Have you or did you do a birth plan?

[Rootatoot]

A lot of people mention these and there is a page at the back of pregnancy notes to write one, but when I mentioned it to my MW, she said 'what's a birth plan?" I think she was being a bit facetious but I took it to mean they're not interested in having one in my local area.

So did you write one? Was there any point? Did anyone at hospital take any notice? What went in yours if you did find it useful? Thanks.

No. I didn't have a written one. I knew in my mind that I would go down the pain relief route if necessary, and would breastfeed, but I didn't have any strong views on anything else. Some of the things that women specify - like who cut the cord, never occurred to me. I took the view that a qualified and experienced midwife would have a better idea of what was good for me than I would. I wasn't chained to a monitor, I could move around if I wanted, but in the end I found the most comfortable position for me was to lie half sitting on the bed.

My only advice would be: expect the unexpected, go with the flow and keep an open mind. I think too many women get unduly stressed by birth plans because they don't always go to plan.

I would be interested in any midwives' opinions of extremely detailed and specific birth plans though.

No i didn't bother either, labour is so hard to predict i think birth plans are a waste of time, i was asked while i was in labour how i wanted to approach it and took a wait and see attitude, you don't know how long it will last or how painful it will be, in the end i had a 12 hour labour with an epidural and had to have my waters broken, just go in with an open mind and you'll be fine, the only thing i would decide on is who you want to be at the birth and go from there.

i don't think midwives like birth plans, i think they see when someone goes in with a really long detailed one that that person is going to be inflexible and a pain in the backside if things start to go wrong (my aunts a midwife) She said to me it's fine to go in with a rough idea of how you want to tackle the pain and what not but that you have to be flexible, the only plan you need is to come out with a healthy baby. At the end of the day its worth trusting the midwives and doctors they have years of experience, i know mine were fantastic, they helped me choose pain relief and got me an epidural when it all got too much and were there supporting me through it along with my mum and babies daddy.

Im 30 weeks and have done my birth plan.
The things i feel strongly about are peace / quiet / darkness.

Minimum people (other than OH) around and absolutely no trainees / students etc.

Also dont want chord cut until its stopped pulsing, and for OH to cut it and tell me if baby is a boy or a girl.

Id rather tear than have an episiotomy

I do not want to be monitored unless essential, and would still like to be able to move
I absolutely do not want to be made to lie on my back at any time.

I want an active labour and hopefully a home birth in my pool, but what will be will be. and regardless of where i actually labour or give birth i feel very strongly about those points.

You can do one on the NHS site which i have done but not printed yet...

I did have a birth plan but my MW wasn't interested in it and I didn't show it to anyone during labour.
This didn't matter because my birth plan was more for me and my DH so we knew in advance what decisions we wanted to make should complications occur. I didn't want to be put on the spot if anything unplanned happened.

Even though I had a birth plan I still entered labour with an open mind and was prepared to go with flow and adapt it as necessary.

I had a detailed plan that did not pan out.

There may be things you feel strongly about such as pain relief, moving about, cutting the cord, whom you want with you (and whom you don't lol), breast feeding, etc.

You can't control how long labour will be or how you will deal with it. You may have an idea about pain relief; I suggest you give yourself permission to decide how you feel at the time. Good luck

I did have one with DS but it was fairly baggy: things I would prefer, mainly, rather than absolute decrees about what I would and wouldn't agree to. I'd say that if there's anything you feel very strongly about, have strong reasons for requesting etc. then it's a good idea to get those written down - e.g. women who have experienced particular traumas in the past might state that certain things such as internal exams need to be handled a certain way. I am terrified of paralysis so wrote in my birth plan that I would prefer to avoid an epidural if at all possible, but that I would be open to the idea should one become medically necessary.

Thinking about it, my non-negotiables basically came down to 'discuss everything with me and DH first'.

I'd say it's worth writing down a birth plan just to get your own thoughts in order, then discussing it with your midwife so you can get clarification on anything that needs it and gauge your HCPs' attitudes towards things like active birth and feeding.

The Plan
I had a birth plan which I discussed with my midwives antenatally. The midwife who delivered my ds also read it and followed it as far as possible.

I think my midwives were positive about my plan because it was flexible. I expressed things as preferences (eg 'I would prefer to tear rather than have an episiotomy'). I reserved the right to change my mind (eg the physiological third stage bit - I said I would like to do this but might ask for the injection. I did have this in the end because I was utterly knackered).

I also put in preferences for what should happen if I needed a c-section. Luckily I didn't need one but I think it meant that I came across reasonable and flexible.

The Truth

Actually, before I went into labour I was utterly pig-headed and determined that I would have a natural birth with no interventions, including examinations. I was very aware though that this wouldn't be viewed well and so saw my flexible birth plan as a bit of a sop to the midwives.

As soon as contractions started though I was glad I hadn't worded it too strongly! I ended up being supported to achieve my goal without pressure to forego pain relief had I really needed it, like the poor woman on OBEM whose mum kept saying no when she asked for pain relief and telling her to take some paracetamol instead (!) because she'd been so adamant before about not using any.

And boy was I glad, after a lengthy second stage, to remember I had left myself a get out clause with the third stage!

I guess what I mean is, have one, get your birth partner and midwives to read it, but keep it flexible and remember that you may have to do things differently on the day.

I second aStarInStrangeways: I had one, it looked really scary and detailed, but it was more for my benefit to get my thoughts in order before labour when I guessed I might not be at my most lucid. It had an if/then approach and was flexible, ie whilst I had a first preference for how the birth would go, I wasn't hung up on it (and the BP made this clear), so if had contingencies: eg if we need a c-section please prep me for skin to skin if poss, if not, hand to DH asap for skin to skin.

I went through it with my community MW in the last weeks of pg and made some adjustments based on that, and when we arrived in the delivery room went through it with the MW who caught DS. It was clear she was respecting it when very close to the end, she almost invited DH down to look at DS's head coming out but I had stated high up in my plan that he (and other non-medical visitors) should stay at my head end!!

I did NCT which helped, but tbh I adjusted it after the classes rather than start from scratch. From my perception of the experience of other mums on my group, those who were most hung up on the plan setting out their 'perfect birth' have struggled the most when things didn't go to plan. I can see how some MWs might discourage BPs for this reason.

Sorry - essay, but if it makes you feel better, go for it.

And cross posts with SnickeringFox - yes, absolutely!

I had bullet points for DD2, mostly in case we had to transfer to hospital which we didn't.

They were things like;
natural 3rd stage,
no internals unless medically indicated,
don't offer me drugs,
I'm breastfeeding,
if intervention is needed, explain properly what and why.

I also added that if a c-section was needed I still wanted skin-to-skin as soon as possible and wanted to see the baby lifted out. If I couldn't do skin-to-skin, DP was to do it.

I'll do the same for DC3, the midwives at DD2's birth commented that bullet points were good and helped them get an idea of where things were going if I had needed a transfer etc.

Thanks for your posts. Really interesting. I'm 33 weeks and just now looking to the birth but to be honest, haven't received any info from my MW at all so far. I don't have my antenatal class on labour/birth for another 2 weeks yet either, but I have been doing some reading because I don't want to feel totally unprepared esp if things kick off early ( I have high bp & this may be a possibility if it's doesn't come under control ).

I just thought that the birth plan, as it is in my notes to be filled in, would be something I'd cover with CMW but from her reaction, I know it won't be.

I'm not really thinking of being inflexible and totally agree that you can't 'plan' a birth as such so best to be open minded but some things I think would be good to write down. As some of you suggest, this would probably help me get things clear in my head as much as anything. I was thinking though that I don't want DH (who is v quiet and shy) to feel pushed into cutting cord when I know he is uncomfortable with that, or to be at the business end when he won't want to be! So those things would be good to point out. I absolutely do not want students present (bad experiences of friends). Think injection for third stage sounds good - unless there are downsides I don't know about?

I think I will write one, in a flexible way, and I'll take it with me. I can imagine that when I'm in labour I might forget to state i don't want students or whatever, so I don't think it's a bad thing. I'm going on hopsital tour today so might ask them about giving them 'birth plan' & see what they think of them.

Thanks guys. I don't know where I'd be in this pregnancy without MN. I've had way more help from you guys than MWs that's for sure!

I had a fairly detailed one with the big caveat that it was a plan and plans change. Long and detailed didn't mean inflexible, it meant that if everything was proceeding normally I didn't want to be answering questions and if if wasn't they had some idea of what my wishes were.

It was a wish list essentially and I got most if it. So stones we had to compromise - I had the choice of wireless CFM or a midwife preent the whole time so I chose CFM.

I had good reasons for a lot of my choices which were, and still are, painful to talk about and certainly not something I was going to dredge up during labour. My birth plan was there in part to explain those and the possible ramifications as well as the ontingencies agreed by my obstetrician and MW. My first question to any new caregiver was 'have you read my birthplan?'. It avoided a lot of unnecessary chatter.

So if you're the kind of person who would rather be left alone then a detailed birth plan is well worth it and stick to your guns about MWs reading it. I think it saved me making choices in labour because I'd already made them with as many contingencies as possible.

From memory mine had 3 sections:

Labouring environment - private, quiet, no hospital gown, knock before entering, minimal MW presence, free to move

Pain relief and intervention - minimal possible, G&A or pethidine, no epidural (I preferred GA and signed a waiver saying I understood the risks), tear rather than episiotomy, CS preferable to ventouse or forceps but if absolutely necessary GA or sedative before ventouse/forceps

After birth - immediate skin/skin with me or DH, let cord stop pulsing before cutting, baby to breast immediately, prefer to find put sex for myself, no injection, cleaning/weighing to wait, yes to vitamin K, no other treatment unless indicated, cotton wool/muslin and water only fir cleaning baby, one of us to stay with him at all times

Ah yes, my dh didn't want to cut the cord either and this was quite firmly in the plan. When ds was born the mw asked dh if he was sure. He was and she went ahead and cut it!

You sound very sensible. Good luck!

I would strongly advise flexibility. I had a minimalist birth plan which I only wrote because my obstetrician made me (was quite surprised she did!). I had very few things on it at all and even then still changed my mind when I was in the throes. You have no idea what it's going to be like till you're there.

A particular mention about students, though. I specified that I would definitely not have medical students (I'm a doctor and didn't want them coming to my ward after seeing my bits) and while I didn't write that I didn't want a student midwife, in my mind I had decided that I would refuse one.

In the end I did have a student midwife with the midwife and we were both so glad. In hospital you may be left onyour own a good bit, which you may prefer. My birth was rather more dramatic, and while I would have been alone very little, the midwife still had to go out to get anaesthetists and obstetricians and while I couldn't have done it without DH there, I really needed someone who wasnt him to talk me through the contractions. She was an incredibly positive addition to the team looking after us.

Very good point frak about making sure people read the bloody thing!

SnickeringFox i saw that episode of obem and thought what a bitch the mum was, the problem is if you haven't been through labour you don't know what to expect, i was not expecting it to be so exhausting and painful and i would never have coped without an epidural it was just too much, i had an injection for the 3rd stage because by half 4 in the morning i was too shattered to want to do it myself i just wanted to go to sleep (i hadn't slept at all in about 2 days). I think a birth plan should be a guide rather than a set of inflexible rules after all the midwives are there to make sure you end and baby both end up alive and well that's the only outcome you need it doesn't really matter how you get there. There are no prizes for not using pain relief, or having a natural second stage, if i have a short labour this time i'm hoping to get away without an epidural but i can tell you know if i'm going to be ther for 12 hours i'm going to bloody have one.

I had a fairly detailed plan, and the things that were important to me I put in capitals. But it was all fairly basic stuff, no episiotimy, no opiates (which I did concede on an hour before delivery) no constant monitoring, no checks unless needed. I wanted it to be as natural as possible within a hospital setting, and the MW's were fantastic. They listened, and that mattered to me more than anything else

I had a detailed birth plan that took into account lots of different eventualities and stressed the fact that we were a hypnobirthing family abd wanted as little intervention as possible. I had planned a water birth at home and ended up having to have a syntocyn drip in the delivery suite after 2 days of slow labour and leaking waters ( baby was posterior). It was about as far from my ideal scenario as possible but the MW were extremely sympathetic to that, read and noted my preferences and helped us create as calm and relaxed atmosphere as possibl. They helped ne stay active and gave really good advice when it came to deciding if i should have the drip and helped me have a natural birth as possible.
It depends on how you feel about labour, personally I wanted to be in control as much as possible. It's my body, my baby and my birth and I wanted to avoid intervention and drugs. It's wrong to assume they 'all know what they are doing'. There are many ways to approach birth but MWs and doctors will tend to err in the medicalised side and it's quite possible you will get different advice from two different HCPs. For instance one junior consultant came into our room abd asked what the birthing ball I was labouring on was 'for'? there will be a different approach depending if you are in a MLU or delivery suite.
I think it's a good way of preparing yourself for all eventualities, makes you think, What will I do if this happens? On the other hand if you are happy to be lead by your HCPs then that's fine too.

But yes you also need to reserve the right to change your mind and be flexible. As has been said, if it's your first you gave no idea how you are going to cope. Also coming from the other angle, if you know you want to have an epi it helps them plan as an aneasthatist might not be on hand when you decide you can't take it anymore!!

I'd agree with that it depends on how you feel about the different approaches i've had a lot of complications and have medical issues so for me the best thing is to listen to the doctors and accept medical intervention but for someone who hasn't had that experience they may find it better not to its all down to personal choice and experience my only advice would be to accept that if you want a healthy baby you may have to meet the midwives half way, if you want them to listen to you you will need to be willing to listen to them

To me a birth plan is more a mechanism to get you (and your birth partner) to think about what could happen during the birth and consider what you would prefer under those circumstances. From my experience, when you are in strong labour is not a time when its very easy to have a detailed discussion on the pros and cons of something and nor is it a time when its very easy to make a rational decision from scratch. That's not to say you should write a birth plan and stick to it like glue - but if you've gone through a lot of the thinking part already then there's a lot less new information you need to assimilate before you can make a decision. But that's me and my perspective - personally I find it hard to put complete trust in any HCP and follow their advice blindly and I want to know the whys and ifs and buts first, but I do realise that's not true for everyone.

You might want to look at the NICE Intrapartum Care Guidelines (to see what best practice is considered to be in the UK) and asking for a copy of those specific to your maternity unit. See what your unit would consider to be "normal" and have a think about how you feel about that. Again, from my perspective, I know VEs every 4 hours are considered normal - they're not something I enjoy and nor are they something that I feel will give a better outcome for me, and so they're something I intend to refuse (although if there's a specific reason other than the passage of time for doing one then I'm open to discussion - especially if the MW is prepared to do them without making me lie on my back!).

Injection for the 3rd stage is a personal choice (unless things have got complicated, when it is likely be strongly recommended). What you might want to consider is delaying the injection for a couple of minutes / until the cord has stopped pulsating - this allows the blood that was circulating through the baby / cord / placenta during the pregnancy to equilibrate (mainly) into the baby. The impact of doing this is still being researched - but benefits are thought to include a significant increase to the baby's iron stores, making anaemia in the 1st year much less likely. If you want to know more, google "delayed cord clamping".

I didnt do a birth plan for either of mine..... and in any case it went out of the window due to complications. I would detail things that are terrible important to you, but other than that the best advice I can give is to be open minded and matter of fact about it all. All the best.

No time to read all posts in thread but I did a very thorough Plan A, if plan A can't happen then this is plan B, if plan B goes wrong then this is plan C. It was clear, bullet pointed so MW could follow easily and quickly. It went completely out of the window as ended up having emergency C-section. I had requested as natural birth as possible, possibly water birth, with my music playing, lots of walking around and dancing (I had 3 soundtrack - labour, birth and post birth, the first being up beat and the latter chilled), with minimal pain relief, husband present and skin to skin contact on arrival of baby... I ended up with a spinal, laid down on back on surgical bed with their only CD of Clannad (fortunately I do like Clannad) and then skin contact came by way of me poking finger through incubator window and stroking baby's hand 12 hours later .

The only, ONLY plan that was fulfilled was that DH was there for birth - I think he is still traumatised almost 4 years on! All went well eventually . I would still write a birth plan though... it was really useful to just spend time being concise about what I really wanted and helped me focus on what was really the most important (health of baby and mother). Really useful bit of preparation esp for first baby where everything is a complete unknown and it is so hard to mentally prepare.

It is important to have several copies as there can be shift changes and keep it concise and bullet pointed as MW and team don't have time to read books and make sure that birth partner makes it known that there is one and knows to refer to it. But be prepared for it to need adapting .

I had a plan for my first. Won't bother this time, it ALL went out the window. I think the only thing I was absolutely clear on was 'absolutely no student is to come anywhere near me with a needle' - I had massive needle phobia and if any stabby stabby was going to be done it was going to be by someone with DECADES of experience who was guaranteed to get it right first time.

Only thing I've said for this one is 12 hours tops. If it's clearly not going anywhere by then, section time. I did 70 hours last time, so it's not like I haven't done my fair share. As soon as anyone starts suggesting epidural: section time. I am not being paralysed again for anything less and certainly not being induced as it did bugger all last time. This isn't written down, but my consultant is aware and agrees, and DH knows that them's the rules.

Oh, and if the midwife I like to call 'The Bitch Queen From Hell' comes anywhere near me I WILL kick her.