FTM Birth Plan

[Dorisday13]

My husband and I have started to jot down some ideas for a birth plan basically home water birth with minimal interventions, I'm just thinking maybe I shouldn't write one and just go with the flow..? As we're first timers. Any experiences of how medical staff took plans, or are they just expected?

I think it is worth making a plan.

The one time we didn't, we were asked for one.

It will solidify your views in your own mind.

I do think it's worth having a general plan, buy also include actions if things don't progress as planned, include how you are going to be transferred to hospital.etc

Even if you don't actually write a plan, I think it's worth talking through with your DH what you'd like to happen, and also your feelings about different interventions which could happen if things don't go smoothly. Also things after the birth like whether you want skin to skin, vitamin K, whether you want a managed third stage or not.

After two births, I would be very specific about how I would want some things to be (e.g. very, very personal thing, but I hate internals) and would want it in a plan so that it got discussed early in labour. But that is only knowledge based on how I reacted in the last two.

For a first birth, I think that the plan is useful for when things don't go to plan. How would you feel about forceps/ventouse or section (the choice isn't always straightforward, but some people are keen for section over instrumental). There are also things that don't need to go into the plan, but are worth discussing - for example, if something happens and your baby needs to go to NICU, would you expect your husband to go with the baby or stay with you?

I found my birth plan for DS was good for getting DH involved. We had a chat and he wrote it all up. I told him he was there to look after me and speak up for me if I couldn't make decisions, if things went wrong etc. Bit dramatic, but it made him properly think and learn about the options we had rather then me telling him (as usually happens with baby related things!)

We are about to do another for dc2, which will be pretty much the same actually. DH is the one that is reminding me this time, so my plan clearly worked

Ok so maybe a home ideal plan and a hospital if things go differently plan...

TBH in a home birth you have lots of time to chat to the midwife and her mind is only on your birth. It seems a bit daft to me writing you want a water birth when there is a big pool in the lounge. They ask you about third stage anyway.

Maybe a few bullet points for dh?

I agree about writing 'I would like a water birth' when you've inflated your own pool!! I do think that the plan is more for if you end up transferring, which statistically you are more likely to as a first time mum so I think it is worth having your bases covered, even if it is just for peace of mind.

Also for anything unusual you want - e.g. I would want the midwives to talk first to DH about any interventions and then him to me (save in emergencies obviously, I mean stuff like ARM)

There are a couple of reasons it's worth mentioning WB in a home birth plan:

1. to say that you'd like to choose the temp yourself (with guidance) blood temp for labour, slightly higher for the birth.

2. to specify whether you want to give birth in the pool and deliver the placenta in there too or on dry land.

My home birth plan is very brief but covers things like: minimising internals, keeping the place dark and quiet, directing questions to DH and doula, giving birth in water, wanting an absolutely natural third stage, using a home made cord tie (no plastic clamp), and having no Vit K for newborn squishy.

Oh yes, I agree details about your preferences for a waterbirth can be useful.

Can I ask why you want to use a home made cord tie? Not come across that before and am interested.

I had the chat with DH on Sunday and we wrote down a few bits and bobs, as I am going through my plan with the MW tomorrow and he can't make the appointment.

I'm not really expecting it to get looked at in hopsital but I thought it would be handy for us to discuss it more than anything and DH could refer to it while labour is ongoing if I am being a bit uncommunciative/ screaming like a banshee and convey the things we'd discussed.

He had no idea about the third stage choices/ vitamin K injection etc so it got us talking about those too.

DS1 hated his hospital cord clamp. It scratched his tummy and got in the way of the top of his nappy. I'm using a sterilised, braided embroidery thread this time so DS2 will be comfier

If your hospital is midwife-led and woman-centred, they will read it. Mine was read and respected when I had DS1. Midwives want to work with women for the most part.

It is a midwife led unit (as long as nothing happens that means I become high risk and get shunted up to the consultant led unit, but all fine so far).

I didn't mean to imply midwives didn't want to respect women's wishes, just that from many of my friends' experiences a) they (MWs) don't have that much time or b) something goes wrong that puts the plan out of the window.

Ooh Badgerina, you birth plan really IS same as mine!!!

Cept for the tie as I'm no way near organised enough.

The Mws need to know to bring an underwater Doppler. You don't want to be getting out and drying off every 15 mins or every 5 mins whilst pushing.

Starlight - they do, but that's a homebirth planning thing isn't it? Sticking it on the birth plan won't help if you are in one of those areas where they don't even read it until they turn up on the day?

Badgerina and starlight, I'm also hoping for/ planning similar aspects to you, do you think this is unrealistic for a 1st baby?

No. Not at all.

My first birth would have been much easier if I'd done it the way I had with subsequent births.

That's true you'll. Perhaps the OP needs to make sure she has some freezer bags to put the doppler in to put it underwater........

And when you ring the mw on the day, remind them.

Yes yes to reminding them when you call to bring the underwater doppler! Also ask them to put it in your notes when you have the homebirth booking.

It is not unrealistic. The one thing I would specifically think through is 'slow' progress. This is not uncommon in first labours, but you come under increasing pressure to 'do something' even if there are no signs of distress. I would think that through and talk it through with your DH- if the midwives are tentatively suggesting transfer and you want to refuse, you need your DH on side with when you will and when you won't.

Doris I personally am planning my second birth, but I know a few women who have had lovely home births with their first babies.

I think it is perfectly realistic to plan a home birth for your first, provided you remain aware (in the back of your mind) that first timers have a higher transfer (to hospital) rate. Whilst bearing that in mind, remember that reasons for transfer are rarely down to an emergency - most likely to be because labour isn't progressing, or because you want some pharmaceutical pain relief.

DH and I attended a home birth workshop at our local hospital, run by midwives, and we were the only second-timers there! All
the other couples (6 more) were first timers, so you're not alone in your desire

As for the other things I mentioned being in my plan:

Keeping internals minimal - be open minded about this. You don't know your body in labour yet, or if you might need that reassurance of knowing your progress. My MW in hospital first time round, kept internals minimal anyway, so I already know that approach works well for me.

Using TENS, water and Entonox instead of medical pain relief - At home you are likely to be calmer, more relaxed and feel safer. This in itself will reduce your pain perception. Home birth can be a natural form of pain relief in itself!

Having said that, again, remain open-minded. If things progress slowly, and you get tired, transfer for an epidural
could be what you need to get some rest before pushing. You can ask for a mobile epidural and have it turned right down before pushing.

Physiological (natural) 3rd stage - if all is well, and babe has arrived safely without intervention at home, then a physiological 3rd stage makes sense. Your body has done everything else, so will know what to do to finish things off and end the story naturally.

Babe can initiate breastfeeding to aid your uterus in beginning to shrink back down; the placenta can arrive in its own time; cord can be clamped once it's stopped pulsating.

If there has been any medical intervention, or the labour and or pushing has been very quick, it is often safer to opt for a managed/medical 3rd stage. Even so, it is possible to adopt a "wait and see" approach.

Cord-tie is down to having a pre-birth convo with the MWs.

Vit K is down to you, and best researched before making any decisions.

Thank you thats reassuring!

the mw has mentioned a couple of times transfer for 'slow' progress, my current opinion is if I'm coping and baby is not in distress then I'm staying put! Really need to discuss that with DH and doula though. I'm constantly annoyed by the 'bean counting' that seems to go on, it's all seems so arbitrary who's decided what is slow and what is normal for that person? Grrr