I'm being induced definitely...can you help me write a birth plan?

[Heathcliffscathy]

I'm being induced at 38 +3 because of Obstetric Cholestasis. It might be before if my bloods continue to misbehave as much as they have been.

So far we have the following:

• Dh present at all times including if there is a need for c-section due to failed induction.
• Utmost to be done to enable as much freedom of movement as possible for entirity of labour
• birth position, on side, all fours or leaning forward on something NOT on back or sitting.
• dh to cut chord and be first to hold baby and place on me
• managed 3rd stage, yes unless just the gel manages to get me going and nothing else used.
• pain relief: breathing, moving, massage, entonox. epidural if there is a need for syntocin drip and contractions become too painful.
• no antibiotics for me or baby until fully consulted.
• no taking the baby for wipe and weigh until we say so
• oral vit k

can you give me any more advice? should I state a maximum number of pessaries to be given?

any advice on c-section stuff?

Am scared out of my mind.

if you want to breastfeed then you could state that if you have a c-section you want baby to have immediate access to the breast (as long as baby is ok of course)

They sometimes like to try and break your waters and then put up a drip (oxytocin?). Not sure how you feel about this, but may be worth thinking about? It depends, I think, on the state of your cervix.

My last induction (DS) was great. 8 hour fairly normal labor and a midwife was with me constantly. On a one on one basis.

Only crisis was when they thought it would be another few hours, so DP left to check on DD at home and I sort of went bionic in the last stages and he almost missed it.

if you are on the antenatal ward for part of your induction, which is par fro the course if you need to have prostin gel or something else to ripen the cervix, once visiting hours are over, your DH will have to leave.

if your cervix is dilated enough , you will be taken to delivery suite for ARM and if that does not get labour going, you will be offered synto.

the max number of pessaries is 3 , given over a set time scale. if they don't do anything, you will be offered a c.section

if you have a birth ball or they have them on delivery suite, use on to sit on by the bed , once you get on or in bed, it is hard to get off, another good thing is to raise the bed as high as poss and lean on it

if a c.section, then DH should be with you unless you need a GA. if it is simply due to the induction not working, then no reason why it would be a GA. he can trim the cord and can have skin to skin, baby does not need washing immediately or dressing immediately as long as all is well - a c.s before 39 weeks can increase risk of some breathing issues, so be aware, baby might need a bti of help. also , if a c.s, there is no squeezing to get all the mucus and fluid out, so that might need getting rid of too

your DH can hold baby next to you whilst you are stitched and there is no reason for baby to be not with one of you at all times from delivery, as long as he/she is well

Really Lulu? Her DH will have to leave outside visiting hours? The policy where I am is that women who are induced have their own room, but can see your point about being induced on the ante natal ward.

Maybe check the hospital's policy on this as some hospitals may be willing to accommodate.

yes, it does vary from trust to trust. esp if induction is started on the AN ward.even when i've had clients in a private room for induction, the husband has had to leave. i can stay,but i have special dispensation (shiny gold doula badge and a v v v good head of midwifery ) but deffo worth checking with the hospital in question,. good point!

In our large NHS trust hospital the policy is that all birth partners leave at the end of visiting hours on the induction ward.
They have two bays with 6 beds in each for inductions.

I was induced on an antenatal bay of the ward at 8pm and DH had to leave, they did let him stay past visiting hours but was gone by 10pm. They called him back at 4.30am as labour was progressing and we walked around a lot and I had a long bath. Didn't get taken to delivery suite until water had gone about 4pm.

I was scared too and cried a lot but ended well, with an unassisted delivery- did have epidural and syntocinon though. As you have said keeping mobile helps and I had pains straight away after first pessary and was in labour within 3 hours, I was told though I couldn't specifically tell the difference.

No experience of CS but rest sounds very reasonable.

they might use the new pessary that stays in for up to 24 hours so no need for repeated internals and insertions.

once it was in i was monitored for 15 minutes then i was encouraged to get up and go for a long walk and up and down the stairs.

dh did have to go at 10pm. that was ok. i'd rather had enough of his company by then anyway. he went home to sleep while my contractions started. i called him to come back at 5am when i was 7cms dilated and moved to delivery suite. ds was born at 6.15am

all fine. entenox, dh cut cord, all the rest of it as you said. we were then free to go home at 9am

i've been told by a midwife in day assessment that as i'm being induced before 40 weeks (i.e. not just a usual induction for long preg) I will be straight into delivery suite with monitoring and dh won't have to go home. I'll get that confirmed from someone else too.

good point about breastfeeding after CS.

lulu do you think that it is good sign that head is 1/5 (i.e. 4/5 engaged?)...has always been a big boy and I've had a feeling that he would come early. do you think that pessary will do me? am second time mum and had vaginal natural birth first time???

I'm so hoping for spontaneous labour...any tips on making that happen gratefully received.

Agree about your DH having to leave if on ward. Which is fair enough, not on for other women to have to put up with some random bloke on other side of curtain.

I get very tense for VEs and had G and A for them. That worked really well for me.

are they really putting you straight in the delivery suite? only, that's going to take up a much needed room for a woman ready to give birth while you might be hanging around a good 24 hours waiting for anything to happen.

I had an induction at 38 weeks and spent most of it on the ante-natal ward. When the pessaries didn't work after 10 hours, I was moved to a delivery room where I had the drip and my waters broken.

The technique they used to break my waters was painful; DS2 wasn't engaged (or something, I can't really remember) so 2 midwives kind of pushed him down while the doctor broke my waters. I used gas and air for this bit, it really hurt!

Things seemed to move quite rapidly after that, although from initial entry to ante-natal ward to actual delivery was 24 hours in total. I'd say 12 hours of it was spent twiddling my thumbs waiting for something to happen.

I'd had a c-section first time around so my birth plan was all about avoiding another as far as possible.

i wouldnt bank on them putting you in the delivery suite, even if they have said so.

they said the same to me with my inductions and it has NEVER happened.

i can only be induced by ARM as i am allergic to the prostin gel. have always gone over 2weeks over, had sweeps etc and each time have had to go through the palaver of going to the ward, so that they can check on baby, do internal exam etc (despite the fact my midwife has always done one at home for me and written her finding in my notes so that they dont need to do it again) but they still insist and say they need to check that i am ready for ARM. LOOK IN MY NOTES< AM ALREADY 3-4cm and fine for ARM, "but its policy" and then they get all huffy that i can have the prostin and why am i taking up a bed on a the ward when they cant induce me anyway.........but delivery floor always busy and so i have to hand around and wait for a space on delivery. complete palaver.

oh and with my first they tried to induce me at 38wks for medical reason, still started off on the ward. They really dont like you to be on labour ward UNLESS you are already in labour, or your waters have broken. or at least that is what the policy is at my hospital.

as you have had a vaginal birth before, hopefully it should go ok, your body knows what to do. have you tried all the usual, sex etc? and maybe ask your midwife if she will perform an examination and sweep if possible?

sorry if i sounded negative, that was just my experience but have been through it four times now and am mad enough to be doing it for a 5th time!

sophable - I had an induction with my second dd - absolutely grand - was given gel at 4am and then another one at around 11ish, was moving, on my feet the whole day, walking up and down the ward, listening to ipod etc, in no pain/discomfort, absolutely nothing happened, had a bath at 3.30 - went into labour at 4ish, baby born with no assistance at 6.45pm!!! Had gas and air, was kneeling at side of bed when dd was born, husband cut cord, although almost didn't arrive on time!! Much easier than the 11 hour labour with 1st dd. I was really nervous when told I had to be induced, way too many horror stories but tbh it was a delight compared to previous labour!!

I was induced by ARM then syntocinon drip and was taken straight on to the labour ward. Was all fine really apart from forceps in the end but even that wasn't that bad. Was 13 hours 23 minutes from arriving until baby born.

Personally I would say don't be too disappointed if things don't go according to your birth plan for whatever reason, I gather you need to go with the flow a bit with induction, eg due to the forceps my DD was taken from midwives by paedeatricians to be checked over before she was handed to us.

Hope everything goes ok for you, x.

Can I add my positive induction story to wigglesrock's? Induced at 39 weeks with the gel at 4pm, strong contractions very soon after, laboured on all fours/kneeling, DD born at 9.12pm, 9lb no tearing, perfect from start to finish! Wishing you luck!

I was induced early with DC1. It was fine - although I was induced on the Wednesday night and didn't give birth until the Sunday. I'm sure it will go to plan for you too, good luck.

Be aware that if you are on a syntocin drip, they are likely to want to monitor the baby continuously (the strong contractions can be hard on the baby), so you may be less mobile than you would like.

Do you have a preference for tearing vs. episiotomy (sp?).

Do you want your DH to give skin-to-skin contact in the event that you are unable to?

Do you want your DH to stick with the baby in the unlikely event that baby is taken to NICU ward?

I'd be tempted to add something about these being your preferences, but you are prepared to listen to advice if the circumstances demand it (makes you sound more realistic to MWs, which I think will make them try and respoect your wishes if at all possible).

Oh, and I put a request for a private room post-birth on my birthplan and they managed to find me one both times. Result .

Another midwife (the senior midwife on labour ward) said I'd be straight on there because I'm being induced early for medical reasons. Said no way would dh be sent home.

So that's two of them that have said that. I hope it's true.

Can we talk about pessary vs sweep? Sweep v painful? but more natural?

how did you know that you were allergic whoever was (I can't find you now)?

My DH was sent home out of visiting hours until I was sent to labour ward. Once in the labour ward, DH was allowed to stay until DD was born.

When I was on the syntocin drip, a monitor was inserted onto my DD's head internally to allow me to stay upright. Otherwise I would have been restricted to the bed. I stayed on my ball throughout (until I started to fall asleep due to diamorphine and gas and air...for my own safety I was moved to an upright chair!)

I used this website to help me write mine. It's a homebirthing site, but has lots of useful suggestions for birth plans that could be used in hospital settings as well.

Click on the 'Planning A Homebirth' link on the left.

So sorry for you that you're facing this stuff in the last weeks of your pregnancy, sophable. Best of luck!

I didn't find a sweep painful, was uncomfortable and no worse than a smear test. It didn't work for me as my cervix wasn't anywhere near ready but the gel worked very quickly 2 days later so it may not be a choice you can make.

Perhaps ask if you can have a female with you overnight, if it is Trust policy that males are sent home.

I was alone overnight and really needed the support of somebody. The midwife weren't much chop. Half an hour after my waters broke I started asking to go up to labour ward, in a lot of pain and wanted pain relief and support. I asked 4 times. Asked them to call my DH. They told me to wait until the morning shift came and got me (nearly 2 hours later!) Then when I was examined on Labour ward I was 9 cms.

Don't want to scare you but my point is, you need someone with you overnight to support you/fight your corner.

Keep your mobile to hand. Mine was buried in the bottom of my bag in the cupboard and I couldn't move enough to get over to it to get it out. I was sort of frozen with pain. Otherwise would have phoned DH myself!

yes if you're on the delivery suite you won't definately have a delivery room as they may all be full with women giving birth or in established labour. The delivery suite in our hospital has bays in it with lots of beds for inductions, and partners are not allowed to stay over night in there unless you're in a delivery room and in established labour.

Just to let you know that my induction started on the Wednesday night. I has various sweeps and gels over the next few days.
My waters broke Friday am.
My contractions were mild and a bit stop/start. Perfectly easy to cope with on Co-codomol (helped me get back to sleep at night).

On Sunday am. I was 3cm dilated and was taken to the delivery ward to have a syntocin drip and really get things going.
Up until Sunday lunchtime I was on the antenatal ward. DH could visit during visiting hours (which were quite generous).

It was nice to be able to potter about and chat to the MWs and other expectant mums - made a couple of good friends actually.

I'm really don't think you will be on the labour ward until you are either in full labour or being put on a syntocin drip. It would have been a waste of an expensive and scarce bed to have me sitting down there listening to the screams for 4 days.

soph i had waters breaking but never went into labour. so that is (i gather) more painful as the waters cushion things. and then i entered the NICE protocol...

some things happened which i have typed and deleted. they were mainly unpleasant.

but none of it hurt like the sheer indignity and bewilderment. to be kind, i think some of the mw assumed i was ok. but i wasn't and nobody ever checked on my mental wellbeing, so make sure someone is ready to speak up for you, rather than just be patting your hand.

make a cs part of your birth plan, just in case. ask exactly what the timing is for induction / cs protocol and make sure you get some sleep in between if it looks as though you won't make their timetable.

cs is not dreadful, for me it was a relief. but it can mess with the bf a bit, so def go for skin to skin (dh if not yours) on delivery and immediate bf, not parked in recovery room.