Do I need to write a birth plan?

[WombatStewForTea]

It's something I keep reading about but it's not been mentioned by my consultant or midwives. I'm 37+5 and have actually only got my antenatal classes this weekend.

I've got a fairly flexible mindset in terms of how I'd like birth to go. If available and possible I'd like a water birth or to labour in water. But I fully recognise that as I'm consultant led and will be on the labour ward that this may not be possible.

Same with pain relief. I'm not dead set on anything. If I need pain relief beyond gas and air then I'm happy to ask for it. I'm open to an epidural if I can't cope or get induced.

The only thing I'm really set on is having skin to skin.

So do I need to physically write all this down? Or is it a conversation I can have in person when in labour?

As others have said, you don't need one, but it does serve to make you aware of all your options. Maybe even making you aware of options you didn't know were available, or options you don't want. More importantly is to make your birth partner aware of your choices, so they can advocate for you if you're struggling to do it for yourself.

From what you've said, your birth plan is:

• Open to pain relief.
• If possible would like to try a water birth.
• Want skin to skin ASAP.
• Go to C-section over forceps delivery.

Possibly include something about Vitamin K administration, what you want done about the placenta, and who is to cut the cord. But the midwives will check what you want anyway at the time. Other than that, you don't need much more for a birth plan.

I just worked through this template after a lot of nagging from my midwife:

www.nhs.uk/conditions/pregnancy-and-baby/documents/birth-plan-blank-form-nhs-choices-pregnancy-baby.pdf

Even if you don't fill it in, it's worth having a think about all the questions so you are clear in your head.

I think if everything goes smoothly and you don't have very strong preferences then they don't refer to the birth plan much. If you need interventions etc part way through, it's a useful reference for your birthing partner and the midwife as you might not be able to make your wishes understood quite as clearly when you are exhausted, in pain and, in my case, very high on gas and air...

I didn't bother. My "plan" was to have a baby as safely as possible and to make decisions as and when needed. Discussed with DH so he knew that I would like to avoid an epidural if possible but wasnt ruling it out (never had a chance either time even if I hadn't wanted one), I quite fancied a water birth but only if pool was free and not requested by someone who had stronger feelings on the matter.

Injection to deliver placenta they ask you about at the time anyway. Ditto vitamin K. They had asked me ante naturally about vitamin K and I just laughed and say of course, I'm not an anti-vaxx twat. End of discussion.

To be clear I am obviously very well aware that vitamin K is a vitamin not a vaccine but many anti-vaxx tests are not and refuse it because they think it's a vaccine.

I didn't write a birth plan partially because my antenatal care also went a bit screwy/disjointed at the end because I was under consultant care and having a lot of monitoring so they told me not to bother seeing my community midwife but then didn't cover a lot of the stuff that should have happened in those appointments. I remember feeling a bit worried about it but it really didn't matter in the end. They didn't admit me until I was pushing anyway so a water birth etc was out of the question, so was an epidural, and it didn't feel like there were many choices to make! They did ask me about delayed cord clamping and whether I wanted the injection for my placenta or not but these both felt like quite easy decisions!

I think the comment from a pp that not making a birth plan is 'how you get ptsd' is both horribly victim-blaming and factually incorrect, by the way. Plenty of women with traumatic births had plans, plenty who don't have plans have perfectly fine births. People don't bring ptsd on themselves by not writing a plan If she's the poster I think she is she's also still pregnant with her first, so take her birthing advice with a bucket of salt...

It can be good to have certain things down in writing e.g. I made it clear on mine that if my baby needed to go to the special care unit that I'd like to try to express breast milk for feeds. I wrote this on my birth plan because I knew full well that in such a nerve-wracking situation I'd most likely forget to tell anyone something like that as my head would be all over the place. It was peace of mind having it on paper - my head didn't need to be full of things to remember in an emotional situation.

Luckily my baby was born completely healthy but there was other stuff on there too that helped. E.g. I wrote that I didn't want unnecessary internal examinations and as a result of this being on paper from the get go I was only offered / had one (obviously if it had been a good idea to have more for medical reasons I would've agreed). By the time I'd arrived at hospital I was already 5cm and wouldn't have fancied having to explain myself in that state. Much easier just to present the piece of paper and concentrate on my breathing! Obviously my birth partner was there to explain things too but I didn't want to create more work for him unnecessarily- he already had lots to remember (timing contractions, offering me food and drink etc).

I think some people think birth plans are about having everything perfectly planned and not being flexible but this isn't necessarily true imo.

Personally I wouldn't bother, giving birth is very unpredictable. I planned on having the birth centre, a water birth with low lighting and relaxing music and no pain relief (maybe gas and air)....

Instead I shat myself infront of about 10 people after literally begging for an epidural. Definetely no low lighting and no classical music

Still an amazing experience and I look forward to doing it again.

@theworldhasgonecrazy1 what a brilliant way with words I'm crying with laughter 🤣 it's just so accurate!

I spent ages thinking about my birth plan and writing it all out. When it came to it, it went out the window and I actually found that things not going "to plan" was much more distressing for me than the actual process of labour/birth. If we have more DC, I won't be writing a plan but DH will know my wishes. Ultimately, I needed reminding that as long as you get a healthy baby out at the end, you are winning. I was shit scared of the possibility of forceps until it was pointed out that it may be a case of forceps or no baby. At that point it didnt seem to matter so much. Good luck - the prize is so worth the process!

Just to point out, the existence or absence of a birth plan, as well as whether said plan is or can be followed, has nothing to do with whether a woman develops post-natal PTSD. Although it’s good to know that not having one is a factor as I’ve also been told that having one, especially one which is too detailed, is a factor.

I would recommend thinking in terms of preferences, not plans, but they are useful to consider different scenarios and how you might respond.

Do consider preferences in the event of a c section - around one in four births end up as sections and it’s worth being aware both of the process and also of any wishes you may have in the event of an unplanned (but non-crash) section, such as skin to skin in theatre if possible.

First baby - My birth plan was a folder with loads of gumpf about skin to skin and drugs ONLY when needed. No one looked or asked.
Second baby - Birth plan was 'All the drugs immediately' spoken. Ignored.
Third baby - Birth plan? Fuck off and let me get on with it alone

I'm still curious about how good the drugs are as I never got to have them.

My Third was an accidental water birth, I was 'not dilated enough' for drugs and the midwife said she could get me some paracetamol(!) I asked to have a bath but the 2 they had were in use so they half filled a birth pool and then the MW went to get paracetamol.
He was out 16 minutes later.

Despite the birthing pool not being full, the water helped relax me so it was easier for him to get out, and I thoroughly recommend it.

I haven't written one, my partner knows my preferences with regard to pain relief, delivery etc etc so can and will advocate for me if I am unable to do so.