Birth plan feedback? Any opinions welcome

[JosephineClaire]

JO?S BIRTH PLAN

Estimated Due Date: 11 November 2010

I have attended both NCT and NHS antenatal classes and I would like to try to have as active and natural a birth as possible. However, I am keeping an open mind towards pain relief options as I don?t know how I will cope with the pain.

Birth companions:

• DH
• In case of emergency, if DH cannot be reached on his mobile, please contact XXX

Early labour and first stage:

• If we arrive in hospital before I am 5cm dilated, I plan on using the TENS machine, walking around, and sitting on my exercise ball to stay in the upright position.
• I?d like to try and rest for as long as possible until labour is established but, if I want to lie down, please encourage me to stay off my back.
• I will follow midwife recommendations for monitoring my baby.
• I would like to use the water pool for pain relief if it is available but I do not want to give birth in the pool.
• I would like to labour at my own pace as much as possible. However, if my waters need to be broken, that?s fine.
• If my baby appears to be poorly positioned or labour is not progressing well, I would like to try a change of position before any recourse to drugs is taken.

Pain relief in first stage:

• I would like to begin pain relief with Gas & Air and see how I manage.
• If I do choose to have an epidural, I would like a mobile epidural if possible as I would like to stay on my side/on all fours/in a well supported squat, in order to keep the pelvis well open.
• I would also like to be examined immediately before the epidural is applied in case I am nearly ready to push.
• If an epidural slows down labour, I would like to attempt to change positions as much as possible before being given a syntocinon drip.

The birth:

• If there is a risk of tearing, I would like to have an episiotomy.
• If I use the pool in the early stages, I want to be out of the water for the birth.
• I would like to use a birthing stool if there is one available. If not, I would like to give birth in an upright/kneeling/supported squatting/all-fours position to give my baby maximum space to descend through my pelvis. I do not want to be on my back or semi-reclining.
• If my baby appears to be stuck I would like to try using the ?drop squat? position for a few pushes first, assuming that he/she is not in distress.
• If I have had an epidural, I would still like as much help as is possible to keep off my back, being on my side or on all-fours

Assisted delivery:

• Only if absolutely necessary will I allow a vacuum extraction or the use of Wrigley?s Forceps ? please explore all other options before this happens.
• If the delivery requires the use of Wrigley?s Forceps or vacuum extraction, I would like a spinal anaesthetic and the procedure must be carried out by a senior member of the medical staff, and not by training or newly-qualified doctors.
• I will not give consent for the use of rotational Kielland?s Forceps, and in this situation would choose to have an emergency caesarean section.

Emergency caesarean section:

• If I need an emergency caesarean section I would like DH to be with me as much as possible.
• If my baby is healthy, please give him/her to DH as soon as possible, to hold for some skin-to-skin contact.

Third stage:

• I would like to have an injection to speed up the delivery of the placenta.

After the birth:

• I would like the midwife to tell us the sex of our baby.
• DH may cut the cord if he wishes, unless the midwife needs to do it quickly for medical reasons.
• If I am in a suitable position, I would like my baby to be delivered onto my stomach. If I need to turn over or get onto the bed, then the midwife may clean my baby and then bring him/her back to me. I would like skin-on-skin contact for our first meeting.
• I would like to breastfeed my baby as soon as possible after the birth and would appreciate some help in doing this.
• If I need stitches, I would like a local anaesthetic or if I?ve had one, a top up on the epidural.
• I would like my baby to receive Vitamin K orally.

Other:

• I agree to a single student doctor, nurse or midwife being present at the birth. However, I would like their role to be kept to one of observer rather than active participant.

Baby feeding:

• I plan to breastfeed as soon as possible. If I have trouble breastfeeding I would appreciate the help of a nurse/midwife, and I would also like to be given contact details for local breastfeeding groups.

Going home:

• I would like to leave hospital with my baby as soon as it is appropriate and safe. If there are no problems after birth, I would really like to leave within 12 hours.

Some questions...

If you're doing everything else naturally why would you have the injection to speed up the delivery of the placenta? (mine was out within 20 mins with no injection FWIW)

Why an episiotomy rather than tearing naturally? I thought a natural tear heals better and is less likely to re-open with a subsequent birth...

Do you want to keep the placenta? we kept DS's and put it in a hole in the garden and planted a tree on the top for him.

I included in my birth plan what I wanted to happen if baby died or I died although I know that is very unusual - MW told me. I couldn't bear the thought of me dying and DH not knowing whether to stay with baby or me - I asked him to stay with baby.

It sounds incredibly detailed - you've obviously read up on positions, pain relief etc.

Have you checked with your midwife that everything you require is available at your local hospital - birthing stool, pool etc.

Also I think there are other types of forceps - I had Neville Barnes (does anybody know what they are, by the way?). Maybe an idea to check which sort your hospital uses.

Maybe state that you'd like someone experienced to do any stitching, neatly, if required.

Hey Knitter, thanks for taking the time to reply

I may not do everything naturally - I'd like to have a go without an epidural to see how I go, but if the pain is too bad, I have nothing against drugs for pain relief.
So as I'm not dead set on 'natural', I decided that for the delivery of the placenta, I'd like to get it over with asap. And this seemed the best way? Perhaps this is wrong (I'm not sure) but I've heard some horror stories about long and painful third stage deliveries of the placenta... so speed and ease appealed to me

Episiotomy just because I've been told by other Mums that it's easier to repair and get infected. Is this the other way around??

I have no interest in seeing/keeping the placenta...so no need to include that on my plan, but it's nice that you did that for your DS

Hey Cuppa - yep, the hospital has these things, but supply is limited which is why I've stated "if available"

I haven't heard of Neville Barnes - perhaps some more research is needed - what was your experience like, if you don't mind me asking?

Good point re: stitches

I think you should consider making it shorter. Depending on when you are in labour you might have a change over (or two!) of midwives and they may not necessarily read a very long birth plan. It maybe better to have shorter bullet points that will be read than a full version that will be skipped over?

The only other thing is your second point in 'assisted delivery' section - I fully understand why you would want a senior member of staff but I think you may need to recognise that with these things it can, unfortunately, come down to which member of staff is available. If it were mine I think I would re-word that point.

I also included the following text on special care

Should baby need to be removed from the room in which we have given birth I would like my birth partner to be with baby at all times.
If extended special care is needed I would like to express milk to feed the baby - no formula is to be given without our permission.

Jo, my experience of having forceps was that it wasn't as bad as it sounds when people describe it.

I didn't have an epidural, just tens, gas and air, and a few hours in the birthing pool. But after about 30 hours of labour and 3 hours of pushing in various positions, including on a birthing stool, plus contractions slowing down, I was just too knackered to push any more.

It was all very quick - on the drip to start the contractions, then a few goes with the vonteuse and me pushing (I'm convinced it didn't stick properly because DS had so much hair!) followed by a local anaesthetic injection, episiotomy and mid-cavity forceps. I was pretty relaxed throughout (prob because I hadn't read up about things that can go wrong). It is the strangest sensation in the world to have a baby pulled out of you. The only way I can describe it is a bit like squeezing a big yellow spot - painful as you squeeze but such a relief as the pus bursts through the skin! Sorry that sounds disgusting but it's the only analogy I can think of!

I'm sure you'll be fine. Try to keep relaxed and keep an open mind and look forward to meeting your little baby.

Hey SpottyLotty - It does look a little long doesn't it?? I just figured that if the midwife changed shifts, the new midwife would skip straight to the relevant sub-section (1st stage/2nd stage etc) and also probably talk to me as well?

Re: senior members of staff - I've mentioned this because I have recently heard of two cases where the baby has been injured due to junior members of staff (in the notes it was suggested that they had not done enough training).
But yes, I fully appreciated that these plans don't always work out and should a senior member of staff not be available, I'd just expect the midwife to come and talk to me about the situation

Knitter - I think I will add the point about formula, thank you

Thanks for the honest info Cuppa - so you would say that the local was enough to take the edge off the episiotomy, ventouse AND forceps??

Did you recover fairly quickly?

It's just too long, edit it down a bit. The early stages need less detail as you will hopefully be having a conversation with your midwife.

Things like 'I will follow midwife recommendations for monitoring my baby.' I don't think need to be stated explicitly.

I would generally go for a tear rather than an episiotomy.

Good luck

JC - Yes, it would make perfect sense for a mw to go to the relevant section but when I was I labour apparently that was too easy... Labour ward was v, v busy and I think they were short staffed.

The only other thing I'd mention, now I've thought more is that I found I really wasn't capable of 'talking' with the midwife.
I found that coping with the labour was all I could manage so decisions and discussions took place between DH and MW but I didn't really take part.
I added on my birth plan that if I was too overwhelmed to talk that my DH as I had discussed my wishes and they could speak to him.
When an important decision needed to be made, MW spoke to DH and then DH spoke to me as and when I could manage to talk/concentrate! He was like my interpreter!

Well I won't lie to you - it was, momentarily, the worst pain I have experienced in my life. But it was literally only for a minute or two, and the pain stopped immediately after DS was born.

Should prob add that DS was 10lb 4oz, so a lot of baby to get out!!!!

But yes, I recovered fairly quickly. Temporary problem with fainting from low iron which tablets sorted out, and I still find tampons uncomfortable occasionally , but it all healed up well!

You probably won't need forceps anyway - I think only one of my friends needed them, most gave birth with no problems

My first reaction on reading it is that it seemed to me overly long and detailed. However I am not a health professional, and I deliberately didn't even have a birth plan with my first baby - my approach was exactly opposite to yours!

There's nothing on there that seems unreasonable or unrealistic, and I certainly don't think you've missed anything out (apart from the formula thing, that's a good addition).

Better get my skates on with my own plan - due in 4 weeks and haven't got round to it yet!

Good luck.

Thanks for your feedback everyone, it's much appreciated. Will now do my best to add the new points and cut the whole thing down.

You'd think I'd be good at that, as I am an editor by profession, but I'm absolutely hopeless at cutting my own stuff!!!

Yes, cut it down a bit. Also, it's fairly rigid. Is this your first DC? If so, maybe be a bit more flexible/open minded about it all, cos things rarely go to plan.

Things like "give the baby to me after caesarian" - you'll be able to tell them that at the time, but the midwife may not have even registered that you had that in your birth plan. In other words, there are some parts that you will have to remind them/ask them to do, regardless of whether it is in the plan or not.

Maybe start with a list of the most important things, then add an "ideally..." section at the end

I'd cut the prequel bit about you doing NCT/NHS (I don't think they'll be that interested).

The bit about ventouse/forceps "only if absolutely necessary" I think you can pretty much take that as read; they won't be doing them for the fun of it!

OMG - that's detailed!

I'm due on 17th July with my first and haven't written one yet. Got 36wk appointment with midwife next week and think we're meant to do it then.

What does your MW think of the plan? Maybe she can help you thin it out a bit.

I didn't have a birth plan for my first, and still don't think it is necessary. You just can't plan this thing! Everything goes exactly opposite than what you thought it was going to be!

I wrote my birth plan whilst in labour with my first, there was a sort of 'form' in my notes to fill in. I haven't had a birth plan with any of my three subsequent births, as I then realised that you really need to just take things as they come and it rarely goes as expected. Plus, in all my labours I was well able to communicate verbally with midwives/doctors.

Something you may not realise, going by what you have said, is that if your baby needs to go to special care or NICU it is usual policy to not allow any parents in until the baby is stabilised and has the necessary lines etc in, usually after a couple of hours.