Why birth plan?
So often I hear women say 'midwife said not to bother with a birth plan' and 'what's the point when you don't know how it's going to go anyway?' and both statements terrify me! To put this into perspective, most women wouldn't just show up on their wedding day without making any preparation and it goes without saying that my child has outlasted my marriage.
I didn't make a birth plan with Judah - my birth plan was blind optimism and positivity and a denial that anything would go wrong, ever, in my home birth. Then, when I transferred to hospital due to the home birth team being at another birth, neither of my birth partners knew what I wanted. It was a good birth and birth experience. But it wasn't as I wanted. I wish now I'd had my wishes written down and understood by everybody present.
As a doula, the birth plan is my JOB DESCRIPTION. I should not deviate unless the mother changes her mind and indicates otherwise. Problems arise? Birth plan. Any issues negotiating care? Birth plan. It takes the responsibility away from the labour support and makes it clear that the birthing woman is the one calling the shots.
It's not just the physical document that is important. Though they really are, especially when a woman's wishes have been pre-arranged with a consultant and midwife and we need to make sure it all goes smoothly on the day. The fact that you've even made a birth plan shows that you are an empowered, knowledgeable woman who understands her options and that is the most important thing!
My birth plan isn't a list of things YOU personally should or shouldn't want. It's tailor-made for me, my situation, my experience and my personal assessment of my risk factors.
My Birth Plan
· I wish to birth at home in water with my partner Dom and my doula Sam. Please notify my mother to collect my son Judah.
· Should my pregnancy progress beyond 42 weeks, induction is not an option for me barring certain medical conditions (ie. obstetric cholestasis and pre-eclampsia) which we can then discuss.
· When I request midwife support please contact them. If anybody present makes me uncomfortable they may be asked to leave the house. I may prefer for them to wait in another room until needed.
· I may find blood pressure and Doppler checks intrusive and may withdraw consent at any time.
· I will be using a birth pool to labour in. Do not offer me pain relief unless I request it.
· I will consider consenting to one vaginal examination to determine baby’s position and cervical dilation if I have any concerns about the progression of my labour. Do not offer me vaginal examinations.
· Do not talk to me whilst I am experiencing a contraction.
· In the second stage do not instruct me to push.
· I wish to catch my baby myself.
· I wish to have a physiological third stage and lotus birth where cord is left intact until the placenta is delivered. Once that has occurred my partner and I will burn the cord to separate it from the placenta. Should there be any concerns about blood loss my preference is to eat a piece of the placenta. Should this not be effective we can then discuss syntometrine.
· I will be having a minimum of one hour of undisturbed skin to skin with my baby wherever I feel most comfortable, whether that is in the pool or out. Any exams will be delayed for at least an hour.
· I prefer to tear over episiotomy. In the event of any perineal trauma I would like to discuss healing naturally versus suturing.
· We are consenting to Vitamin K.
· Please take photographs of the birth.
· We are saving the placenta for encapsulation, it must be bagged and placed in clean tupperware in the fridge within half an hour after delivery.
Should there be any legitimate health concerns about myself or my baby we can discuss transfer to the hospital. I would want to transfer if there was significant blood loss during labour or concerns about baby’s heart rate. I do not wish to transfer just because labour is slow. In the event of transfer I would prefer to go to University Hospital of Wales rather than Royal Glamorgan. If transfer occurs after birth and I must travel separately from my baby I wish my doula to accompany me and my partner to accompany our baby.
After my baby is born I do not wish to be physically separated for any reason other than major resuscitation.
I will be breastfeeding my baby. If I am not available due to being in theatre I would like my doula to accompany me and my partner to have skin to skin during this time. If there are concerns about baby’s sugar level please contact my friend x who will wet nurse my baby.
In the event of caesarean section I would like the drapes lowered and immediate skin to skin. If a general anaesthetic is used I do not want photographs to be taken as this will upset me and we will have a rebirthing ceremony at home.
I've definitely come a long way since blind optimism, as you can see the plan covers a few eventualities so that my birth partners know how best to follow my wishes. It's important to have an advocate as there are some points in labour where you cannot speak, and worst case scenario where you may be unconscious or not physically present to care for your baby. The knowledge and the evidence-based information that has been used to create my plan is not apparent, but is accessible for anybody interested in their birth choices. Some things to think about...
1. Place of birth
2. Methods of pain relief (including water)
3. Methods of monitoring
4. Vaginal examinations
5. Room conditions (lighting, music etc.)
6. Language and behavior of medical staff
7. Second stage preferences (instinctual vs. directive pushing)
8. Third stage preferences (cord clamping, physiological vs. managed)
9. Vitamin K
10. First hour after birth (skin to skin and feeding preference)
11. Methods of induction - have you made a plan beyond the 'due date'?
The website Evidence Based Birth is my go-to for all things birth related!
And anything else that is significant to you. We need to give the knowledge and control back to women to make the best decisions for them and their babies, whatever those decisions are. Only then can we achieve truly empowered, positive birth.
I will be discussing this plan with both partners before the birth to make sure we are all on the same page and happy!