Birth plan

[Alwaysalwayscold]

I'm nearly 38 weeks and don't have a birth plan sorted, long story short my midwife is useless and hasn't discussed any of it with me! I have downloaded the NHS template but there's a lot of unknown on there so if anyone has any advice or experience on any of the following it would be a great help-

Birthing equipment? It asks if I'd like to use any.

Special facilities? I'm going into a low risk ward where I'm 75% certain to have access to a pool, would love to hear people's opinions on that as I'm very unsure!

Pain relief? Really unsure on this one

Episiotomy? I had never heard of this and it sounds awful :(

Injection to deliver placenta?

Vitamin k?

Honestly I'm really stressed and really annoyed at the service (or lack of) I've had from my midwife. She literally just takes my blood pressure, feels/listens to the baby and sends me on my way. If I try to ask a question it feels like an annoyance and she explains it using medical terms I don't understand.

You don’t need to have one, but if you’ve an idea of what you’d like/not like, maybe just jot it down so it’s handy for when you go into labour. You might not be in the right place to discuss it all there and then, and it just means that the midwives helping you will have some idea.

Not essential though - I did have one last time and it all went to shit essentially. I still felt very well looked after though, and I suppose doing some research about what all the things meant, meant I understood what was happening to me.

For reference, I am due to give birth in a month. If I go into labour naturally, I’d like to give the pool a try. If I need to be induced, I’d like an epidural (had one at last induction, it was great and allowed me to rest). I might ask for an epidural anyway, but want to see how I’m coping.
I will consent to the placenta injection and vit K injection - did last time, no problems.
And I did have to have an episiotomy last time as I needed forceps, but this wasn’t a choice I don’t think. Everything healed fine and so if it was needed and they asked me either way, I would say yes.

Do you find it comfortable to sit on a big inflatable exercise ball? They might have those. You know they have pools. So if you’re interested in trying those things out if available, say so on the birth plan. If you really don’t want to use a pool, you could write that down so they can allocate you a room without and leave the pool for someone who does want one.
Pain relief - you’ll probably want some at some point. Do you want to try gas and air first and see how you go? If you’re really bad with pain epidurals can be great, or you might want to avoid it because the idea of a needle in your back makes you feel a bit queasy.
Episiotomy - this shouldn’t come up unless they either need to get the baby out quick (and they are basically right there in the birth canal already) or they think you’re going to tear badly and a cut is a better option. You can say you’d prefer to tear rather than have an episiotomy though. I had to have one. It healed fine.
Injection to deliver the placenta is a pretty standard thing they do. It helps reduce the risk of losing a lot of blood in the minutes/hours after birth. I’d say yes unless you have strong feeling about it.
Vitamin K injection is for your baby. It helps their blood clot and reduces the risk of bleeding (potentially fatal bleeding) to your baby if they get bruised as a newborn/during birth. It’s a standard thing for all babies at birth. You can opt for oral drops instead, but they work less well and need to be given daily for a period of time. You can refuse vitamin K altogether, but no midwife or dr would recommend that. I’d say yes to the Vitamin K injection personally.

There’s a website called labourpains.org which has a lot of useful information on pain relief in labour and anaesthesia for various different scenarios if you were to need to go to theatre for anything - might give you some ideas of things to think about or ask about. It’s run by the obstetric anaesthetists association and is very reliable in terms of the facts & statistics etc. HTH.

My episiotomy was fine. A tens machine I found useful for pain relief in the beginig. You can buy or rent one. Both times when I got in water my contractions got stronger and I didn't like it which surprised me, most people like it.

Are you able to have a tour of the ward? There they can show you the equivalent available.

Sorry you haven't found your midwife helpful.

A lot of the information you need is covered in antenatal classes, were you offered any through your hospital? You could also look online for online classes. The positive birth company offer a hypbobirthing course which also incorporates antenatal education.

Labour pains.org covers pain relief options incl risks/benefits/side effects

Tommys are brilliant for pregnancy information too

You don't need a birth plan, but it helps to know your options so you can make informed decisions when you are in labour.

In an ideal world midwives would have as much time as possible to cover antenatal education in appointments but often it isn't possible

Don't stress.

Talk to your birthing partner about what you want and don't want do they can advocate for you if you are spaced out on drugs.

But also be prep that plans often go out the window when circumstances change.

Argg typed out a long reply and lost it!!

Thanks everyone, this really is very helpful. I appreciate my plan could well go out the window but I'd like to at least have it as a starting point.

I feel confident about accepting both the injections now which is a big help.

I've done a virtual tour of the birthing centre on my hospital website and it looks like they've got all sorts of equipment in there. The only drawback is that I have to move to a proper labour ward if I need an epidural.

It's likely they'll have a lot of that equipment on a labour ward as well.

FWIW my birth plan was that I was open to pretty much anything. I thought of it more as the opportunity to see if I had any preferences. I had a couple. Vitamin K injection for baby was one, as was the injection for me for the placenta. I also wanted to try starting off on minimal pain relief, and work my way up to the stronger stuff as and when I requested it. Beyond that I figured if there was a need for an episiotomy/forceps/C-section then I would accept it. My husband went through it with me too, so he could advocate for me (which he did splendidly).

My birth plan first time round ended up going out the window, but I’m still glad I made it. The benefit for me was more about having the opportunity to think about what choices I might make when faced with different situations. It also helped me to have great conversations with my partner about how he could help me at each stage.

if it helps, here’s how I broke mine down:

early labour

• what environment would you like to go through early labour in? Do you have any candles you particularly like the smell of and find calming? Is there a playlist that might help you get through this early stage?
• what do you want to do to pass the time? This bit can be long so it might be helpful to get some games/tv ready to distract you.
• pain relief? What choices would you make in early labour?
• early labour positions - research different positions that can help ease labour pains and make a note of them. Then you can cycle through them if you’re getting uncomfortable. Partner massage techniques are also handy to have listed here.
• task list - is there anything you need to pack last minute for the hospital. Have a checklist so you can do this without thinking too much, or you can ask your partner to do it for you. For me this was things like packing my toiletries back which was in constant use, or my water bottle that I use daily,

Active labour

• the same sections, but consider that you’re more likely to be in hospital/at a birth centre for this bit unless you’re planning a home birth.
• the pain relief section here is important. What is your preference order? I knew I didn’t want opiates for example because they make me sick, but in the later stages of active labour you don’t necessarily have the headspace to reason like this. Having it noted down can help your birth partner to advocate on your behalf.

birth and after birth

• Write down your ideal birth scenario at the top (I.e birth centre, water birth, if you’re particularly averse to labouring on your back etc). If the choice was episiotomy or a natural tear then what would you opt for?
• after birth - a check list of what you’d like to happen. Delayed cord clamping? Would you take the oxytocin injection to speed up placenta delivery? Do you want to try and breastfeed.
• emergency c section - how does your checklist change if faced with an emergency c section scenario? Do you still want to do skin to skin? Would you want the curtain lowered at any point?
• c section under general anaesthetic - again, what would you still like to happen in this situation? You wouldn’t be the first to meet your baby in this scenario, do you want a member of the team to take a photo of baby’s first cuddle with your partner?

it seems like a lot, but I felt so much more ready for having considered all of these situations. It helped my partners confidence too.

best of luck :)

You still have time to do an online hypnobirthing course which will cover what to expect during labour and birth, help you to weigh up your options for all the questions you have and hopefully help you feel more confident and in control. I did one by The Positive Birth Company and would really recommend it, it was £40. Good luck!

I made it very clear in my birth plans that I wanted a natural third stage and for DH to cut the cord, These don’t seem to be areas considered in some of the above plans. I would certainly look at a number of templates to ensure all areas important to you are covered. Both my birth plans were read and taken on board by my midwives and obstetrician and respectfully followed. I hadn’t considered how I felt about students but agreed to one being present as the obstetrician said she might not otherwise get to see a labour with no interventions.

Lots of really helpful replies here already. I agree with what others have shared. I also had to have an episiotomy and whilst it sounds awful and not like something you would ever choose, in the moment it was a relief! My little boy had a hand up by his head and I'd already been pushing a while. They recommended episiotomy to help him along and I was just desperate to meet him by that point! It really wasn't bad (although undoubtedly made the recovery over the following days a bit harder/less comfortable - small price to pay though!) After the snip, he was out on the next push or two.

Birthing plans very often go out the window anyway! I had specified a birthing pool ideally but when it came to it, I couldn't be bothered moving to where the pool was! I also ended up not using any pain relief but was open to it if needed. Basically just keep your options open and try to go with the flow. I do second the recommendation for Positive Birthing Company hypnobirthing course. It prepared me so well, made me feel very empowered about the birth. I've paid for it again. Now pregnant with my second as I'd like to refresh before the big day comes!

Good luck with it all! And trust your body to know what to do when the time comes 💗