First time mum to be, would like some advice!

[Ozziegirly]

At my next appointment with my Obs apparently we are going to talk about my birth plan. Now, I have done some reading and also have some ideas, but what I don't want is either to be bamboozled into something I don't know about, or not ask the right questions.

So, basically, I guess my "aim" for the birth is:

"To try to avoid induction for as long as possible, although I am happy with as much monitoring as you wish. I would prefer only to be induced if there is a medical reason and not on an arbitrary day.

I would like to labour in a calm atmosphere with minimal examinations, I would like to be able to move around as much as possible. I will probably want gas and air for these stages.

I would like to avoid pethadine. I am scared of a foreceps delivery more than of a c-section. I may want an epidural, but if a mobile epidural was available I would much prefer that".

So does this seem realistic, or will she look at me like this and think "here comes another one with unrealistic expectations"?

Carolondon - My understanding is that if forceps fail then they have to go to CS, there is simply no option. So why not skip the trauma of forceps and go straight to CS (this would be my arguement). In the back of my mind when CS are mentioned, is always the thought that HCP are instructed to keep CS down so that the trusts CS rates look good.
If I was looking to choose which hospital to go to I would look at CS rates and go the the one with the highest on the assumption that they do not take risks and get on with performing the op rather than worrying about their rates.

Thanks gailforce, i never thought of that argument. I will use it if there are any issues with this.

Carolondon - it's often considered safer to use forceps than EMCS if the baby is down past a certain point. So although you can state you don't want forceps if it comes down to forceps or pushing the baby back up for an EMCS they will probably go with forceps.

Just wanted to say that forceps and CS are not the only option. I requested they try a ventous (sp?)before forceps. They are a lot less invasive and scary but not always as reliable if they cant get the angle of application right.

I am a little at induction at 40+7.
Thats a bit early seeings as you're not overdue really until 42 weeks.

I was induced for DD1 at 41+3, which ended in CS for failure to progress. Having had DD2 naturally at 41+3, I question whether I should have waited a bit longer with my first.

If you're anti intervention then read up on what induction actually means. It can work fine, but it also puts you on a kind of birthing protocol.

On the other hand, baby could surprise you and be early!!

Am I right in thinking you will be induced when you are only 7 days late, just because you are 7 days late and only that?

Mine have all been late.

DD was 14 days late. Was induced on day 12 of being late (this was because I was approching 42 weeks and no sign of having her)

DS was 11 days late. Not induced.

DS2 was only 6 days late. Also induced but that was because he had unstable lie.

As far as I understand it it is fine to go to 42 weeks before the risks increase for the baby. I was never monitored just because I was a week late.

Thank you so much for your messages and sorry I didn't reply last night - I typed a response twice and the darn computer crashed each time.

I rechecked my notes this morning and they say that they will induce at 41 to 41+3. This is something I will discuss with my Obs as I would be happy to go longer than that as long as the baby is happy. I was 11 days late too and loads of people I know seem to have gone well over 10 days late.

And thank you so much for all your suggestions re pain relief, I feel like I can go into this discussion now with things a lot clearer as to what I will require (pain relief if forceps are necesary, but try to do everything to avoid them), and minimal examinations unless specifically necessary.

Ozzie, I suspect that you'll have a fight on your hands about the induction date, although I hope I'm wrong. It seems like a very strong policy in most hospitals. Research in the area, like most aspects of birth intervention, is contentious; the risk is that the placenta starts to deteriorate and the baby will be stillborn, but it is incredibly incredibly rare.

This might be an Australian thing, given the above accounts, but I don't know anyone who was "allowed" to go more than 41+3 in this State.

Fetal heart monitoring is done flat on your back and strapped to your tummy, generally. That was the experience of my friend who laboured in your hospital (and she ended up with an emergency c within two hours of being admitted for induction) but it doesn't have to be. At my hospital, they did a 'trace' on admission - so about fifteen minutes of having it strapped to me while I did my standing-up labouring thing - so that they had a start point. Then they just used a doppler thingy every few hours. So yes, you don't need to be strapped on your back to have fhm, but it's easier for the hospital so it often happens that way. Definitely worth checking.

Oh! And also, check their policy if your waters break before labour starts. Most hospitals, esp. the private ones, have a policy that they'll induce within 12-24 hours of waters breaking. My waters broke 48 hours before any labour contractions started, and in the end it was over 5 days between them breaking and the delivery, so it's not always the case that waters breaking herald immediate labour.

Thing is, I don't mind being induced, if they can say that there's a reason - I'm not totally against it, but I'm just a bit against a load of pointless medical procedures just for the sake of being induced on an arbitrary day.

Do you know under what circumstances they will do foetal heart monitoring?

I'm hoping that induction won't even be necessary and I'm thinking about it for nothing. I am sure of my dates and the baby has measured exactly spot on for dates so far, so fingers crossed he will carry on being a little textbook baby (I guess some of them have to be!) and he'll arrive bang on time.

But I just want to be prepared.

Hi Ozzie,

Just a couple of things that came to mind while I was reading this thread (I'm 39+5 today and in Sydney, in case you don't remember me from the first time frolickers thread!).

The first thing is that my local public hospital has mobile CTG machines in the delivery unit (for the feotal heart trace), and I think that you might be planning to give birth in a private hospital (??), so I would have thought that they would have the mobile CTGs too..... that means you don't have to be strapped to the bed if you did need constant monitoring. Maybe that makes you feel a bit better?

The second thing is that I was told that policy has changed recently (in NSW anyway) and they now use morphine instead of pethadine. I don't know if that changes your opinion on pain relief - maybe just good to be able to discuss and read up on; our antenatal class were told morphine is much better tolerated and less side effects are likely (could be bollocks, who knows!!).

Finally, I'm 39+5 today and after a fantastic pregnancy with no complaints, I can honestly say that if I was offered an induction this afternoon I would take it. I am soooooooo fed up and just want the baby out now!!!! I really didn't think I would feel this way in earlier stages of pg. I'm not saying that I know better than you how you will feel, just that I suprised myself with how fed up I am in these last few weeks. Maybe keeping an open mind is the best policy with regards induction? 40+10 is standard for my local public hospital BTW.

HTH! As an (also) first time mum-to-be, I have no useful personal experience to add (sorry).

Pepperoni, thank you, that's all really interesting.

And yes, morphine does change my opinion actually. Basically although I have never had to take any painkillers before (apart from over the counter ones) my Dad has had pethadine for severe sciatica and also for kidney stones, and he said the sickness for him was worse than the pain, he said there were points when he actually kind of wished he could die as he felt so utterly sick and was just retching and retching (this was many years ago though).

And I do tend to react to medications/food etc in the same way as my Dad, so I have always been nervous about having pethadine.

I'm excited that you're 39+5 already!

I will ask about the mobile CTGs.

helen that's good to know re internal examinations. I am very squeamish about smears (after a terrible one a few years ago that I foolishly allowed a trainee to do! It still makes me wince when I think of it now...) and generally don't like being poked around, but it's nice to know that I probably won't notice it anyway.

I'm actually feeling fairly calm about the birth itself, but I just want to make sure I am as prepared as I can be.

Ah, but this is the thing, most induction policies work on a nebulous sort of risk benefit ratio - i.e., most of the time there's no risk, but just in case we would like to induce you.

I felt the same about induction, and in the end didn't need it but I do understand your position entirely.

Ask about the foetal heart monitoring, but usually it's used as a standard part of induction; my friend just had the thing strapped to her from the off. I think that's because there's a greater chance of foetal distress with an induction, but don't quote me on that. Certainly, though, this is part of the whole cascade of interventions thing; induction means greater monitoring means greater chance of false distress indicators, etc.

But I really should say, here, that I'm a natural birth/home birth advocate and very anti intervention-as-standard, so please take me with a grain of salt.

But I do tend to agree with you tortoise. Much of the reading I have been doing with strategies for pain control are to do with keeping mobile, moving around etc, certainly not lying flat on a bed!

My fear is that I will be induced, so will need monitoring, won't be able to cope with the pain as I can't move around, will need an epidural and then will need more intervention as I won't know what's going on - pretty standard "cascade of intervention".

BUT I need to remember that they can't do any of these things to me without my consent! I don't plan on being pointlessly bolshy, but equally I don't want to be treated as a medical case if there's nothing actually wrong.

All of the same concerns as I had. TBH I think a lot of this depends on your ob and your hospital, and I'm sure you've chosen those with these things in mind. I didn't bother with a birth plan because I knew the hospital was compatible with my preferences, and that worked out fine.

When's the appt? I'll be interested to know how it goes. Also, if you ever want coffee in town I'd be happy.

Certainly I think it is right to try and aim for as little intervention as poss, and to keep moving as much as poss.

However I think you are wrong to be more scared of forceps than cs. My DD was induced, I had an epidural and forceps, the recovery was fine, my stitches healed fine and quickly, two weeks after birth I was pushing DD into town, meeting up with my NCT ladies for a coffee and BFing DD in public like I'd been doing it all my life.

A CS is a serious operation that takes a long time to recover from. It makes it MUCH harder to look after your newborn in the first weeks. Its hard enough as it is, what with sore bits, engorged boobs, painful nippes and being totally knackered!

I blessed those forceps - after pushing for nearly 3 hours and verging on collapse, two little sustained pulls (with me pushing too) and out she slid, slowly and gently. They don't yank the baby out, they just use them to add traction while you push.

I was so chuffed that I avoided a CS.

Ozziegirly

Just to add, I planned a homebirth with DD but as I said she had to be induced on her due date.

So monitoring and the drip, epidural, forceps. I think it is true what they say about the cascade of intervention.

But the reality is more complex than - no intervention = good, lots of intervention = bad.

Your birth experience it about much more than the bare facts that appear in the debrief notes aftewards. If (for example) you have a lovely midwife like I did, you may find you are not bothered about the intervention at all - I certainly wasn't. It is difficult to predict how you will feel. I thought I would be best off at home. Actually I loved being in hospital, the care, the attention, seeing all the nurses and all the other ladies, dads and babies. I was terrified of forceps - when it came to it, they were a godsend.

I think you should aim to move around as much as you can. But keep a totally open mind and just go with what you feel at the time. Its a whole new experience and when push comes to shove (no pun intended) who knows what you might want, or what the baby might need.

Best of luck!
Bumps x

Bumpsadaisie it's a matter of opinion whether c-s or forceps are 'worse'.

There are plenty of people on our c-s after traumatic birth thread who disagree with you.

Sorry, I'm not trying to undermine your post but sometimes it's really unhelpful when people tell you there's a definite order of things which are worse.

Fair enough.

Bumps x

Sorry, I am over touchy on this subject, my problem I know x

Ozziegirly thank you for starting this thread. Your first post is really helpful for me - I am a first time mum and not really close to doing my birthplan but you have managed to put into words a lot of what I would like to have on mine

No problem Withorwithoutyou - I see you had forceps without pain relief and that is totally different to what I had. I know some people take a long time to recover too.

Hi Ozzie,

Your ideas for your birth plan seem very sensible to me.

I think this has probably been said, but I had a forceps delivery as baby was big and back to back, and we were both really tired. I had had an epidural, so thank goodness, I didn't feel anything, except a bit of tugging, and if it can help, it didn't seem brutal at the time, if you see what I mean.

I think they have to cut you, (they did me) which is not fun, but it's maybe better than a nasty tear. I did feel bruised and sore for 6 weeks or so, but again, I think lots of women do, with or without intervention. I was terrified about incontinence, but am pretty much back to my old self.

Try not to feel too frightened- sometimes big babies pop out quite easily, and things rarely go to plan, whether in a good or bad way. A colleague of mine ( you might have heard this too) recommended massaging in sweet almond oil into the perineum to keep the skin supple. Some say it can reduce trauma, and she did not have a single stitch or tear. Finally, I so agree with the others on this thread who say that availability of pain relief is so important, and my heart goes out to anyone who went through an assisted birth without it.

Hope everything goes well

Just a point, hospitals may have a "policy", and it may be for excellent reasons that you would do well to consider. But it's THEIR policy, not yours. You are not bound to submit to it.

Thank you for all your messages, it's really so useful to hear everyone's point of view, and has definitely reassured me a bit about forceps - and WOWY, your posts mean I'll definitely make sure that there is something huge and underlined saying that I won't consent to forceps without pain relief.

Littlesilver I had wondered what would happen if I just didn't consent - I don't think I would go down that route, but what can they actually do? I suppose refuse to treat me. ANyway, I am sure it won't come to that.

tortoise meeting up for a coffee sounds very nice indeed.