Writing a birth plan

[DiamondsAndDaisychains]

Just finished writing my first ever birth plan for my sixth (and last) baby! Anyone else writing one or are they a waste of time? If you're writing one, what's in it?
Check mine out at diamondsanddaisychains.com/?page_id=139 (I'm an official Mumsnet blogger!)

I wrote a meticulously detailed one for DC1, didn't bother for DC2. I wanted a minimal intervention water birth, which I got with DC1. My friend was due the same time and wanted the same as me but it all went very badly wrong. Major intervention was the only way. She has had CS for the two subsequent births as she and the baby were lucky to get through it the first time.

This taught me that it makes very little difference what you put on a piece of paper. You can write abou whale music and candles but you might well get a crash CS.

Diamonds, have just been reading your blog and it is fantastic, hope you don't mind me asking but am so interested in your decision about pain relief. I had a classic cascade of intervention with #1, couldn't cope with synto. drip and had epidural then ventouse and found whole thing v. scary, so much so that I get in such a state in labour but won't touch pet hiding and have since avoided epidurals... My second was back to back and 9lb 13 and the pain was v difficult to deal with with g&a but was too scared to do anything else. My third labour was much quicker but I got to hospital with not much time to spare and it was far from relaxed with me trying to insert cannula in one arm and I've antibiotics in other for group b strep. I couldn't keep still and things got quite tense as I was 'told off' repeatedly while I was basically in sheer panic about the pain!! Was writing my birth plan for #4 due in 4 weeks but have just been diagnosed with gestational diabetes so for first time having to give serious consideration to c.section or being induced. I loved the sound of your calm approach and would love to experience labour in a less anxious manner, perhaps epidural is the way ahead?

Sorry that should read 'won't touch pethidine'

I think they are a bit of a waste of time, especially the very long and wooly ones. You want something the midwife/anaesthetist etc can read in a few seconds.

Mine with DS was:

Birth partner is [DH's name]
He might want to cut the cord - ask him at the time.
3rd stage - if in the water and blood loss ok, happy to try for physiological [so I didn't need to get out the pool], but otherwise, managed
IM Vit K for baby
We want to find out sex ourselves
No pethidine - if opioid analgesia needed, want diamorphine
Obviously would prefer as few interventions as possible, but ultimate aim is healthy mother and healthy baby.

That really, really was it and it will be the same this time.

Thank you all for responding! Dr Seuss, I know that the birth plan isn't necessarily going to go to plan, but I found it really helpful to think things through before they happen... things like, what would I do if I need an episiotomy?? Even just thinking through the practicalities of en early epidural and what that would mean to other options like a water birth (ruled out) or how and where I want to be when the baby actually comes out....
HappyNappies - THANK YOU! So glad you liked my blog x My midwife and I have discussed and planned an early epidural, as I guess you know from reading my blog! It is giving me a lot of reassurance to know it will be in place before things get too painful and although I know they don't always block 100% of the pain, I am hopeful it will be tolerable. I am also going to a osteopath who seems to think he can get my pelvis in the "right" position for birth so I can avoid another back to back labour.
Bartlet, I like your no-frills birth plan. Do have a policy on tearing/ episiotomy? And what about where you want DH in an emergency?
x

"Bartlet, I like your no-frills birth plan. Do have a policy on tearing/ episiotomy?"

I was hoping to neither tear nor need an episiotomy but was happy to be advised at the time and saw no point in ruling anything out. In the end, I did need an episiotomy but I don't remember it hurting (everything rather hurt at that point!).

"And what about where you want DH in an emergency?"

Not sure what the decision is there.

Anything can happen in childbirth. I think it is worth thinking about the possibilities but not getting too attached to anything in particular. I worry that women sometimes can set themselves the target of the 'perfect' birth and then feel they have failed when they have used pain relief/had an epidural/C-section etc.

Mine is currently:

Waterbirth if possible
Gas & Air (and Tenns if no pool available), please don't offer pethidine unless asked
Delayed cord clamping

And that's it

Bartlett what's the difference between pethidine and diamorphine, why the choice to have one over the other?

I wasn't planning to do one this time. I had one last time but I don't even remember taking it out of my hospital bag and it's not that I didn't have enough time. I made decisions as I went along based on the midwives' advice and my personal preferences. If I get everything else I need to get done before I go into labour, I'll do one but it's not high on my priority list now.

Having said that, I really enjoyed reading your blog Diamonds and you've given me pause for thought. Especially the bit about cleaning the baby and wrapping it in a towel instead of putting it directly on its mummy tummy. I've seen them do that on OBEM but did not think that was usual policy and thought it was C4 policy or the policy of that particular NHS Trust. I'm sure I got my DS straight away without asking and that he wasn't wiped or washed until I did it 5 / 6 days after the birth. I loved your tip that breastfeeding is best done without TV or other distractions, where possible. I agree that it's a wonderfully quiet and relaxing time (when nipples have settled down) and that it should be savoured as much as possible. I tended to read during nighttime feeds but just relaxed and enjoyed the moment during the daytime feeds.

Oh, and, by the way, I scrolled down on your blog and you are a very yummy sixth time mummy! Gorgeous pictures.

Pethidine has been shown to be less effective in severe pain and to cause more nausea and vomiting, the latter because of what it metabolises to. Diamorphine is a much 'cleaner' (fewer side effects) drug, so that's what I wanted to have if I needed it.

There was no way, however, that I was going to have diamorphine at home. If I needed opioid analgesia, I was going to be transferred to hospital as I have seen (and delivered actually, now that I remember) babies born not long after the mother was given one of those drugs. They are fine if delivery is not expected in the next roughly 4 hours as it gives time for mother and baby to metabolise it, but if a baby is delivered soon after administration, it can often be sleepy and not breathe well. That's not a reason not to have a very good drug for pain relief and it is easily managed in hospital with a few extra hands around, but it wasn't something I wanted to risk at home with only two midwives.

I do like your birth plan, Fluffy, Short and to the point! I never believed that the TENS machine would actually work, but it was AMAZING and kept me going from 2am to 5pm and to 7cm, before getting in the pool.

I see, thanks Bartlet! My mum and sister have 8 children between them and never had a labour over 4 hours (one was 40 minutes ), so I want to steer away from pethidine/etc just incase I'm the same, for the reasons you mentioned and also I'd read it can interfere with establishing breastfeeding because the baby is so drowsy. I'm just hoping I can hack the pain :o

I think if there is a decent gap between administration of diamorphine/pethidine as they aim for and delivery, there should not be any more of the drug in the baby so shouldn't affect delivery. (Will be brooking for a swift delivery (although 40 minutes sounds a bit swift!) for you!)

Childbirth does really hurt so you shouldn't feel bad or guilty if you need or want pain relief.

And, finally, even though anecdote is not data and the MN approach to stats does my head in, I had a completely unmedicated birth and DS was still very sleepy and we struggled to BF for the first few weeks, so it is not a guarantee either way.

We just need to do what we need to do to get through and, however it happens, be proud of ourselves at the end!

Thanks for your answers again, Bartlett, hope it didn't sound like I was interviewing you! I'm just fascinated by what decisions people make and ultimately whether I should be making similar decisions. The question about where you want your DH in an emergency was raised on the NHS website I used as a template and I thought it was really interesting. My DH would be fine if I needed an emergency c-section, but I was a birth partner for my sister and her husband went to pieces, so I think its an interesting one to think about. I also had a friend whose well-meaning obstetrician was offering her DH an inspection of the stitches following a third degree tear... think I'd rather keep that to myself regardless of how fascinating my DH might find it!
Thanks for the compliment MissPolly, and for reading my blog. I guess because I have so many children people often ask me for advice and for years I've ducked and dived and tried to get out of offering an opinion - mainly because I didn't want to get it wrong! - but this time round I am attempting to embrace the role of being an "old hand" and am really hoping that my experiences might help other mums. So thanks!

Inspect her stitches?!? boak

DH didn't think he'd want to see anything at the business end or cut the cord. In the end, he thought it was the most wonderful thing to see his baby's head emerge and he did want to cut the cord, so we left a lot of it up to seeing how he and we felt at the time. He most certainly did not inspect my stitches though!