Birthing plans are utter nonsense, aren't they?

[thingymaboob]

I'm pregnant with my first but I'm a paramedic and I've delivered my fair share of babies, some of whom needed resuscitating and some of the mothers needed other various interventions. I guess people don't call Paramedics unless the shit is hitting the fan! I have also delivered others where is was a text book delivery and everyone was fine so I know it's not all doom and gloom! I now work for a large hospital trust with a big maternity unit and I attend obstetric emergencies as part of my job. So, I know my experience is very extreme. I have been asked to think about a birthing plan but I think birthing plans are nonsense because nothing goes to plan and the midwife just laughed when I said "my plan is to have a baby and no one die, I also want to be a stones throw away from the obstetricians and anaesthetist and to have as much medicine and medical intervention as possible". I cannot stand all this hippy dippy nonsense and la la la head in the clouds. I want a practical pragmatic approach, but why do people think I'm being negative?!

I think it doesn’t hurt to have an idea. For me I was adamant no pethadine for any reason (they tried to give me pethadine to “help me sleep” repeatedly during induction whilst telling me I wasn’t in labour - I had to keep saying NO PETHADINE (so not sure anyone even read my few bullet points!) I was in labour btw - 6 centimetres and was refused gas and air but told to have pethadine (but that’s another tale!) my only requests were no pethadine, DH to tell me the sex and skin to skin with a high preference for no episiotomy unless essential (I had the birth from hell but got everything on my wish list so can’t really complain!)

Actually I think you have a birth plan. "Please give me all the drugs necessary before you start poking me with various implements to get the baby out. Thank you" . I had a birth plan, no epidural, no vontouse, no forceps or episiotomy and no drugs to speed up the labour. Guess which of these I had after a 48 hour labour? All of them, and the best part was the epidural, so much so that when I had 2nd DC I practically walked through the door of the hospital requesting one.

I get exactly what you mean. I'm an icu nurse and I've seen it when childbirth goes horrendously wrong.
I couldn't believe that I would have a normal delivery and insisted I was not at my local birth centre but the hospital much further away. I felt that even if things went smoothly I'd never want to do an emergency ambulance transfer if it could be avoided. When you've got that in the back of your mind it's hard to see things from another perspective.
My midwife thought I was very negative and told me "child birth is an everyday thing" to which I laughed and said great but I'll still be going to x hospital thanks.
For a bit of balance I had a few minor complications but generally a lovely birth on labour ward with no interventions. I couldn't go to the midwife led unit in the end anyway so the discussion was irrelevant in the end.

Mine was more a series of preferences - including for some of the more likely scenarios if I didn't have a straight forward delivery. Not all of the choices you have to make are medical and can be made by the professionals. Things like wanting the baby delivered straight on to me even with a EMCS (which I got after an assisted delivery as they knew I wanted it, although they then had to them whisk him away), that if the baby and I had to be separated I wanted DH to go with the baby not me, that I didn't care about what kind of 3rd stage I had. One of the things that can cause PTSD is feeling like you lack control. Thinking about options before hand, discussing them with your birth partner and writing down some thoughts is a way of keeping some control. I certainly think it helped me deal with what turned out to be a difficult first birth.

The 2nd time round I also listed some of the things that went wrong the first time and that therefore I was particularly worried about, and also a summary of what sort of things worked and didn't work for me last time (e.g. pethidine made me vomit). It was still a short list of bullet points though, it fit on a page of A4.

I think you're spot on. With my first I typed my birth plan! It went out the window. With my second i did a birth plan but it was much more practical. I said I'd like to try without pain relief but that I would probably want an epidural. I also said I wanted to be encouraged move around because during my first labour I didn't move at all and it was SLOW. So during my second they sent me for a walk and it really helped her things going. Labour was 20 hours faster! Coincidence probably.

My point is that whilst I don't think you can predict and it could all go out of the window...you can say some things which will help the MWs support you if it is more straightforward. So likes rather than wants.

I've had two births both of which could easily be described as very difficult and I wouldn't say that writing a birth plan is pointless. I don't think it was hippy-dippy or clueless to write one. When things were going pear shaped it was helpful that the midwives had read it and knew what my preferences were for various things. Of course births don't go to plan just because you've written one, but I think it helps to think about what you would do in different circumstances in advance.

I do hate all this laughing at silly first time mums who bother to write birth plans, as if they're stupid and naive.

I didn't bother first time as I had no idea how I would cope with the pain and what relief I would need so I went in with the view that I'll do whatever is necessary to get baby here safely.

As luck would have it I had a pretty much text book labour and delivery with only gas and air. This time I know roughly what to expect in terms of pain so I've written a plan roughly following what happened last time. The only difference is I've stipulated skin to skin which I didn't get immediately last time as ds was born with cleft lip and palate (diagnosed at 20 week scan) so he was whisked off by paediatrician to check over. I'm also open to diamorphine as I had so much gas and air last time it sent me loopy and I had to push and deliver with zero pain relief on board.

I had a hippy dippy hypnobirthing experience and pool delivery.

But a pretty vague birth plan because I had no experience and wasn't sure if I was being naive thinking I wouldn't need all the drugs. I think the only things I'd really decided on was I didn't want episiotomy - DS blew the doors off on the way out all by himself 🙈

Having given birth twice now, I know I cannot speak while I’m in labour. so to have certain things written down and to let your birthing partner/midwife know what you want is in no way airy fairy. It’s pretty sensible actually. You want to be in on the decision making don’t you? To have someone respect your wishes? You need to fully concentrate on remaining calm, managing your contractions and doing the best job you can. Not stressing and trying to articulate what you want.

I had my 4 before birth plans were invented, and epidurals were in the very early stages. But I wonder how people who are not medical professionals can possibly know what kind of drugs they would/would not like, especially for a 1st birth.

When I had my last 2 at home (not my choice, just the policy in the area at the time) there was gas and air available, but I didn't use it, because it had made no difference in my previous labours.

I've had morphine based pain medication and gas & air before being pregnant, and I knew that I didn't want either of them when in labour. That opinion didn't change once I was in labour.

Totally right.

Waste of time.

I did NCT who made out birth plans to be the holy grail of how your birthing experience should be. I, luckily, had a bit of common sense and just made a short bullet point list of a few preferences - I wanted to go to the MLU (which is within our hospital so only a lift ride away if things went wrong), wanted OH to tell me the baby's sex, didn't want pethidine or meptid, wanted skin to skin immediately after birth, wanted to BF if possible. Basic stuff. I was always of the view that I'd do whatever I needed for us to be safe and well and if that clashed with my ideals then so be it.

I got some of my preferences. OH told me the sex which was a lovely moment and I didn't have opiate based pain relief in labour but was subsequently high as a kite on morphine for two days after. But after a three day induction which was horrendously traumatic and could have been fatal to me and DD quite honestly I did not give a shit. I just wanted my baby here safely and for us both to be ok. We were, in the end luckily.

Planned c-section for me at 38 weeks next time as not allowed another v birth. Won't bother with a plan. If we don't find out sex again I'd like OH to tell me but other than that everything else I'll just go with the flow.

I think working in emergency services you probably have a slightly skewed view OP, and are less likely to have the first time mum 'head in the clouds' thinking that lots of first time mums have especially if they have been incessantly told what a wonderful experience birth is. It can be, of course for some but for lots of isn't. I think we do a real disservice to expectant mums by not telling them what birth can be like realistically. No need to terrify people with horror stories, that's just mean (I won't tell my birth story in detail to expectant mums unless they insist and I always want them it's not very nice or standard) but we should be making sure women are prepared, and that they know that if things don't go 'to plan' then it's not their fault.

Pre-birth I was asked (along with the others in my group) my by NCT teacher to see her next group when they were 8 months pregnant to share my story. Her last group did the same for us and we heard all positive, lovely stories. No EMCS, no inductions, no complications really. After birth, when she heard my story she didn't want me to do it anymore. The only two ladies from our group who were invited back was the one of us (out of five) who'd had an unassisted pool birth using g&a and other other who'd had a home birth. The other two ladies like me had complications and assisted births and were also un-invited. Sums up NCT for me really!

Absolutely not. A birth plan isn't a plan for the only way it could possibly go. It's a plan for your intentions so no one is hassling you with stupid questions when you're in labour about things they could just as easily have read for themselves if you had written it down for them. Think about it as the minutes from a meeting, so you don't have to have the same conversation with someone with someone 15 times about the same thing. I expect as a paramedic, you always do a handover to the team that takes over a patient after you (rather than expecting the patient to repeat all that information to everyone 10 times), it's basically like that.

And for what it's worth, my birth plan with my first pretty much is exactly what happened and it was lovely. It made it so much easier that I wrote it all down in advance and the midwives could leave me alone to get on with things.

Probably not adding anything new, but I found writing a birth plan really useful for 2 reasons:

1. It made DP and me have a conversation about things we hadn't thought of (we used an NHS form as the basis for ours) like vit K and would he want to catch / cut the cord (he said NO!) with plenty of time to go. We also were able to have a disagreement about where he'd go if there was an emergency (with baby/with me) while it was still hypothetical. So in that sense, it was like the preemptive hindsight we do at work ('how could this go wrong? what would we wish we'd done now if it did?)

1. It meant I didn't have to talk to the midwives hardly at all (arrived 40m from giving birth) as they just skimmed the doc (which basically said 'have had a normal pregnancy, have PGP, will take drugs/interventions/toast as you see fit but prefer not') and got on with it rather than asking me questions I couldn't answer!

Not rtft. Bit Yes, birth plans are a nonsense. With DD I did the usual and wrote down that I wanted low lighting and pillows and water and all that jazz. I ended up induced and had a bad experience with student midwives not believing I was in labour and generally in a bit of shock once I was in the labour ward.

With DS the community midwife had to force me (good naturedly) to write a birth plan. I eventually did. It said "no student midwives"

Labour is not something you can plan from start to finish. You can write down preferences for pain relief and so on but you can't plan for how the labour will go.

I think birth plans are useful because they give nervous first time mothers the deluded feeling that they will be in control when the shit hits the fan - limits their pre-birth panic somewhat.

Complete waste of time otherwise, IMO.

Oh yes - important to write down if you want the vit k injection for the baby and if you want skin to skin and if you plan to breastfeed or not.

But all the guff about positive thinking and visualisation can actually end up fuelling a lot of negativity. I know people who felt like failures because they ended up in hospital rather than home birthing and another who couldn't have a vaginal birth despite trying to push for hours.

A birth plan may well be nonsense, but it makes you consider all possibilities. It means you’ve given things some thought so you are prepared when they arise.

I've had one very 'as planned' birth and one 'awful, most definitely not as planned' birth.
As also said upthread, I looked at it as a bit of a wish list, but really used it to rank my preferences. I found it forced me to really research the options and then think about the circumstances I was happy to take them in. I found it to be very helpful for both births, and particularly in the second one for DH to understand my preferences too as I was unable to speak for myself.

Well they are and they aren't.

I really wish I had spent some time even minimally researching high forceps deliveries before my birth. If I had I would have made an birth plan not to consent to one. But I didn't so when the doctor said "we think we should use forceps" I gave consent. Dh (a doctor) equally unversed in high forceps deliveries didn't query it either.

I wish I had said "no, I don't consent to that what so are the alternatives" and I would have had a c section and a lot of near-death/hard recovery/good luck in not being incontinent would have been avoided.

Even if I had put high forceps in my birth plan, I hope I would have also put "don't let the chief resident who has never done one before do it" I won't even write down the consequences of that.

So yes, what music is playing and who cuts the cord are kind of useless -although maybe they are essential to some women and if so, why are we scoffing. But what medical procedures you have concerns about is very useful. Actually anything that empowers the patient tends to be useful.

Yes they are imo. It sets your expectations towards something that is hardly in your control and when things get out of hand it's difficult to get over the fact that your birth plan got out of window especially if you like to plan ahead or are a perfectionist...

Totally pointless to have one, I never did. Unless baby has read it too and is on board with the schedule

I don’t think the actual plan is a bad idea but people have to be realistic about the fact they are at best idealistic. I remember a lady I was at NCT who wrote a very detailed plan and refused to entertain the possibility that the birth wouldn’t follow it to the T. She had a birth that required lots of intervention and ended up in an emergency C - section. It took her a long time and a lot of heart ache to accept it wasn’t possible to follow her plan.

I’m with you Thingamy - didn’t bother with birth plans for either of my DCs. Just the “make sure we’re all safe & healthy” one