Birth plans

embee

Hey folks,

Just wondering if ye had written out birth plans in the later stages of pregnancy? I did, wanted a lot of things I didn't get, got a lot of things I didn't want.... read it afterwards and thought "God, all I managed to make sure of was that I didn't have an epidural!" I honestly think, whenever I go again, that I won't even bother with a birth plan - the one biggie I had was NO EPIDURAL, and I managed to dodge that, so I suppose in ways I got what I wanted.

I didn't want induction, ARM, syntocin drip, constant monitoring, fetal scalp electrode, epidural, pethidine, didn't want to tear or be cut (I tore slightly, prefer that to an episiotomy), wanted placenta to come physiologically and not given a jab to spur it on.... got them all bar epidural and pethidine!

Wanted massage, dim lighting, privacy, minimal intervention, gas and air as only means of pain relief.... didn't get any of it bar gas and air (but I'm very, very glad of the Entenox!)

Other things I never even thought about putting in my birth plan was that I wanted my Mam there as well as the bf... was only told afterwards that she could have been there if I'd wanted.... never put in the birth plan that I wanted to be mobile and walk as much as possible... spent the entire labour on my feet apart from the pushing phase.


So... has anyone EVER got all (or at least most) of what they wanted according to their birth plan?

First time mums to be - have ye written one and how rigid is it?

Tis a subject that intrigues me - I liken birth plans a bit to murphys law - what can go "wrong" will go "wrong"!

January

*ahem*... The bolded ones are the things I did get...

LABOR
I would like to be free to walk around during labor.
I wish to be able to move around and change position at will throughout labor.
I do not want an IV unless I become dehydrated.
I would like to wear contact lenses or glasses at all times when conscious.


MONITORING
I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby.
I do not want an internal monitor unless the baby has shown some sign of distress. Although I did have a procedure where baby's oxygen levels were checked which involved taking a blood sample from babies head in utero...


LABOR AUGMENTATION/INDUCTION
I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before pitocin is administered.


ANESTHESIA/PAIN MEDICATION
I realize that many pain medications exist I'll ask for them if I need them.
I would like to use gas and air as my first choice of pain relief. Ended up getting every type of pain relief available (including spinal block and general anesthesia ) except for pethidine.


CESAREAN
Unless absolutely necessary, I would like to avoid a Cesarean.
If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
I would like (coach) present at all times if the baby requires a Cesarean delivery. He would have been with me at all times but since I was under general anesthetic they are not allowed into the theatre!
If the baby is not in distress, the baby should be given to (coach) immediately after birth. Baby was brought straight from theathre to my boyfriend


EPISIOTOMY
I would prefer an episiotomy rather than a tear.


DELIVERY
I would like to be allowed to choose the position in which I give birth, including squatting.


IMMEDIATELY AFTER DELIVERY
I would like to have (coach) cut the cord.
I would like to hold the baby while I deliver the placenta and any tissue repairs are made.
I would like to have the baby evaluated and bathed in my presence.


BREASTFEEDING
I plan to breastfeed the baby and would like to begin nursing very shortly after birth. I was still out from the anesthetic and me and my boyfriend never discussed me breastfeeding so the poor soul gave her a bottle!! I did try breast feeding on day two and baby didn't latch on so gave up a week later...

As a first time mother and a serial googler, I decided on my birth plan pretty early on in the pregnancy (I think I was 13 weeks when I made this plan up). I was pretty rigid in sticking with it even going so far as to give copies to my mother and my boyfriend so whichever I was with at the time of going into labour, would also have a copy!!

Unfortunately, things didn't look good from the outset!! My waters broke the day before my due date and after a trip to the hospital and very mild contractions, I was induced the next day. They had to break my waters as the day before only my back waters had gone... so that was strike one . I was also hooked up to my syntocin drip and put on a constant trace because of this.

I think your likening of the birth plan to murphy's law is brilliant embee... because basically everything that could go wrong, did go wrong!!

Lillyella

I always read others birth plans with great amusement. I often think of women attending really busy hospitals like Holles St and the Rotunda, and handing over Birth plans requesting low lighting and massage to midwives. Do you really think that they have time to read through and adhere to them all?

January

Lillyella wrote: »

I always read others birth plans with great amusement. I often think of women attending really busy hospitals like Holles St and the Rotunda, and handing over Birth plans requesting low lighting and massage to midwives. Do you really think that they have time to read through and adhere to them all?

Lillyella, yes, they should have time to read through them and help you to achieve the kind of birth you want. They don't have to adhere to birth plans because they are not contracts or strict rules for birth, but wishes and hopes! Aren't you appointed a midwife when you get to the delivery room anyway? I know I was, and she stayed with me at all times during labour, even going so far as only leaving the room once, for her break, where another midwife took over.

If they want a stress free mother (and in turn a stress free child...) isn't it in their best interests to help you achieve the kind of birth you want??

embee

Lillyella wrote: »

I always read others birth plans with great amusement. I often think of women attending really busy hospitals like Holles St and the Rotunda, and handing over Birth plans requesting low lighting and massage to midwives. Do you really think that they have time to read through and adhere to them all?

It's not like you show up at the hospital in labour and hand over a birth plan that's never even been discussed before. In the hospital notes booklet that I kept throughout my pregnancy there was a page towards the back for the mother to write a birth plan and preferences regarding pain relief etc. It was discussed at ante-natal check ups I had towards the end of my pregnancy too. Low lighting and massage are not unusual requests to make - when I had massage down on mine I meant for the bf to do that, I wasn't expecting a massage from the midwife!!! Just didn't have time in the end cos it all went rather quickly.

As adrieanne said, it's in everyones best interests to try and stick to what the mum wants as much as possible.

Lillyella

Don't get me wrong, I'd love to have a birthplan which included everything I'd desire and expect to have it adhered to, but even though I am paying through the nose to have my baby in a private hospital, I still don't expect to get everything I want. Ultimately it depends on how busy the consultant/midwife is and whether it is safe in their opinion for me to make demands on my medication etc.

January

Lillyella wrote: »

Don't get me wrong, I'd love to have a birthplan which included everything I'd desire and expect to have it adhered to, but even though I am paying through the nose to have my baby in a private hospital, I still don't expect to get everything I want. Ultimately it depends on how busy the consultant/midwife is and whether it is safe in their opinion for me to make demands on my medication etc.

But you see, that's where you're not understanding it. You can't expect to have your birth plan adhered to, because you cannot predict the way your labour is going to go.

If I had of stuck rigidly to my birth plan and expected it to be adhered to, myself and my baby would probably not be alive right now. You can make all the plans you want, but it may still turn out differently, like everything else in life.

Ultimately, if you want massages and stuff like that, it is up to your birth partner and not the midwife to give those. But things like pain relief will be discussed well before it's needed. A consultant or midwife would never force a type of pain relief upon you, you have to ask for it.

littlebug

I had my vague birthplan in my head which basically entailed having as natural and intervention free birth as possible but I went in with a "lets see how it goes attitude". I don't recall being asked if I had a birthplan but second time round I was asked what my pain relief plans were.
First time round the only thing I wasn't happy with was that I couldn't move around as the baby was premature and needed constant monitoring. Other than that everything else was as I wanted (minimal gas and air and no other pain relief, no intervention or episiotomy). Second time round was perfect... I walked around through labour (all 45 minutes of it:D), no pain relief, no intervention etc.
I was lucky in that I had quick easy labours and births.

Lillyella

adrieanne__x wrote: »

But you see, that's where you're not understanding it. You can't expect to have your birth plan adhered to, because you cannot predict the way your labour is going to go.

If I had of stuck rigidly to my birth plan and expected it to be adhered to, myself and my baby would probably not be alive right now. You can make all the plans you want, but it may still turn out differently, like everything else in life.

Ultimately, if you want massages and stuff like that, it is up to your birth partner and not the midwife to give those. But things like pain relief will be discussed well before it's needed. A consultant or midwife would never force a type of pain relief upon you, you have to ask for it.

I've been through labour Adrieanne, I know how it works. And I fully intend having what sort of pain relief I would prefer (everything for the record) but i'm talking about non medical factors.

Why hand a written birth plan to a midwife which includes the type of music you would like to play at the birth? If this is something that your birth partner is responsible for, then hand it to them instead.

Quality

I wrote out an elabourate birth plan in 2005 when I was pregnant with my son. I was 9 centimetres by the time I got to the labour ward and the labour only took 14 minutes so they didnt even get to have a look at it.

I kept it up with my pregnancy books and so repacked it for my last labour. Sure I was 9 centimetres when I got into the labour ward this time as well and Glen was born after 12 minutes!! So again it wasnt taken out of the bag.

I must say I was very much in control of my labours, I found the midwives in Our Lady of Lourdes hospital on my last two pregnancies to be very supportive.

templetonpeck

omg you're all freaking me out :eek:

Birth plans? I thought they were only for people who wanted 'unusual' births, I was just planning on going in and doing what they tell me

All this business about chosing between tears and not, omg I have no idea :eek:

SanFran07

templetonpeck wrote: »

I was just planning on going in and doing what they tell me

What if what they're telling you isn't actually based on best practice...but to speed up your labour because you're bed blocking ......That's where having a birth plan is is absolutely necessary. If you want to avoid routine interventions just to get you out of the labour ward as quick as possible.

There's a lot more to it than just Googling a birth plan. A midwife can spot a birth plan download a mile off and knows exactly how much time you put into it...so in the midwife's eyes if you don't take it seriously why should she...

Unlike the UK Ireland has no National Maternity Guidelines so anything goes.....so unless you understand what's routine and what's medically necessary and ask for what you want - you'll get the birth you're given.

Routine interventions vary between hospitals - have a look at the Cuidiu Consumer report on maternity services to see how your hospital fares ...some are better than others.

SF

templetonpeck

Thanks for that San Fran, but, my thinking is if I was going for a heart op, I wouldn't go into the operating theatre with instructions on how it should be carried out.

Speedier birth is best for all concerned isn't it? Again I would think the faster we can all get baby out the better Unless there's a whole bunch of consequences I'm not aware of

And whether you've googled a birth plan or not, I don't think a midwife should have discretion as to whether you've taken the process of creating one seriously enough before deciding whether to act on it or not.

embee

templetonpeck wrote: »

Speedier birth is best for all concerned isn't it? Again I would think the faster we can all get baby out the better.

A labour that is naturally fast (as in Qualitys) is fine, but one which is artificially speeded up through augmentation and heavy intervention may not be. Women who are induced are more likely to need c- sections and may experience further complications. Ideally, women shouldn't be induced unless absolutely necessary. My own labour was full of intervention, from cervical sweep, induction, arm, oxytocin drip, fetal scalp electrode etc.

With the benefit of hindsight I'd have refused induction at the stage it was offered (I was term +12 but baby and I were both fine). Would have waited as long as possible and stood my ground. There was no medical reason for my induction other than being overdue and the labour that resulted from the induction was very very intense and overwhelming. Would have rathered a longer more gradual labour instead of the feeling of not being in control etc.

SanFran07

templetonpeck wrote: »

I wouldn't go into the operating theatre with instructions on how it should be carried out.

Neither would I. A birth plan is not about telling your midwife/consultant how to do her job - it's about helping her to support you in the best way possible. Chances are you've never met your midwife before you meet her in labour and it makes for a much better experience for you if she has some pointers on how you'd like things to progress (in the assumption that everything progresses normally) In an emergency I'm happy to have all the tools of medical science available to me but in a normally progressing labour leaving well enough alone is the safest tactic for mother and baby.

H.Street has a strict 12 hour birth policy with routine breaking of waters and 35% of first time women have their labours chemically driven because they are labouring too slowly for hospital policy....these are practices that stopped in the UK over 10 years ago.......and yet continue in our National Maternity Hospital .....:(

You should be able to go into hospital and assume that all of your care will be based on best practice (as it would be for other areas such as heart surgery...oncology etc...) sadly that is not the case in the majority of Irish maternity care.

Quality

Unfortunately my speedy birth did have consequences, Baby had swallowed meconium and because the contractions were not too long he had not expelled a lot of the mucous from his system.
He ended up in Special Care for the first night.

So fast births do have there down sides.

littlebug

I was about to say that Quality... my speedy one (2nd) didn't have to go to special care but was coughing and choking a lot over the first 24 hours which was actually pretty terrifying.

Can I also add that not only will different hospitals have different policies but different consultants will too. I did my homework before my first and found that one in particular in the hospital I was going to did episiotomies as routine on first time mothers which appalled me. I was private and luckily got the consultant I heard was least interventionist and had a "stand back but keep and eye on things" approach, only getting involved when needed or at delivery. The word episotomy was never even mentioned.

templetonpeck

I thought the reason behind inducing women and not letting them go passed 14 days from their due date is because of the risk of the baby's first bowel movement happening inside the womb was greater, rather than hospital policy?

And Quality, that must have been very frightening for you all, but your labour was naturally fast wasn't it, as opposed to artificial intervention being a factor?

I am assuming also that the only way to find out about all the options that are in fact open to you is by going to ante-natal classes? And I'm also therefore assuming that doing ante-natal classes in the hospital you're going to give birth in may not be all that objective?

cobweb

hadnt really thought about the birthing plan apart fromm I dont want my baby to have injection of Vitamin K.

Where/ How do I find out more info on it?
going to Coombe

VeryBerry

templetonpeck wrote: »

I am assuming also that the only way to find out about all the options that are in fact open to you is by going to ante-natal classes? And I'm also therefore assuming that doing ante-natal classes in the hospital you're going to give birth in may not be all that objective?

I think the first place to start would be to read your hospitals labour management policies. Cuidiu is a great website where you can do this, and compare hospital policies and statistics http://www.cuidiu-ict.ie/fulcrum.html?ep=13.

Another great website to check out is the National Institite for Clinical Excellence (NICE) guidelines, which outlines whats best clinical practice, based on the most up-to-date and high quailty evidence available; http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7252&set=true. Its UK based, but there's nothing really comparable for Ireland.

My view on the whole thing, is that its best to be as knowledgeable and informed as possible. Read up on everything available, so that you're going into labour well-prepared for all the different options.

I have an idea in my head of how I'd like the birth to go (a mental birth plan if you like!), and that's based on lots of reading and research about what's best for mother and baby. But I won't be writing anything down, and I'll be going into the whole thing with a very open mind, and very willing to take on board all offered advice. In the end of the day, the midwives and doctors are the experts, and I wouldn't lightly disregard their recommendations.

axel rose

I requested a C section and got it. Although I suspect it was a combination of luck and going private.

SanFran07

Even if you don't actually write down your birth plan. There are two questions to have your partner prepped to ask if you find you're not sure if what you're being offered is because there's a medically compelling reason to interrupt your labour OR because it's just hospital policy...and every woman is treated the same.

1 - Is my partner ok ?

2 - Is our baby ok ?

In the majority of cases the answer will be YES ! So the next logical question is - 'can you help us understand why we need to rush labour?'

Another great tool to help you make informed decisions is BRAIN

B - Benefits of what you're being offered
R - Risks/tradeoffs - are there any?
A - Are there any alternatives to what you're proposing
I - Instincts - what does your gut tell you.....
N - What if we do nothing....can we wait a while?

The Cuidiu site is a fantastic resource and the more you understand about how Irish maternity care works the more empowered you and your partner will be to navigate the system and have the best birth possile

cobweb

thanks for that
at least i have a few nmonths to get this sorted

MrsA

I had a naturally very very fast labour on my son, and now that I am 32 weeks pregnant again, I am quite aware that it can happen again.

For this very reason I chose my maternity care providers to be the Community midwives as I agree with how they manage labour. I feel that it is important when choosing care that you ask questions about the philosophy of the caregivers.

I want as natural a labour as possible, and that is what the CM's want as well, I want a natural 3rd stage, and that is what they want as well, so after a lot of discussion there has been no need for me to write a birth plan - as we agree on everything I want.

The other point to remember is that "Babies don't read birth plans "

M

Quality

templetonpeck wrote: »

And Quality, that must have been very frightening for you all, but your labour was naturally fast wasn't it, as opposed to artificial intervention being a factor?

Yes this labour was naturally fast.

My previous labour was induced at 10 days over, It was also very fast, I was only 14 minutes in the labour ward, there were no complications with his birth though.

VeryBerry

MrsA wrote: »

For this very reason I chose my maternity care providers to be the Community midwives as I agree with how they manage labour. I feel that it is important when choosing care that you ask questions about the philosophy of the caregivers.

I want as natural a labour as possible, and that is what the CM's want as well, I want a natural 3rd stage, and that is what they want as well, so after a lot of discussion there has been no need for me to write a birth plan - as we agree on everything I want.

This is also why I chose to go with the Community Midwives. That, coupled with the shorter waiting times and longer consultations time, the fact I could see them in my local community health centre, and the fact that they'll visit at home for 7-10 days after the birth.

beth-lou

I never had a birth plan. My main concern was that my baby was born safely and that I was safe and I trusted the maternity staff to do that to the best of their ability. I never felt rushed or pressurised into anything, I did have an episiotomy but I was happy to have that rather than risk a tear and my friend had 54 stitches after her first from a tear, so I didn't mind having an episiotomy if it was required. There was no pressure from the team, they advised it might be best after a while, and I said yes. When my waters broke there was merconium in them and so baby was monitored throughout labour which lasted about 14 hours in total. At no time did I feel like they were interfering with the natural flow of things, but then again I didn't have a list of things that I wanted to happen.

On my second, the labour was much faster, 5 hours in total. They were brilliant and tried to discourage me from an epidural, but I wanted one and I got it, although it didn't work very well. I delivered the second baby with no episiotomy and she was 11lbs 2 oz's. I have to say the midwife was brilliant.

I'm due my third in July, and again I will have no birth plan. I think it's impossible to plan for a birth other than to imagine how you would like things to happen. But more often than not it will happen on it's own terms.

The people I have known who were the most disapointed with their baby's birth and the whole experience, were those who had very detailed birth plans, and who for whatever reason, be that a distressed baby, or an extremely long labour, (one person stuck it out for 2 and a half days) had to have c sections or an episiotomy or be induced or other such deviations from their plan.

At the end of the day the hospital will do their best for you and your baby. They will not put you or your baby at risk. Sure have an idea about whaty ou want, but be prepared for the unexpected and trust your midwife and doctors, ( within reason of course) and be open to the idea that it may not go as planned and the most important thing at the end of the day is a healthy baby and a healthy you.

G&T

Ive had 3 children and am currently
cooking No4.
The only thing/plan I ever brought into
the hospital was an open mind.

I went to visit a friend of mine who had a
baby with a birth plan.
thing's did not go to plan(surprise)
Her lovely healthy baby was in the cot beside her and
all she did was give out about what the staff hadn't
done for her,

If you want control have the baby at home,
the hospital's have enough to worry about than scented
candles and pot pouri,
and none of it matters anyway.

embee

G&T wrote: »

If you want control have the baby at home,
the hospital's have enough to worry about than scented
candles and pot pouri,
and none of it matters anyway.

It is easier said than done to have a homebirth in Ireland, unfortunately.

Also - you say that candles and pot pourri don't matter. Well yes, they do. Anything that can help a woman to relax and feel as at home as she can is a welcome addition. Obviously within reason, but they shouldn't be discounted merely because a hospital is too busy or has enough to worry about.

Hospitals deal with people, not numbers or machines.

SanFran07

G&T - I get the feeling that you're delighted that your friend didn't get the kind of birth she wished for.....what was she thinking:rolleyes: Imagine the cheek of her trying to have the safest most gentle birth possible for herself and her baby.....it must be hard having friends like that...and those poor midwives having to deal with all of her demands....yep home is definitely the place for her.

I'd love to know what was on her birth plan....did she ask for something completely off the wall like wanting to use the bath...or something really unreasonable like wanting to avoid an episiotomy? The problem isn't with the birth plan itself it's usually with the staff who read it.....(assuming everything was normal)

You're missing the point about having birth preferences....it's not about telling staff what to do. It's helping us understand what you would like and how we can best support you. You've never met your midwife before and believe it or not we're not psychic - we want to help you have the best birth possible - so help us to do that !

A birth plan gives the mum the perception of control.....and in research has shown that women that felt in control felt their births were much more positive and a positive birth means less PND...more breastfeeding....happier mums and happier babies ! Believe it or not it is possible to have a healthy baby AND a great birth ! Try telling a woman who has been traumatised by her birth experience that she should be grateful.....

I agree that keeping an open mind is key - but that doesn't mean you leave your brain at the hospital door.

Your friend is going to need some support in getting to grips with what happened and why her birth preferences weren't respected - please encourage her to talk about the experience and put her in touch with AIMS Ireland.

Tracy

Sammag

As a (nearing on) 34 year old woman who is hoping to look at having a (first) baby in the next 2/3 years (minimum expected delivery not for at least 12!), the only birth plan (something I had never heard of before reading this thread) is that the said child is delivered by c-section. That's all.