If there is one phrase I hate hearing it is this: “And then the birth plan went out the window”.
I have to say it is not usually uttered by MY clients because my clients don’t write birth plans – they write birth PREFERENCES . The idea that you can plan birth is misleading. You cannot predict exactly what will happen; you can, however, prepare for eventualities, educate yourself about choices, and, yes, you CAN take some decisions in advance.
A birth preferences sheet – I prefer this term to the more old-fashioned “birth plan” since birth can sometimes be a series of crossroads at which the woman needs to choose one road or another – should communicate everything to the medical personnel that they need to know about you in order to care for you appropriately. A well-written birth preferences sheet takes account of variables and offers alternatives, and also lets the people reading it know what kind of a person the mother is. It also helps your partner feel completely informed about what you want.
ABOUT THE BIRTH PREFERENCES TEMPLATE
This template is appropriate for most UK mothers-to-be. My aim is to help you focus before the birth on the choices you will have, and to communicate those choices when you won’t be able to, or won’t feel like communicating. It is extremely helpful to take as many decisions as possible in advance of your labour – the process itself encourages you to research issues early on instead of feeling bounced into decisions on the day. Keep your decisions realistic but think positive as well: do not fall into the trap of expecting the worst.
Most hospitals I have come across include a birth plan form in the mother’s handheld notes. Whether you use this form or a template like mine, discuss your choices and options with one of your midwife team or medical team in advance – at least a month before your baby is due.
A clear, informative birth plan can help you to feel more in control of things but if you are very rigid in your demands, you may risk having that “birth plan flying out of the window” feeling – a sense of complete loss of control. On the other hand, a birth plan which stresses that you have “an open mind” about, for example, pain relief, is one which hands over too much control to other people. Think about the fine line between having an open mind and being a pushover.
As it is now, my free downloadable birth preferences template stretches over several pages. Each section is made up of suggested options. Once you have deleted all the options you don’t want, it should take up no more than 2 sides of A4 in clear, concise, unambiguous bullet points. That is as much as anyone can read in dim light at 3am!
Once you have got your birth preferences the way you want it make several copies. Have one in your handbag, make sure your partner is carrying one – and at least a couple with your maternity notes.
A good birth preferences list should include the following information:
Who I am
Who is with me (and how to reach them in an emergency)
Preferred place of birth
In the UK, here are the different environments in which most women choose to give birth:
- Hospital labour ward
- Midwife-led birth centre
- Free-standing midwife-led birth centre
- Home with NHS midwife
- Home with independent midwife
- Room with a birth pool in either home or hospital or birth centre.
What I would like you to know about me
Think of two sentences which answer these questions:
- Apart from the obvious fact that you are having a baby, what one thing would you most of all like your midwife to know about you?
- The midwife has the job of being your new best friend. How can you get that relationship off to a good start?
Previous birth or births
If you’ve had a baby or babies before, there may be aspects of that experience you want to keep and others you don’t want to repeat. Say so here! For example: “Last time I had an epidural at 3cm and ended up with a ventouse delivery. I would like to avoid that situation this time.”
An environment that feels safe and familiar boosts oxytocin levels and reduces adrenaline. A dim, quiet room where the mother feels safe and private will make labour work more EFFICIENTLY than a noisy, over-lit room. Wanting a calm, unstimulating environment is not being fussy – it just shows you know how labour works!
Induction and if labour stalls:
Would you be happy to have assistance from invasive procedures (e.g. breaking your waters) if labour stalls? Or would you rather be left for a while with your partner to enjoy a quiet cuddle – which is likely to get things moving again? How do you feel about induction?
Keeping upright and mobile helps labour move forward but you will need rest as well. Many couples do not get as much support and advice on movements, positions, breathing techniques as they could have yet midwives often know a great deal about these things. Unlock her wisdom! Try including a sentence such as “I would welcome your advice on mobilising and coping naturally with labour”
Coping with pain
Whether you are an all-Hypnobirthing or a straight-to-epidural girl, you are likely to feel more empowered if you make it clear to medical professionals that you do not need to be OFFERED drugs for pain relief. Being offered drugs can feel demoralising and undermining. So find out what the hospital has to offer first. Then add a sentence to your birth plan such as:
Please do not offer me pain relief. I am fully aware of the options available. Please do not inform me of them when I am in labour. I WILL ask for what I want, when I want it.
Now think about how you are going to cope with labour. List the methods you will be using in the order you will bring them into play, and delete the ones you don’t like: for example:
- TENS machine. This works best if applied from very early labour.
- Hypnobirthing techniques. If you have done a hypnobirthing programme you should start using your breathing and relaxation as soon as you feel the first contractions/surges.
- Movement and Massage from your partner or birth companion – practice “figure of eight” and hip rotation movements, also any massage techniques, before you go into labour.
- Warm water – a shower, a bath, a birth pool (most maternity units with pools recommend not getting in before 5cm dilated
- Entonox (“gas and air”)
- Diamorphine/pethidine – talk to your midwife beforehand about these and ask about effects on baby.
- Water injections, spinal block
- Epidural anaesthesia
- General anaesthetic – Extremely rarely used, for very urgent caesarean births.
You are entitled to decline vaginal examinations if you wish. You are also entitled to request more than the standard “one every four hours”.
It is no longer standard for women to be “put on the monitor” for 20 minutes on arrival at hospital. Monitoring makes it difficult to move about. If you don’t want electronic fetal monitoring, say so. Intermittent monitoring with a handheld machine is adequate in most cases.
Accepting interventions is your decision – but on the other hand, most of us feel that if a doctor recommends an intervention it must be the thing to do. Of course, this would be the case if your baby’s life was clearly in danger. But many women have been offered interventions and turned them down with no ill effects so do not feel inhibited about asking the “BRAINS” questions when it comes to interventions:
What are the B enefits of this intervention?
What might be the R isks?
What are the A lternatives?
What does your I ntuition tell you – your own, the midwife’s – could happen here?
Is anything bad going to happen over the next hour if we just do N othing?
(And S mile as you ask your assertive questions. It helps!)
If you wish to recommend an intervention, please discuss it with us and allow us to consider our decision alone.
Preferred delivery positions
Many hospitals (you may have seen them on the TV!) still get women to deliver their babies lying on their backs. An upright, forward-leaning position is far more conducive to a straightforward birth. Try some positions out before you go into labour and decide for yourself what you could manage.
After the baby is born
Do you want your baby washed/wiped first or not? Wrapped or skin-to-skin? Handed to you or to partner first? Who is to say what sex the baby is – you, partner, anyone else?
An injection to help uterus contract – or would you prefer to let uterus contract in its own time, allowing full supply of blood to go to baby through umbilical cord? Or would you prefer a “mixed managed 3rd stage – with the injection administered after the cord has finished pulsating? Studies show that waiting at least three minutes before clamping the umbilical cord improves a baby’s iron levels.
Who is to cut cord?
Operating theatre and emergency caesarean
Some decisions you can take right now might include:
- Screen up/screen down
- Partner to accompany mum at all times
- Partner to be with baby at all times
- Skin to skin contact if possible
- Music on during operation
- Absence of trivial conversation while baby being born
Oral/Injection/not at all?
Yes or no? If yes, do you want to try as soon after birth as possible (this helps the placenta come out)?
Add your own “thanks” at the end of your birth preferences. It never hurts to say thank you, even though it’s you who is doing all the work!