negative midwife / birth plans

[user1465146157]

Hi all, wanted some feedback on my midwife appointment today to check if i'm being sensitive (I'm 37 weeks so it's possible!)

I was told to bring in a birth plan for this appointment so I typed up some notes about my ideal situation, and stated very clearly that I KNOW my plan is a best case scenario and I understand things may not go the way i want on the day. I'm very open to pain relief if I need it and have no problem taking something to help me through - i just don't know what to expect or what it will be like.

I've been REALLY trying to be positive about the birth even though I obviously have natural fears and its my first one.

I kind of got the feeling the midwife was smirking at the plan - even though I kept saying, i know things may not go the way i want.

The plan mentions Hypnobirthing and I ask for support in using breathing techniques to try and get through.

I also said that unless necessary i'd prefer not to use forceps or ventouse - understanding i might have to so will be open to it.

The midwife was very adamant that they may well have to use these in case theres a danger to the baby - she kept talking about the baby's heart rate. I get that she's right and of course I'll do whats best for the baby - but i can't understand why she'd phrase it the way she did given we don't know what will happen. She made it sound like they definitely will be using forceps / ventouse.

Then she said that once I'm 10cm, they would expect the birth to be done in 2 hours. I feel like thats a bit rushed, and made me feel worried that if i'm not done in 2 hours then they will pressure me to use forceps or other things to quicken the process.

I've never heard a time limit like this before - have you?

Then, lastly we talked about episiotomy which I've said - i'd prefer not to but if necessary then I'd have to. She said that it sometimes helps to do the cut as you may tear anyway, and it may be likely we'd do that.

I understand she has to be realistic, and I am really being realistic too, i just feel like a lot of what she said is based on the worst case, but she was talking as if these things WILL happen. They may well do, just felt a bit like i was made to feel scared instead of reassured.

anyone else had similar experience? Shall i stop worrying given that no one knows what will happen?

thanks in advance.

Urgh, what is with some midwives and their smug I've done this a thousand times you haven't therefore your opinion is not valid.

I have one of those, I am choosing to flat out ignore her and will make myself clear to the midwife that is there on the day.

Rather than explain things in a nice calm manner I have been completely dismissed, made to feel like an idiot and patronised. Funny thing is, my friend is a senior on/gyn so I know what I am saying is completely right and acceptable however oh no this dingbat knows best.

I'm dying to say well Dr xx the senior consultant doesn't agree. But I don't see the point in arguing with someone who is so set in there ways. She is community midwife there to do the checkups at the clinic I attend- I am just hoping like mad she isn't on shift at the hospital when I am there.

Long winded way of saying yes her attitude towards you stinks but water off a ducks back. Inform yourself and make yourself very clear on the day. The word no is powerful especially when you know what the alternative just as safe options are.

OP I think a birth plan is great and I found mine incredibly useful - yes, it may not go to plan, which you're clearly aware of, but it's so important to take the time to think about what you would like to happen, given the choice. You've mentioned you are doing hypnobirthing, which is great, and the birth plan is an important part of visualising a positive birth.

I think the midwife was right to make sure you are aware of all the possible issues, but I would say that now you can make sure you focus on the things you can control - for example your birthing environment (lights on/off, who you want in the room, music, birth pool or not, etc), whether you want to have minimal interventions (for example 'please don't offer me any pain relief, I will ask for it if I need it', and you are perfectly within your rights to say, for example, 'no internal examinations unless absolutely necessary or the baby is distressed'), and what you want to happen afterwards (skin to skin etc, keep lights low and calming environment, etc). Make it clear that you are using hypnobirthing and you would like your midwife to support you with it - you'll find lots of mat units are now very clued up with this.

I handed my midwife my birth plan as I arrived, and she really stuck to it. Don't be swayed by negativity - its more than likely you'll have a different midwife for the birth than the community midwife anyway, and she may well have a different attitude. You will be awesome, it's what your body is built to do

Also re the pushing deadline - yes it's NICE guidelines, but as long as the baby is fine then you should be allowed to go at your own pace (I pushed for 3 hours, had external monitoring every 15 mins to check the heartbeat which remained fine throughout). They're not going to have a stopwatch and crack out the forceps after 2 hours if you're pushing well and baby is fine

I never bothered with a birth plan as I was booked for a section but to e honest you need to understand that it isn't really a "plan" it's a wish list. Sounds like midwife was just being realistic. They don't want you to have forceps etc either they don't have Dr's milling around desperate to do forceps and ventouse deliveries!

OP, you sound very grounded to me. I don't understand why some posters keep telling you that you need to be realistic and that interventions can be needed, as it's quite clear you know that.

I found writing a birth plan very frustrating. You get told to do it, and then you get told it's pointless! It's all very well certain HCPs thinking they're not a good idea (according to one poster upthread), but most women don't write them because they're lentil weaving hippies with their heads in the clouds. I only wrote mine because my midwife said I should and because we were told to at (NHS!) antenatal classes.

Also in my experience, some midwives are excellent but some do have a sneery "you know nothing, I've seen it all before" attitude. Sounds like you might have experienced the latter.

I was so determined to be "realistic" before my first labour that I actually think I went into it with quite a negative mindset, which isn't helpful at all. I think your approach sounds better, OP.

It's important to be well informed but personally I think writing a birth plan is pointless. There are so many different variables and you have no idea how you will feel or cope at the time. Before going into labour nobody wants forceps or an episiotomy etc. With my second I only had to push for 5-10 min and it hurt like hell. If I had to push for two hours in that kind of pain I'd be begging for them to help me get the baby out. I've friends who were glad at the time to have an episiotomybut were horrified at the prospect of it before labour.

Interventions are offered where there is a medical ground for them. In reality the choice you have is often to agree to an intervention you may well not want or put your baby or yourself at risk.

I am hopefully having a home birth and the home birth midwife has sat with me and written a birth plan.

I am not being too constrained. I have refused forceps but would consider a ventouse (obviously if I had to be transferred to hospital). Luckily home birth midwives seem very relaxed and very aware of mums choices. She has written that forceps will be refused and a c section should be given instead. I have also asked for more examinations as I have had cervical issues and we don't know the extent of any scar tissue that could stop my cervix from dilating. I didn't want to be contracting for hours and hours with no progress so I have asked for examinations every 2-3 hours. If no progress they will transfer me in for a c section.

It really does depend on the midwives I think. I love that I have met all the home birth midwives so I know who will be turning up at my house and who will hopefully be delivering baby. They are all so passionate about home births that they want you to feel relaxed and happy as it makes labour a lot quicker apparently.

what is with some midwives and their smug I've done this a thousand times you haven't therefore your opinion is not valid.
I have one of those, I am choosing to flat out ignore her and will make myself clear to the midwife that is there on the day.

Bloody medical professionals and their years of training, eh? If only they had got a mate who had done it instead of them, they'd be in a much better position to know what they were talking about...

I did hypnobirthing (first birth) and it was brill. No pain relief although I did ask (!) too late. Didn't really want it though and had said that in my birth plan. Control everything you can (e.g. Labouring environment and permission for VEs) and make sure your birth partner is fully clued up on the birth process and your wishes. I couldn't have done it without my DH being so supportive.

I tried to "breath the baby down" for three hours in the pool and got nowhere. Had to get out and give it some serious welly on land. Doctor said I was too relaxed and she sees that a lot with hypnobirthing! No harm though and I was glad I'd tried the pool. Took over two hours of pushing on the bed, which was the most comfortable place surprisingly, after I'd tried everything else.

Read Spiritual Midwifery by Ina May Gaskin - very empowering and encouraging.

I think as long as you've done your research and understand why you have certain preferences, it's completely fair enough to assert yourself to help you to have the birth you want.

My birth plan included a home birth in a pool. It didn't include being induced and having an epidural. I got the latter but had researched risks of various interventions so knew I'd consent to suction cup but not forceps for example. I think you're being sensible to state preferences but cover all bases.

I wanted to hypnobirth but it didn't happen for me. It was a lovely way to relax in the final few weeks of pregnancy though.

I found midwives to be a mixed bag but it's the ones who help you deliver your baby that matter most. My DD was in distress so I had to push her out quickly. I found one of the midwives assisting annoying and not very helpful in her instructions for pushing. I asked for a switch and the next midwife was brilliant and my DD was out 10 mins after she started to help me.

I think midwives have to be a little cautious when it comes to birth plans for first time mums as so many of us end up having interventions of some sort but it sounds like she didn't communicate very well. I hope you have the birth you want but if you don't it can be a positive experience anyway.

My biggest piece of advice is to stay assertive and have a birth partner who knows how you feel about pain relief, interventions etc and will advocate for you.

pottering, it wasn't me who made that comment but in my experience some midwives are smug and patronising. Most are very good and are able to be realistic without being rude. But there are some good and some bad midwives. As with all professions.

Funnily enough I am a medical professional myself I just don't specialise in ob/gyn hence why one of my closest friends who is a specialist has been advising me.

So I have had all the training thank you very much. I am also treat my own patients fears and anxieties with respect, taking the time to calmly explain what may happen and what to expect. I certainly do not go in with the attitude I have been getting from my community midwife that is for sure! Of course she knows better than my best friends decade or so of complex deliveries and assisted labours.

There people go again, assuming they know best. Trust me they don't, often that includes physicians believe it or not. Hence my recommendation to educate yourself on all eventualities and alternatives to standard of care. Medics are following guidelines that have been through a number of assessments based not only on gold standard but also on health economics vs risk, that is often why they will push for certain procedures such as induction and forceps first even if experience tells them it will end in a c section in certain circumstances.

So actually it is not just getting my mate to do anything for me. But thanks for your opinion

Have you considered a home birth? If you ideally don't want any interventions, it could be a good environment for you.

Don't bother with a birth plan - who on earth is going to take the time to read it?! You won't have the same midwife deliver your baby as you see during your pregnancy, and the midwife/doctor you do have will likely change whilst you're there as a result of shifts anyway. They will generally come in, do what's needed and leave again. I wouldn't even recognise the vast majority of people who've helped deliver my babies and they probably wouldn't recognise me either (not my face anyway ).

Of much greater use is educating yourself about the various options and likely birth scenarios so that when you are asked about something (eg shall we break your waters?) you are informed and able to ask the right questions/make the right choices for you.

Birth very very rarely goes as you expect it to (particularly a first birth): birth plans are an attempt to feel in control of something which we ultimately cannot predict.

@ricepolo - your midwife will read it! Even though I arrived at the hospital 6cm dilated there was still plenty of time for her to read it and act on it. Also, most midwives do 12-hour shifts, so unless you have a very long labour, many women will have the same one throughout labour (as I did) and the care I received felt very personalised.

And yes, we cannot predict what will happen in labour, however the overwhelming evidence shows that women who are prepared for and able to be relaxed about birth - which having a birth plan can help with - have better birth experiences.

Your experience of birth seems quite medicalised - I didn't see a doctor until I needed stitches afterwards, and most mat units now don't break your waters unless the baby is distressed. Hopefully this OP had access to a midwife-led care unit or similar, which will allow her to labour with minimal intervention, should she want this (and barring complications).

My community midwife read mine - we had a series of boxes to fill in on things like pain relief, who we wanted with us, were we happy for students etc. She went through mine and commented on a few things, which we discussed, but generally agreed with it - though I have a reasonable amount of professional experience of labour and birth so mine was very grounded and medically-oriented.

I have no idea if my LW midwife read it!

I was told that if DS wasn't out after 30 minutes of pushing, they would need to assist. 2 hours sounds too long to me!

I think your midwife was just trying to be realistic, but maybe she needed to be a bit more sympathetic.

I would take a birth plan with a pinch of salt though. Mine totally went out the window from the beginning as I had to be induced, which meant that I didn't get to go to the birth centre I wanted.

Thanks so much everyone who's replied to this post.

I agree the word 'necessary' in hindsight maybe gives permission - I'm going to have a look at re-writing the plan.

I am so realistic about the fact the plan is just a plan - honestly i'm trying to give the day some structure in my head, knowing that it may well not happen. For my sake and also for my DP who I'm sure knows less what to expect.

Good to know about the 2 hour thing - I've never heard that before despite attending Antenatal and NCT classes.

Thanks for the advice about it all being my decision - I hope it can be. I've discussed with DP and given my state of mind may not be usual, he will be the one talking about next steps and interventions if it comes to that. He is concerned that while he will keep in mind what I want, he feels less confident going against the advice of medical professionals, as do I.

It's a tough one and understood the MVs want the best for us. I've just read a lot about hospitals and protocols and how sometimes the need for beds and space creates an element of rushing the baby out. Fingers crossed that won't be the case.

Thanks again

I don't think anyone really wants intervention during labour but you just have to trust the professionals that they know what they are doing.

Your midwife seems set on an episiotomy , I have refused one the first time and didn't need one in any of my three births. I had to argue the first time, while pushing to not cut me. I have never needed stitches after either. But everyone is different and some people skin stretches more, baby is in better position lots of variables and if your need baby out straight away or not. So I think it's a difficult one to call.

But I have never had one and after that first birth I was told I was the only intact female on the ward so it seemed at that time like a better do it just in case approach. So after that I always refused them.but I think see how it goes at the time that's all you can do

Yes to a plan! Be clear about what you consent to. Be aware that you have the right to consent or refuse any treatment. This includes a final examinations, breaking your waters, episiotomy, any drugs, any intervention whatsoever. Wether this is sensible is another matter of course - which is where doing your research comes in.

Whatever people may say it is perfectly possible to be in a niche medical situation where you've done some quite specific research about your own condition and thus are actually more informed than the medics looking after you. I have argued medical fact with midwives when pregnant with twins because I've read up and they were wrong.

The only thing you can't do is ask for a treatment.

Write a birth plan encompassing the main eventualities - should you go off plan you won't have thought about the choices you do have then. What do you want to happen if baby is in scbu, would you prefer a c section to a forceps? Etc etc. There is always choice within the parameters of necessity.