Is no plan a good plan?

[frogalou]

Hello
I am 30 weeks pregnant and I have decided not to have a birth plan. I have done an ante natal class where we talked about breathing, but I have not decided if I will ask for pain killer or not, it is my first baby and I want to just see what happens.

Am I being very naive? Some friends of mine had plans, but few were followed, so I feel it is better to go with the flow rather that get frustrated about nothing going to plan.
Are there things I should plan no matter what?
Thanks

FWIW, with DD my plan didn't come out of the bag and I didn't have a great time in labour. It was the opposite of what I'd hoped for.

With DS, my 2-3 sides of A4 were read by the MWs on arrival at my house, and even when things didn't go smoothly and I transferred in, the MWs made sure that the hospital team were aware of my wishes and they accommodated them as far as possible (not strapped down in ambulance, DS delivered straight on to me in theatre and weighed after skin to skin, DH told me the sex, discussion of CS before use of forceps again, oral vitamin K) - rather than just following standard hospital procedure.

My plan was:

Go to hospital
Have baby
Come home

All went to plan.

I didn't have a plan either. I went in with an open mind regarding pain relief - I would start with TENS and move down the options if necessary.

Things like a managed third stage - what on earth is that? Or who would cut the cord never crossed my mind. OH faints at anything that makes him squeamish so he mopped my brow instead of going down the "business end".

The hospital has a policy of skin to skin straight afterwards, they don't wash newborns either.

I took the view that the midwives are the professionals and I would take advice from them. I think someimes birth plans can be over eleborate and over thought about which only leads to disappointment.

I would be interested in what midwives think about long lists of dos and don'ts.

I must admit I read my Birth Plan the day after the event itself and did almost split my stitches laughing..... you are not being "naive" to not bother with a birth plan and just see what happens- you are actually being very sensible!

I think it is a good idea to get first time mums to "think" about the birth before the day, but no-one gave my birth plan even so much as a glance during the event itself. I wanted a natural birth ... in a birthing pool with a midwife.....what I actually got was a surgical birth ....

but I now have a gorgeous DD (2 yrs) who would not have been with us without surgical help (HUGELY glad I hadn't opted for home birth as I would be childless now)

Can I just say that that DD's birth was still wonderful. Not what I had "planned", but an amazing, huge, emotional moment. ....You will meet your little baby and there is nothing more amazing.

Didn't have a birth plan either, was never asked for one. Just wanted baby to be born in safest way and trusted in the midwife on the day.(s)

I didn't have much of a plan with my DD as I felt I couldn't predict what would happen, or how I would deal with the pain. I uses the 'birth plan' notes in my preg diary to record a few ideas, but it was brief and wasn't really discussed with my MW or during the delivery, but I did know if I wanted injections etc.

I would recommend looking at the NHS direct/choices birth plan (Google birth plan) and using that to think through your own preferences. It doesn't have to be detailed, but it might help you think about your options &/or talk with birth partner or MW, including discussing managed third stage, vit k oral vs injection, pain management options etc.

I think its good to go with the flow and not be too specific, particularly with your first and regarding pain relief, but equally, you will be asked if you want your baby to have vit K and you need to know your preferrence etc.

To be honest, does it matter if you sit there laughing at your pre-birth notions of how it might be?

Things don't always have to be said with the caveat or constantly clarifying "But yes of course, things might not go to plan". At 30 weeks, I'm getting increasingly irritated by constantly having to qualify my bloody thoughts!

I'm writing a general birth plan right now on my preferences for various scenarios simply because it makes me feel better right now. I get anxious, I am a bit of a control freak. I'm also a grown woman of reasonable intelligence - I get that regardless of my ideal, things are going to go how they're going to go. I am flexible, I am open to a lot but equally, if it hadn't been for reading up on birth plans, I wouldn't have known that my DH can equip himself with the phrase "If my wife and baby aren't in any immediate danger, and have time to think about what you're proposing, we'd like to take that time please" upon being presented with a choice to make in a given scenario if things take a tangential turn. I'm the kind of person that caves to pressure from professionals - I don't have a huge amount of faith or confidence in myself to hold off on doing something when perhaps there's an alternative.

So yeah, I do think there is a lot of value to writing a birth plan. If you're the kind of person that can go into hospital and not really care how what happens when, you're only focused on the end result then great - you obviously don't need one. But if you're the kind of person that gets anxious, or needs to feel involved, or whatever - there is a sense that writing one gives you a voice and a sense of involvement, even if you know your labour will tread its own path anyway.

Think it all depends on how specific your birth plan is. Mine was quite vague but did contain things like No Pethidine due to a family history of ending up in resus after having it. Both me and my MW thought that it wasn't worth the risk with me. I also asked to give birth in the Midwife Led Unit which I did.

With DC2 I asked for a water birth if possible and whilst the MW read and followed the rest of the plan I didn't get a water birth as she came too quickly. The MW did follow the rest though including a physiological 3rd stage.

Mine was more of a wishlist and I always had it in my mind that at the time I would do what was safest for me and my baby.

I had a bit of a birth plan with DD1, but ended up with a Caesarian, as she was breech.

With DD2, I had a brief one, but was induced. Nothing went to plan, and I can't remember a lot of it.

With DC3, DP will be with me, unless something goes drastically wrong, and he is strong enough to speak for me if I feel unable to. He knows what my pain thresholds are after last time, and will want to cut the cord, so I will rely heavily on him for support.

I will investigate a few bits that a few of you mentioned and let them know how I feel about C section (fine with it), pain relieve etc so I am given options on the day.

My mw said today that they will speak to me about the birth plan when I am on week 36.

Out of interest, what do people tend to go for for vit K (injection or oral?)?
What is the general feeling about Pethidine?
Thanks!

We did oral vit K. Can't tell you about Pethidine sorry as mentioned in my last post, but there is some evidence based info on it here .

Did vit k injection for DD, will do it for DC#2 on arrival. I think there was a thread either in the childbirth or pregnancy forum a couple months back that discussed the options. I personally didn't see the point of doing the oral drops & then remembering to follow up x weeks later for more drops. I think the suggestion that the injection may be linked to leukemia has been discredited but not an expert by any means...

Pethidine can be useful if you are having a long drawn out labour & struggling with the pain. However, if you don't 'like' the feeling, it can't be undone and the effects last up to about 4hrs. If baby is born during the effects, baby may also exhibit the effects, so be a bit sleepy & so on, but in a hospital setting, staff will be prepared for that. Again, I'm not an expert but I didn't fancy it, although I would have tried it before an epidural, as really, really don't like the whole spinal injection idea. In the end, my labour was too short for pethidine or epidural to be necessary/discussed.

We're not giving Vit K at all. Baby will be born at home, no family history of HDN.

www.aims.org.uk/Journal/Vol13No2/vitk.htm

Never make a plan it never happens to be of any use whatsoever!
Congrats!!

I found pethedine excellent. Would highly recommend it - actuallly enabled me to doze for a while after 22 hours of contractions with ds1. With dd1 (dc2) I had it to, and went off to sleep for a couple of hours, then just woke, pushed and gave birth in about 20mins. Excellent stuff

frog Re pethidine in labour, it is seen as rather old fashioned by Obs and many really prefer not to use it because

• a lot of people react badly to opiates and this may be their first time of having them so they might not know
• causes drowsiness in both mother and baby and so can impede delivery/pushing and hamper breastfeeding

However, many hospitals do still use it as it's cheaper than an epidural, an anaethetist might not be available to do an epidural and women might need more than gas and air and a trusty paracetamol . Personally I'd far rather have the epidural.

I also think a plan is a waste of time. I think it's great to think about what you really do want and really don't want and have a couple of bullet points in a power point presentation. I just know what I would like, to stay active,, what I don't want (pethadine). Of course I don't want my fanjo attacked with a medieval torture instrument but if my baby is in danger i see little point in planning for that, it will be largely out of my control. my plan was home birth, my reality was induction, PPH, 2 week hospital stay. I think people who get too hung up on their plan often have a real sense of disappointment. Luckily i had time to come to terms with my plan being unrealistic for my circumstances. Great to hear some get a birth that all goes to plan, you are lucky, but in my experience this is the minority. I think planning flexibility is eminently sensible and to be applauded.

I had a plan for DD1 which ended up being nothing like the reality but I am still glad I made it. The midwives (all of them, I was there for a few shifts!) read it and whenever something on the list was still an option they did it, even though most of it wasn't possible.

The reason I am glad I did it is because as posters have said above - I felt I knew what my options were and undertood more of what the medical staff were advising or asking me about. You are certainly in no frame of mind to start taking in complicated explanations of your options and their various pros and cons when you are in the middle of labour! Also, whilst some people above have said their DP knows what they want and can voice it if your labour means you can't get the words out, this doesn't take into account:

• the possibility that your DP may not make it there in time (eg traffic, work, early arrival, fast arrival etc)
• how much detail your DP knows about your choices. If they just know a few headline points that might not suffice if the circumstances mean the medical staff need to ask more questions etc
• what is your DP going to be like in the midst of your labour? Even some of the most confident and calm men might not react as expected in such a different situation to their normal life, and might not be able to put your case as strongly or clearly as you would have done yourself. Or indeed they may not remember all of it!

So my advice (feel free to ignore!) is to read up on the options for labour (e.g. water birth, active birth), pain relief, and what options you prefer for the various post birth things that happen. Put them down in short bullet points but always bear in mind that they are just your preferences. Don't worry if they don't happen! It just means that at least if things start to go other than than you had hoped, you still feel you roughly know what's going on! I certainly took comfort from that at the time.

Both of mine had oral vitamin K, simply as I didn't want their welcome to the world to involve being pricked with a needle if it was unnecessary - they'd both been through enough by the time they were born anyway! MWs made all the arrangements for the follow up doses