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?

jenny - what a pity you didn't actually try the pool - the pain relief can be phenonemenal. You mighthave managed fine without the epidural. As a midwife i would have encouraged you to try the pool first.

Physiological third stages are really best with physiological labours - having an epidural is a pretty major intervention and physiological third stage is not reommended in that situation.

Maybe next time

1. with a first birth you cannot possibly have enough knowledge to make an informed birth plan.

With ds1 I was as informed as its possible to be on a theoretical level. With ds2 I had done the practical...

When pg with ds1 I asked the midwife if I needed to do a birth plan or should we just go with the flow on the day. She said that most mothers with birth plans end up going with the flow as you just can't plan for an act of nature. So I didn't bother with a birth plan for either which is just as well as neither time was anything like I could have expected.

Before I get jumped on by all the people that say they are fully informed, I mean that before you have given birth you have no idea about things like people taking blood samples from baby's head while he's still in there; being covered in monitors and unable to do that squatting you've practised for months; arriving too late for the choice of pain releif so only having gas and air; the breath-holding helplessness while they rescuscitate him; and a baby who'd swallowed all his own poo in utero puking ALLL over you just as you think you're about to experience your first breast feed......etc....etc
I certainly didn't find out about these things from books and videos.

Mears - you say physiological 3rd stage is best with physiological labours? Why is that? I wanted the injection after my 3rd delivery and although she had agreed with this before we started, the mw was suddenly v unkeen after I had given birth. It took me an hour to pass the placenta, during which I had very heavy contractions. I was white as a sheet (we have photos to remind us!) and bled profusely afterwards. (Didn't need transfusion though.) Mw was so impressed with my dinner-plate sized placenta she went off and showed all her colleagues!

I could only conclude at the time that she'd forgotten to bring the relevant drug (syntometrin isn't it?) but I'd love to hear if there was actually a good reason to have the physiological 3rd stage.

Elasticwoman - if you stated you wanted the injection you should have got it IMO.

Physiological third stage is a natural conclusion to a physiological labour and means that the baby gets the blood it should do after delivery. This boosts the baby's iron stores for the first few months of life. Mother tends to bleed less in the days after delivery (although tends to lose more blood at actual birth). She often has less afterpains too.

No real need for a routing drug when nature can do the job - but that should only be with mothers agreement.

this is a good explanation

Thanks, Mears. Don't know why my mw couldn't have given me that explanation - I may well have chosen the phys. 3rd stage anyway if she had. I remember she didn't really want me to get out of the pool after the birth, saying I wouldn't be able to, but I said Oh yes I can, and stepped out. I had terrible afterpains - so wonder how much worse they could have been if I'd had managed 3rd stage. Have to hand it to mw though - 10 lb 6 oz baby (and I am average size woman) and no stitches. She deserved much credit for that.

Mw was also reluctant to give me entonox - I had to ask 2 or 3 times before she gave me any and then the head crowned on the first whiff of the stuff and I didn't have any more after that so she didn't put it on the birth notes.

Is there a type of mw who is very keen to make this sort of decision for the mother?
I wonder why my mw had such decided preferences about how this birth should go?

Sorry, I haven't read all the posts, but I wrote a birth plan just to get clear in my head what I wanted, but I didn't take it to hospital - only 1 dc at the mo and as it was my first labour I didn;t really know what to expect so decided to put my trust in the hands of the 'experts'. Not a great move as it turned out! I got stuck at 5cm dilated and ended up with an emergency cs after 12 hours of labour (only logged as 12 hours because this is when my waters were broken for me, and despite the meconium and the fact that ds's heart rate had been erratic they still let me go for 12 hours). Ended up giving birth to a blue floppy baby with an apgar of 2 and only at 4 after 5 mins. Maybe a birth plan wouldn't have helped in my case anyway. I do remember being annoyed by the MW who, when I asked for an epidural said 'you seem to be coping on G&A' to which I replied 'I'm coping but it's farking painful!'

I found a birth plan useful because it made me think about all the options - and like someone else said, it was only partly about pain relief, and included things like putting babe straight onto my chest etc.

It was also good for DH to read and understand as well.

One thing I would change is the way I worded it. I think I must have asked not to be offered pain relief unless I asked. The problem was that I was induced and the contractions started immediately, and I became incapable of asking for anything or indeed thinking about anything.

Luckily DH was a complete star (remembered to make me go to the loo every hour, got the MW to check my sugar levels and it was he that made the decision about the epidural - which I will be eternally grateful for!)

Probably your midwife didn't want to disturb the natural labour rhythms. Had you stayed in the pool your placenta may have delivered more quickly. However, you have to explain why you are suggesting certain things as a midwife. I would have suggested the same as her but with the reasons behind it. If you said you didn't want to do that I would have respected your wishes.

Mears, she was emptying the pool which of course had been full of filthy water! Baby and I were both wrapped in towels.

Well I'll ask for you next time! Although am now geriatric in childbearing terms.

Potoroo - yes that's kind of the situation I found myself in, except I DID ask for a form of pain relief which was in my birth plan and it was refused. No one else here seems to have experienced that - how interesting.

My consultant, when I saw her recently, seemed to think that the midwives were scared I'd want something more and then sue them or something, so they refused me the pain relief I needed .

I think they thought I was some kind of hippy who wanted the natural, drug-free experience. Not at all, I was just scared of having an opiate injection which I might react badly to and terrified of having a needle in my spine.

Like I said, it was never once explained to me that the hospital policy was no gas & air until really late first stage. If I'd known that I would probably have risked the meptid, but nobody explained that to me at any point.

Actually I should feed back a bit more about my meeting with my consultant, because I thought it was really interesting.

She said that my birth plan was "quite prescriptive" and she seemed to think I had unrealistic expectations of labour. She said that the women with the most detailed birth plans tend to be those who have the most problems.

I personally don't think my birth plan was prescriptive at all. I think it got me the minimal intervention that I wanted. The water, once I was able to use it, helped a lot. I had asked to be encouraged to try different positions etc. before they resorted to any interventions - this happened and it eventually worked. If it hadn't been for my plan requesting my labour to be allowed to go at its own pace I would almost certainly have ended up with a forceps delivery or a caesarian, because the second stage went on for so long.

I had stated a preference not to have an episiotomy, but it ended up being necessary and that was fine - no problem. I also stated that I was flexible about the third stage - that my preference was for a physiological third stage but that I would see how the labour went. When it came to it, I was quite happy to have a managed third stage. All in all, my delivery was a hell of a lot better with my birth plan than it would have been without it.

The only problem with my birth plan was the section about pain relief, but even here I stated that I was keeping an open mind. I don't think my birth plan was at fault here - I think the MW should have explained why I couldn't have gas & air. If she'd done that I would have probably reconsidered and asked for meptid, which I now understand I could have had at that stage.

I suppose my point is that the problems I had in the first stage of labour were less to do with my birth plan and more to do with the midwives being too busy to talk to me or explain anything, let along spend any time helping me manage my contractions. But the consultant has been very very quick to lay the blame on the way I wrote my birth plan, which I think is a little unfair.

I agree Twinklemedan - it wasn't your birthplan that was the problem - it was the policy of the hospital to deny you gas and air without any justifiable reason. Also the lack of midwifery support.

Interesting stuff, ladies.
I made a birth plan - very loose and general - before I discussed the actual birth with my mw, and I had my baby at a mw only unit but my own mw was not on duty that night. As a result what I'd put down was followed rather than any changes I might have made.
Overall I was perfectly happy with what happened. I would have asked for gas and air earlier if I had known I could - I stated this in my plan but didn't ask soon enough - and I would have preferred to give birth in the pool rather than come out for the last stage.
I suspect that the birth plan is more helpful the second time around because you are simply more aware of what is going on. I did have my placenta induced btw, and I will again; regardless of the bleeding and the afterpains, I just wanted it overwith by then and wouldn't have been happy to wait any longer.
I highly recommend having a midwife unit birth rather than a hospital one, also; they seem generally more relaxed.

That's the thing with childbirth StarlightMackenzie, it's predictably unpredictable.

Things can be absolutely fine one minute and then the next you can have a full scale emergency.

Doesn't mean anyone was careless, negligent or anything in between.

It's how a situation that has arisen is dealt with that is important.

Sadly when an emergency arise there isn't always enough time avaiable for the professional to give a full explanation .

That is where a good debrief can mean the difference between a mother being satisfied with her care or otherwise.

Birth Plans ... two edged sword eh?

Can work for you , or against you

if u want one why not be aware oover 90% birthplans dont go to plan! esp analgesia

Haven't read the whole post but I didn't have a birth plan other than the fact that I didn't want pethadine.

I had very high expectations of my pregnancy and ended up having a rotten one and therefore felt shi*t for not living up to those expectations. When it came to my 'birth plan' I discussed it DP and came to the conclusion that as long as I had a baby at the end, I didn't really mind.

Good job really cos I developed pre-eclampsia, was induced and after 48 hours given an emergency c-section.

But as I had no expectations, and a gorgeous DD, I forgot about the crap bits of the experience fairly swiftly.

yes Birthplans are a potential wishlist

Applauds auntyspan for her sensible 'take' on her delivery

I find it really sad that so many of you have found that having a birth plan has worked against you. Its really only an aid to communication after all and should act as a tool to give the midwives some cues as to what a woman would like in her labour, not something taht is written in stone, never to be discussed or contradicted.

In the labour ward where I work, we get a lot of people with elaborate birth plans, some of which has already gone out the window before they ever get to labour ward, but most of it is usually pretty standard stuff.

Actually, an experienced midwife can usually tell in the first 5 minutes of talking to a woman, whaat they are going to want and should then adapt their care accordingly - but sadly, poor communication lets the situation down time and again.

What you should really put on your plan is 'if I need any medical intervention, can the Doctor please read this birth plan', as I have rarely seen a doctor actually read a birth plan, let alone try to follow one.

Sorry for the long post

Earlier on Lulumama suggested using the term 'birth preferences'.

really good idea, seems less rigid somehow...