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

most with forceps or c-section. Even a bleed in early labour can put you in the consultant unit, even if all goes fine after that. I think managing expectations is v important.

Ah, so that's how you make text bold! I only meant to add the missing text from my previous post..

I am consultant led after multiple losses. That's why I picked my hospital. For the stats for "women like me" .. Not a shiny MLU tour.
My post was more a retort to NCT ideal worlders who turn their noses up at good hospitals because of what seems like a high intervention rate. Like its birth to order. Like hospitals where they have more planned challenging cases are "worse" than others due to more consultant led births etc (reminds me of the oncology dept in the papers which was told it wasn't as good as another dept a few years back because more people died there... Common sense anyone?).
The way I saw it, I was gonna have a medical used pregnancy... May as well pick a place where they know their way round medicalised pregnancy rather than be botched with by someone out of practice.

Also weirdly of the people who have given birth over the last year I know, NCT seems almost a jinx! The women who just did free ante natal fared about 50% more "to plan" ... Odd. It wasn't just expectations though... NCT babies came early, with blood pressure issues etc.
Bizarre!

Squizita - my main point to the OP was about being realistic. I don't apologise for having prepared for a MLU birth as I had a trouble-free pregnancy (conception was the very difficult and protracted bit in our case) and because that's what the NCT and NHS ante-natal classes I attended led me to believe I could have... In my view, they misled me.

I take your point about looking beyond the raw stats though. A bit like with fertility clinic success rates, school league tables etc where intake largely determines outcome.

Thanks Me and the other PP who answered about Kiellands.

They do use them at my local and about 18 mos ago a baby was very seriously damaged by a comparatively inexperienced dr using them. I know this through a GP who is a friend of a friend. It prompted some massive internal review at the hosp but afaik they are still using Kiellands.

I have a health issue (renal) which may mean a home birth is inadvisable and the thing which terrifies me most about going into hospital is being bullied into accepting Kiellands when I am too tired to argue as they want to keep the Csection rate down.

Only sorry I think there's been a misunderstanding. Why on earth would I be having a go because you had a healthy pregnancy?
-you posted saying people should check the stats on their hospital.
-I agreed and went further: you should dig a bit deeper
-You were the one who then posted as if 1) I was somehow under the misapprehension that this would make birth predictable and 2) I was approaching it from a low risk angle. I was a bit surprised because not only had I agreed with you, if anything I was saying check more than just the basics.
-I clarified that for me, I wasn't just checking for the NCT "ideal" (which seems to vary as at our local one interventions are heavily covered) in the MLU but recognising 1sr births(and meficalised births) are more likely to need intervention... So yes go beyond the stats.

I am at a loss as to why you think I was having a go at simple pregnancies.
Apologies.

The point about feeling misled is an interesting one. I was out at a friend's over the weekend where they glossed over a recent birth story in our group of mates because it was so 'bad'. I have no idea what happened in detail, but the new mum reported feeling 'violated'.

On the way home I was thinking about how so many of my friends have had 'bad' birth situations. Not even always for their first one either, sometimes a random second or third goes pear shaped. Everything seems to end in intervention, often c section, and I wonder why? Do we go in to this a bit blindly, get panicked or easily persuaded or what? I get that maternal death rates from childbirth have fallen etc, and that interventions save lives, but how come so many women in my circle of friends (I get that this is anecdotal), feel 'violated'? Something seems wrong with our expectations, or the medical approach to childbirth.

Sorry, that's off topic and rather more suits that other one about childbirth changes over the years.

OP - sample birth plan below:

Have baby.

That was mine, ontobeanonymous. A pointless exercise because the baby doesn't read it!

Goats I wonder about the internet... Things I have read on MN and Baby centre boards from either people who birth easily or angry people after intervrntion (let alone elsewhere):

• if you rest up before labour you won't feel as much pain
• stay away from hospital! If you choose a HB it will be intervention free
• intervention is always a problem and you should ask for a debrief
• Ina May's book shows birth as it really is (as if it is a bible not an edited book promoting her methods) - don't read any negative stories
• if you say NO to interventions most likely it will be OK (IMO bloody dangerous. Also of you then say 'yes' you'll feel a failure).
• DRs and MWs don't understand birth.
• it is relatively easy to learn to 'breathe out' baby and not push.

Some pretty extreme views... And most with the idea if you JUST TRY HARD ENOUGH you can have a perfect birth. My mum also cites expectations of birth 'damage' (e.g. incontinence) have changed: so women want a traditional birth but without the damage her/my grans generation took as a risk. Like a sanitised version. Ask a British woman about fistulas... Many will be clueless...

There are so many "aggressively rose tinted" opinions online that if you were the kind of person who wanted to read the positives, it might be easy to create the image of every intervention a failure, violation, problem ... Not just ones resulting in issues/pain, but anything.

I know a woman who paid for masses of rather woo (and v v expensive) alternative birth prep, but refused hospital ante natal because she said it was the "system" brainwashing you. Thankfully her birth went well clinically: but she developed real trauma about how painful/primal it was. She thought before that the "system" lied and babies were breathed out- they just wanted to cut women willy nilly. She has therapy to this day, doesn't trust herself, all sorts of issues.

...her intervention was stitches after (as 60% of women have) and some pelvic floor help afterwards (not having done any before because she hasn't had any conventional prep).
It was purely the idea that if there were no interventions, birth would be "nice" that threw her.

How much worse would a vonteuse or emc be with that mindset?
I bet there are women who have experienced that.

Really interesting post Squiz. I'm 30 weeks with my first and have read Ina May and Juju Thingy and about four million hours' worth of online blogs. I do pregnancy yoga and will be doing the NCT course next month.

Honestly, probably all distraction techniques than feeling they'll be actually that useful. I sort of feel like the more info the better but that might be wrong. Definitely recognise the JUST TRY HARD ENOUGH message and in fact I worry I've conveyed that to my DH. He's not even slightly pushy but I do think he thinks that it'll be fine as I get loads of exercise, do yoga and understand the process.

But I look around at the women I know who have given birth and the odds are way against me!

You could start by using the template on the NHS choices website, here: www.nhs.uk/Conditions/pregnancy-and-baby/pages/birth-plan.aspx#close
It gives you a good idea about what kinds of things you should mention.

Splendide My circle of friends are a combination ... the example I gave was extreme. Most of my friends talk more openly about how it is tough but not impossible.

Of those who have had kids recently 4 it was what's considered straightforward: pushing, G&A, shot of pethadine (2 more had births like that but with epidural and monitoring).
6 had "interventions" (though of those, several expected it in advance).
2 C-sections (1 planned, one emergency).
It kind of matches the average stats for my local places.

So you might well be lucky!

One of my friends who was in early labour for a WEEK rolled her eyes about interventions and epidurals and said "I f**ing wish... it was the daily grind got to me... the big contractions bloody hurt but I was so relieved it was nearly over" which just goes to show I suppose that we cannot even predict what part will feel like a problem! Birth warriors would applaud her birth: she feels she was a bit of a mug and should have used some pethadine to get a nap in!

In my pregnancy record book there's a section with questions on preferences (it says you can alternatively attach your own birth plan) and it gives examples. A lot of it is about how you feel about things or concerns you may have rather than out right demands or refusals.

I have a birth preferences list for DC2 due in 4 weeks. I had birth trauma from DC1's birth and I want to avoid things that I feel will be triggers (e.g. my SPD was so so painful I had to have my legs physically held open on the bed by mw and DH, lost consciousness due to PPH and had memory gaps, DS needing resus and not understanding what was happening. I laboured fast and furious and was not able to express myself at all).

My preferences this time are active labour positions, minimal VEs in current labouring position, don't want to get on the bed, monitoring in active position, deliver kneeling if poss to protect pelvis, immediate skin to skin (with cs too if have one), will ask for pain relief as needed pls don't offer. I have also explained my previous birth & listed relevant medical info and that I've been using natal hypnotherapy, and asked for someone to go over the details of birth 2 with me afterwards. I've also included BF preferences. Thankfully SPD is nowhere near as bad this time.

The main purpose for me with writing the list was thinking about what things I might have options for, and discussing these with DH, my doula and my mw.

Obviously my main aim is healthy baby, healthy mum; but if this can also be achieved while protecting my mental health as far as possible then that would be good!

I have a SIL who is a proper warrior. But that's in every aspect of her life, her birth circumstances didn't surprise me at all.

On the other hand I've got a partner who reckons you should just go for an epidural straight away - "Why the hell wouldn't you?" Then he heard about the post forceps/theatre/every drug going birth, 6 months later no sex issues that some friends of his are having, and sort of changed his mind. Haha.

I've hired a doula. I expect I'll be somewhere in the middle - like most women are. I just hope I don't find the hospital element of it all incredibly stressful. Erk. I'm scared of hospitals, and slightly of the unknown. Not of pain.

That's a good last line Katherine - when I interviewed my doula, the main thing I had that I wanted assistance with was 'Three healthy people leave hospital, ideally without PTSD."

My DH made the point when told he was my 'advocate' during birth and to make sure I got what I wanted, that why would he go against what a medical professional was telling him was best. Seriously, I can read all I like about the birth process, it doesn't make me better at it than anyone else. And if something goes wrong and a midwife or Doctor says I need something, I'm most likely going to go with it. I don't think anyone's out to sadistically hurt me for no reason. Childbirth is still a hard, painful, messy and dangerous business at times, and I've known people who have had a hard time healing afterwards, not because they were 'violated', but because that's what can happen when an infant comes out a vagina. No one seems to go into hospital for an operation and expect to tell the Doctors what to do. I'm all for having a go at the natural birth, I'm going into the MLU, hoping to use the birth pool and G&A, but if I have a long labour, if I get exhausted, if baby gets stuck, I'm happy to be whisked away to a bed and an epidural because I can't control what happens.

What exactly is a birth warrior? I've never even heard that term before...

Redling - I think maybe you've misunderstood what people mean when they talk about people advocating for them if you think it means disagreeing with medical advice about your/your baby's safety.

For example: in my first labour I was told that I should have a routine period of continuous monitoring for about half an hour on admission (though was left for closer to an hour. Belts went on, mw wandered off). Told to lie down and have belt strapped up. I was in agony on my back. This happened a few times. E.g. when they broke my waters, half an hour on my back to check that my baby was happy. It was only afterwards that I discovered that it would have been perfectly possible to do the monitoring in the kneeling up position that I found far more comfortable. Just a bit more bother for the midwife, and I might have needed to lie down if that position didn't get a decent reading. Or in some of the situations, she could have used the handheld Doppler - she basically just didn't want to crouch down and was keen to have a print out for her file.

I was too exhausted and in too much pain to argue, but I really could have done with an advocate who, after the first time, said "Penguins is finding it really difficult to be in this position. Is there any way we can do it differently". By my second and third births, DH was well briefed to look out for things I was finding particularly hard going and find out if there were ways to make them better.

Or another example, lots of units will have expectations about how fast you 'should' progress. However, if everyone is ok and wants to wait, you don't need to necessarily go down the route of augmenting the labour. If you are too 'in the zone' or in too much pain to hold a discussion on that, having your DH 'advocate' for you on that can be useful - whether you eventually decide to hold off or whether there are strong reasons for augmenting.

In my third labour, I had an amazing, amazing midwife .I can't praise her enough. I certainly didn't need an advocate. But, like any profession, there are better and worse mw's (and more and less observant and/or compassionate ones).

Squizita- I totally agree with you about a balanced view. I had DC2 and 3 at home. And after a rubbish first birth read Ina May as a way of balancing my feelings about that and putting them in perspective. Not because I believed that all births go smoothly.

Actually what was rubbish about my first birth wasn't forceps (ok, those aren't ideal, but the registrar was kind and compassionate and it was fine). What was hard is that I had a very long and very intense latent stage, and was treated like a silly girl who wasn't coping with minor discomfort (I can confirm from my later, unmedicated birth that the pain I was feeling at that point was as bad as it got. I literally wanted to march back to hospital and tell the patronising "some of us have low pain thresholds" mw that she had been talking bollocks). I had been sold the idea that I could just distract myself through that latent bit. And that, by the time the pain got really bad, I would have pain relief options. To basically be told first "stay at home and stop whining" and then "stay in that room, lie on your back for some monitoring and stop whining" was really tough and I was pretty traumatised afterwards.

So I can imagine how, if you have believed that the whole of birth is going to be find if only you do the prep, it could seriously damage your mental health.