Do I need a birth plan?

fiona-f

My antenatal class was disappointingly vague so I thought I'd ask here.

In an ideal world, I'd like a natural, minimal intervention birth. I say this without any idea of what a contraction feels like or how I might react. So I am also open to any or all pain relief options if I find I cannot cope otherwise. Similarly, I would prefer no interventions but I trust my doctor not to push interventions unless she believes it necessary, in which case I am 99% certain I would take her advice. I genuinely don't believe she'd propose, e.g. forceps, unless there was a good reason so I see little point in me saying "no forceps unless required", which I've seen on some sample plans. In my hospital booklet, it says "we aim for you to have as natural a birth as possible" which seems fine by me. The only thing I feel mildly strongly about is avoiding induction if possible but again, similar considerations apply and as by definition I wouldn't be in intense labour at the time, I could discuss with my doctor as and when it arises.

So, my question, is there any point in writing all that into a plan (I'm not even sure where to start - any samples or links welcome) or would I be fine going with just on the basis of the general hospital policy of natural as possible but options available if required. Thanks.

Chattastrophe!

Oh you sound so like me. And in hindsight, absolutely yes, I'd have gone in there with a birth plan. I'd also have made sure that my birth partner was firm with regards to the birth plan. I basically said that I'd leave it up to the midwives to make the decisions on the day. This was a horrible plan and not something I'd do again. Six months later and I'm still not right after the birth, and still amn't sure if I could ever go again.

SmokeyEyes

fiona-f wrote: »

My antenatal class was disappointingly vague so I thought I'd ask here.

In an ideal world, I'd like a natural, minimal intervention birth. I say this without any idea of what a contraction feels like or how I might react. So I am also open to any or all pain relief options if I find I cannot cope otherwise. Similarly, I would prefer no interventions but I trust my doctor not to push interventions unless she believes it necessary, in which case I am 99% certain I would take her advice. I genuinely don't believe she'd propose, e.g. forceps, unless there was a good reason so I see little point in me saying "no forceps unless required", which I've seen on some sample plans. In my hospital booklet, it says "we aim for you to have as natural a birth as possible" which seems fine by me. The only thing I feel mildly strongly about is avoiding induction if possible but again, similar considerations apply and as by definition I wouldn't be in intense labour at the time, I could discuss with my doctor as and when it arises.

So, my question, is there any point in writing all that into a plan (I'm not even sure where to start - any samples or links welcome) or would I be fine going with just on the basis of the general hospital policy of natural as possible but options available if required. Thanks.

My midwife in appointments close to my due date (gave birth 11 days ago) asked me to bring in my birth plan which she went through with me and then signed and put into my chart. We googled what was usually on birth plans and only had a small one asking to be informed and consulted on everything as it happened, that I wanted epidural at whatever point I felt I needed it and wanted it straight away if I had to go on the drip that speeds up your contractions. Also stated ideally didnt want forceps etc. but once youre in the thick of it I dont know if what you wrote down is really consulted at all...I had a few different people through labour and birth plan wasnt really mentioned it was more about dealing with it as it happened!

vibe666

It's going to depend on where you have your baby, different hospitals have different policies on intervention and there can be a huge gap between what is medically necessary and what is hospital policy.

Have a good read up on the Nice guidelines and have a Google on birth plans and the various hospital policies to see what will suit you best.

Also have a look at www.gentlebirth.ie, it might look a little "new age" on the surface (it really isn't), but it will give you your best chance at the intervention free birth you are looking for imho.

zoe 3619

Hi.I had a birth plan written out.seemed ignored by the hospital.go with the flow.every birth is different,so you can't allow for every eventually.nothing can be done without your consent.just have to take it as it comes.you can ask for pain relief/epidural at any stage,or you can question any procedure they recommend.just make sure your partner knows where you're at,so he can speak for you if needs be.

Jerrica

It's absolutely worth writing it all down I call mine my birth preferences because the baby is highly unlikely to know what my big plan is and she'll suit herself (:D) but this way I get a say in what kind of experience I'd like to have. It is, after all, my body, and I don't think it's unreasonable to have a say in what happens to it. Two things though: the preferences are flexible and have changed over the course of the last nine months, and two they keep me and the baby's safety in mind at all times (plans go out the window if one of us is at risk).

I use phrases like "I would prefer that.." which gives me the flexibility to try one option but still be open to others if I'm not happy. Remember that nothing can be done to you without your consent. And like Chattastrophe said, get your partner in on the action - I'm due in two weeks and this evening my husband sat down with me again to run through all our preferences and make sure he knows what I'd like and how best he can communicate that.

There's a good article about the role of birth preferences here:http://www.eumom.ie/pregnancy/how-birth-preferences-can-help-you-have-the-best-possible-birth/

Also, big fat +1 to Gentle Birth - wonderful community, wonderful program.

fiona-f

Thanks all. I've just looked up Gentle Birth - is it too late to begin now with just over a month to go? Is the 'Positive Hospital Birth' cd the one I need? Do any bricks-and-mortar shops sell them or can I only order online?

Chattastrophe! wrote: »

Oh you sound so like me. And in hindsight, absolutely yes, I'd have gone in there with a birth plan. I'd also have made sure that my birth partner was firm with regards to the birth plan. I basically said that I'd leave it up to the midwives to make the decisions on the day. This was a horrible plan and not something I'd do again. Six months later and I'm still not right after the birth, and still amn't sure if I could ever go again.

Do you mind me asking what you mean by this and how you feel a birth plan / written preferences would have changed this? Or if that is too personal, I'm sorry for asking and please ignore me.

vibe666

fiona-f wrote: »

Thanks all. I've just looked up Gentle Birth - is it too late to begin now with just over a month to go? Is the 'Positive Hospital Birth' cd the one I need? Do any bricks-and-mortar shops sell them or can I only order online?

Join the Facebook group and ask. https://m.facebook.com/profile.php?id=273661266056860

You honestly couldn't meet a nicer bunch of mum's.

Chattastrophe!

fiona-f wrote: »

Do you mind me asking what you mean by this and how you feel a birth plan / written preferences would have changed this? Or if that is too personal, I'm sorry for asking and please ignore me.

When I was on the ward after having my baby, I got my phone out and took photos of every page of my hospital file, because I was just too addled to even try and decipher them at the time! So a few days ago, I had a good look through.

Basically at six days past my due date, I went into natural labour at home. Regular contractions, and my waters broke. I'd wanted to stay at home as long as possible, but more waters were coming with each contraction, and after a few of them I saw some meconium. Now we'd been told in antenatal classes that a lot depended on the amount of meconium - if it was very thick and dark, an emergency section would be likely - mine was nothing like that, I wasn't even worried as I could feel the baby moving and I'd only had a hospital appointment earlier that day, however seeing as my waters had broken I headed in to Holles St. If there's such a thing as enjoying labour, I really was. The pains were a few minutes apart but felt somehow "healthy" and normal and manageable.

I was hooked up to various monitors from the minute I arrived. I'm usually quite assertive, and would normally have been full of questions, but I'd gone into some sort of inner zone where I was just focused on getting the baby out. When they said they wanted to give me Oxytocin, I should have asked why it was necessary. Or I should have had my boyfriend prepped to do so. However I guess I just assumed it was to do with the ctg they'd been doing on the baby - with the meconium in my waters, I assumed he was in distress at the time.

Looking back at the notes, the ctg results were perfect - the baby was fine, which had been my own gut feeling at the time. The one and only reason they had written for giving me Oxytocin was because my blood pressure was high when I arrived at hospital. High blood pressure had been an ongoing thing throughout the pregnancy and I'd been tested and regularly monitored, and the doctors were happy that it wasn't a problem and that it wasn't an indication of preeclampsia or anything else. If I'd known they were giving me the Oxytocin just because of high blood pressure, I'd have refused it.

Anyways long story short, the Oxytocin worked far too well and I'd a very fast and agonisingly painful labour. I'd been told at the start that the Oxytocin would make things a lot worse and that 99% of women who get it need an epidural ... I said that I'd have liked a natural birth, but if I was going to need an epidural at some point then I'd rather get it early on ... they said not until I was well on in labour, however things escalated a lot faster than planned and the anaesthesist was busy elsewhere, it was pretty much all over when I finally got the epidural. At least the delivery of the placenta was pretty much painless as a result!

I think what made it worse for me was that I'd briefly experienced just how "nice" labour can be. I was so happy and excited when my waters broke at home, that I was going to avoid being induced a week later. I was so happy at how well I was managing the pains.

I didn't have freedom of movement during labour because the whole time they were putting me in different positions to try and attach a clip to the baby's skull. I don't know why I went along with this, as I said, my own gut feeling was that he was fine. But no matter how logical and rational and strong-minded you are, it's f*cking scary being in labour. In my case, I just let them do what they wanted.

If I were to go again I'd be researching every form of pain relief and have it all written out, and I'd be discussing it with the hospital from the very first appointment and looking for assurances that there won't be delays. I do think a natural birth with no pain relief would be lovely, but the last one f*cked me up so much that I won't even attempt it again.

I'll be avoiding Oxytocin at all costs. I will take a section before I'll allow them to put that stuff into my body. I'm not saying it's evil, it's just not for me.

I'll be discussing everything in advance with my birth partner, and also I'll be more clear with them about my expectations of how they should support me during the birth, and ask questions and look for explanations when I'm not in the right headspace to do so. It's one of those things you assume they'll know to do when the time comes, these assumptions can be dangerous.

I'll be trusting my own instincts. If I know myself that the baby is OK, I'll avoid excessive monitoring or intervention.

I'll have all of this written down and I'll be shoving it in the faces of anyone I deal with in the hospital, at any stage of the pregnancy! My little boy was perfect and of course he is worth it all, however I absolutely did NOT forget the pain of it five minutes after he was born, I doubt I ever will. I can't just blame the hospital staff, it was my own responsibility to stand up for myself, I didn't do that. Will certainly do so in future.

lazygal

You need to have birth preferences and your partner or birth partner needs to know them well enough to be able to fight your corner. I had preferences for no formula to be given at all, as I wanted to breastfeed. Husband had to swat away the nurses first time but he knew the score. I also had preferences agreed with my consultant (planned c sections) and when I was stuck dealing with a different one husband again stuck up for me.
Don't forget you are under no obligation to agree to anything, especially having your waters broken, internal exams and induction. I found a lot of medical staff say things like 'I'm just going to do this' or 'we need to do X, baby is in distress' but there are very few times when things genuinely need to be done in a hurry. If I'd had a vaginal birth I'd have specified no coached pushing as a lot of women find it disruptive and can't focus.
Just one piece of advice, I had to explicitly say 'I do not consent to that' for a doctor to agree not to do something, so its a handy phrase that leaves no room for doubt on the part of medical personnel.

Chattastrophe!

lazygal wrote: »

Don't forget you are under no obligation to agree to anything, especially having your waters broken, internal exams and induction. I found a lot of medical staff say things like 'I'm just going to do this' or 'we need to do X, baby is in distress' but there are very few times when things genuinely need to be done in a hurry. If I'd had a vaginal birth I'd have specified no coached pushing as a lot of women find it disruptive and can't focus.
Just one piece of advice, I had to explicitly say 'I do not consent to that' for a doctor to agree not to do something, so its a handy phrase that leaves no room for doubt on the part of medical personnel.

Yes I'd absolutely agree with this. I felt that everything about my labour and birth was completely out of my control because the midwives, while lovely, were telling me about what they were going to do rather than asking me. I was told I was about to get an episiotomy and at the time I assumed it was because of the baby being in distress - looking at my hospital notes, I'm still not quite sure why it was done. (It healed perfectly, it was never sore and I had no side effects, I just wonder whether it was a necessary intervention.)

And as regards the coached pushing - I was only pushing for a few minutes before he was out - but I remember at one stage being shouted at to push when (as I repeatedly told them) I wasn't actually having a contraction, it was doing nothing, but they were still shouting at me to do it.

I realise I must sound like a total pushover. That's the odd thing, I'm not like that. From when I went into labour, though, I went into a different frame of mind where I wasn't myself anymore, and I wasn't standing up for myself the way I usually would. I just didn't have it in me, it's not that I panicked. The opposite, if anything. I completely relaxed and let the professionals take over and make all the decisions. As ye can see, this didn't work out too well for me!

That's why I think it's so important to have ALL your preferences in writing, and have someone there who will back them up and not let them be ignored.

SmokeyEyes

Chattastrophe! wrote: »

Yes I'd absolutely agree with this. I felt that everything about my labour and birth was completely out of my control because the midwives, while lovely, were telling me about what they were going to do rather than asking me. I was told I was about to get an episiotomy and at the time I assumed it was because of the baby being in distress - looking at my hospital notes, I'm still not quite sure why it was done. (It healed perfectly, it was never sore and I had no side effects, I just wonder whether it was a necessary intervention.)

And as regards the coached pushing - I was only pushing for a few minutes before he was out - but I remember at one stage being shouted at to push when (as I repeatedly told them) I wasn't actually having a contraction, it was doing nothing, but they were still shouting at me to do it.

I realise I must sound like a total pushover. That's the odd thing, I'm not like that. From when I went into labour, though, I went into a different frame of mind where I wasn't myself anymore, and I wasn't standing up for myself the way I usually would. I just didn't have it in me, it's not that I panicked. The opposite, if anything. I completely relaxed and let the professionals take over and make all the decisions. As ye can see, this didn't work out too well for me!

That's why I think it's so important to have ALL your preferences in writing, and have someone there who will back them up and not let them be ignored.

Well said! To be honest I trusted without question everything they did simply because in a hospital situation you feel theyre making every decision in your best interest and the interest of the baby so we did put our trust in them completely. Thankfully with pushing I could still feel contractions so midwife just told me to go with them and try for three pushes each time while my fiance and two midwives talked me through them! The only thing I found odd at the time was that after my waters were broken I had no checkup to see how far along I was until the epidural was in...I thought they would only give it up to a certain point so you would always be checked beforehand? Once it was in and I was checked they discovered I was fully dilated

Millem

Chattastrophe! wrote: »

When I was on the ward after having my baby, I got my phone out and took photos of every page of my hospital file, because I was just too addled to even try and decipher them at the time! So a few days ago, I had a good look through.

Basically at six days past my due date, I went into natural labour at home. Regular contractions, and my waters broke. I'd wanted to stay at home as long as possible, but more waters were coming with each contraction, and after a few of them I saw some meconium. Now we'd been told in antenatal classes that a lot depended on the amount of meconium - if it was very thick and dark, an emergency section would be likely - mine was nothing like that, I wasn't even worried as I could feel the baby moving and I'd only had a hospital appointment earlier that day, however seeing as my waters had broken I headed in to Holles St. If there's such a thing as enjoying labour, I really was. The pains were a few minutes apart but felt somehow "healthy" and normal and manageable.

I was hooked up to various monitors from the minute I arrived. I'm usually quite assertive, and would normally have been full of questions, but I'd gone into some sort of inner zone where I was just focused on getting the baby out. When they said they wanted to give me Oxytocin, I should have asked why it was necessary. Or I should have had my boyfriend prepped to do so. However I guess I just assumed it was to do with the ctg they'd been doing on the baby - with the meconium in my waters, I assumed he was in distress at the time.

Looking back at the notes, the ctg results were perfect - the baby was fine, which had been my own gut feeling at the time. The one and only reason they had written for giving me Oxytocin was because my blood pressure was high when I arrived at hospital. High blood pressure had been an ongoing thing throughout the pregnancy and I'd been tested and regularly monitored, and the doctors were happy that it wasn't a problem and that it wasn't an indication of preeclampsia or anything else. If I'd known they were giving me the Oxytocin just because of high blood pressure, I'd have refused it.

Anyways long story short, the Oxytocin worked far too well and I'd a very fast and agonisingly painful labour. I'd been told at the start that the Oxytocin would make things a lot worse and that 99% of women who get it need an epidural ... I said that I'd have liked a natural birth, but if I was going to need an epidural at some point then I'd rather get it early on ... they said not until I was well on in labour, however things escalated a lot faster than planned and the anaesthesist was busy elsewhere, it was pretty much all over when I finally got the epidural. At least the delivery of the placenta was pretty much painless as a result!

I think what made it worse for me was that I'd briefly experienced just how "nice" labour can be. I was so happy and excited when my waters broke at home, that I was going to avoid being induced a week later. I was so happy at how well I was managing the pains.

I didn't have freedom of movement during labour because the whole time they were putting me in different positions to try and attach a clip to the baby's skull. I don't know why I went along with this, as I said, my own gut feeling was that he was fine. But no matter how logical and rational and strong-minded you are, it's f*cking scary being in labour. In my case, I just let them do what they wanted.

If I were to go again I'd be researching every form of pain relief and have it all written out, and I'd be discussing it with the hospital from the very first appointment and looking for assurances that there won't be delays. I do think a natural birth with no pain relief would be lovely, but the last one f*cked me up so much that I won't even attempt it again.

I'll be avoiding Oxytocin at all costs. I will take a section before I'll allow them to put that stuff into my body. I'm not saying it's evil, it's just not for me.

I'll be discussing everything in advance with my birth partner, and also I'll be more clear with them about my expectations of how they should support me during the birth, and ask questions and look for explanations when I'm not in the right headspace to do so. It's one of those things you assume they'll know to do when the time comes, these assumptions can be dangerous.

I'll be trusting my own instincts. If I know myself that the baby is OK, I'll avoid excessive monitoring or intervention.

I'll have all of this written down and I'll be shoving it in the faces of anyone I deal with in the hospital, at any stage of the pregnancy! My little boy was perfect and of course he is worth it all, however I absolutely did NOT forget the pain of it five minutes after he was born, I doubt I ever will. I can't just blame the hospital staff, it was my own responsibility to stand up for myself, I didn't do that. Will certainly do so in future.

That is terrible chattastrope. It sounds like they were rushing you? Gosh I am so glad I did the domino. I had all machines etc and wasn't allowed to move but no oxytocin or episiotomy. They let me take my time it took me 22 hours in total. I hear you though you are so out of it with pain that you don't really know what's on. If you go again you should do domino as you will get to know your midwife real well and they will try and stick to your plan. Everyone of the domino midwives are just amazing and sooooo good at their job. They genuinely care so much

pwurple

Birth plans can be very useful, but the most important thing to write down I found was "Explain what is going on". It shouldn't need to be there, but some midwives do forget that you have not seen as many births as them, and don't know half the terminology they use.

My second birth I had this written down in my birth plan, and the midwives took much more effort explaining what was happening. I was induced, and i asked what every single readout on that monitor was, what I should expect to feel, etc. They took the time to explain everything in detail. (baby heartbeat, my muscles contracting, my blood pressure ). This continued all the way to the birth. I asked where the babies head was, if my pushes were effective so I could change position if not, etc. i found coached pushing very helpful actually. I wanted no-one touching me though when I was pushing, so told them that too.

When I needed stitches afterwards, I asked them to draw me a diagram of exactly where the tear was, and then asked for a surgeon to do it instead of midwife, as it was deep (and my stitches on first birth were botched and needed to be re-done).

I didn't do any of this on the first birth, i just went with the flow and with most of what was being suggested. Both births were absolutely fine, I was perfectly happy with how things went, but I felt much more in control second time around, due to my own assertivness kicking in really. Very hard to be assertive as a newbie on first birth though.

I do have friends who had very detailed birth plans written down, and some of them felt deeply upset, disappointed and like complete failures when things didn't go to this plan. Just bear in mind that births are all different if you can, and everyone healthy at the other end is a very successful outcome.

eviltwin

The first I ever heard of birth plans was in a UK pregnancy book when I was expecting my second baby. I mentioned in a midwife appt at about 6 months when I should bring it in and she just dismissed me and made it seem it wasn't the done thing over here. I should have been firmer but wasn't and let it go. I knew roughly what I wanted though so assumed that would be enough. I was induced due to pre-eclampsia, it was fairly serious so I just let them do what they said needed to be done and didn't question anything even though I didn't really understand a lot of what was happening, I found the staff was in general very dismissive. I don't think our system wants mothers who are proactive, they want you in and out as quickly as possible which on one hand I can understand - they are under huge pressure - but mothers deserve to be treated better and listened too.

Lustrum

From a dad's point of view, so you may not all agree with this!

When my wife gave me the first draft to read (she had copied a lot of it from the yoga teacher) I objected to the way it was written more so than anything else. It was basically demands ie. "I do not want etc...". Maybe it's because I work in an industry where things can change at the drop of a hat, and you have to be able to react and adapt, but this just seemed wrong to me. I got her to change it to " we would like..." and spent plenty of time talking about how although we had preferences, the ultimate goal was a safe and healthy delivery for both of them, and we were willing to listen to the midwives at all times and take their advice on board. We were extremely lucky that those that we dealt with in holles st were very receptive to the preferences, and my wife was able to talk through them all with the midwives before the contractions really kicked in.

Talking to the midwives afterwards, they said they don't get that many mothers with a birth plan, so whenever they do, and I think when it's written with respect to them (rather than being demanding) they will try their utmost to give you the kind of delivery you would like. Again, we were extremely lucky that the birth pretty much matched what we hoped for in the plan, as opposed to forcing the birth to be like the plan. I also think they're a good idea as it gets both mother and father prepared for what's about to happen, and gets you talking about it before the event.

I understand completely the frustration of many mothers that things didn't go quite to plan, and why procedures are carried out that don't seem necessary (I'm not remotely medical so can't comment on that) but from my point of view as a new dad, as long as both my wife and baby were safe at the end of it all, that was what was and is the most important part of any birth plan.

lazygal

I don't like the "mother and baby are ok" attitude. I hear it all the time as a reason not to complain. Women I know are realistic about birth and their plans or preferences are usually straightforward and about being consulted and involved in decision making. Just because you're not physically hurt by birth doesn't mean you can't speak out or make sure things happen differently next time or advise other women on what to do or say.

Lustrum

I'm not using the "mother and baby are OK" thing as a reason not to complain. It's more that it needs to be remembered that this is the goal when you go into labour, and in some cases the birth plan/preferences may go straight out the window, depending on what your baby wants to do. The medical staff not informing you what is going on in inexcusable, and shouldn't need a birth plan for them to realise that.

As I said, birth plans are a great idea, and everyone should have one. However the plan should not be written up thinking only of the mother - it needs to include the father, the midwives, and of course, the baby

Jerrica

Lustrum wrote: »

As I said, birth plans are a great idea, and everyone should have one. However the plan should not be written up thinking only of the mother - it needs to include the father, the midwives, and of course, the baby

You'll have to explain this. I'm having the baby, it's my husband's job to support me, not the other way around. It's also the midwive's job because to support me, not the other way around. It's the obstetrician' job to support me, not the only her way around. And I'm going to assume that you understand that as a mother I will always have my baby's safety as the number one priority in everything I do, but I consider my mental health and physiological well being as a pretty important factor in the journey I'm about to take. So please explain to why I should have anyone other than me and my baby in mind when I state my preferences.

Ocean Blue

Jerrica wrote: »

You'll have to explain this. I'm having the baby, it's my husband's job to support me, not the other way around. It's also the midwive's job because to support me, not the other way around. It's the obstetrician' job to support me, not the only her way around. And I'm going to assume that you understand that as a mother I will always have my baby's safety as the number one priority in everything I do, but I consider my mental health and physiological well being as a pretty important factor in the journey I'm about to take. So please explain to why I should have anyone other than me and my baby in mind when I state my preferences.

Maybe she just means that it's such a busy crazy time that it's hard to remember all preferences so it's no harm to include everything you think of, even if it doesn't only relate to you/baby. For example, dad does/doesn't want to cut the cord - dad does/doesn't want to be invited to look down the business end - midwife should/shouldn't clean baby before handing to you - widwife should/shouldn't suggest breastfeeding etc etc.

Ocean Blue

Jerrica wrote: »

You'll have to explain this. I'm having the baby, it's my husband's job to support me, not the other way around. It's also the midwive's job because to support me, not the other way around. It's the obstetrician' job to support me, not the only her way around. And I'm going to assume that you understand that as a mother I will always have my baby's safety as the number one priority in everything I do, but I consider my mental health and physiological well being as a pretty important factor in the journey I'm about to take. So please explain to why I should have anyone other than me and my baby in mind when I state my preferences.

Also on the point of it's your husband's job to support you, not the other way around - ill have to disagree. Yes it's you giving birth but you are a team and you are both having a child. It's a stressful time for dads I imagine, seeing their partner in pain and having limited ability to do anything about it. If I sense my husband is stressed or uncomfortable I'm going to try and help him if my situation allows it. Whether that's encouraging him to get a break out of the room, or ensuring that I or the midwife explain something clearly if he seems not to understand what's happening, or reinforcing his preferences against a pushy midwife re cutting the cord/watching the actual birth, or a million other issues that might arise. If he is scared/anxious/stressed he isn't going to be much use in supporting me so it's in everyones interests if I try to support him also.

Jerrica

Ocean Blue wrote: »

Maybe she just means that it's such a busy crazy time that it's hard to remember all preferences so it's no harm to include everything you think of, even if it doesn't only relate to you/baby. For example, dad does/doesn't want to cut the cord - dad does/doesn't want to be invited to look down the business end - midwife should/shouldn't clean baby before handing to you - widwife should/shouldn't suggest breastfeeding etc etc.

It's a he judging from his post discussing it from a Dad's point of view. If that's what he meant then I agree wholeheartedly regarding requesting points about Dad's role and my own preferences reflect that. But the points relating to the midwife are still my preferences, they just involve the midwife!

Ocean Blue wrote: »

Also on the point of it's your husband's job to support you, not the other way around - ill have to disagree. Yes it's you giving birth but you are a team and you are both having a child. It's a stressful time for dads I imagine, seeing their partner in pain and having limited ability to do anything about it. If I sense my husband is stressed or uncomfortable I'm going to try and help him if my situation allows it. Whether that's encouraging him to get a break out of the room, or ensuring that I or the midwife explain something clearly if he seems not to understand what's happening, or reinforcing his preferences against a pushy midwife re cutting the cord/watching the actual birth, or a million other issues that might arise. If he is scared/anxious/stressed he isn't going to be much use in supporting me so it's in everyones interests if I try to support him also.

And that's why (like I said above) we're doing as much work as we can before the big event to make sure we're both informed so that we can both get on with our respective roles - me pushing out a baby and him being the best damn support provider I could ask for

krankykitty

I can see why you might want to consider the father in your preferences, for example if you have to be taken away for repairs etc that you want baby to stay with dad etc. I really don't know why you'd consider the midwives... They'll be well able to push whatever it is they want based on the hospital policy, whether that policy is evidence based or not.

Edit, I don't want to sound critical of midwives as there are many wonderful ones. However they are under pressure to follow their procedures and this is where a well researched birth plan might help a woman to avoid unnecessary interventions she would prefer not to get.

Ocean Blue

krankykitty wrote: »

I can see why you might want to consider the father in your preferences, for example if you have to be taken away for repairs etc that you want baby to stay with dad etc. I really don't know why you'd consider the midwives... They'll be well able to push whatever it is they want based on the hospital policy, whether that policy is evidence based or not.

Edit, I don't want to sound critical of midwives as there are many wonderful ones. However they are under pressure to follow their procedures and this is where a well researched birth plan might help a woman to avoid unnecessary interventions she would prefer not to get.

The original poster (in relation to this point) never said anything about the midwifes preferences though. By my reading he just said he feels the birth plan should include things that relate to the midwife. Subtle but very significant difference there.

I actually think it could be a very good idea to have a section specifically relating to the Midwife, even if it just duplicates a lot of your preferences. If things go hectic during the birth and the midwife remembers seeing a small chunk summarising those things relating to her somewhere in the document she's a lot more likely to revisit that than read the whole thing again.

Lustrum

Jerrica wrote: »

You'll have to explain this. I'm having the baby, it's my husband's job to support me, not the other way around. It's also the midwive's job because to support me, not the other way around. It's the obstetrician' job to support me, not the only her way around. And I'm going to assume that you understand that as a mother I will always have my baby's safety as the number one priority in everything I do, but I consider my mental health and physiological well being as a pretty important factor in the journey I'm about to take. So please explain to why I should have anyone other than me and my baby in mind when I state my preferences.

What I mean is that there are going to be other people in the room that you need to take into account. Yes, I am a he, and I can tell you it is not nice to be standing there watching your wife screaming in pain and there's nothing you can do about it. However, as we had discussed what kind of delivery my wife wanted, I knew better than to shout for an epidural. That's what I mean by taking dad into account.

The midwives are there to provide you with a service in the best and safest way possible. By demanding things of them in a birth plan, I doesn't seem to me to he the best way to go about getting what you want. However, if written with respect to the midwives experience, and explain why you would prefer things to happen in such a way, this will give the midwives an insight into how you would like your birth to go. That's what I mean by taking them into account.

Your baby is going to come out whatever way it happens, be in perfectly in line with your plan or the complete opposite of what you want. You have no choice but to take the baby into account.

Look, I'm only offering an opinion. I will never go through childbirth or have to write a birth plan, but have a limited experience of what's involved from a different perspective to you. My prime concern for my wife was that she would be disappointed if things didn't go the way of her original birth plan. I feel that by taking all the other people involved in the experience and all factors into account, while you may be disappointed if things don't go to plan, you will be able to see the bigger picture and realise what is the most important thing at the end of it.

Like I said, it's just an opinion.

Jerrica

Lustrum wrote: »

What I mean is that there are going to be other people in the room that you need to take into account. Yes, I am a he, and I can tell you it is not nice to be standing there watching your wife screaming in pain and there's nothing you can do about it. However, as we had discussed what kind of delivery my wife wanted, I knew better than to shout for an epidural. That's what I mean by taking dad into account.

I'm quite sure it's no fun at all, but how would you suggest the birth preferences could take your feelings about your wife's choices into account? Would you have liked to be able to decide that for her? I'm genuinely not being smart about that, but I do believe that it's your wife's decision to make about what's happening to her body. By the way I'm also of the opinion that in general it's better to use phrases like "I prefer that...." as opposed to "I want...."!

Lustrum wrote:

The midwives are there to provide you with a service in the best and safest way possible. By demanding things of them in a birth plan, I doesn't seem to me to he the best way to go about getting what you want. However, if written with respect to the midwives experience, and explain why you would prefer things to happen in such a way, this will give the midwives an insight into how you would like your birth to go. That's what I mean by taking them into account.

I adore midwives, I think they do an incredible job and the vast majority of them are consummate professionals who want nothing but the best for the women they see. In fact I regret going for consultant led care as opposed to a MLU as I do feel that midwives in an autonomous unit are more likely to provide mother-centred care. But outside of a MLU midwives are at the behest of the hospital, and they have to abide by hospital policy. Again, I think we're both on the same page with regards to demands vs preferences, but there are a few issues where you may find that you actually do have to be a little demanding. For example, the Rotunda has a CTG on admission policy. This means that as soon as a woman presents for admission during labour the first thing she has to do is lie down with a big strap on her at a time when she's unmedicated and trying to get to grips with what's going on. The CTG has a high false positive rate, it restricts how easily a woman can move around (meaning it may be harder for her to get into a position that's most comfortable for her to manage her pain) and in fact for otherwise normal pregnancies an admission CTG contravenes the HSE 2012 guidelines (see Section 4.7). So despite it going against the regulations, the hospital does it anyway. This - to me - is a valid time to state a demand over a preference, I've had a normal pregancy, it's all been fantastically routine, so why can't I get what is considered national best practice?

Lustrum wrote:

Your baby is going to come out whatever way it happens, be in perfectly in line with your plan or the complete opposite of what you want. You have no choice but to take the baby into account.

Agreed, but you can vocalise preferences that optimise the chances that the experience will be the one you want All any parent wants is the safe arrival of their baby, but the mental health and wellbeing of the mother is so, so important. Chattastrophe has incredibly bravely described the experience she had above, and sorry but it's not fair for her to have to keep rationalising "well he's ok so I should be ok with it" all the time, the maternity system failed to inform her adequately of why certain steps were taken and from what she has described her wellbeing was not considered during multiple steps of her birthing process.

lazygal

I don't know anyone who's birth plan or preferences demanded anything. Most women, as I said, are realistic. They know things don't always go to plan and that things can change quickly. I know women who wanted a natural birth but ended up having a general anesthetic and a c section. There's also women who are asking for things like not having their waters broken. Not being hooked up to a tracing monitor. Not being told to push when they want to stop pushing. Baby not being given formula as they want to breasfeed. No women I know are looking for an all white non sterile room with Enya playing and hushed voices and a magical birth experience. They are looking for they and their babies to be delivered safely. But that doesn't mean that medical personnel can ignore requests from women who are put under pressure to be induced because 'baby is a big size' or 'we induce as a matter of policy after ten days'.
I learned a lot from my first experience. Baby and me were fine and I got brilliant care from my consultant. I had a planned section so I didn't have any interaction with the midwives on delivery. Second time I trusted my body and my mind to process things and I was an active participant in the decisions being made. I'll never forget one consultant deferring to my husband when a big decision had to be made. I don't think I was unrealistic about thinking I was the most important person in the decision making process, not my husband.

eviltwin

Pregnancy and birth is not an illness, its a natural process. Obviously there are cases that need to be managed and things can go wrong but intervention should be about what's best for the health of mum and baby not about saving time or meeting targets. And while obviously the father has an investment in the process he's not the patient. I've also never known anyone demand anything in their birth plan, its a wish list of what women would like all going well but as Lazygal says women are realistic, we know its not always going to go that way.

Drdoc

lazygal wrote: »

I don't know anyone who's birth plan or preferences demanded anything. Most women, as I said, are realistic. There's also women who are asking for things like not having their waters broken. Not being hooked up to a tracing monitor. Not being told to push when they want to stop pushing. Baby not being given formula as they want to breasfeed.

Have to agree here. As someone who works in the medical field, I can tell you that very few women actually do have birth plans and of those I've seen most are very realistic. I didn't have one myself because I felt I knew enough to be able to vocalise my concerns on the day; however I did advise all my friends of their options and not to feel railroaded into anything and if needs be to write that down.

On a side note, Chattastrophe have you considered organising a debrief of your birth with the hospital? Most will be happy to facilitate this to answer questions and perhaps it might help you come to terms with it a bit better.

SanFran07

As a midwife I very much encourage parents to write down their birth preferences and to see it as a communication tool rather than a contract or guarantee. Ideally parents should expect their care to be evidence based and if half of what passes for appropriate care for healthy women and babies was found to be happening to children in Temple Street there would be a national scandal and political uproar.

Birth preferences help parents have safer births - they really shouldn't have to ask for best international practice with written requests - it should be a given.

LegacyUser

SanFran07 wrote: »

As a midwife I very much encourage parents to write down their birth preferences and to see it as a communication tool rather than a contract or guarantee. Ideally parents should expect their care to be evidence based and if half of what passes for appropriate care for healthy women and babies was found to be happening to children in Temple Street there would be a national scandal and political uproar.

Birth preferences help parents have safer births - they really shouldn't have to ask for best international practice with written requests - it should be a given.

Could you expand on this please? It's quite a worrying statement which my worried mind is interpreting in a very exterme way so more details of what you mean would be helpful. Thank you.

fiona-f

SanFran07 wrote: »

As a midwife I very much encourage parents to write down their birth preferences and to see it as a communication tool rather than a contract or guarantee. Ideally parents should expect their care to be evidence based and if half of what passes for appropriate care for healthy women and babies was found to be happening to children in Temple Street there would be a national scandal and political uproar.

Birth preferences help parents have safer births - they really shouldn't have to ask for best international practice with written requests - it should be a given.

That's a pretty alarming statement, can you be more specific please?

vibe666

fiona-f wrote: »

That's a pretty alarming statement, can you be more specific please?

There's a huge difference between internationally accepted best practices for childbirth and what is hospital policy in most Irish hospitals.

Have a look at the Nice guidelines for childbirth (posted earlier in the thread afaik), you'll find quite a disparity between what is recommended and what you'll experience in a maternity hospital here.

My wife had a similar experience to Catastrophe's with our first in holles st with and as a result of their 12 hour turnaround hospital policy, it was 6 months before she was able to walk right and a full year before she was fully physically back to normal and it took a second (amazing) birth using the gentlebirth technique to fix the mental wounds completely.

SanFran07

It should be alarming Fiona. As I said if it was happening in other areas of medicine it wouldn't be tolerated. AIMS Ireland and others have been campaigning for years to have this publicly addressed but it continues to fall on deaf ears but women and their partners are starting to ask more questions and adopt a more curious attitude about what they're being offered (specifically in the absence of any compications).

Midwives want to give evidence based care - international best practice....we want to support you to have the safest birth possible but hospital policies often prevent us from doing so. Midwives are caught between a rock and a hard place. If a mum gives us written birth preferences on which routine procedures you want to avoid we can bypass most of the hospital policies and provide you with quality, personalised care. Without written birth preferences we have to follow the local policies/guidelines which can include breaking your waters on admission, speeding up your labour with synthetic hormones..time limits, admissions CTG, refusal of food....etc etc. Help us help you! Find out what's routine in your hospital and then have a look at the NICE Guidelines as mentioned earlier to see what's actually medically necessary for a healthy mum and baby (not a lot really!).

Birth preferences don't tell us how to do our jobs - they help us do our jobs better. If there's a complication then it's no time for debating NICE Guidelines but when all is well the majority of mums (and dads) need is reassurance and support to have the best birth possible as defined by them.