Birth plan - what to write??

[Cornberry]

I'm 36 weeks and I know I need to write my birth plan but I'm not really sure what to put down. Seems odd to write a p,an for something that's bound to be unpredictable. I sort of want to write no drugs unless I feel they're necessary and that's it. What else can you put? I'm drawing a blank. Advice welcome!

I would go for a friendly relationship from the first- you are hardly going to do that if you write down that you think they might lie to you and treat you as unintelligent!

For my first I spent quite a bit of time detailing how I wanted a natural soothing labour, in a birthing pool, no drugs bla blah blah

I spent 4 days in slow agonising labour being turned away from the hospital 3 times before finally breaking down and screaming in the middle of the corridors begging for a c section, and taking every drug they offered me!

I wont even bother writing one this time around as nobody even looked at it last time anyway. Its nice to have an idea of what you want but bear in mind things can and will change so you just have to accept its may not always go to go to plan.

I wrote a birth plan, and would advise everyone to do one. I call it birth preferences though. Preferences for your labour/birth/postnatal.
Mine was 3 pages long, and Was full of things I felt strongly about. Things I see other midwives doing that I don't agree with or wouldn't want done to me.

Examples..

Don't offer me analgesia at any point, I will ask for it
No students, observers (I work closely with the students, I didn't feel it was appropriate)
No large ward rounds with unnecessary people
Baby straight to me in all circumstances after birth unless needs active resuscitation
Cord clamped with my consent only
Do not tell me the sex of the baby, I want to find out myself
no formula at all, I have expressed milk frozen if required
Hands off my perineum
Consent for episiotomy
No strict time constraints on labour
No bounty people to see me
No cord blood donation

I ended up being induced, had tens, codydramol, pethidine, entonox and epidural in that order, had syntocinon drip, emergency caesarean at fully dilated, baby in NNU and paediatric ward for 2 weeks due to sepsis, me with sepsis. However, I was happy that my preferences were taken into account, I had no plan (you can't plan it) but everything that was important to me was seen by everyone who cared for me.

I just don't see how writing a plan that covers some of your requests which aren't actually that dependent on how the birth itself goes can be regarded as 'setting yourself up for a fall/.

Surely things like "my DP doesn't want to cut the cord" or "If I am unconscious my DP will do skin-to-skin with the baby if they are well" cover all eventualities?

I kind of plan on doing a few bullet points for each scenario - not exactly this but along the lines of:

• no interventions needed: I would like to remain active as long as possible, and would prefer to avoid an epidural but am happy with gas and air"

• some interventions needed: I would prefer to avoid episiotomy but if one is urgently needed I want pain relief during it; I would prefer ventouse to forceps; I do not consent to high forceps (something I am not having unless we are both nearly dead - these are v. rare but generally the UK uses forceps a LOT more than anywhere else I've lived!) and would proceed to caesarean if they were indicated

• CS: the baby should be with DP as soon as possible after birth for skin-to-skin; I do consent to VitK injection

Or whatever. To be honest my main note will be "I function better in complex medical situations when I am kept informed at all stages." Some people prefer to just get on with things without knowing what's happening, but I very much need to be kept updated.

StAlphonsos - Well, I suggest think a bit more widely then.

In the post-birth hormonal crash, with a DS who wouldn't feed and lost too much weight, agonising pain from my episiotomy, no sleep for days, and all the rest of it, I could barely think straight.

Comparing how I felt then to my fairy tale of a birth plan made me feel utterly shit. And yes, like a failure. I too didn't plan on consenting to forceps, but they happened.

You may not see how a birth plan might make YOU feel like crap in the aftermath, but at least have the empathy to realise that it might have that effect on other people.

To me, it was a permanent written reminder of my naivete and how I'd failed. That's my experience and it's a valid one. I know birth plans can be very useful for the majority of people, but for me I wish I'd never made one.

I am sorry if you felt I lacked empathy, Running, and it really does sound like you had a horrible experience.

I think maybe I wasn't clear enough - I figure a birth plan saying "I would like the baby to have the Vit K injection" couldn't set anyone up for 'failure' because it's nothing to do with the birth, so to speak.

Surely childbirth is a matter of luck, and positioning, and so on - if the baby has other plans, I will have to work around that! Simultaneously planning for the best and preparing for the worst is where it should go, surely? If forceps are totally unavoidable, of course I'll have them - but what's wrong with saying 'if you have the choice between ventouse and forceps, I'd rather the forceps' rather than 'do what you like with me because it's all terrible anyway'? Why does it have to be either/or?

I am sorry you feel like you failed - I can't see at all that you have though! You did the best you could with the hand that was dealt you, and who could ask for more? It must be an awful feeling, and I really hope next time round is a much better experience.

Thanks Alphonsos. That's v kind.

To me, it was a permanent written reminder of my naivete and how I'd failed. That's my experience and it's a valid one. I know birth plans can be very useful for the majority of people, but for me I wish I'd never made one.

See it makes me quite angry that women are left feeling like this. I think it's a sign that they've been 'mis sold' what a birth plan can do.

For example, things like "I really don't want diamorphine because I've ahd a bad reaction in the past" or "I would like DH to tell me the sex of the baby" don't set people up for failure. They aren't about how the birth goes, but about things you can do in most situations.

Likewise stuff like "tell me early if you think forceps looks likely as I'd prefer a section" can't always be followed, but often it can. And it's not about a perfect whale song and candles birth, it's about preferences if it isn't so good.

Running - sorry, deleted a bit. I should also have said "I am so sorry you felt awful and had a bad experience".

I used the NHS one. For each section it basically says "I would prefer this, but I know that may need to change." So for the section about instrumental deliveries it says that if possible I would prefer to move straight to C section rather than have forceps used, but I understand that it may not be possible.

It also mentions that I have an overactive bladder and can't tolerate even small amounts of caffeine without feeling like I have a really bad UTI, because for most people a cup of tea is pretty harmless! If I was lactose intolerant, or vegan, or had other dietary requirements or strong preferences (really really hating tomatoes or something) it's be a very good place to mention those as well.

I've put in mine that students and trainees are welcome. I've had a trainee sonographer and a student midwife at my regularly scheduled appointments and I found that it was actually REALLY soothing and enjoyable, because I was first examined by the trainee, and then by the fully trained person, and the trained person explained a lot of what was going on to the trainee. I learned interesting stuff about what they are looking for and how they find it, and I felt more involved in my own care because I had more information and was more involved in discussion.

Many a time you get women on MN who think they have 'failed' despite people telling them they haven't and that they shouldn't let it spoil the important part- being a mother.
You wouldn't get this feeling of failure if they hadn't built up in their minds what it was going to be like.

It is hard to get a balance though, isn't it?

One one side of me I have all the people in my gym saying that (I am still working out five times a week at seven months) I will sneeze the baby out - but I know in practice that's extraordinarily unlikely. In fact, I can't remember, genuinely, the last time I heard about a 'straightforward' birth.

I both know and believe these things are not controllable, and I don't believe that there is any 'moral' component in having a baby. No matter how it happens, I will not have failed, because I don't believe any method or style of birth is morally better: I would like to have whatever causes me least damage, but I will just have to deal with what happens, good or bad.

So, a birth plan is fine, surely, unless you regard it as some sort of legally enforceable contract between you and the baby?

Sounds like you have a great attitude StAlphonso.
I think that can help a bit, depending on circumstances
Good luck!
I had two straightforward births, first one longer than second
Though the fact they were 16 and 13 yrs ago probably helps too!

I didn't write one. Leaving it open and taking things as they come nearer the time.

Ha, thanks Juggling! According to many it'll be no help at all, of course. 48 hours into labour I dare say it'll be gone out the window anyway.

I had a quick labour and was having contractions on top of each other before I got into hospital, got gas and air straight away. I remember thinking 'there's so much I need to tell them, but I can't' then I forgot about my birth plan anyway, they didn't bother to discuss it with me either. I could have given yes/no answers but they didn't try to talk to me or even allow me to have just one bit of my birth plan go right whether they read it or not, I don't know. They were in and out of the room not really taking much notice until I started to rapidly bleed (not that I knew) then it turned into an emergency, then my lovely birth plan went out the window.

I just wanted my son straight away and I honestly did not know why they took that bit from me. I wasn't told why they thought an episiotomy was necessary either. That's what made me miserable, the lack of information. Had I been told exactly what was going on, I would have understood why they cut me, and took my son over to the incubator thing for air. No. I was was just sitting there after crying for him, still no explanation.

I don't think birth plans are actually spoken about in depth when you write it when your pregnant, especially with your first. There's not enough time given to you to actually go over it properly and prepare you for it. Some people say that there's a fine line between scaring pregnant women and informing them. But really I think if you tell a pregnant woman the actual likelihood of things happening, she'll be able to prepare a whole lot more for it. Like for me if they told me why they do episiotomies when I was pregnant, I could've stopped her, or said 'no, why?' then she'd give me a decent reason for doing it. You would take the information in anyway because I doubt you'd be thinking 'okay, this is definitely going to happen to me'.
I didn't think I would be cut open with my first baby and not know why for 3 years. I thought midwives actually spoke to you, no? Or should I have put 'Make communication with me, the labouring woman that is giving you a job, don't just write it in my notes that I'm coping well and not say it to my face as I am just a metre away from you', 'Tell me what is happening to both me and baby especially if I am profusely bleeding' and ' Tell me why you are about to physically assault me' in my birth plan?

Feelings of failure and guilt are linked to traumatic stress symptoms Mehitabel6 and you can still feel like that even if you did not write down that you want pan pipes, fairies and to breathe out the baby. I feel bad, 4 years later, that I did not have instant feelings of love for my baby due to the 81 hour marathon that went awry towards the end. I know its silly to feel bad about this but I still do.

I had a great relationship with the delivery team. My midwife was lovely but nobody told me the baby was in distress and they forced me down a trial by forceps route and if I'd known she was in distress I would never have consented under duress as they put her life at risk. What if the forceps had not worked? She could have been brain damaged. As it was she was fine but I'd had undiagnosed pre-eclampsia (due to medical laziness to deal with my results- my community midwife did take samples) and DD was tiny as a result. I was left needing a double prolapse repair 18 months later. My birth plan also said I did not want a trial by forceps. So I think I would be entitled to say please tell me the truth. I can explain why to the mw.

Ach, with my first I wanted a water birth but in reality the labour went on forever and when I did get into the water it slowed my contractions right down so I didn't get my wish. It wasn't to be.

This time I'm going into this with no expectations. Anything positive will truly be a bonus.