and without clocks or any timing! Am very logical normally, so didn't expect to be like that. Worth bearing in mind if you don't seem to be progressing (given that it's unlikely to do much harm).

I also wish I'd worked more on coping techniques if the early stages were a long hard slog. Exhaustion by the time you even get going seems to be one of the main reasons people I knew found things went down a route of interventions they didn't want. There are good things you can do - but enough babble from me. Fingers crossed for a six hour wonder birth!

Thanks, NewYears. I don't like bright lights or loud noises at the best of times, so am hoping I don't become a total wreck in hospital!

You know what. I will let you in on a big secret. There is a light switch and there are curtains. Hospital units don't like to remind you of this, but they are there and you can use them.

Go on, please, please. If it helps you. I wish I'd had the sense first time round to 'de hospital' the room a bit more. I might have got somewhere...

Thanks, NewYears. I have briefed DH to be very assertive on my behalf on that subject in the event that I find myself a bit distracted to be assertive for myself...

It wasn't even lack of assertiveness in my case. It was walking into a hospital paralysed my brain! Didn't cross my mind to do anything about the room. Good plan to brief your husband to think about the room when you walk in. I know a lot of people think it's all wishy washy to worry about, but it seems to really matter to me.

I imagine it being something that will matter to me as well, although I guess you never know until the day. It just seems that when all other animals seek out somewhere dark and quiet to have their baby, we often end up doing it under neon lights...

seems odd