Creating a birth plan

Can you plan a birth? Probably not – after all, birth like life can be unpredictable and there are no guarantees about what will happen on the day – or night!

But I do believe that you can educate yourself about the most common decisions that have to be made during labour in advance, and that for many people – me especially – knowing that you have done the research beforehand will allow you to make an informed decision on the day, if you encounter one of the common labour situations.

Now that my due date is starting to loom for this baby, I figure it’s time to start thinking about my birth plan this time around. And what better place to start than by examining my first birth plan and then deciding what I’d like to change.

So here it is – the birth plan I prepared before Little Man was born, with notes about how it played out in reality and some thoughts about any changes I hope to make.

Overview
This document lists our birth preferences in the case of an “ideal” labour. It is not meant to be rigid. We are happy to change it, after discussion with you, if there are problems with my labour.
Labour
• I wish to be able to move around and change position at will throughout labour.
(There were times during my labour when this happened and times when it didn’t. I hated those times when I wasn’t allowed to move around – like the 20 minutes I spent on the trace. I’d really like to avoid that this time around.)
• I would like to labour in water (bath or shower) for as long as possible.
(This wasn’t an option as they didn’t have a free bath available for me. The midwife led unit I’m attending this time has a pool in it though, so I intend to take full advantage of that!)
• I would prefer to keep the number of vaginal exams to a minimum.
(This wasn’t an issue. If anything I was wishing they would examine me more because I was keen to know how I was doing. The midwife talked me into waiting though because she was worried that if I found out I wasn’t progressing I’d start to doubt myself. )
• I also request that the least invasive or restricting versions of procedures (i.e. walking epidural, external monitor) be used.
(I didn’t really get my wish here. See the next section on monitoring. )

Monitoring
• I do not wish to have continuous foetal monitoring unless it is required by the condition of my baby.
(They couldn’t track Little Man’s heart properly, so they ended up putting a monitor in his scalp during labour – I would have preferred if this didn’t happen, but I accept that it was necessary at the time. Mainly I agreed to it because they said that if I did then I’d be free to change position again and I was desperate to move. I felt my first pangs of maternal guilt when I saw the cut on his scalp afterwards though. I’d like to think I’d question the necessity more this time around, but the truth is that I NEEDED to move when the internal monitor was suggested and all I really heard was “if you do this, you can move.” )

Labour Augmentation/Induction
• I do not wish to have the amniotic membrane ruptured artificially unless signs of foetal distress require internal monitoring.
(My waters broke when I started pushing, so I got my wish here. But I remember at one point – which I now realise was near the end – the pressure was so strong I was really considering asking to have my waters broken in the hopes that it would ease the pressure. I think that was wishful thinking on my part though. The real issue was the baby’s head – not the bulging sack of waters!)
• I would prefer to be allowed to try changing position and use acupressure to augment labour before labour augmenting drugs are administered.
(This was never an issue as I went into labour naturally. )

Pain Relief
• I would like to try relaxation, breathing, and acupressure techniques for as long as possible; then gas and air, and an epidural in that order, if needed.
(This worked out exactly as I’d hoped – acupressure was fantastic. I tried gas and air around the time I was getting ready to push but I didn’t like it and quickly abandoned it. I never got to the point of needing an epi. And this time around, because I’m attending a midwife led unit, there is no epidural option, but that doesn’t worry me. Hopefully the pool will help instead. )
• I do not want any kind of anaesthesia offered to me during labour, though I would like it available if I specifically request it.
(This is one thing I would change if I could – one midwife was really annoying me by asking what seemed like every five minutes what would I like for pain relief, even though I said I’d ask if I wanted anything. Part of me wishes I had shown HER the birth plan. But she seemed very young, and in hindsight I wonder if she was just nervous or at a loss for what else to do or say to me.)
• I will want local anesthesia for repair of tears or of episiotomy.
(This was the first thing I asked about when the doctor mentioned I had a second degree tear and would need stitches. I ended up getting a local anaesthetic and then making liberal use of gas and air while getting stitched. Shiver. This does not form part of my positive memories of giving birth!)

Episiotomy
• I would prefer not to have an episiotomy unless absolutely required for the baby’s safety. (This wasn’t an issue last time and hopefully won’t be this time!. )

Caesarean
• If it is determined that a Caesarean delivery is required, my baby should be given to my husband immediately after birth, providing it is not in distress.
(Again not an issue last time thankfully. )

Delivery
• Even if I am fully dilated, and assuming my baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
(I was feeling the urge to push long before the midwife agreed to check me and determined I was at 10cm. This time around we’ll have to see how it goes.)
• I would like to have my baby placed on my stomach/chest immediately after delivery.
(This happened. If I need stitches again,
I’m considering asking Charlie to do skin to skin with the baby while I get stitched. Last time I felt really out of it on gas and air while the doctor was working on me and afterwards I just wasn’t sure it had been such a good idea to have me holding the baby!)

After Delivery
• I would like the cord to be allowed to finish pulsating before it is clamped or cut.
(I was asked about this without prompting, and this happened. And apparently it’s policy to leave the cord finish pulsating in the MLU. )
• My husband does NOT wish to cut the cord, so we request that the midwife or doctor does this once it has finished pulsating.
(The midwife/doctor cut the cord. I’m fine with that again this time around. )
• I want to deliver the placenta naturally and without the aid of drugs, unless absolutely necessary.
(I was bleeding, so they advised I get the injection and I agreed. I’ll take the same wait and see approach this time. )
• If possible, I wish to hold my baby whilst I deliver the placenta and whilst any tears are being seen to.
(As I mentioned above, I did this, but then I got really out of it on gas and air while I was being stitched, and in hindsight, I’m not sure how safe Little Man was in my arms!!)

Breastfeeding
• I intend to breastfeed my baby and would like to do so within 30 minutes of my baby’s birth.
(This didn’t happen because Little Man fell asleep straight away, and it was 2 days before he latched… I will be doing everything in my power to avoid that this time around. )
• Unless medically necessary, I do not wish to have any bottles given to my baby (including glucose water or plain water). I do not want my baby to be given a soother.
(I had to give formula from a bottle after 8 hours because Little Man’s blood sugars had gone so low because he wouldn’t feed. No other alternatives were offered such as pumping or syringe or cup feeding. I wish I had known more at the time rather than agreeing to this, because it was a long time before he latched properly, and I don’t know if nipple confusion had anything to do with it. If supplementary feeding is required this time, I’ll be insisting on an alternative to a bottle. )

Quite a list. It’s interesting to contrast my “plan” and the reality, and it’s more interesting to look back now and see how my thoughts on how Little Man’s birth played out have changed over the past few years as I’ve learned more and grown in confidence as a mother also. One thing that I didn’t even consider for my birth plan last time, but I am thinking about this time is the delivery itself. I remember being asked if I wanted to touch the head while I was starting to push and I squeamishly said no. This time around, depending on what position I’m in giving birth, I have half a notion that I’d like to catch my daughter myself. It’s just an idea I’m playing around with. It’s something I’ve seen done in numerous positive birth videos, so I know it’s very possible. I don’t think it’s anything I’ll formally add to my birth plan, but I may see what happens on the day/night and decide then.

I’d love to hear from any of you who had a birth plan on your first or subsequent children. What did you include in it? Was it a plan as such or a list of preferences? Did you follow it when you went into labour or did it get thrown to one side? And was there anything you didn’t include in it that you would for a future birth?