Writing a birth plan

[Izzy82]

This is probably a stupid question but I'm 38 weeks pregnant and have no idea how to go about writing a birth plan.
the midwife has never mentioned writing one and my next appointment with her isn't for another fortnight so there is a chance I'll have given birth before then.
So a) where do I write it
B) what do I put on it
C) what do I do with it once it's written
D) does anyone have one I could look at

Thank you
Xxx

Multiple they don't do it at all in the UK. If the parents want to for religious reasons they go private. I guess they might if it was damaged in some way but not at birth.

Keep it short, simple and be open minded. No need to write things like 'I would prefer to avoid forceps/ episiotomy/ enema', your midwife knows this.

Useful info would be things like ' at times of stress I need lots of information / to be very quiet'.

All midwives hope for a peaceful, mobile normal delivery. They also hope to avoid a huge haemorrhage and often advise syntometrine as it is a life saving intervention, especially after a long labour.

Lots of good advice above but try to keep it short. Write on an A4 size paper or less and pin it on the inside cover of your notes. Tell your midwife it's there. If there is a change of shift you will need to discuss it again.

Good luck.

Third time round mine will say - drip in, baby out.

I think birth plans are a dangerous concepts as especially first time mums it seems like a plan rather than an ideal. Good idea to write preferences but you can't really plan birth.

Agree with pp that you should be very careful about writing no epidural.

See how you feel and be aware that they can be hard to get even if you have said you want them depending on theatre use and anaesthetist avail.

I'd reiterate that you should keep it short and to the point. Mine was about 6-8 bullet points. Imagine the reader has about 15 seconds to absorb the main details. And on the issue of whether to write one or not, without wanting to worry anyone, in the very, very unlikely event that you have to have a general anaesthetic like I did, it is really comforting to know that you have written down a plan for things like Vitamin K, and that your partner has a copy (really important!) because he's going to find that those kinds of details go right out of his head as soon as you're wheeled off to the operating theatre!

First time - DS delivered at 29 weeks due to PE, I hadn't had time to write one!

Second time - whatever happens I would like a private room after the birth. DS2 arrived at 39+4 and I got my private room :)

Interesting what pommedeterre says about just saying 'drip in - baby out' for the third one. I did a full plan for my first baby, but to be honest don't think it was really necessary. The whole experience is so new - and each birth is so different - you don't really know what you will want or need. Agree with the poster upthread who said no need to put stuff like 'want to avoid forceps/episiotomy' as they are well aware of that!

Briefing partner well is key too, I think, as then he can be your eyes/ears/mouthpiece when you are too out of it. My DH told me about all sort of discussions he'd had with the midwife that I have no memory of at all!

Hope this doesn't sound alarmist (certainly NOT meant to!), but the only thing I wanted to make crystal clear second time around was that I wanted an epidural and that I didn't want to be told there was no available anaesthetist for any reason. The first time I had been 'persuaded' guilt-tripped into saying that I wanted to avoid an epidural (why???!!) and I felt quite angry that I hadn't been given an honest view of what to expect. And I know everyone experiences pain differently and people may come on the thread saying how it was a breeze for them etc, but just sharing my experience in the hope that it might be helpful.

Surely you shouldn't have to state that pain relief, certain procedures such as induction etc are not to be done without your permission?

I would NEVER state that I don't want an epidural, even if it is my preference not to have one. I'm pretty sure though that they aren't going to refuse you one, just because you said you didn't want it on your birth plan?!

What's quite interesting (for me anyway), is that the closer it gets, the less I care about how it happens. I'd love to think I can have a nice natural time, stay at home for ages, choose position, be in a pool... all this nice stuff. But half of me is more like 'epidural as soon as possible, get it out safely, ideally don't mess up my future sex life'.

Want to avoid forceps does go without saying but what about "I do not consent to high forceps and would prefer a CS"?

Genuine question - would that be worth saying?

MultipleMama I hope you don't mind me asking but you are having your brother-in-law as a birth partner? Can't stop at the thought of having any of my three BILs as a birth partner (actually one of them is really sweet and would no doubt be lovely and kind, but I wouldn't want him looking at my nethers for his sake!) So, what sort of a bloke is your BIL? (pretty fab I'd guess. . .)

Didn't have one but was asking about getting a private room from the minute I got there (can't be booked in advance)!! It was what I was most concerned about!

I really don't know splendide. I wonder why do they use forceps when they can use suction? (Sorry i don't know the correct name of the instrument) Maybe it depends on baby's position?

Dh and I watched an episode of OBEM one night, it might have been 2 years ago now and there was a horrific forceps delivery. It looked so, So rough for the baby (who was left with marks on face). I too would prefer a CS rather than forceps of it was to be that rough.

I was wondering the same multiplemama, is he your oh's brother or your sisters Dh?

"I do not consent to high forceps and would prefer a CS"?

I want to say the same thing (on advice from my doctor friend). I've tried by saying "No consent to Keillands forceps, ventouse possible, but otherwise CS"

Not sure how seriously that is taken, and how much 'persuasion' goes on. After many conversations about this issue with various people including doctors, I think I might end up getting shouty about it, so it needs to be written down so that boyfriend takes it seriously too.

Ventouse, that's it! Mind went blank.

Yaki I completely agree with your anecdotal evidence (neonatal trainee). My birth plan was done only as I'm a medical PITA:
My birth partner & DH's name is...
Students may be in the room but may not deliver the baby
Clean and dry, then skin-to-skin
IM vit K
Followed by a couple of specifics relating to my medical history - one of which was completely ignored.

I wrote quite a lengthy birth plan, which my MW read thoroughly & everyone adhered to. I was nervous, and it gave me a feeling of having some control. I had a waterbirth with no intervention & while I do realise I was 'lucky' I also felt empowered & knew I wasn't going to be bullied into things (our hospital has a high 'emergency c section rate for instance).

I did write I was willing to be flexible & accept advice.

One thing to consider adding is Delayed Cord Clamping, not all hospitals have adopted it as standard.

Foodiemom - ive been told by 3 hospitals (moved house when preg with ds1 so was seen at one hospital in the first half and another for the second half and now im under a different hospital again for this pregnancy), that if you put "no epidural" on your birth plan that the aneathetists will not give one for pain (obviously if a spinal is necessary for medical intervention they will do it). Apparently they cant judge you to be properly consenting if youve changed your mind on it.

I think there have been problems with people who write no epi in the birth plan but then change their mind in labour but are then unhappy they were given one after and in some cases even make complaints against the hospital! Thats why my midwife said that the hospital im under now has a specific section in your handheld maternity notes that must sign prior to labour Or they will not allow you to have a epidural for pain relief - full stop.

I think a birth plan is important as even if it goes wrong they still know your priorities and it also reminds them you're a person not a grow bag!

My MW knows what I want but she's not paid to be my MW at the hospital if for some reason I can't go ahead with my homebirth. So the birth plan is there as a back-up so I don't have to try and explain things to the new MW/doctors. I have a copy in English and German so there's no miscommunication.

During my last PG they went to examine me without asked and during my 2nd PG I heard them talking about inducing me without discussing it with me hence permission for everything.

BalloonSlayer and foodie - my brother is a MW and since he isn't licensed here in Germany he will be my Doula instead. My brother-in-law is my brother's fiancè and the photographer

Oh and it's a brilliant bloke , has to be to put with my Sullen, quiet Russian brother!

Interesting about the epidural and consent. I suppose it would be OK to put something like "I would like to try to avoid an epidural, unless I find the pain unbearable"? That states that you would like the encouragement/support to manage without but keeps your options open.

My birth plan was LONG, I thought of everything! As it happened, the midwives barely had time to read it because I was ready to push by the time I got to the birth centre - not really supporting Yakiudon's theory! I think having given birth, I will go with a shorter, easier to read/remember version next time. I think I was worried that I wouldn't be able to answer questions etc so I just wanted it all down there.

Mine was:
First Stage
Birthing pool
Free to move during labour
Intermittent, external fetal monitoring
Minimal vaginal examinations - i.e. only if labour appears not to be progressing normally
Nobody shouting unless there is a true medical emergency

Pain management
Natural pain management techniques as far as possible
Gas and air in late stages
Avoid pethidine or epidural

Second Stage
Give birth upright - even if I have had an epidural, I want help to try to achieve this
Use normal breathing and push according to instinct
I DO NOT want anyone shouting at me to push, or telling me to hold my breath

Third Stage
Immediate skin-to-skin contact with the baby
Start breastfeeding as soon as possible after the birth
Cord clamping delayed until it has stopped pulsating
[DH] would like to cut the umbilical cord
After this, I am happy to have drugs administered for an actively managed delivery of the placenta

Post-natal care
Vitamin K injection
My previous baby had a tongue-tie, which was not diagnosed until 6 weeks and this significantly interfered with establishing breastfeeding. I would like to see a lactation consultant for advice before leaving hospital

Special circumstances
If a caesarean is necessary:
We still want to have skin-to-skin contact when the baby is born
I still want to breastfeed as soon as possible
If there is a problem which makes it difficult/impossible for me to breastfeed straight away, I would like help to express milk or for the baby to have donor milk. I DO NOT want the baby to be given formula milk.

It all went to plan, except the birth pool since I didn't get there in time!

Foodie - essentially they use forceps where ventouse won't give enough grip. Or where any rotation is needed.

I had a birth plan for both,the first was literally just the questions asked in my notes,no moreI had no idea what to expect and thought I would leave it up to midwives etc.
My second was much more detailed but for my husband.He would be the one to advocate for me in the delivery room as I was none too eloquent first time round so I explained all my fears and decisions to him.He was therefore able to answer questions quickly on my behalf-he did check with me that that was still what I wanted- and also push for certain things that had been a problem.I felt much more calm in that birth but I couldn't have done it that way with my first.
I intend to do the same this time,just amending it due to new experiences last time.
One thing I had on it was if I had been pushing for more than 1 1/2 with little or no progress to re-check that I was in fact fully dilated.I had a horrendously long pushing stage with first as when they told me to start pushing and I did they let me go for 4 1/2 hours before a consultant came in,looked at the chart and very crossly asked why nobody had checked me again and then did only to discover I was not fully dilated.The midwives were fantastic I must say,I never felt it was down to their inattention but more that shift changes and low staffing had probably confused things and as it was mine and DH's first delivery we didn't think it was abnormal to didn't think to ask.
That is why I made sure to to put that into my plan second time round!
HTH!

Keillands are a specific (more risky) type of forceps.
Shallow forceps are used as a stronger version of vonteuse. They carry risks of tears etc.
Keillands carry bigger risks for mother and in rare cases baby - theyv twist or rotate deep inside the birth canal.

Many hospitals simply won't use them these days anyway because a modern cesarean is safer.