VBAC birth plan - is this too regimented? Any advice welcome!

[RedFraggle]

Well after lots of tears last night I made a start on a birth plan so that I have something to take with me when I arrange to see the midwives / consultant etc.

It is rather long though... Does it seem a bit too thorough? Any thoughts welcome, but obviously quite a lot of the bits relate to the birth of my dd and therefore relate to my paranoia.

Anyway, here is what I have:

BIRTH PLAN
My birth plan may seem rather in depth, but due to my traumatic first delivery I have emotional issues with certain processes.
I do understand that in an emergency many of these plans will have to change so I have included my wishes for this possibility and would like them to be followed as much as possible.

? My authorised spokesperson is my husband, he is fully aware of my wishes and I wish his word to be accepted. I would like him to be with me at all times.
? I would like to be scanned at 38 weeks to check for positioning, if baby is breech I do not want ECV, just be booked in for a c-section at 39 weeks.
? I would like to attempt a VBAC but due to the nature of my first delivery, if I panic or feel at any point that I cannot cope, then I would like to be able to go straight in for a c-section. I had PTSD after my first baby and do not wish to aggravate this.
? I am willing to have a female student midwife me throughout, but I do not want her to be responsible for my care.
? I do not want to be induced at all; I have a previous c-section scar.
? I do not wish to go overdue. I would like to have a c-section if I reach my due date without going into labour.
? I do not want to have continuous foetal monitoring whilst I am in labour, I would like to have regular intervals of monitoring to check the baby is ok.
? I would like to try to remain upright for as long as possible.
? I know the hospital has a 6 hour time limit on VBAC, but request that if labour is progressing well and I and the baby are comfortable and safe then this could be extended.
? If my baby is in the OP position I would like a doctor to check presentation as labour progresses ? I am worried about brow presentation problems.
? I will be bringing a TENS machine with me and would like to use gas and air.
? Please do not offer me other drugs, I will ask if I feel I need more pain relief.
? I understand I may need to have a canula in place in case of needing a c-section at short notice. I am fine with this as long as it does not impede my movement in the labour room.
? I do not want any interventions along the lines of episiotomy / forceps / ventouse. If the baby is not progressing and intervention is required, I would prefer to have a c-section.

In case of c-section

? If I need a c-section, I would like it to be arranged before it becomes a ?crash? scenario if possible.
? I do not want to be left with no one I know before the operation - no pre-operative abandonment.
? I would like to be conscious for the operation.
? I want my husband to remain with me.
? I have already had a caesarean operation; please use the existing transverse scar.
? I wish to breastfeed as soon as possible after delivery.

? My baby must be brought back to its parents, by its father as soon as it is checked as OK.
? I wish to have skin to skin contact with my baby, please leave one arm accessible/unrestricted.
? Please do not have the screen so high that I can not have my baby lying across my chest.
? I want suture of my incision, not staples.

Redfraggle,

If this is what you wish then so be it! It is your birth after all!

I would want to query why you don't want to go overdue and what you mean by overdue. Overdue, in my book, is >42wks and as many women don't go into labour till around 41 wks if you CS at 40 you may deprive yourself of a VBAC. Something to consider?

Do you feel it important to be pro-active as far as positioning is concerned? If so then have a look at Spinning Babies

You're doing well! It's hard having to face this and deal with your previous trauma.

HUGS!!!

Hi - I think you're plan is good. I'll take some of your ideas for mine! There are many aspects of it though that you could discuss and agree with a consultant or midwife beforehand, and also you can request a discussion with an anasthetist before your due date. I did that last time (because of previous reactions to aneasthesia) and the guy was really helpful, explaining absolutly everything about epidural/spinal and under what circumstances I would require a general. It was very reassuring - and as I ended up with a complicated birth and an emergency C sec I had all the drugs available, and I knew what they were for...

You could for example sort out your point about the transverse scar beforehand, as it is now common practice to reuse the same scar. My hospital won't induce or use syntocyn (SP??) under any circumstances for women who have had previous sections, so check with them, it might not be necessary to have it on your birth plan. Same with suture/staples.

Also, what I did with my plan was to seperate it in sections so that it is easy and clear to read - i.e. VBAC, Pain Relief, Monitoring, C section, etc...

I'll write my plan now!!

HI Doulaklaw,

I am speaking for myself here, not on behalf of Redfraggle and I don't want to highjack this discussion, but if I don't have a VBAC I won't feel 'deprived' at all. I would like a VBAC, but if it ends up in a c sec I won't feel worst off.

I was over two weeks overdue with first birth and was induced, and I have exactly the same point as RF in my plan - I just don't want to go overdue this time. Can't really explain why, but it's a very strong feeling. Anxiety, maybe? Fear of feeling pressurised? I really don't know...

Thanks for the comments!

Blueberry Pancake, You have it pretty much spot on.
I went two weeks overdue with my dd, I was in hospital every other day as she was hardly moving so I had to keep going in to check all was ok. I was then induced etc.

To top it off my mum told me afterwards that she had been really concerned for me going so far over as my aunt's baby had died due to a failing placenta when she went overdue. All in all - I just do not want to go over 40 weeks.

I also agree with Bp in that I don't see a c-section as failing in anyway. I don't consider a VBAC as something to be deprived of. I would far rather have a controlled c-section than undergo the stress of last time with the bonding issues that followed. The only reason I am considering a VBAC is for my dd's benefit. I don't want her to miss out on my attention due to a longer than necessary recovery. For me personally it makes no real difference which exit route this baby takes!

BP, no offence taken at all! :-)

The main thing is that options are considered and an informed decision is made. The main thing is that yours and RFs emotional state is protected.

In my opinion the induction is what causes most problems and a lot of trauma. This is why I cancelled the one booked for me at 42 weeks and then went into labour that night. You DON'T have to have the induction 'offered'. You can ask for expectant management if you go past your date or you could elCS, it's your choice. My choice was to opt for expectant management after 42 wks, which I never needed.

One of the biggest troubles we as mums have is that we are not given the full facts, we are offered things but not given all the pros and cons or we're told that we are not 'allowed' things that are our right to choose.

The system fails so many of us......

Hiya, well in terms of my experience with going overdue, I had to meet with the HEAD of midwifery to extand their standard 12th day induction moved to the 14th day... The hospital where I gave birth just didn't give me the option - although I know that realistically, I just had to walk out or not show up - what were they going to do, arrest me?

They insisted on monitoring the baby's heatbeat every two days for the last week of going overdue as the Placenta was starting to not work as well. So really there was no medical choice of being induced. I would not have taken the risk of harming the baby and would do the same if facing the same situation again.

Anyway, RedFraggle, one other thing I have on my birth plan is to see the baby before they wash him/her, and I want my husband to tell me the sex and nobody else.

Blueberry Pancake,
Good point about the headings, I was struggling to get everything down in a vaguely logical order!
I am planning to have an appointment with the consultant and midwives very soon. I have an appt already booked in with the consultant at 36 weeks to arrange a date for my c-section as they have already agreed to an elective. I still just can't decide - I get so stressed out at the idea of a VBAC that I have to wonder if it is worth the stress! Especially when they are fine for me to have a c-section. Oh well still got a while to go yet to decide - I'm only 27 weeks.

RedFraggle.... have you spoken to anyone about the trauma of your first delivery? Birth Crisis

With regards to your birth plan make sure it is assertive but neither passive nor agressive. If you want to email me you can on lovelymarslady at aol dot com.

Hi MarsLady,

I did have counselling after the birth, but being pregnant again has set everything off again. I am coping (just about) but still find it very hard to actually talk "in person" about it all. I'm ok with saying the basics of what happened, the mechanics if you like! It's when I try to express how I actually feel about it that I get all stressed and upset. I have been to the birth trauma website a few times and have found some of the info there really helpful, but I feel a bit of fraud sometimes reading about other peoples horrendous experiences - my baby is alive, so it sometimes seems a bit shitty of me to still be struggling about what was essentially a small part of the process of having her.
With regards the birth plan, I'm finding it hard as I have that many things I'm scared about this time around. First time I had no real expectations - I just wanted to have my baby and come home! This time... aaargh! There are lots of things I definitely don't want to have happen, but I am wary of being too prescriptive as then I will be disappointed if it all goes pear-shaped and I had a firm plan in mind.

Refraggle...I am currently supporting two women through the BTA who have had c.s and found it traumatic, so if you do want to talk /email, please do

i think i left my email addy on the other thread

lulumama 21 @ hotmail .com

and mars is a wonderful source of comfort and support too !

just because your situation was not as traumatic as others might appear, it does not make your feelings any less valid, and they need to be heard and accepted too. x

RedFraggle... if you want to email me on lovelymarslady at aol dot com then please feel free!

I know that the feelings have resurfaced. It may be that you need to talk it through again and (despite my love of talking) I'm a very good listener.

I had a similar birthplan for my vbac a week ago. At the time of the birth though, lots of my views changed. Eg. I begged for the epidural I swore I wouldn't have, and even asked for an episiotomy if it would help get the baby out at the end! I think it is good to put it on paper, but also good to remember that you are likely to change your mind about things on the day depending what is happening. You simply can't plan for every eventuality.