Birth Plans - to write or not to write?

by Sarah Bernstone

To write, or not to write, that was the question.  At first it seemed obvious; this was all part of the antenatal process.   It was talked about in all the books and at all the classes (we attended NHS and Active Birth as our local NCT groups were heavily over subscribed), and it was clearly the ‘Done Thing’ to write a ‘Birth Plan’.

But wait a minute, then there were the articles in commercial magazines telling you on the one hand, Birth Plans were useful, but on the other hand giving countless experiences of mothers who had abandoned every last plan for drug free childbirth the moment the contractions hit home: "Give me drugs, give me total sensory deprivation and back up drugs" as Edina Monsoon yelled in Ab Fab!  Or mothers who had been in such a flurry that they never even looked at the plans and felt chastised by them afterwards as they felt they had somehow failed to live up to their own expectations of themselves and childbirth.  Talking to other mums at work many of them were dismissive of the value of birth plans too.

So what to do?  Would I be setting myself up for a fall with my positive birth plan, or should I simply venture off into the unknown without a ‘map’ and hope for the best?

Well, being Mrs Organised (in those days anyway) I sat down at the PC and typed up a long plan with a hundred and one provisos, and boy, am I glad I did!  With the help of the NCT book, Sheila Kitzinger's guidance, and input from both sets of antenatal classes, I put together a plan which covered all options at all stages:

• Pre-labour & induction
• Early stages of labour
• Later stages of labour
• Transition & delivery
• Third stage & post delivery

Within these areas I planned my ideal scenario - natural methods with no medical intervention - breathing, movement, aromatherapy, massage, water etc - and then acknowledged that things may not go to plan.  In these secondary scenarios I planned what courses of action I was prepared to take if intervention were required - Tens, gas & air, epidural (but NOT pethidine) - and how I would like things to happen if a Caesarean became necessary.

In the event, at three weeks overdue, having tried all the usual methods of self-induction (hot bath, sex, massage, reflexology) and a few others besides (bouncing on a trampette was recommended by one midwife!) I had to go into hospital for my induction and my plan swung into action.  After two pessaries and 12 hours I was about 2cm dilated. 

Having given that my best shot, we were happy for the midwife to break my waters to speed things up.  I managed 2½ hours of movement and breathing to cope with the intense contractions which resulted (as well as wearing the Tens machine), before caving in and screaming for an epidural!  Having read my plan, the midwife offered me entonox as an interim solution, but I didn't like that & was still determined to go for the epidural.  An examination once that was in place showed a mere 4.5cm dilation, so I was glad I had made the decision.  Eventually, 18 hours later, and 35 hours after the first pessary, the surgeon recommended a Caesarean. We asked for 10 minutes alone to consider this, then half an hour later our beautiful baby daughter, Ella Phoebe, was born by Caesarean Section. 

The best thing about my birth plan was that even though things did not ever reach my ideal scenario, we always felt in control as we had planned for all the "what if's…" and the hospital had followed our requests.  My top tips for all new mums-to-be are:

• do make a birth plan
• consider all scenarios and plan for them
• share your birth plan with your antenatal team in advance
• ‘learn’ it in case there is no time to refer to it specifically on the day
• revisit it afterwards and congratulate yourself on such great planning and execution!

Remember, birth can be an exciting or harrowing event - but if your planning is in place, you have the power to feel confident and in control, which is the key to a positive childbirth experience.

Any plans for your birth….?

Sourced from Sarah’s Active Birth class notes and Mother & Baby 2000

Planning your birth starts the moment you find the thin blue line on the pregnancy test – do you want home or hospital?  Which hospital?  Water or not?  Drugs or alternative therapies?  Natural or caesarean?  Many of your early thoughts may change through the coming months, but then plans should always be flexible.

Your birth plan can be written or memorised, a short note, a form from the hospital or a list of your priorities.  The most important thing is to say that you and your partner should be consulted and remain informed at all times – whatever else you decide to include is entirely up to you.

The best time to pull together a formal plan is after your antenatal classes (NHS or NCT or both) when you have had time to discuss and learn about all the options open to you – but preferably at least a month prior to your estimated due date or else you might just run out of time!

When you have formulated your plan, make sure you discuss this with your midwife or consultant, that your plan is practical and that you have planned for all contingencies.

Here are some things you may like to consider when drafting your plan:

Induction & Acceleration – when, why, how soon and what methods?  

Early labour – at home?  Midwife in attendance?  When to go into hospital?  

In hospital – how many people can attend?  Do you want your partner, sister, mum, a friend, a doula?  Are you happy to be observed by medical students?  Privacy?  

Environment – what are in the rooms already – beanbags, balls, birthing pools, cushions, private toilet/bath/shower etc?  Can you bring in your own props?  Are candles allowed, aromatherapy, music?  Do they allow homoeopathy, hypnotherapy, acupuncture, massage?

Mobility & position – do they expect you to lie still and be monitored constant  Can you use a birthing stool?  Give birth in a pool?  
ly, or can you move, stand, squat, lean over?

Monitoring – how often and how long?  Belt monitoring or internal monitoring? Can vaginal examinations be kept to a minimum?  Will they check your dilation before administering drugs or an epidural (at 8cm the pain may be unbearable but you will probably be on stage 2 before the drugs kick in, so it may be best to hang on in there)?

Food & Drink – what can you bring?  What is available – think of your partner too!  What is allowed?  

Pain relief – what is your order of preference – Tens, entonox then epidural?  Is there anything you want to avoid?  If you prefer to try not to use drugs, you can ask the hospital not to offer them but to have them available in case you ask for them.

Second & Third stage – are there time limits – can you negotiate longer times before intervention?  How long would you like?  Are episiotomies routine or is tearing accepted?  Is syntometrine routinely given?  What positions would you prefer to try/are you allowed?  Can your partner cut the cord?  Can you look at or even keep the placenta?  Who stitches up the perineum and how experienced are they – hold out for the best!

Intervention – forceps?  Ventouse?  Caesarean Section?  Epidural or general anaesthetic (GA)?  Can your partner attend?  If you have a GA, can your partner look after the baby until you come round?  If possible, parents should have time to discuss any interventions alone and may request more time to decide.

Baby – will it be delivered onto your stomach or taken away and cleaned & wrapped?  Which would you prefer?  Can you find out the sex before they announce it?  Can the baby stay with mother, or father if mother needs treatment?  Breastfeeding straight away?

Intensive Care – can you breastfeed or express?  Can you get a bed nearby?  Can your partner stay?

Feeding – is there full breastfeeding support?  Are milk or water ever given without asking – if you are concerned you can put a notice on the crib: ‘mother’s breastmilk only’.

Night time – do you want the baby in your bed, a crib or in a nursery so you can rest?  What nursing/midwife cover is available overnight?

Whatever you do, make sure your birth plan shows not only your ideal choices, but in the event that things do not go to plan, ensure that you have covered all other options.  This way, if you end up having a less than perfect birth, you can still feel informed and more in control.  In the words of Chris Salvage, midwife, “Being flexible in the initial approach will help alleviate any feelings of disappointment afterwards.”  She also recommends a full debriefing with your midwife afterwards to discuss what happened and why.  Read your delivery notes, ask lots of questions and ensure you understand your own personal experience.

Did you write a birth plan? Did it go to plan? Do you have any advice on writing birth plans? Let us know by commenting below:

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