Birth Plan

[Onebirthplaneveryminute]

I had a birth plan drawn up today with supervisor of midwives at the hospital I am attending.

I'd be really grateful for thoughts/comments etc.

Here it is:

Care-plan for O

Obstetric history - P1, augmented labour following prolonged rupture of membranes, at 41+ weeks, using syntocinon with an epidural. Progressed to a khiellands forceps delivery in theatre for an OP position and prolonged 2nd stage.

O in this pregnancy is seeing a specialist midwife for support and has had referral to the mental health team.

Issues discussed from previous pregnancy and birth.

? O suffered OCD in her last pregnancy which she never disclosed. She feels she went into an anxiety state during childbirth and has no recollection from her baby being born and the 24 hours following this. She suffered PND subsequent to this.
? O has no concerns with care/ management with labour or birth last time.
? O has also been suffering OCD and depression in this pregnancy but is now becoming controlled.
? Dr X and I have reassured O that she is most likely to have an uneventful labour and normal birth. She wishes to aim for as active a birth as possible in order to maximise the chances of this.

Plan for this birth

I have discussed a birth plan with O. I have discouraged an elective CS in view of risks. She prefers to give birth in hospital.
If remains low risk her aim is to have a water-birth.

If O goes post dates and workload enables, she should have two stretch and sweeps to encourage spontaneous onset of labour.

We have discussed the process and reasons of induction/augmentation of labour and are happy to have management of care within hospital guidelines, she would like the opportunity to use the tools available to help cope in labour such as TENS, birthing ball, water, mobility, music and dimmed lighting etc whether it be a low or high risk labour. In order to allow mobility she is happy to have an FSE (fetal scalp electrode) to assist with fetal monitoring if continuous monitoring is necessary.

She is happy to have diamorphine, gas and air and an epidural if she is not coping well.

Information given for waterbirth sessions, booked on active birth session and TENS hiring info given.

If all low risk would like an early discharge.

Supervisor of Midwives

It all sounds very good, however my concern would be that it takes a long time to get to the actual birth plan details. Personally I would be tempted to also have a more basic plan which doesn't have things like previous labour details, just a short amount of bullet points which are most important to you, eg:

• I would like a water birth and dimmed lighting if possible
• I will consider any pain relief depending on how I'm coping

Etc. I would just be worrying that no one would bother to read through such a long birth plan, I was advised to make it as straightforward as possible so it was more likely to be consulted if I needed it to be.

There's a couple of things you haven't covered, do you want a managed or natural 3rd stage? Do you have any preference re cutting cord, would you want birth partner to do it, wait til it stops pulsing etc.

Like I say, it's very thorough but I would probably give it in when I arrived at labour ward and keep a simpler one with me to be consulted regularly. Is your birth partner up to speed with what happened last time, and what you want this time? That made the biggest difference for me during labour!

I didn't write it, the supervisor of midwives did, so am assuming the unit will be used to her style. To be honest I expect they are more interested in the background stuff from wht she said, and for natural birth they will offer cord clamping, physiological third stage etc- I'm more interested in whether there's anything in it that's not consistent or I shoukd reconsider.. Esp related to induction and fetal scalp electrodes etc

One thing I wondered is this bit "She is happy to have diamorphine, gas and air and an epidural if she is not coping well. "

Do you have a preference about the order they are offered - e.g. gas and air first? It makes it sound a bit like diamorphine is your first preference (which of course is fine if it is...). Do you even want them offered, or do you want to ask?

Also, personally I would phrase as something like "happy to consider X if she feels she needs it". Phrases which make it sound like it is the midwife's decision about what happens are a bit of a bugbear of mine...