Birth plans - do you think they're a good idea?

[Twinklemegan]

I'm interested in other people's experiences of birth plans, particularly for first births. For example

1. Did you feel you had enough knowledge to make an informed birth plan?
2. Did your labour and birth follow the plan. If not, why not and was it your choice?
3. Were there any consequences of your birth plan which you didn't anticipate?
4. What would you do differently next time?

I'm not doing any formal research, I'm just interested in other's experiences. I for one feel that, in hindsight, I didn't have enough information about the various pain relief options to make an informed choice. My birth plan affected the way my labour and pain relief was handled. For example, I had no idea that by asking not to be offered meptid or an epidural (but for them to wait for me to ask) I was condemning myself to labour without any pain relief whatsoever, gas and air only being available in the late stages.

Anyone else?

As a midwife I do not view birthplans as set in gold unless the mother has written the words "do not offer me pain relief unless I ask" because she is stating upfront she does not wish to be swayed off the path she has chosen.

However, that is rarely written and a birthplan often needs to be amended according to the woman's experience.

Twinklemegan - I am a bit confused. Are you saying you were denied the use of gas and air when you asked for it? Had you been diagnosed as being in labour at that time?

I do not agree with your consultant saying that gas and air is for the later stages of labour only and not to be used more than 2 hours. I have seen many women cope with gas and air only and I use it as a first step in the pain ladder.

I think they are useful and you personally should have explored all issues beforehand.
However, I never got to write mine as my MW was booked in to do it at 38 weeks, 2 days after I ended up having DS

I'm probably a bad example, as I had a particularly difficult birth. However, I didn't put my birthplan in writing, as recommended by the MW, which in retrospect was a bad idea. While I was in the MW-led unit all my verbal requests were followed religiously, so it was fine that it wasn't written down. When I transferred to the consultant-led unit, I had no say whatsoever as far as the consultant was concerned. If I could do it all again, I'd have a piece of bright orange paper stapled to my notes saying that I did not consent to instrument delivery unless DD was in immediate and severe danger. It was the only thing that I felt really really strongly about, and it turned out that I was right, as DD was ventouse and I still haven't healed 10 months on. Easy in hindsight of course!
The MWs at the antenatal classes all stressed being flexible, which as long as you feel respected and supported is fine as far as I'm concerned. I wanted waterbirth, but it was slowing things down, so it was fine that they recommended that I get out and be more active. I didn't want pethidine, but when I was very tired and panicky it knocked me out and allowed me to rest.
Weird that you couldn't have gas and air though, it was one of the first things I was offered (ie very early on).

Mears, yes and yes (think we've discussed this before - your thoughts were very very helpful to me - thank you!)

SMS - I too had things in my birth plan about after the birth, etc. Pain relief was only a small part of it. I pretty much followed the template provided in my pregnancy file.

Vole, if you're implying that I didn't explore the issues beforehand, then you're wrong. I discussed it at length with my community midwife and read a lot as well. But it seems that there is no one set of facts, judging from mine and others' experiences.

My thoughts are that if women are being encouraged to write birth plans, which they certainly are in my area, then the correct information should be available to them to make informed choices.

I don't want to discuss my experience particularly. I just wanted to kick off a discussion - thought it would only be polite to go first.

I didn't have a birth plan for either birth, but particularly for my first I don't think I really considered the prospect of labour that much, in a naive kind of way. My thinking was very basic: hospital birth, yes; drugs? yes, if I need them; dp there? yes.

I hadn't considered any of the following: alternatives to pharmaceutical pain relief, my thoughts on intervention(!), delivery of placenta, vitk injection or drops. I hadn't even really thought about feeding...I knew I wanted to give bf a go but was quite uninformed about the process. On reflection, I think it was because I was more concerned with how the hell you coped with a newborn baby at home (had never changed a nappy before dd1) than actually giving birth to one!

As it happened, I ended up having a positive experience of childbirth. DD1 born in hospital (svd), no intervention required, only needed gas and air, born in the pool. BF succesfully for 9 months.

So I think I am of the opinion that maybe (some) ignorance is bliss. If you don't have a plan, you're less likely to be let down if it's not followed.

But I am aware I was lucky and fortunate with my experience

No - I meant that rather than going by what other people have said was best for them, that 'you' explore the options and choose what is right for you.
An example would be - pethidine is great - but how often do they mention that it can make you really sick but if you make sure they give you something for the sickness you'll be OK. If my DH had had his way it would have been 'natural' and no pain relief at all. About the same sort of relief he'd have had when he has his vasectomy

waste of time. Mine was as simple as it gets, and the MW still didn't manage to follow it.

I think making one whiles away an evening or two if you want to type it out really neatly with subheads and bullet points.

I think they're a waste of time. you can't control what is going to happen you have to go with it - and despite giving my MW 2 copies of the plan plus an extra one on the day, she only got 1 thing on it right...

Its a good idea.. I was adamant that I didn't want the cord cut until my baby was breathing on his own etc... When the time came i had forgotten ( i was a bit tired !!! lol!!!) Luckily it was written down, so the midwife remembered. It was only a little thing, and both my babies births were pretty straightforward.. you can't really lose anything as long you know its not a contract with your baby!!!

I love writing my birth plan but I have phrased everything as "I would like to try". I have a sentence at the top that says i am completely flexible according to the situation but would prefer etc etc.

i am going to be in the MW led unit so hopefully this will go someway to being able to do it all as i wish, but things happen and i have put in abit about CS / interventions etc.

Last time, i asked for minimal internals and to use the water and both were granted.

Message withdrawn

I think birth plans are very helpful

1. Yes, especially second time around
2. Ds1, everything went to plan as much as possible, other than being induced labor and delivery were perfect. Ds2 the only thing that didn't go to plan was that ds2's cord had to be cut at the perenium rather than dh cut it, and he wasn't placed on my stomach due to coming out a little distressed. Other than that it all went to plan.
3. Nope.
4. Nothing.

One thing that helped was reviewing it with my practitioners before the birth, so we were on the same page as far as the birth was concerned.

First birth plan was like a frigging essay, full of the dos and don'ts........all went out the window with an extremely long labour, and a v.large baby who was back to back!
Second time around I decided that all I really really wanted was to be kept mobile for as long as possible, and that's what my birh plan said, and bless her the midwifr kept making me move around, and second birth was a million times more pleasant than the first!

i think the best plan is to have a very relaxed plan, know what you want but be prepared for things to not go to plan. i planned a purely natural birth and was at the birth centre ready to get into the pool and we found out my baby was breech and i had to have an emergency c-section. but because i was told by a good friend who has 4 children to have a very relaxed plan i wasn't too upset that it didn't go at all to plan.

1. Did you feel you had enough knowledge to make an informed birth plan?

I think I did. I read an awful lot and also watched a lot of birth programmes on Living TV, which sounds cheesy but was actually really really helpful.

2. Did your labour and birth follow the plan?

Yes. Apart from having an episiotomy, which I'd have preferred to avoid and also not being able to use the pool (but that was because I gave birth too quickly after arriving at the hospital so not all bad!)

3. Were there any consequences of your birth plan which you didn't anticipate?

Not really.

4. What would you do differently next time?

Have the baby at home so there is more availability of tea and biscuits immediately afterwards when I want to eat the world.

1. Yes I had enough knowledge, because I had been to NCT antenatal classes.
2. Apart from not being able to use the birthing pool, things did go according to plan, more or less.
3. I did use the same birth plan next time, and on that occasion the pool was available and dh knew how to attach the TENS machine which I found v helpful before using the pool.

1. I did have enough knowledge, but from books, MN and the NCT class, not from any HPs.
2. I didn't have a physiological 3rd stage beacuse I started to bleed, and I trusted the MWs enough to let them do what they thought best. Other than that it went exactly according to plan.
3. I hadn't anticipayed that the MWs would follow my birthplan to the letter, to the extent of arguing with the docs to let me in the pool, and indeed keeping said docs away unless they were actually needed (I was 'high risk' and had been threatened with an immobile and highly medicalised labour and birth)
4. Absolutely nothing I'd do differently.

I wrote 'pain relief on request and not before', didn't need any, didn't request any, didn't get any, was fine. Didn't feel 'condemned' to anything.

(Actually I'd been about to say 'how about some g&a?' when they told me they could see the head, which reassured me I was nearly there and I could do it without)

1. yes I had enough info and had a clear idea in my head of what would happen - after reading a lot, swimming in early months and doing stretches in late months I felt I'd be happy with little pain relief and a water birth.

2. not at all. first I was quite suprised to find I absolutely hated the birth pool. was in for less than 10 mins. Then I took some gas under the midwife's pressure (as it was hurting quite a lot by then), hated it, quit taking it, carried on okay. But finally ended up with an emergency section as ds just wasn't coming out!

3. um, no.

4. would do more exercises/stretching - Janet Balasakas (sp?) type. I didn't have any doubt that a section was the right thing to do - after 10hrs of labour I was knackered and could still feel his feet under my ribs, fgs - but perhaps if I'd been more limber he would've come out...

1. Did you feel you had enough knowledge to make an informed birth plan?
   At the time of writing it, yes ... in hindsight, no!

2. Did your labour and birth follow the plan. If not, why not and was it your choice?
   Not at all ... in fact, I may as well have not bothered ... I hadn't explored the possibility that I might be induced, and all the fiddle-faddling around that goes with it ... the only thing that eventually happened the way I wanted it to was

3. Were there any consequences of your birth plan which you didn't anticipate?
   No

4. What would you do differently next time?
   Well, am 35+ weeks pg now, and my birth plan only lists the things that are really important - in fact, here it is ( I haven't done all of it, as the rest is things in bold red type about me being allergic to latex and various other things!)

MY WISHES FOR THE BIRTH
I have only written down things that are very important to me. My greatest wish is to be treated as an intelligent woman, and not patronised. The birth of my son was an incredibly traumatic experience, and I do not wish to suffer the same nightmares and flashbacks after this birth as I did with my son.

Positions
? I need to stay as active as possible due to suffering from SPD. However, if I do decide that I need to lie down, I need to lie on my side.

Pain relief
? I wish to use TENS, water (the pool), and Entonox. Please do not offer me pethidine: it makes me incredibly sick.

Second stage
? Please do not feel you have to shout at me to push. This happened during the birth of my son, and has been a recurring nightmare since.

Third stage
? I wish to have a physiological third stage. Please do not inject me with Syntometrine unless there is an obvious bleeding problem.
? I would like for the cord to stop pulsating before it is cut.

Yes I had enough info I have epilepsy so I could only have gas and air or epididural. I attended hypnotherapy sessions for pain relief - I had everyhing planned birthing pool and hypno for pain - gas and air for delivery. delivery on all fours.

What happened my daughter opened her bowels in my womb ate some, pulled on the cord tried to come out arse first so after 12 hours of labour being hooked up to a heart monitor we had an emergency c/section.

what would i do next time go with the flow and not bother because at the end of the day your child is in control!!!! not you

good luck herbal tea worked for me and music we took in kettle and cd player she was born to Chasing Cars

I had enough info about what pain relief was on offer and how each option worked so I felt able to write my birth plan using the info. I planned to have a natural birth in a birthing pool with just gas and air, and then requesting stronger pain relief if necessary and a section if it was really necessary.I also used phrases like " I would prefer to have / not have..." "If really necessary..." My m.w. read my plan when I was in the early stages of labour and described it as "pragmatic" but funnily enough things didn't go to plan!
I did feel that my wishes were taken into consideration and as soon as I found the pain too much to bear without gas and air I was offered it. I do think you have to know what pain relief is available, how it can help and what the possible side effects can be before you can write a birth plan. I felt that the plan gave me some control over what was happening and my bh knew what was on the plan so could speak for me when I wasn't able to. Unfortunately I had to have an episiotomy and ventouse delivery. It seemed chaotic at the time with a doctor, 3 MWs, and various other medical people around but every stage of the procedure was fully explained to us both and the atmosphere in the operating theatre was calm, almost relaxed.

I did a lot of research first time round, as I worked in a teaching hospital at the time and had a lot of time on my hands, so read virtually every issue of "Practical Midwife", a very pro non-intervention magazine. I had a fairly vague plan with ds, in that I had a good chat with the midwife about what I would like, and my home birth was all lined up the way I wanted. So far so good, but my waters broke two weeks early and were meconium stained, the midwife I had worked with pre-birth was on holiday, and the hospital where we ended up had a doctors/midwives know best culture, and in any case ds was transverse oblique and we went pretty much straight to c-section.

Second time round I knew I wanted a VBAC, but didn't really think about anything else (didn't do classes because it was only 16 mths later and we thought we would remember everything!). We used a different hospital and pre-birth they were great, but when it came to it I ended up with a useless midwife and forgot that the one thing I really really didn't want was to be induced (and I was absolutely given the choice). So yes I regretted no birth plan. There isn't going to be a next time!

The problem with birth plans is that they are written in ignorance.
I marvelled at the statistic that birthing pools are only used in five per cent of deliveries - until the moment I lay on the bed in the delivery suite, 3cm dilated, howling with molten pain in the hips and pushing inappropriately. "But in the antenatal classes you were so keen on a water birth - shall I get the pool filling for you?" a sympathetic midwife whispered into my ear. I told her I would rather have an epidural.
You just don't know the level of pain you are going to go through, and the complications you will face.
A friend confided that her birth plan had included aromatherapy candles and special music tapes. How nice, and how irrelevant. She had an emergency CS after 36 hrs, by which time she said she had pretty much eaten the candles and chucked the tapes at the wall.
I think my NCT classes implanted a feeling that pain relief was only for bad mothers. Having an epidural felt like failure, though I did enjoy lying there reading a magazine and remarking idly "I believe I'm having a contraction".
From reading the thread it sounds like second birth plans tend to be reactions to the disaster of the first.
I have only one tip. I wish I had insisted on a natural third stage. They didn't ask and just pulled my placenta out by tugging on the cord - and this gave me endometritis, which needed treatment with 'cef and met' (metronidazole and cefalexin). This resulted in my having to express milk and throw it down the sink for weeks just to keep my supply going, as DD was sensitive to the antibiotics in my breastmilk. Thrush set in and I ended up expressing for six months.