Birth Plan - Do they work? Are they really followed

[Wills]

For dd's birth I didn't really put a birth plan together because I didn't know what to expect. For this little one there are certainly some things I would like to ensure happen/don't happen! I would like to know other people's experiences/views on whether their requests were followed or not. I will put a birth plan together because it will help organise my thoughts but the general consensus amoungst my friends is that birth plans are not even read. I don't mean things like... I don't want cesarian and then things get dramatic etc if I or the baby were at risk then I don't care what they use/do but there were aspects of dd's birth that I would like to ensure don't happen again. Things like, I was given pethidine - I wasn't even asked - and it didn't work so I would like avoid having it again as its pointless. Also I would like (if possible) to put the baby straight to the breast. It was at least half an hour last time before I even held her (long story). So... what do people think? Are birth plans truly followed where medically possible or should I hand a list of dos and don'ts to dh and get him to stand his ground?

Wills, I can't believe they gave you Pethedine without your consent. I didn't have a written birth plan but made sure dh knew the couple of things I was absolutely sure about. One of which was should they take the baby out of the room after the birth, whatever state I was in ,he should go with it. And I also wanted to hold my baby as soon as it was born. I did make sure the midwife knew this as well - only because I wasn't sure if dh would be able to remember more than one request

Yes, mine was followed both times. I think it also served as a reminder for DH as to what my wishes were. It's also quite a good exercise in itself as it straightens things out in your mind - I find I need to have written things down to make them stick in my memory.

1st time round it was several hours before I got my hands on DS1 due to repair work My birth plan for dS2 stated that I would like to delay and "repairs" to allow me, DH and the baby time alone together and this was followed (although the repairs weren't as extensive).

I think if your plan if flexible then it is more likely to be followed. Make sure your birthing partner is aware of your wishes and ready to jump on anyone who tries to go against them without consulting you.

I didn't actually have anything written down but told dh and kept 'testing' him in the weeks running up to the event. The midwives didn't really mention having a plan during labour but things more or less went the way I wanted until dd got into distress (after 5 hours of pushing!) and we got transferred to another hospital where I ended up with an emergency section.

I think that, as soupy said, the more flexible the plan the more likely it is to be followed (more or less!)

Good luck!!!

p.s how long have you got left?

Wills - it depends really, I am sorry to say, on the midwife who attends you in labour. SOme are brilliant and will go out of their way to try to keep things the way you would prefer them, even to the point of arguing on your behalf with doctors; most will read the birthplan and will stick to the bits that seem practical in the situation (but of course we all write birth plans with the understanding they cannot be written in stone); sadly I have seen a few midwives laughing about the things in people's birthplans (normally the sort of midwife who I can't understand WHY they do the job, and the reason I am having an independant midwife who i know).

So yes - write your birthplan, but be realistic and be aware that circumstances may cause a deviation from it. Certainly the things you have mentioned are entirely reasonable in almost all circumstances. But the list of do's and don'ts for your dh is a good idea as well. REmember - legally nothing can be done to you or to your baby without your permission. Everything - from taking your blood pressure to injecting you with something - should only be done if you allow it (although holding out your arm if someone waves a blood pressure cuff at you is taken as implied consent - and there is a bit of leeway in a true emergency!)

I felt my birthplan was very useful both for birthing partner and midwife and means when you are in pain you can just say, "Look what I said!" instead of having to explain and justify your wishes. I kept it to one side of A4 in 12 point font, in bullet points, so it could be read quickly and understood very easily, ie midwife could not say, "Oh, I'll read it later," and then not have time.

I agree that flexibility is the key - if you ensure your birthing partner knows the score, thats the main thing. We had planned for dp to cut the cord, but as it was, ds didn't breathe when he came out so the mw had to work very quickly and clamped the cord herself so that ds could be revived. That sort of flexibility is crucial. I have to say that I had very good mws at C&W and when it came to potentially controversial topics such as did I want a managed third stage (ie the injection to expell the placenta) and was ds to have the Vitamin K injection, I was consulted by the mw before she went ahead. I was also asked when I got into the labour room if I had any specific requests. I trusted the mws I had implicitly and when it came to me having an epidural as I was knackered and the contractions were going nowhere, they made the decision with my dp (who, rather helpfully is a surgeon) as I was not on this planet by then!

Just to echo OOP's point - keep it brief and tell your partner what it says.

I found I couldn't speak or think in the middle and end of labour but I did know what I wanted to say so was very pleased it was all down on paper.

BTW - nice midwife-led birthing-unit read it and kept to it, hospital (got transferred in second stage) did what they liked but it didn't seem appropriate to say 'have you seen my birth plan?' ...

Mine was followed too wills, in fact I found it recently and all was done exactly as I asked. This was at home though. Agree about flexibility if necessary too. So I think they're worth doing.

Thanks for all the comments, they've really made me think. I'm still hoping for a home birth but as little one is still in breech position I'm trying to get my head round being in hospital. WWW - it simply never occured to me to have a birth plan for home - good point thanks. I agree that it certainly needs to be flexible. Good point over the one page and bullet points - I could probably write an essay explaining the whys IYSWIM. Its getting the right level/tone so that people read it isn't it. By the way pethidine was given to me because I'd been induced that morning, laboured all day and they wanted to stop the labour so I could go to bed for the night before starting me again. Looking back I presume they felt that since it wasn't for pain relief it wasn't up to me so didn't bother asking. My dh asked as the mw (cow!) was injecting it. Needless to say it didn't work - not at all so I'm keen not to have it again because it was pointless.

As for holding the baby - I should probably ask this on another thread but I'm desperate this time to hold the baby asap. Last time dd was a little blue and so was taken away - this is fine - but I'm naturally keen that all realise that I want to hold the baby asap and put it to my breast. If you have a cesarian - is this still possible?

Wills, mine said things like I wanted dh to cut the cord, I wanted lights kept low etc etc. There were provisions for if I ended up in hospital too, like I didn't want students thanks, that kind of thing. I hope your baby turns, did you see the tips on motherinferior's thread? I posted a link for turning methods and I think others had some good advice. Fingers crossed for you.

I'm quite new here (hello!) and I read this thread with interest as , like Mears, I'm a midwife as well as a mum.
With regards to the question Wills, assuming the baby is healthy when it's delivered, there should be no reason why you can't hold it and put it to the breast straight away, even if you have a Csection. It may be an idea to check this with the surgeon though. Some are happy to let dad cut the cord, too! You have plenty of time for skin to skin contact with the baby across your chest as you are being stitched up.

In relation to the birthplan issue, as a midwife, I really appreciate birthplans. In this day and age when it is unlikely that you know the midwife looking after you in labour, and meet her when in considerable pain and not feeling up to much discussion, it is useful for her to get an idea of your preferences. Naturally, if she feels something won't be possible, she should raise the issue. Unless there is a complete emergency situation, there is no excuse for not reading them. In my hospital, there is a designated page opposite the labour notes page in the maternity notes. As some of you have mentioned, it is important to realise that no birthplan should be set in stone. Things can change, either by choice or necessity. However, nothing should be done without your full informed consent.

Well I made a birth plan and almost nothing on it was followed. So all I can say is lucky you whose plan was followed... but if I ever have another baby (unlikely) I won't bother.

Hi Cheekygirl. Like you I really like it when women come in with birthplans so that you get some idea of what their thoughts were prior to going into labour. We have a pre-printed basic sheet within the hand held noted but some mothers bring in their own. The only downside is sometimes I have seen birthplans that are written in such away as to infer that midwives do not know the reasoning behind requests, and have no knowledge of natural childbirth. In the main though, I think they are really positive.

The quick answer to your question - no - they weren't even looked at. Get dh to convey the wish list.

I'm semi glad I had a birth plan cos it's quite nice to think you know what you're doing!!!! Ha haaa!!!! However my plans for a wonderful water birth didn't happen purely because if anyone had laid a finger on me or asked me to move to another room to get into a pool I would have knocked them out! I found a position that I could deal with everything in and I wasn't giving it up. Nor did I deck out my room in lavender candles, put the CDs I'd picked out on the stereo, or any of the lovely things I thought I'd do. I did however have a great and relatively easy delivery and wouldn't have changed a thing about it. The thing I think is a bit of a bummer with a plan is that when it doesn't go that way it could lead to being disappointed for some Mum's. Anyway why don't you have it written down anyway, have someone with you that knows what you want and then just go with the flow. Good luck and hope you get the home birth you want.

NO!

Cheekygirl - thanks for the answer on the c/s. That will now be put down. Its an enormous relief to hear that even with a c/s you can still have skin-skin contact and breast feed straight away so I will endeavour to check this out with my consultant if I end up going down that route.

Very interesting thread ... thanks Wills, for starting it.
In answer to your question about 3 months ago I would have said ... write out your birthplan and then burn it! Mine, with DS was not even referred to once during the whole labour! I felt it was a waste of time and all it did was set me up for massive disappointment.
However ... I have found a gem of a midwife for this pregnancy ... and she is proving to be an absolute star. Luckily I am able to pick an independent m/w here who will see me right through to the end (something I had no choice about in the UK and I never saw the same person twice ... not to mention the amount of shift changes during the labour !)
Anyway ... we have talked at length about the fact that I quite possibly suffered Post Traumatic Stress Disorder after DS' birth (need to dig up that old thread about that) .... and that with the continuous care that she will give me and a birthplan we can avoid a similar scenario next time!
The information about holding the baby after a c/s is new to me cheekyGirl ... but I will talk to my m/w about that. I didn't hold DS until he was a good few hours old and I just don't want that to happen again!!

I wrote quite a detailed birth plan because I had some set ideas on what I wanted and didn;t want and it was all followed to the letter, although I don't know how much of this was because of the plan and how much was just that it was all common sense.

I said I didn't want pethidine or an epidural unless absolutely necessary and near the end when I was asking for an epidural, the midwife got me breathing the gas and air more regularly and that took the edge off enough.

I also said I didn't want to be lying down and wanted to move around to find the easiest position. In the end I didn't feel like moving round at all and the only position I felt comfortable in was sitting up straight on the edge of the bed. I don't know what I was thinking of because there was no way I could have given birth like that but the mw encouraged me to kneel on the bed leaning on the head of the bed, which was raised. Since that, I haven't been able to think of another position that would have been comfortable for me so that was well done.

I said I wanted syntocin given straight after the birth, so they did that while I was still getting over the shock and didn't notice at all. And so the placenta came out really quick and while I still had a tiny bit of energy left!

I'd also said that I wanted the vitamin K given as an injection to the baby but they asked me again what I wanted at the time, which I thought was good, in case I'd changed my mind after seeing dd or something.

I think generally midwifes are very careful to try and follow a birth plan but there's no harm in writing one, even if you think it might not do a lot of good. And if your DH has a copy on him through the birth and is very familiar with what you want, then he can prompt the medical staff if they're not quite doing what you want.

Whoops, meant syntometrin, not syntocin!

The first time I wrote a birth plan and it all went out of the window as things went quite wrong. The second time, I felt so much more in control of what was happening and the midwife took into account everything that I had written. Including me saying that I would sue her if she cut me unless it was a dire emergency!!! Poor thing!!

Wills, if you do have a c-section you can still be given the baby right away before it is wiped down etc. I forgot to ask in advance and regret this. I wish I could have seen him actually lifted out too - I'm not very squeamish!

Wills, I held DD after my c-section straight away for a minute or wo. She was then taken off for 5 minutes to have her APGAR tests, wiped down and brought back to me for more cuddles whilst I was sewed up, etc. I didn't even ask for this, it was just done - DH got a quick cuddle too as this time.

I wrote a plan which outlined my basic philosophy (based on as little intervention as possible, promoting my own endomorphins etc,) and including some specifics. I asked that any need to change from the plan would be explained along the lines of what were the risks, side effects, and what would be the risk in 'doing nothing'.I also included details for the midwives like, make themselves at home re tea, coffee and food from the fridge. My midwives were great, and really took on board the spirit of my beliefs and personality. When things went drastically 'off plan', and we did need to go to hospital for the complete catalogue of interventions in the last 15 mins, they were still asking my permission about every minor detail. This helped me enormously, and made me feel as if I was still a person....despite the difficult ventouse/episiotomy bloodbath indignity! (oh, and being locked out of the hospital at 4.30 a.m after pushing for 3.5 hours, hanging on to the railings alone in the street while dp went to find help....but that's another story, and I don't think you need to include a contingency for that sort of thing in your plan)