Birth preferences

[HopefulllHolly]

Hi all!

Wondering if anyone has advice/views. Will be my first baby (and likely only as she is a long awaited IVF babe!). I will obviously chat to my midwife but I am the type who likes having a bit of a plan to begin with or I just end up agreeing to whatever and feel cross at myself! 😅

So…

I want to have a natural birth but with an epidural but I don’t want any interventions like forceps or the suction (read a lot about tearing and the babies come out bruised and all misshaped so I just can’t do it), I would have an emergency caesarean if they couldn’t get baby out in this situation.

I also strongly don’t want an induction at all, so I want to opt for having sweeps instead and hope baby comes on its own and if she doesn’t then have a caesarean so I’m not too past my due date. Is this allowed or is it totally pointless?!)

So two questions (and I’ll obvs ask midwife but I was wondering if anyone here had views - especially those who are well researched or have babies already):

• What day should I start having sweeps? Guessing the midwife will advise when they’d usually start them but just interested!
• What day should I give as a deadline for baby to come naturally? I don’t want to go too far past EDD tbh because it’s a slight increase in risk the later you are (and my partner was 2 weeks late and came out scaly 🤣). I was thinking of opting for a C-Section at 41 weeks and give her a week to come out naturally - that way it’s kind of the best of both. Does this sound reasonable?

Anyone have thoughts? Thanks in advance! 😘

I think you're great to have a plan and a clear list of things you want.
I would say if you have a birthing partner make sure they can advocate your wishes but also do be open minded and flexible.
I was 40 weeks to the day. My waters broke (no sweep etc) and no contractions. So I had to be induced, and they had to use a kiwi delivery as baby was distressed, so things can happen out of our control!
I wanted to have an epidural but I dilated too quickly so it wasn't possible. Anything really can happen,so it's nice to have a plan, better to have an advocate for you, but ultimately you cannot control everything or know exactly how you will feel at the time x

I went for my induction but become ill quite fast from the medication so they had to take the medicine out and I ended up in EMCS. I would never agree on induction again even without it giving me fever etc as all my friends having inductions ended up in EMCS and told me they would never agree on it again either.
I think it's good to have a plan but keep open mind and be prepared to go with the flow as things can change really fast on the day and all that really matters is that you and baby are both fine.

Do you have a partner you can bring with you to the appointments and birth?

For me that was the easiest way for me to deal with any pressure from the hospital. I outsourced arguing with midwives and whoever to my partner, so that if I felt overwhelmed or unsure, I didn't have to be the one to summon up the courage or the strength to fight it when I'm in an already compromised and vulnerable state.

They can't force you to have an induction or any treatment, but equally you can't force them to provide a treatment, such as c section, if they want to refuse it for some reason.

I don't know if there is any timeframe for when you can have sweeps but I don't think it makes so much difference.

If your baby is ready to be born then I think things like walking in the last week of pregnancy, making sure you stay relaxed and get as much oxytocin as possible is what helps your body also be ready to birth.

Just to add a different experience of induction- I had an amazing induction experience. I was induced at 41 weeks with a pessary and little dude arrived 12 hours later with no further intervention and a very small graze. I was up and about immediately after.

good luck with your birth and congratulations on your little miracle!

I think it's great to thoroughly think everything through before hand! Even if it changes on the day, you'll be more informed about the choices you are making in the moment.

I wanted to avoid interventions as far as possible. Induction was a complete no (as I just know too many people who ended up with an emergency section after days of failed progress!).

I was sure beforehand that I wouldn't have an epidural due to the increased risk of intervention and c-section. I ended up going completely natural (I did ask for gas and air but was told it was too late, I progressed quite quickly on arrival!). I didn't have any sweeps but went into spontaneous labour at 37 weeks so no need. Good luck!

Snap!

Everyone was quite surprised. Apparently that is quite rare for planned pre labour Cs.

Hi there it's a labour ward midwife. Lots of really good advice here. I would also recommend Positive Birth Book which is packed with good quality evidence. Personally I am skeptical about a natural birth with an epidural. They surely do happen but few and far in between, in my experience. Epidural increases the risk of needing augmentation with oxytocin, needing intravenous antibiotics in labour and needing an instrumental delivery amongst other risks. I firmly believe epidural should be available on request but only after the mum has been made aware of the above risks. I always suggest to my clients to hold off epidural for as long as possible on entonox, TENS machine and sometimes morphine. Some women do remarkably well without epidural. Tall and slim women tend to labour better than short and overweight women, however this isn't true for everyone. How long the labour is going to last and how the baby is going to be born depends on the size and position of the baby and the size and shape of the woman's pelvis. So combinations are endless. To make things even more complicated babies twist and turn in labour all the time. So we often don't know until the last 10 minutes how the baby is going to be born- spontaneous vaginal delivery, instrumental birth or a Caesarean section. Doing a Caesarean section when the baby's head is far down the birth canal is possible but very unkind to the baby and more risky for mum. Instrumental delivery in this situation is usually a much better option. You are only 22 weeks. It's really good you are thinking about your birth decisions now. Good luck with your research. I hope it helps

If you go into labour, either naturally or induced by any means (that includes sweeps although gentler than other forms of induction), you can't really say 'I don't want instrumental or vacuum' and that is because in the event that you are fully dilated and baby is coming but there is urgency for any reason, it would be preferable to use instruments - doctors will only perform an emergency c/s at fully dilated if vacuum and forceps have failed and that is because they would have to push baby back up to deliver through the abdomen and that carries a higher risk.
Sweeps are usually offered from 40 weeks and research around being overdue and risks associated with it is after 42 weeks, so if you are offered an induction for being overdue it may be at 41+5 and usually after the sweeps have failed to bring on labour (assuming you accepted them)
You can definitely decline induction and opt for an elective csection instead.

@HopefulllHolly

I'm a midwife and I would say my biggest tips would be to spend time learning about active birth and hypnobirthing. When you get an epidural, you increase your risk of assisted delivery but also of a labour dystocia where labour stalls and you may need oxytocin to accelerate the labour. I say that as someone who had epidurals for all labours, but it does increase the above risks

Also if spontaneous labour and all normal, I'd say to try and labour for as long as possible at home.

Have a good chat with midwife and explore every possible outcome then go in with an open mind. Sometimes assisted delivery is the safest method. Also sometimes it's just to rotate baby into a better position so that you will deliver vaginally.

Pethidine is also amazing pain relief in the early stages of labour.

In my unit, they recommend induction at 40 weeks with IVF pregnancy so check out what they recommend in your area.

Also spinning babies is a great website for encouraging optimal birth positioning.

Prep is key, it's like running a marathon. You don't just get up and do one, you train hard before hand

Hypnobirthing is amazing and can really help even with an epidural, just to help you stay calm if the plan goes off a bit.

Things that are useful in my opinion - hypnobirthing, lots of gentle exercise in pregnancy (walking, swimming, yoga), not spending too much time on sofa in last months or at least propping yourself up to help baby get in good position, oxytocin near your due date (cuddles, orgasms, hot chocolate), perineal massage, relaxation.

Early labour I could have advocated and made choices. First labour there was a point where I got so exhausted I couldn't really. Second labour from transition on I wouldn't have been capable of articulating anything other than 'get this baby out'.

I'm not kidding about the big poo - your body just pushes of its own accord. I've heard women can give birth in their sleep when in a coma etc - your conscious mind doesn't have much to do with it!