"There's no point in writing a birth plan, I'll just go with the flow."
"I'll only be disappointed when things don't go perfectly."
"No one ever reads it anyway."
These are comments I hear frequently when the subject of birth plans comes up and I want to set the record straight.
- Birth plans are not about planning a perfect birth, and are not setting you up to fail.
- Going with the flow doesn't work if you haven't researched your options and have enough information to make an informed decision. It is important to be flexible, but not to blindly allow other people to lead you down a path which may or may not be appropriate for you.
- The process of researching and writing the birth plan is as important as having anyone else read it. It is important that you and your birth partner/doula are aware of your birth plan and can pass on the information to the midwife or other professionals involved in your care. You can put a copy in your notes and discuss it with your midwife at one of your routine appointments and then explain the key points to the people you deal with during the birth.
So now you have (hopefully) decided that a birth plan is a good idea(!), here are my top tips of what to include:
Pain Relief - Find out what pain relief would be available to you. Understand the benefits and risks of the different types of drugs available. If you would like to try to avoid drugs then think about using hypnobirthing techniques, a birth pool, a tens machine, massage of your lower back from your birth partner (I recommend all 4!)
BIrth position - There are many benefits to an active birth so think about the different positions you can use during birth (I teach lots to couples on my course)
Monitoring - Continuous foetal monitoring (STUDY LINKED TO BY SARA WICKHAM). It can restrict your movements and has not been proven to improve outcomes for mum or baby so question whether you would be happy with this.
Students - especially relevant here in Cardiff as our hospital is a teaching hospital. Are you happy with students to attend? Would you prefer to limit the number of people who attend?
Birth pool - Is there a pool available in your desired place of birth? What are the chances it will be available? If you need to hire one for a home birth you should research availability and prices now. If you are hiring a doula they often provide one as part of their package.
Place of birth - Have you considered all your options? Did you know that you have the right to give birth at home even if it isn't advised? Hospital procedures are based on a population risk and are not specific to your situation. Understand your own personal risk factors and how place of birth can affect this.
Sweeps - A routine procedure often performed on or around your due date and in the subsequent appointments. It is a form of intervention and so you should ensure you understand the procedure and what the purpose of it is. It is entirely your decision as to whether you accept a sweep so don't feel pressured into it, and if your body isn't ready to go into labour, a sweep won't help.
Artificial rupture of the membranes (breaking your waters) - This is performed occasionally to induce or speed up labour. It introduces a risk of infection into the uterus and can lead to further intervention. Discuss the risks and benefits before agreeing to this course of action.
Vaginal examinations - These introduce a risk of infection into the uterus, and can make mum feel tense, interrupting the natural flow of labour. You may wish to reduce the amount of examinations you have, or you may be happy to have them as and when the midwife suggests.
Induction - Did you know that you don't have to be induced at 42 weeks? An alternative would be to have regular monitoring to check on the health of the baby and the placenta. Consider how arbitrary your due date is and understand the risks and benefits of both induction and waiting it out.
Things to have available during labour - music-will you take your own speakers/headphones. Do you want your birthing ball? Things to make you comfortable.
Delivery of the placenta - it is standard for women to be injected with artificial oxytocin to assist with the delivery of the placenta. The alternative is to allow your body to do it naturally. Understand the benefits and risks of a managed 3rd stage.
Interventions - Would you accept the use of forceps or ventouse, both of which carry a significant likihood of an episiotomy.
Skin to skin - It is really important for mum and baby to have as much uninterrupted skin to skin time as possible after the birth. This improves bonding, increases oxytocin levels which will help with the delivery of the placenta, assist with the uterus shrinking back to its original size, reduce blood loss, facilitate breastfeeding.....the benefits are endless! If mum is unable to have skin to skin with baby for whatever reason, then next best is dad.
Delayed cord clamping - this is when the cord isn't cut until it has stopped pulsating, and all the blood has passed back to the baby. It is now standard practice in most areas and has numerous benefits for baby. Even if your baby is born by Caesearean, it is usually still possible to allow the cord to go white before cutting it.
Vitamin K - Are you happy for baby to be given the vitamin K injection? Did you know it is also available orally? Do you understand why it is routinely given?
There is a final tool I would like to make you aware of, and that is your brain :) I always teach the birth partner this as it helps them to remember if they are in a situation where they are being asked to make a decision during the birth:
B - Benefits What are the benefits of the proposed intervention
R - Risks What are the risks of the proposed intervention (often you are only told the benefits)
A - Alternatives What are our alternatives? (often you are led to believe there is only one option when you may feel an alternative is better for your situation.
I - Instincts Trust your body and your instincts, what is your body telling you?
N - Nothing What happens if we do nothing/wait another 30 mins? If there is no immediate danger this can give you time to try a different position, try and increase oxytocin production or to have a discussion about the alternatives in a calm manner.