what do midwives really think of your birth plan?

[flymo79]

I'm 37 weeks and haven't written one yet, I feel like if I do I will be setting myself up for disappointment if it doesn't happen, but also nagging feeling that if I don't set out what I really wouldn't be happy about I'll only have myself to blame re interventions etc. Are there any midwives on here? Or can someone let me know how much your birth plan is actually taken into account?

I've never written a birth plan. I've had three babies.

To suggest that I am under-educated in the birth options and possibilities as a result is rather naive. You could argue that I didn't write one, ever, because I had done waaaaay toooooo muuuuuuuuch research and understood that birth is pretty much a lottery.

I didn't ever pack a hospital bag either. I like to be surprised by what dh manages to claw together in the aftermath.

Que sera sera, and all that.

madwomanbackintheattic I hope you didn't take my post to mean people that didn't write birth plans were undereducated. That is not what I said not what I met.

Quite simple I meant that doing research before birth for a birth plan was the useful part of the plan not the final bit of paper.

I did the same as a PP, plan a, plan b etc. I found it really helpful just to think about all the different options mainly post-birth. Like do you want a physiological third stage, etc, do you want your baby cleaned before being given to you (I very definitely didn't, my SIL equally strongly did).
In my second and third pregnancies (based on what had happened first time) I wrote that I wanted the cord to stop pulsating before being cut and that we wanted to find out the babies sex ourselves rather than being told. Things like that can apply almost whatever birth situation you have.

Mine said no pethidine (sp?) as my sister had a very negative experience. That was it . To be fair, I have a complex disability and no-one knew how I'd cope with labour so all options from ELCS to water birth had been discussed so I knew I'd have to go with the flow.

Birth plan for DC2 - same as DC1 please!

I see lots of people on here saying that you should think of a birth plan as a wish list, and I actually quite strongly disagree. I think that, if you write the birth plan correctly (which admittedly I didn't in my first labour!) there will be bits which apply whatever happens.

By my third child my plan was three pages long (though it was headings and bullet points, not a three page essay!). There were some issues from previous births which strongly shaped how I felt about things (internals, getting a running commentary on certain procedures as they went along). But there were also headings for different scenarios - if I was at home, X, Y and Z. If I was in hospital please don't offer pethidine, please try and move to C-section if high forceps is looking likely as I want to avoid these, etc. Plus stuff that applied to almost any birth: how I felt about students, vitamin K jab, etc. As it happened, I had a smooth homebirth, but there were relevant preferences for section, instrumental, etc.

Ideally a birth plan will include your preferences for a wide range of situations.
For example you could put all the following points on your plan, but the second two would only kick in if things moved in an unexpected direction:

1. I would like a natural birth with minimal interventions.
2. In the event I need an epidural, please be aware that I am very anxious about needles.
3. I would like to give baby skin to skin contact as soon as possible. If I am unable to give skin to skin contact, then the baby should be passed to my partner for skin to skin contact.

"and understood that birth is pretty much a lottery."

Unfortunately part of that lottery is the member of staff you end up with - how they will behave towards you during labour.

I have seen some really bloody awful practice in hospitals. One example is mums being badgered to push, encouraged to breath-hold in second stage, and given lots of direction when there is absolutely no need. It's because the midwife has always practised in this way or maybe wants to wrap up the birth as quickly as possible. If I was writing a birth plan I would put 'no coached pushing' on it in big letters, with (in small letters underneath) 'unless there is a clear clinical indication for it.

"I dont think they do any intervention or epidural now unless its necessary anyway, well thats what my midwife said."

Our epidural and intervention rates are through the roof. In some hospitals the MAJORITY of first time mums will have a c-section, forceps or ventouse delivery. That's just not right is it? And that proportion has increased massively in just the last 20 years, without there being any corresponding fall in the stillbirth rate.

If you know a lot of midwives and you talk to them in confidence about the sort of practice they see in their day to day work with their colleagues they will tell you that there are some really, really unhelpful practices that are common currency for some midwives, and that some hospitals are like sausage factories in the way they deal with mothers.

Honestly? Nothing from my birth plan 'came true'.

These included: minimal internals (this was observed until the drs got involved), epidural over opiates (was persuaded to try pethidine as was only 4cm - was fully dilated within an hour), dad to take baby if me and baby separated (dad was fainting), delayed cord clamping, natural 3rd stage (was highly managed as was in theatre).

The only thing that went to my plan was 'vit K okay for baby'

So I don't really think it's fair to say 'any birth plan can come true if it's written correctly'!

I think it depends how you look at it Cultural - there were bits of your birth plan that applied and were followed, even in your situation. I didn't say that the plan would come true, but that bits should apply.

Having a couple of preferences recognised can help you feel that you have a say. In my case, there were only one or two bullet points if I ended up with a section (please let DH tell me the sex and please explain what's happening if you can because I get very, very anxious if there is lots of medical language going on around me which I don't understand due to previous history). If only that last point had been followed, it would still have mattered to me a lot that it was in there and that it was. And it should have been possible to follow that bar an absolute crash section.

dad was fainting !

I never considered that and DH can be squeamish and has asthma

Mine is going to mainly be about telling me stuff as "ANXIOUS: PREVIOUS LOSSES/APS" but hopefully if I go into labour during vague working hours I'll get someone from the 'team' for my condition who knows the score.
--Have guaranteed I'll be hobbling in at 3am now haven't I??"

There was one very specific thing in my birth plan which was totally ignored. OH had decided he didn't want to cut the cord. We'd discussed it and were fine with it. He was so adamant that he didn't even want to be asked that we put it in my plan;
"OH does not want to cut the cord. He doesn't even want to be asked. If you ask he will feel pressured to do it so don't ask." Read by mw. Discussed with mw. Ignored by mw. Lots of "is Daddy going to cut the cord?? Go on Daddy!!". He did cut the cord but felt pushed into it. I don't know what else we could have written really.

Aside for things like the vit K it's really hard to plan really. Everyone wants to avoid an episiotomy. My friend was very specific about wanting a c section rather than ventouse/forceps but as it didn't come to it I don't know if they would have respected that or not.

I didn't even make a birth plan

They asked me everything as and when it became relevant. All the stuff about vit K, cutting the cord etc was during early labour, and they double-checked with me after she'd been born. They also asked if I wanted OH to tell me if it was a boy or a girl, which I said yes to and they happily obliged :)

I'd specifically said I didn't want epidural or diamorphine, but when it came to it, the induction was so intense that I did go for diamorphine. They asked if I was sure, I said yes, they gave it to me.

I'm glad I was relaxed about it because there was no pressure to have this experience, and no feeling of failure when things didn't go to plan - eg having the diamorphine, giving birth on my back (but not flat). It was more a 'hey ho' feeling than a 'my birth is ruined'.

The only thing I made very clear beforehand was an apology for the fact that my veins are rubbish (as they soon found out when trying to fit a cannula )

People can be very sneery about birth plans on mumsnet, but sometimes it's hard to talk very coherently when you're in labour and it's helpful to have the basics written down. e.g. some people would like an early epidural asap and have no intention of ever giving birth without one, some people would prefer to try without pain relief at first. I wanted to try for a natural 3rd stage and wrote that down, when it got down to it I was so tired I just didn't care, but they said oh this is what you wanted, let's give it a try, and it was fine, so that was quite helpful. I don't think it's being unrealistic or naive to have preferences as long as you're not rigid about them if something changes in the labour.