Birth plans

[magnumicelolly]

Tell me about yours? What was/is on it? All thoughts appreciated!

[StarlightMcKingsThree]

No-one's going to be sticking a stethoscope on a woman in labour anyway. Don't be daft. Unless you want to be deafened by amplified screams.

[StarlightMcKingsThree]

Sugarcane. My midwives were kind, just incompetent. The SHO on the other hand was barbaric.

[ThurlHoHoHow]

I can only talk from my experience and that of some friends, but when finding that the baby's heartbeat was irregular the HCPs wanted to check for dilation - if you were 10cm then I know friends who (very successfully) started pushing with close monitoring as birth was so imminent. However if the woman was only 4-5cm then the decision was generally taken to go straight to a CS. Plus, again this is my personal experience, but as my waters hadn't broken they wanted to do that to answer more questions i.e. was the water infected or was the baby just getting tired, which I do see the wisdom of. It also meant they were prepared for the baby that was going to be born - so we had several NICU nurses as they knew my DD would be rushed off. I would hate to have more nurses than necessary in a CS and possibly deprive someone who needed them of those nurses, by refusing a blood test.

I'm very sorry you had such a traumatic first labour and your DC suffered. You are very right to say that women should have more say and your birth plan makes complete sense in your circumstances. However I do still believe that it isn't helpful to tell a first time mum that there is no need for HCPs to touch her. There is a middle ground, which to me is knowing more about the tests and the interventions and making an informed choice in each situation.

[stickysausages]

It really pisses me off when people say birth plans are a load of crap, nobody looks at them, there's no point etc etc... bollocks!!

First thing mw did when I was admitted was sit down & go through it with us, I had bullet points about wanting a natural birth, in pool if possible, no drugs that would affect baby, natural 3rd stage, vit k injection, delayed cord clamping etc.

I also made sure dh was onboard & that he could speak for me if I couldn't.

I pointed out several times that it was a first baby & I didn't know what would happen, so I would be flexible & take advice to keep baby safe etc.

I think the mw respected it all, and realised I knew what to expect, what I Ideally wanted, and helped me towards it.

Had I said DRUGS. EPIDURAL. to my mind, this would have been sacrificing myself to interventions & letting it all happen to me, rather than having any control. As a nervous patient, feeling I had some kind of power was actually useful :)

[Auntierosemary]

Mine said EPIDURAL. I got one. But only cos I also shouted it, repeatedly. Nobody looked at my birth plan once.

[Shenanagins]

Op, you are probably terrified after reading this! You know what kind of attitudes you have towards the medical profession and intervention in general.

Most women are middle of the road and will accept it in order to achieve a successful delivery.
Some women don't want any intervention which is their choice. Others have very detailed plans and been left upset when things don't work out as they planned.

Read up on all aspects of birth and think what is important for you.

For me, drugs / intervention where necessary. Skin to skin contact. Midwife tells us the baby's gender so we found out together.

First labour required a lot of intervention which was fine with me, second one very little.

[ThurlHoHoHow]

That sounds like a really good plan, sticky. I suspect that different hospitals and different midwives do or don't read plans. They should definitely take the time to, though.

[stickysausages]

Best thing my mw to me was that I might get to a point where I thought I couldn't do it, but to remember I could! That stuck in my mind, even after she went off shift. I was examined internally once in earlyish Labour which was fine, she was very gentle & then once more in established Labour to check I was far enough on to get into the pool, this wasn't painful, but I was having contractions during & really missed my gas & air!! The exam itself was fine :)

[mercibucket]

mine was 2 pages long and i tried to cover most eventualities. i cant remember if i put in about nicu as well, i think i might have said something about wanting dh to go with the baby rather than stay with me if necessary. mostly it was a flow chart kind of approach so if sll goes well, the a b and c. if labour stalls then d and e. if breech then f and g. if stuck, then h and i. etc

[ThurlHoHoHow]

So sorry for the hijack last night, OP Hope you are still reading...

If I was to write a birth plan for DC2 I would either be very vague and just say "let's see what will happen" and include 2 or 3 things that were very important, such as skin-to-skin and DP not cutting the cord.

Or I would be very detailed, but include each possible situation. So it would say - yes to ventouse but no to Keilland's forceps. If a cs, certain music to be played and still skin-to-skin where possible. If baby has to go to NICU, DP to go with the baby not stay with me etc.

[magnumicelolly]

Just catching up now thurl!
I was terrified anyway shenanigans, lol!

[Shenanagins]

Don't be terrified, it will be fine, i even did it twice!

[catellington]

Hi magnum
In answer to your question:
I think this thread shows that everyone is different so you have to go your own way

Even if it's your first baby, doesn't mean you can't educate yourself about labour and birth and make a plan if that's what you want.

[babynelly2010]

I wrote birth plan both times.
First time MW read it and followed as close as she could.
Second time she totally ignored. If I had another chance I would still write one and make sure to go over it with them so they have no chance of skipping things, like stitch up anything above 2nd degree. They not only did not but also misinformed me. With that said both of my plans said on top in big letters that this is just a plan and more than anything I want a healthy baby and will do anything to achieve that as long as I am informed, or something to that regard.

[minifingers]

I think of birth plans with the following in mind:

When it comes to low risk women, routine interventions such as regular monitoring and internals will improve the outcomes for a tiny number of women, and have no positive effect or harm the labours of everyone else.

Most people are very accepting of the idea of large amount of iatrogenic harm in maternity care in order to save a small percentage of mums and babies.

I'm not, at least as regards my own care, and therefore rejected local protocols for how labour is managed, and put my own in place as Starlight did. I was prepared to take responsibility for the outcomes - good and bad.

If I had to go into hospital my birth plan would say this at the top:

READ MY BIRTHPLAN AND TAKE NOTE OF MY PREFERENCES. I would ask the midwives to sign it to confirm that they've read it and taken it on board.

[StarlightMcKingsThree]

Things like 'No forceps' don't actually mean that. What it means is don't be sloppy with your support and have me on my back for your convenience and the basis that if the baby becomes badly positioned you can always drag him out.

Things like 'No Internals' means midwives have to check on you more often, spend time getting to know you and your behaviour in order to monitor you and observe you more carefully, not to mention pay a lot of attention to your words to build their picture of your progress. Instead of pop in once every couple of hours, flip you on your back, stick their hand up your fanny then leave you to write a number on a chart in their office before they forget it.

I think it is also worth saying that having a Contrary Mary birth plan increases your chances of being assigned the more experienced midwife when you go into labour.

[minifingers]

I think most people have no concept of how routine interference in labour can mess with optimal hormonal physiology. We wouldn't do it to any other mammal - repeatedly stick hands into their birth canals during labour, constrain them in one position and expose them to lots of unfamiliar stimulus, and expect good outcomes. But somehow we expect to do this to humans and it won't impact on the progress of labour. There's a reason why unassisted deliveries are generally quicker, less painful and less complicated than labours involving medical professionals, and that's because the mother isn't being interfered with!

(Not making a case for widespread free-birthing BTW. Births do go unavoidably wrong sometimes and it's worth having a midwife on hand if this happens. But on the whole routine interference in labour does more harm than good for the majority of women).

[LeBFG]

In my hospital, there were certain routine things linked to dilation: sent home if less than 3cm, no epidural before 3cm and no pool after 8cm. The biggie was you weren't allowed onto the delivery ward before a certain dilation. If you want no internals, you will have to check with the hospital/MLU on their policies on this. You could end up making your labour much more difficult if you hit against standard policy that you didn't realise existed rather than just planning to accept one or two internals.

[StarlightMcKingsThree]

With my first I went into hospital shrieking for pain relief. I was made to endure an internal, found to be almost 2cm and although not sent home, was refused pain relief.

If I had not consented to an internal, I would have got pain relief on the basis of my reported PAIN.

[QuietNinjaTardis]

I had one internal when I gave birth to dd two weeks ago and that was because my contractions didn't seem to be very intense so the midwife checked me (at my request) to see if anything was happening. I'd been having contractions since 6am that morning and this was at 5pm. I was only 3-4cm and we decided I'd go home to rest and come back when they were longer/stronger/more intense. I went back at 3.15am the next morning. Dd was born at 4.02am and I didn't need to be checked. The midwife could see that things had progressed and I was ready to push when I got there and apart from pouring water on my back while I was pushing in the pool she was very hands off and let me get on with it.
I agree with starlight that there is too much intervention starting with sweeps and internals. If everything is progressing normally then there's no need to interfere.
If things aren't progressing normally then to a certain extent it's obvious. After pushing for two and a half hours with ds he still hadn't appeared. He was obviously stuck and therefore I needed help getting him out which is fine.
Oh and I think the whole culture of you need to be a certain cm dilated before getting pain relief is bollocks. Which is why I went to my lovely midwife led birth centre for dds birth and really didn't want to go to hospital. So glad all went to plan as I can honestly say her birth was amazing.

[Bue]

Genuine non snarky question for Starlight. Why did you have MWs at your birth if you had no intention of allowing them to do anything in case of complications? (McRoberts is sometimes the only way to resolve a SD for instance.) You sound as if you are better suited to free birthing.

[StarlightMcKingsThree]

I never said I wouldn't allow them to do ANYTHING. My baby needed their expertise should he/she need help or support, and I needed an expert observer to voice their professional concerns and/or call in for support/assistance.

The McRoberts isn't the only way to deal with SD, but it is usually the first attempted which IMO is the most dangerous for the baby of the options but makes everyone feel better because they are 'doing something'. Should an emergency like that occur I wanted a calm hands-off approach so that I could concentrate on what my body was telling me to do and a midwife experienced in enabling this.

[Bue]

No it's not the only way especially if you are already in an upright position and can use a position change, but to think a hands off approach will necessarily be appropriate to resolve SD is very naive IMO! I can appreciate your approach to midwifery care at the birth, however.

[StarlightMcKingsThree]

I have hands.

[StarlightMcKingsThree]

Bue, honestly. If everything had been tried and I just couldn't budge the baby, I'd not just lie there with the baby half out ignoring the midwives plead to let them get their hands in.

I don't think anyone, however strongly worded their birth plan would refuse to even consider a revision.