Would seriously like your opinions/suggestions on this birth plan (DD2)

[designerbaby]

Feel it's too long, probably, but there are various issues to address resulting from my previous labour hell experience, so not sure what I should/can cut/change.

This is a genuine request for opinions/suggestions and I promise not to get sniffy/huffy/pissy if you want to tell me it's crap.

TBH I wasn't going to write one at all, but increasingly concerned that midwives I've seen aren't fully aware of my history, even though they're all lovely, partially because I've swapped hospitals and booked late (35 weeks) so haven't had all my appts. here, and partially because I see a different one every time and it's quite hard to decipher from my notes what the situation is.

That, and I do feel it's a good idea to put it down on paper somewhere...

I've tried to only include the stuff that's actually important to me... so there's nowt about third stage etc. because I'll be so happy to have gotten the baby out without too much trauma I really don't give a stuff...

Anyway, waffle waffle... Please let me know what you think? Thanks!

DB
xx

Birth Plan

History

? Previous labour induced with Misoprostil given orally at 42 +14
? Hyperstimulation occurred, with little dilation
? Drugs administered to stop contractions
? Epidural given at only 2cm dilated
? Syntocin drip to re-establish labour
? Further 20+ hours of labour, slow progress
? Baby passed meconium
? Traumatic forceps delivery in theatre
? Extended 3rd degree tear, cervical tear and lateral vaginal wall tear
? Large baby (4.3kgs)

Preferences for this birth

Induction of labour

? Would prefer expectant management until 43 weeks, (dependent on scan estimation of size of baby) should I go overdue
? Should this be contraindicated, (e.g. due to large baby) then may ask for elective Caesarean rather than any form of chemical induction
? Stretch and sweep fine, but had 4 last time to little effect

Primary concerns

? Aim this time is to avoid a repeat 3rd degree tear due to possible long-term effects
? Therefore would like to avoid interventions, and try for as ?natural? birth as possible
? Midwife-led unit seems like the best place to achieve this
? Use of pool for water birth if at all possible

Environment

? Calm and relaxed, non-medicalised environment, as quite anxious
? Low light, and as few interruptions as possible
? Prefer to stay at home as long as I feel able

Pain relief

? Primarily gas and air
? Would prefer not to have Pethidine if at all possible as concerned about effects on baby
? Water - feel this is key to achieving the above
? Do not plan to have another epidural, unless extreme circumstances dictate otherwise

Other considerations

? To be encouraged to remain active and mobile throughout
? Positive, yet firm guidance and encouragement to achieve the birth I hope for
? Will listen to, and follow, medical advice, but please explain thoroughly so that I understand why something may be necessary. Felt last time that things were done to me rather than with me.
? Very aware that this is a plan and represents ideal scenarios, and that things may well not go according to it. Am prepared to be flexible dependent on circumstances
? Trying very hard to remain positive about this delivery, and appreciate your help with that

Your previous labour sounds awful .

I don't think everything on your list needs to go into a birthplan.

I think you need a list for discussion with your consultant/midwife, which would cover:

MLU and waterbirth - what is the hospital's policy, any reason to think you won't be eligible, if there are any question marks about it, negotiate with your consultant now so it can be written on top of your notes that you've been Ok'd for waterbirth.

policy on elective c section if the only other alternative seems to be an induction. Do your research now so if you go overdue you don't have that worry on top of the agonies of being post-dates.

Discuss stretch/sweeps with your mw. If you didn't find them too distressing, imo it's worth a go, especially as you are so keen to avoid induction.

I think you need a separate birth plan, which could cover:

very anxious about this delivery due to previous difficult induction, forceps delivery and bad tear.

want to labour and deliver in water to help with pain relief and to reduce risk of tearing.

want the lights dimmed and minimal chatting/noise. No extra people eg students. [do you have any views about routine VEs to assess progress?]

please encourage me to remain mobile and try different positions if necessary

would like to avoid having an epidural or pethedine.

I'd try to keep the actual birth plan on 1 page of A4, double-spaced, big print and with bullet points

Hope that's not too bossy! I went over and over my birth plan with my doula and it helped me think about things that I hadn't realised bothered me.

Overall a very sensible birth plan.

Points to consider (and ensure are ironed out before you labour)

1. Most (all if I'm honest) units have a strict criteria for using water for pain relief and delivery, gestation 37-42 weeks being one of them. The rationale being increased risk of oligohydramnios/reduced placental function/fetal size. If you wish conservative management ensure you have an ultrasound to estimate fetal size and perform dopplers once you are past 42 weeks and that the consultant has given you the go ahead prior to labour.

2.Do not rule out induction based upon your previous (albeit traumatic) experience as you be favourable for a straight forward amniotomy and avoid the need for prostagladins or syntocinon.

I wish you a straight forward lovely birth experience this time.

I think it is clear, concise and to the point. Agree perhaps mention of induction and sweeps etc prob not necessary as will presumably be discussed when you are not in labour. However, if it makes you feel better to have all in the same place I don't think it is a big deal.
Also I don't know if you have considered but I found a tens machine really good so if you want to stay at home as long as poss this maybe useful. (obviously can't use in water) Good luck with the baby and I hope you get the birth you want xx

I think it sounds like a very well written plan. Good medical terminology so the med profs know you know what you're talking about, and it reads extremely well.

3 suggestions:

1. Have a succinct, bullet point version for quick reference for the midwives, as well as your current version.

1. Include something about your birth partner - DH knew all my preferences, we discussed it endlessly, and my birth plan stated that everything should be discussed clearly with him should something not go to plan.

1. TENS machine, until you get in the water. Some people hate them, but I sing about them to everybody who listens - it was magic for me.

Good luck. You do sound very anxious about this birth (understandably) and preparing for it like you are is an excellent idea and will certainly help.

One little thing I wish I'd known about - if you end up with a retained placenta, make sure they get you upright and catheterise you to help (this will be in my next BP as I had an MROP last time). It's a tiny chance, but I wish someone had told me about it. it was the one thing I hadn't researched and 'planned' for.

Hi DB History a very good idea.

Agree that the Induction of Labour part doesn't really need to be in the birth plan as you'll only NEED a birth plan if you're IN labour or have consented to go in for Induction. The S+S stuff will have already passed by the time you need to waft this document in front of HCPs. You could state that you ONLY want to consider an ARM form of Induction and that anything else proceeds immediately to C-section.

Primary concerns a good idea - but again presumably you'll only be SHOWING this to your community midwife ( in which case the full document would be a very good idea to go through together in detail having booked a double appointment) so therefore telling them you want to be in an MLU will be less useful as a) you'll already be there or b) you'll have already consented to be in hospital. Every thing else in this section looks very useful though.

Environment
First 2 points a good idea. Third will already be over by the time you get there.

Pain relief & other considerations
All useful. And well expressed IMHO.

Well done DB Sure beats the hell out of my "GET it out" Birth plan!

Sorry, 42+14? You were 44 weeks pregnant?

Thanks for all responses...

Good spot littlesilver I was obviously 42 weeks or 40 + 14... that would've made me look a right eedjit... It did FEEL a little like 42 + 14 at the time though...

pureas... er this is/was my short bullet pointed version... You should have seen draft 1. It does fit comfortably on a side of A4 though - but will try and cut waffle further and make type size bigger... Brevity never been my strong suit!?

Good idea about birth partner (although DH usually has NO problem making his presence felt and/or taking over if he feels he has to...) and gosh, TENS! I keep forgetting about TENS! Must hire from NCT forthwith.

Rolf (and others) I did think about having the two bits separate - i.e. stuff prior to labout - inductions and whatnot, and during labour ? pain relief etc. but it seemed too much of a fag to have two documents to go through with antenatal midwife, and also that some of my 'previous' might be useful for the midwives during labour to be aware of... what do you think? Bad idea?

Hospital I am at VERY anti CS... which in theory a good thing. However, right now I feel like I will refuse a chemical (i.e. drug-based) induction although happy to have sweeps, and an amniotomy if things are favourable. But if I refuse to consent to anything else, then their only options are to let me be pregnant forever or do a CS, surely? It's a fight I'm prepared to have if it comes to that, because I WILL NOT take the risk of the hyperstimulation nightmare I had last time. DD and I lucky to make it through unscathed after 4 hours of an unbroken contraction, from what I've read...

malteser I know that going beyond 42 weeks with expectant management will probably rule out the birth centre, and render much of what follows null and void - but as said above, decided to keep the two bits on the same sheet...

Hi Arcadie thanks for taking the time to post here as well!!

Agree that point 3 of environment pretty point-less... Will cut in attempt at brevity suggested by others!

Still pondering the one doc or two option... appreciate your feedback.

My main concern is that despite having had two consultant appointments booked to get something confirmed about my elgibility for MW-led unit both times I saw rather flakey SHO instead, and despite syaing that she supported that decision there has been lots of waffle about "it's really down to the consultant on duty at the time" etc. and there's nothing on my notes. (previous 3rd degree tear means it's not a given that I'll be allowed, see). I've another MW appointment next week, and I plan to sit ther until they get something on my notes in black and white.

But really, thanks loads... you've all been really really helpful and generous with your time, and I appreciate it.

db
xx

p.s. Yes, Rolf, last time was, sorry, shite. But this one WON'T BE. See final point...

Good luck with all of it. I am interested to read that someone else is planning on declining all chemical based induction. I am currently ttc #4; 2 of mine have been induced and there is no way on God's good earth ANYONE is EVER putting up synto on me ever again.

I would put money on your previous hellish birth being due to being given misoprostol, which is notourious for causing hyperstimualtion and is really not recommended

keep it short and to the point and make sure your birth partner(s) are fully clued up and aware of your wishes and can be your advocate

Good luck, I am reading that you def want to avoid being induced, ergo the cascade of interventions, and third degree tears

and if you manage to labour in a relaxed environment you can hopefully manage pain better

sounds like a plan, BUT remember things might not go to plan. so have up your sleeve

pain management
what happens if you are mega overdue and they insist on some type of induction

good luck, I am in the same boat as you and also want to avoid stitches......

I bet this time will be faster and the baby will "slip out like an oiled pig" as may friend put it...!!!

The last thing you want to be worried about when you're in labour is arguing your corner about being "allowed" in the MLU. I think if there is anything worth standing your ground on, pre-labour, it's getting an endorsement on your notes that you're ok for the MLU. My consultant wrote it all over my notes for me, and also wrote a letter to the senior midwife setting.

On the day, if they are dismayed about you refusing your consent to a chemical induction, the ball is in their court.

Hope it goes well for you. I post this all the time but hypnosis really helps with tension and anxiety.

Hi, DB, better late than never, I figured. Here is my twopence worth:

Lots of good advice re keeping it brief, well spaced and in LARGE font.

Do give sweep(s) another chance, there is such good evidence that they can work, particularly if you are post dates.

Totally agree with lulumama that is you had straightforward ARM if you cx is favourable you are v likely not to need chemical augmentation.

Also as this is NOT your first VB (traumatic as the first may have been) this delivery has every chance to be 'easier' for lack of a better word... ?more natural ?less traumatic. YKWIM.

Sorry, I am waffling, not all relevant for your birth plan .

Can you speak to most senior midwife/consultant midwife/labour ward manager?
Get yourself OK'd for the MLU - I think that's the biggie, isn't it?

Good luck with your next appoinment.

Like the idea of an "oiled pig" slipping out myself !