Birthing Plan

sciencebod

Had a quick scan for a thread on this subject but couldn't see one - sorry if I've missed it and there is one. So basically I'm 32 weeks now and I've been advised to maybe put a quick birthing plan together. Can any one recommend a template I can use off the internet or any Irish/UK websites listing things I should include. Or could you just tell me if you used a template or made your own up.
Thanks in advance.

January

My advice is, don't bother.

Honestly, labour is so different for everyone and things can happen so quickly. Go with the flow. Have a few ideas in your head and discuss them with the midwife when you get to the labour ward because chances are the midwives/consultants you see at your hospital visits will not be at the birth.

Chattastrophe!

January wrote: »

My advice is, don't bother.

Honestly, labour is so different for everyone and things can happen so quickly. Go with the flow. Have a few ideas in your head and discuss them with the midwife when you get to the labour ward because chances are the midwives/consultants you see at your hospital visits will not be at the birth.

Yeah, pretty much this!

If I was going again, my "plan" would be to hopefully end up with a healthy baby. Just about anything could happen in the hours/days between pregnancy and birth! Definitely do your research, and know your preferences, but I wouldn't ever go for a "birth plan" ... it's just not something that is likely to be within your control, when the time comes!

Mummilk

Look up gentlebirth and you will find birth plans. Have a plan but be completely open to whatever happens as you can never plan what exactly will happen but it is good to have a birth plan. I didn't have one last time round but will have one this time. Things like pain relief, positions and cord clamping should be thought about and written in the plan.

I nearly crumbled during labour the last time and nearly took pain relief that I was completely against before labour (the one that makes you sick ) as it was offered but if I had of specified my birth prefences before hand I wouldn't have had that issue.

Merkin

Had my midwife's appointment today and spent an hour with her and she asked me about how I felt about setting up an appointment to go through a birth plan and I said I had no intention of having one and she was honestly delighted. We had such a candid talk on foot of my decision and she said it is the best approach not to have one - it invariably ends up with a happier Mummy come delivery time. She said in her experience, the women who come in with very definite birth plans of how their labour is going to go invariably end up quite psychologically traumatized when it works out the opposite way.

I do intend to apply some hypno-birthing techniques and may look at using a Tens machine in early labour but otherwise I am leaving it all in the capable hands of the medical professionals. I will do my research and educate myself on options so I'm not confused or at sea when the time comes but you can't plan for the un-planable so it's not something I've any interest in. You can educate yourself yes, but having a clearly set-in-stone birth plan for an event that is going to take its own course is counter intuitive to my mind.

Moonbeam

Write down you preferences and have your birthing partner well versed in them but in an emergency anything goes .

monflat

Moonbeam wrote: »

Write down you preferences and have your birthing partner well versed in them but in an emergency anything goes .

I didnt have a birth plan . I had a great midwife on my first
Things went horribly wrong and had c s
Same on second

However you do have ideas of what u want ie pain relief or not epi or not.

It all is baby dependant.
If things go a different way you would be horribly disappointed

I figured out no matter how prepared you are physically or mentally how fit you are if the baby does not present in the way it should .

If only all births were waters breaking contractions immediately a few pushes and baby in your arms !
Keep all options open !

Jerrica

Personally I think birth preferences (not a plan, because as has been said, baby may have his or her own ideas!!) are very important if you feel they're something you'd like/ would respond to.

Would you like to be able to listen to music or have dimmed lighting?
Would you prefer to leave your waters in tact when you present to the hospital? (Some have an ARM policy)
Would you prefer a physiological or an assisted third stage?
Do you want pain relief or would you like to be left to it until you request otherwise? Is there any pain relief you're uncomfortable with?
Do you want coached pushing?
Do you want to request delayed cord clamping?
Do you want to move around if possible?
Do you want the option of using the bath/ shower for labouring?
Do you have a preference for the number of VE's received?

Preferences are just about having a say in what's going on. Many of them will be done anyway, but having spoken to a number of midwives about this many are in support of women actually stating them so that they know what experience they're looking for. It goes without saying that if you or baby are in distress then whatever needs to be done will get done but in the event that your birth is normal (which most are) having preferences allows you to guide what type of experience you'll have. Nothing is set in stone, it's about saying "if possible I would prefer..."

It's very personal, some women are happy to let the midwives do what they feel best, and some women would like a say. It all depends on you!

As mentioned Gentle Birth have a template for preferences, you'll also find hospital policies vary so you may have to be prepared to negotiate on some if you feel strongly about them.

Edit: article here on birth preferences. http://www.eumom.ie/pregnancy/how-birth-preferences-can-help-you-have-the-best-possible-birth/

Jerrica

January wrote: »

Have a few ideas in your head and discuss them with the midwife when you get to the labour ward because chances are the midwives/consultants you see at your hospital visits will not be at the birth.

If you get your preferences signed off by a consultant or midwife during pregnancy they'll be held on file and the labour midwives will refer to it when you present to hospital. They should do anyway!

monflat

Jerrica wrote: »

If you get your preferences signed off by a consultant or midwife during pregnancy they'll be held on file and the labour midwives will refer to it when you present to hospital. They should do anyway!

I understand that patient to midwife ratios in this country are not up to standard but i dont think a midwife is goin to launch something on a person without consent and explanation .
They operate best evidence based practice and of course they are not going to force sonething onto you that you dont want.

They will go through everything with you to advise on right choices etc..

I did not have a plan but i had plenty of preferences which were listened to.
I just hate those birth plans that say " treat me and my baby with respect, be gentle with my baby "

Those ones annoy me

Jerrica

monflat wrote: »

I understand that patient to midwife ratios in this country are not up to standard but i dont think a midwife is goin to launch something on a person without consent and explanation .

unfortunately it does happen. There's nothing nefarious about it, but sometimes hospitals have policies that are so commonplace for the practitioner that consent may not be explicitly saught. I am absolutely pro-midwife, and don't want to give any impression otherwise, I just see nothing wrong with writing down what your preferences are.

monflat wrote:

They operate best evidence based practice and of course they are not going to force sonething onto you that you dont want.

for the most part, yes, but not every hospital policy is best practice. For example the Rotunda admission CTG admission policy contravenes the HSE 2012 best practice guidelines (for an otherwise normal pregnancy admission ctg are not recommended). The same hospital also routinely uses syntometrine for managed third stage labour when syntocin is considered best practice. I booked with the Rotunda, I'm super excited to birth there, I just have preferences certain areas of my birth. This way I feel I'm making informed choices and that's really important to me.

monflat wrote:

I did not have a plan but i had plenty of preferences which were listened to.

That's brilliant and I'm really glad you felt heard and respected, it's a great thing:)

newtoboards

Have a plan of what you don't want rather than a birth plan really. It can all go out the window pretty quickly in the end (ended up with an emergency section so not the birth I had planned) but if there are definite no's then go with it. I had no forceps on my list but on the day if they told me they needed to bring him out my left nostril using a rope attached to the back of an articulated lorry I would have happily agreed.

Sarah Bear

newtoboards wrote: »

Have a plan of what you don't want rather than a birth plan really. It can all go out the window pretty quickly in the end (ended up with an emergency section so not the birth I had planned) but if there are definite no's then go with it. I had no forceps on my list but on the day if they told me they needed to bring him out my left nostril using a rope attached to the back of an articulated lorry I would have happily agreed.

Oh god I hope they don't have to do this nose rope/lorry technique with me..

newtoboards

Sarah Bear wrote: »

Oh god I hope they don't have to do this nose rope/lorry technique with me..

If they do you can rest assured that you'll be delighted to hear the soothing bleeps of the truck as it reverses into your delivery room in readiness for dragging the baby out of you

pwurple

All I filled in on the Birth plan page was "no pethidene please", simply because it didn't suit me when I tried it on my first labour. Everything is explained as it comes along, you are given choices as things crop up.

If you feel you won't be able to understand them for whatever reason (focussing on hypnobirthing maybe) then writing down preferences might be a good idea, but as every labour is different, it's hard to have a concrete plan.

You can overthink the plan, and really really want it to go a certain way. If it goes another way due to circumstances, people may feel quite depressed afterwards, like they failed in some way.

Mummilk

Absolutely people can over think it and I know some people do get depressed when their labour doesn't go the way it was expected but I still think having an idea of what you want or don't want on paper before labour is hugely beneficial. I didn't have my preferences written down but a lovely but v stern midwife in the delivery ward (was offered the pethinine by the mw in induction ward) asked me what I had planned for pain relief and I said no epidural but I was rethinking that decision she told me to go with my original plan for another while she showed my hubbies where to press on my back and I managed it with just gas and air and was delighted afterwards.

kandr10

I can understand stating a preference if you previously had an adverse reaction or whatever. I don't understand how you could have strong preferences before labour, not knowing what it's going to be like. (Even if you've had other children). Other than choosing to have pain relief or not there's not much in your control. You could easily change your mind on that mid labour whether it's written down or not so what's the point?

lazygal

You can have strong preferences before having a baby. I wanted to breastfeed so was very clear about no top ups of formula or water being given. If I'd had a vaginal birth I'd have specified no coached pushing and no "come on you can do it" because I hate that approach. I'd also have had a strong preference for consent rather than approval being sought for any intervention.

krankykitty

I know you can't plan or predict what's going to happen but at the very least I would have wanted to be asked my consent for each and every intervention they wanted to carry out on me.

Too many hospital policies which aren't necessarily best practice are unfortunately routine. It would be assault in any other branch of medicine!

kandr10

lazygal wrote: »

You can have strong preferences before having a baby. I wanted to breastfeed so was very clear about no top ups of formula or water being given. If I'd had a vaginal birth I'd have specified no coached pushing and no "come on you can do it" because I hate that approach. I'd also have had a strong preference for consent rather than approval being sought for any intervention.

Yeah I see where you're coming from. I also hate the coached pushing. When it came down to it though it was needed. I decided I'd had enough ages before and the midwives kept me going. If I'd have been managing I'm sure they'd have left me be a bit more.

I might be missing something but I don't see a strong distinction between oral consent versus oral approval. Surely it amounts to them saying we'd like to do xyz and you saying yes or no? Do some midwives just not give a refusal option ? I can see why that would be annoying.

Generally I suppose I'm coming at it from the point of view that these are the experts and they have way more experience in choosing the best times and methods for intervention. Maybe I put too much faith in them but I know nothing about their field of work.

lazygal

A lot of the time it's put to you that "we/I need to do this" without explanation or actual consent being given. Like an episiotomy rather than being allowed to tear naturally. Most interventions are not urgent, yet the woman doesn't have the procedure explained or other options given.

JDD

I wrote a birth plan. Spent ages over it. Best part of it was sending it to my husband so he could understand my preferences and be my voice in labour. Ended up never giving the birth plan to midwives in the end. That was fine because i was induced and everything sort of goes on a different path to natural labour if you are induced. Great thing about writing a plan is that you really decided what was important to you and what you didn't really care about either way. I think they're a great idea, though I wouldn't foist them on your midwife or obstetrician when a frank discussion in advance of labour would do.

Highly recommend the gentlebirth book. It explains every reason why certain decisions should and should not be taken, and it gave me all the knowledge I needed to ask the right questions in labour.

The One Doctor

Birthing plan? For my girlfriend the plan is to get the baby into the world as safely as possible. Other then that, the birth can't really be planned. Actually you can plan to your heart's content, but the experts, the baby and your body will have the final say.

How Strange

I think women should be fully informed of what happens during labour and delivery in terms of interventions so they know what to expect. They also need to know they have rights which have to be acknowledged and respected. I don't subscribe to the 'doctor knows best' attitude.

Child birth is unpredictable and you need to out your faith in the professionals to an extent but not to the point that things are done to your body without consent.

For me, I definitely didn't want an episiotomy. It sounds barbaric and my husband knew if any midwife went to cut me she'd better cut herself first to see how she liked it. I'd have preferred to tear naturally which I did.

I wouldn't say a plan is practical but definitely be informed of what can happen to you even on a normal delivery and both you and your partner should be informed of what, ideally, you want and don't want.

Jerrica

The One Doctor wrote: »

Birthing plan? For my girlfriend the plan is to get the baby into the world as safely as possible. Other then that, the birth can't really be planned. Actually you can plan to your heart's content, but the experts, the baby and your body will have the final say.

A set of birthing preferences also puts the safety of Mum and baby as number one, it's not an either/or situation.

krankykitty

The One Doctor wrote: »

Birthing plan? For my girlfriend the plan is to get the baby into the world as safely as possible. Other then that, the birth can't really be planned. Actually you can plan to your heart's content, but the experts, the baby and your body will have the final say.

Unfortunately the "experts" don't always subscribe to the safest most evidence based methods, see the recent scandals in maternity care in the regional hospitals for proof of that. There's nothing wrong with having knowledge of all the different scenarios how the birth might go and informing yourself of the various choices that you may have in these scenarios so you can at least have some say in how you and the baby are cared for.

lazygal

Jerrica wrote: »

A set of birthing preferences also puts the safety of Mum and baby as number one, it's not an either/or situation.

If I have another baby not being called mum by hospital staff will be high on my list of preferences. Way to avoid checking my name!

kandr10

krankykitty wrote: »

Unfortunately the "experts" don't always subscribe to the safest most evidence based methods, see the recent scandals in maternity care in the regional hospitals for proof of that. There's nothing wrong with having knowledge of all the different scenarios how the birth might go and informing yourself of the various choices that you may have in these scenarios so you can at least have some say in how you and the baby are cared for.

To be fair, those scandals are exceptions to otherwise good maternity care. You're right in saying being informed is important. I agree it would set you up much better for labour and delivery. If doing a birth plan helps some people with that then good for them. I just think when it comes down to it the doctors and midwives are advising based on your particular circumstances and in line with hospital guidelines. You would want to be extremely well read to be confident in going against their advice. The danger is that some people might not be and decide against certain interventions because of reading opinions etc online. Not everyone obviously.

olaola

I think it's important to have one, and for your partner to understand your choices so they can be your advocate if you're unable. My midwife knew mine, and while it didn't go exactly to plan, she knew what were the deviations and we discussed them at every point and then moved on. I felt in control, I understood why things had to change and I had no problems reconciling with how it turned out.

How Strange

I found the old school midwives very dismissive of them as if it marked you out as a bit of a troublemaker who wouldn't just do what you're told. The younger midwives, in my experience, encouraged them as they thought it showed you were prepared for childbirth in so far as you can be prepared.

I know one woman who was told on her first child that the best position for labour and delivery was on her back on a bed. What he didn't say was it was the best position for him to do his job. She never knew she could move around and find a different position.

A healthy scepticism goes a long way as far as I'm concerned. I respected the medical staff but it didn't mean that I surrendered my body to them just because I was having a baby.

monflat

How Strange wrote: »

I found the old school midwives very dismissive of them as if it marked you out as a bit of a troublemaker who wouldn't just do what you're told. The younger midwives, in my experience, encouraged them as they thought it showed you were prepared for childbirth in so far as you can be prepared.

I know one woman who was told on her first child that the best position for labour and delivery was on her back on a bed. What he didn't say was it was the best position for him to do his job. She never knew she could move around and find a different position.

A healthy scepticism goes a long way as far as I'm concerned. I respected the medical staff but it didn't mean that I surrendered my body to them just because I was having a baby.

Well times are changing old school midwives had been taught in one particular way
New younger midwives enter a profession of evidence based practice and research to back up the evidence .

However hospital policy dictates what has to be done etc sometimes with evidence practice goin out the window.

lazygal

Hospital policy still has to come with consent. In HS, for example, they practice active management of labour, but you can refuse consent for every intervention. You might be marked out as awkward but so want. I refused some interventions because I had been clear about my preferences.

Moonbeam

I ave had 4 since January 09 in Holles St.
I had my husband well versed in what I wanted and did not want.
I wanted a healthy baby more or less summed it up but then there were my preferences...

No Intervention
No Epidural
Everything natural.


In an emergency anything goes.


I was lucky on my 1st there was no intervention and I think labour was about 2 hours,on my 2nd and my 1st very fast labour her heart dropped and they had to break my waters,on the 3rd it was all really quick again but I let them give me the injection to deliver the placenta because I felt so sick and was in shock again and was not well at all after another very fast labour on the last and the fastest (official labour is 2 minutes on my chart) I did not go in to shock which itself was a shock and everything went as I had hoped.

By the 3rd child my main aim was to make it to a hospital and have someone here with my other kids!!


Not everyone has it so straight forward but that doesn't mean that you are not allowed have preferences and to voice them.

Chattastrophe!

Moonbeam wrote: »

I ave had 4 since January 09 in Holles St.
I had my husband well versed in what I wanted and did not want.
I wanted a healthy baby more or less summed it up but then there were my preferences...

No Intervention
No Epidural
Everything natural.


In an emergency anything goes.

See what I found hard was actually figuring out what exactly was an emergency?

I was like you, I'd have loved an all natural birth, but I knew the priority was a healthy baby. So, like you, my plan was to go for as little intervention as possible, but to accept any intervention in case of an emergency.

Labour felt so lovely and natural to me at the start. I was at home, having had a consultant appointment that morning, where everything was fine. I was getting contractions, they got regular. A couple of hours later, my waters broke.

But an hour after that, with waters still coming with each contraction, meconium starting coming with them. That's when I rang a taxi to go to the hospital.

And when the hospital did a CTG, and were concerned about the results of that and also the meconium, I made the decision to go what they wanted. They gave me Oxytocin and an (ineffective) epidural, and the birth was hell to me. And the thing is, right up until I got the Oxytocin, I felt calm and fine and happy and in control, I could feel the baby moving away. I wasn't worried about either of us, despite the meconium etc, and in hindsight I wonder if I should have refused the Oxytocin.

But what if I'd refused it and the baby wasn't OK in the end? It's such a difficult judgement call to make, when you're actually there in the moment. It's all good and well in theory in the run-up to the birth! If I'd gone with my own feelings and my own instincts, I would have held off on the Oxytocin for a couple of hours at least and waited to see how things progressed. But who knows what would have happened then?

It worries me because I think that, if the exact same thing happened next time around, I probably still wouldn't trust my own instincts enough to go against what was being advised by the medical professionals. It was mentioned to me that CBT can help a lot in the lead-up to the birth, I'll definitely consider looking into it.

Moonbeam

I have to say labour has never felt lovely to me but there is always relief that pregnancy is over!!
I have to say I can not say what I would have done if anything went wrong I dunno if I could trust my instincts or panic!

Sligo1

Moonbeam wrote: »

I ave had 4 since January 09 in Holles St.
I had my husband well versed in what I wanted and did not want.
I wanted a healthy baby more or less summed it up but then there were my preferences...

No Intervention
No Epidural
Everything natural.


In an emergency anything goes.


I was lucky on my 1st there was no intervention and I think labour was about 2 hours,on my 2nd and my 1st very fast labour her heart dropped and they had to break my waters,on the 3rd it was all really quick again but I let them give me the injection to deliver the placenta because I felt so sick and was in shock again and was not well at all after another very fast labour on the last and the fastest (official labour is 2 minutes on my chart) I did not go in to shock which itself was a shock and everything went as I had hoped.

By the 3rd child my main aim was to make it to a hospital and have someone here with my other kids!!


Not everyone has it so straight forward but that doesn't mean that you are not allowed have preferences and to voice them.

Good grief! All I can say to you is fair play!

krankykitty

BRAIN acronym for informed consent
Benefits:

How will this help my labour?
How will this help my baby?
How will this help me?

Risks:

How will this affect my labour?
How will this affect my baby?
How will this affect me?

Alternatives:

What are my other options?

Intuition:

What does my gut say?

Need Time:

I need time to think this decision through.
I need a private moment to talk with my family.
I would like to wait for now.

kandr10

krankykitty wrote: »

BRAIN acronym for informed consent
Benefits:

How will this help my labour?
How will this help my baby?
How will this help me?

Risks:

How will this affect my labour?
How will this affect my baby?
How will this affect me?

Alternatives:

What are my other options?

Intuition:

What does my gut say?

Need Time:

I need time to think this decision through.
I need a private moment to talk with my family.
I would like to wait for now.

That's a fantastic way to remember how to ask the most relevant questions, which is definitely hard especially when in labour.

How Strange

I think the major issue in Irish hospitals is that most/perhaps all of them have a managed labour policy (created by Holles Street) and they are stretched beyond capacity. The reality is that these policies aren't compatible with the actual process of childbirth which could take 24-36 hours or more.

Once you go into hospital and are admitted for being in labour a clock starts ticking. I think it's 10 hours in Holles Street and 12 in the cone. That's not a long time especially on your first child. Once you get near that deadline the oxytocin, forceps etc etc are introduced to speed things up. It's proven that one intervention can lead to another in a cascade effect which increases the likelihood of it ending in a c-section.

You are entitled to refuse interventions but I think you need to be very aware of what's happening to feel confident to do that. That's where a birth plan/preference list is great because most likely you've done a bit of research and you know what to expect.

Also I think as a mother or a very soon to be mother you instinctively want your baby to be delivered safely. I don't think most women would put their baby's life at risk if the medical team said x, y or z had to be done.

lazygal

On my last pregnancy in HS I refused several offers of intervention, not because I wanted an all natural birth but because I knew nothing was happening after my waters broke and I wanted to wait for my consultant to perform a c section rather than pursuing a VBAC. I had to specifically tell one consultant "I am not interested in that option, I do not want that intervention" for him to agree to leave me alone. There was no need to rush decisions, I was getting antibiotics to combat infection risks and I knew myself nothing was progressing.

sciencebod

I just want to say thank you to you all for taking the time to reply to my post. I do understand that the birthing plan is not set in stone and yes baby's health and mine are paramount at the end of the day. However I would feel better if I just had something to take in with me that was written at a time when I was of sound mind and feeling less vulnerable, if you know what I mean. It's first time for me and things like the episiotomy scare the hell out of me. My friend recently had a baby and she felt the minute she agreed to the epidural, she was treated like a piece of meat down there. I will def be considering some of your points when putting the plan together - and no I wont be writing a dissertation - just a few pointers with regards to what I would prefer to happen and not happen on the day.