NHS - When do you speak to someone about a birth plan?

[BumbleAw]

I'm approx 25 weeks and wondering when/with who I speak to about a birth plan
E.g. Medications, vaginal birth, csections, inductions

I'm consulatant led for being high risk and want to make sure I've had the opportunity to discuss things as I'm aware there may be complications. They won't let me go past my due date, so wondering could I opt for an elective csection over induction if I chose? I've heard to many horror stories about inductions and it has made me wary

When do you usually talk about this? Or do I have to bring it up? Do I have the option to have a vaginal birth or c section? Do I speak to the midwife or consultant?

Thanks

This is my first and I’m only 18 weeks, but in my trust you book onto antenatal classes around 30 weeks, and once you have the information from those you then discuss your options with your midwife.

I found this guide quite useful to give me an idea of what to expect and when: https://www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments/

I had 3 x high risk consultant led care pregnancies. I was induced with all 3. Baby no 1 straight forward induction, born next day at 38.1. Baby 2 induction took 2 x days to get going but when it did, arrived very fast at 37.2. Baby 3 induction at took days to work, eventually my waters were broken. Long story short ended up with an emergency c-section at 38.2.

In my experience the obstetricians won’t book c-sections / inductions until you’re in the 3rd trimester. You discuss your birth plan with the midwife but again not until in 30w+.

Don't dismiss an induction. It’s a cliche but every birth is different and if you’re consultant led care, you are looked after. I felt I was.

Badger notes says that I will be discussing my birth plan at my 36 week midwife appointment.

But actually we discussed a bit about my concerns with a vaginal birth in my booking appointment and the midwife said straight away that an ELCS was an option. As it is everywhere in the UK that’s covered by NICE guidelines is (not sure if that includes NI). She then referred me to a consultant and he booked my c-section in when I saw him at 16 weeks. He said we’d have another appointment together at 36 weeks to go through the risks and do the paperwork. Felt a slightly odd approach, but he could tell I’d done my reading in advance of the appointment.

I am having some CBT with the perinatal mental health specialist through Talking Therapies (I didn’t meet the threshold for the perinatal mental health team) to help me with some previous medical trauma. They have offered to write my birth plan with me.

If you do think you may want a maternal request ELCS, then it’s worth raising this with your midwife at your next appointment. They can then get you referred to a consultant. Much harder to do that and get it booked if you wait until 36 weeks when the theatre lists for electives may start to be filling up. They can’t decline at that point, but they could say they can’t fit you in at the usual 39 weeks which might mean waiting until 40+. You aren’t committing to anything at the point of speaking to your midwife, or even the consultant.

editing to add: I’m currently 18 weeks pregnant and low risk but have always been under shared care because of that first midwife appointment and the referral to the consultant. Actually, that shared care looks like 2 consultant appointments (one 16 weeks to book the c-section, and a follow-up at 36 weeks) with the remainder of my care being with a midwife. I was actually given a date by the consultant for my c-section but that was very unusual. He was quite brusque, but I realise now that was his way of doing me a favour and helping reassure me!

I am consultant-led. I spoke with my consultant, during my first appointment, about pain relief, induction, c-section, vitamin K injections and the fourth stage of labour. I'm now 35w+4 and am due to speak with my community midwife in more detail about the birth plan at my 36 week appointment which is coming up this week.

I spoke to my midwife about ELCS at booking appointment (due to previous abdominal surgery) and saw the consultant to discuss high level details at 16 weeks. I will see the consultant again for a more detailed discussion at 32 weeks. I am surprised how late some of the other posters have been left.

Following! Thank you for the comments above so far. Have to admit that the timescales people mention being given are giving me anxiety given I was a wk32 baby myself! I was hoping to nail down plan A/B/C fairly soon after 20wk scan.

Mines 13 now so things may have changed but we never had ante natel classes through nhs, most places it’s only a thing if you pay

I'm consultant led due to having an emergency section for my DD, I was able to book onto a "Birth Choices" clinic with a midwife who went through the risks/benefits of an ELCS and a VBAC. It was mostly stuff I knew but I was able to ask a load of questions specific to me. I still haven't decided but the appointment made me feel more informed. Maybe find out if that's an option for you?

At my trust you get 5 classes free of charge - they’re online (except for the breastfeeding one which is in person). I was surprised when I read it and checked with my midwife because I’d heard they can be really expensive, but she confirmed that’s how they do it here.

I never got a chance - so don't count on it. Never saw the same midwife or consultant twice from 30 weeks onwards.

However, while it's important to think and talk through your preferences - ideally including your birth partner who can advocate for you - I think the idea of a birth plan is a myth. Its gives an illusion of control over something that there isn't much control over on the day.

Be prepared for what options you might have, but don't expect anyone to be pouring over your birth plan checking with you what you wanted. (Or maybe my 1.5h labour was just too quick for anyone to even think about whether or not there was a "plan"!)

My hospital also offers a free antenatal course. Think it’s 3 in-person sessions. They ask you to decline it if you are going to pay to do a private course like NCT though. It’s from 28 weeks.

gave birth at 34 weeks last time and prior to that never had a convo about birth plan. 26 weeks so far and no one mentioned it. have a consultant appt in 2-3 weeks time so maybe then. seems a bit silly to leave it til you're at term with a previous prem birth