Friday, 11 February 2011

The birth plan

When I was writing my birth plan, the biggest problem I had was knowing what kind of things to put. Of course theres obvious things like, I'd like a water birth, I don't want pain relief etc etc, but theres so many little subtle things that you might not think about until the actual day, or even afterwards, as hindsight is a wonderful thing. I was very fortunate in that we were given an excellent template to work from on our Mindful Mama course, and after talking to friends/family family and hearing all sorts of stories and 'I wish I'd known' I felt like I was in a good position to write something I felt comfortable with. Being a researcher, I had of course read loads of books and blogs, research articles and studies, forums, websites etc. You name it, I'd read it. When I sat down to write my birth plan I felt like I knew everything a person could possibly know about labour and birth without actually having gone through it.

In this blog, I'm going to share my birth plan with you, so those of you who are interested can see what one looks like, and the kind of things you might want to include. For some of the points, I'll explain why I made that decision, or why I decided to include that particular thing. The most important thing I can say though, is that this is the ideal. This is the perfect vision of birth I have in my mind and I completely accept that it might not go quite to plan so I've tried to reflect that in some of the statements that I make. The most common piece of advice I've had from every woman who's been through the birth process is to keep an open mind, and be aware of every eventuality - I think that's probably why I've read so much so I'm prepared for everything that could happen!! So, here goes...

We will be using self-hypnosis and relaxation techniques throughout labour.

I think I've probably covered why this is important to me in previous blogs. I will add that this decision was partly based on a wonderful book called 'Childbirth without fear' by Grantley Dick-Read and also on the 'facts' about birth I've learned as part of the Mindful Mama course and during my pregnancy.

We would like a natural birth and would appreciate a quiet, calm and dimly lit environment.

From the moment I found out I was pregnant, I knew that I didn't want pain relief. The idea of drugging myself up and being out of control never sat right with me, and the more I've learned and understood about birth, the more firmly I stand by this decision. This is why it was important for me to have a home birth, because I will be in an environment where I feel safe, comfortable and relaxed as opposed to one which is sterile, full of medical equipment and where I can hear other women going through the same thing. Having a natural birth enables me to remain in control of the process and to be able to experience every good and bad bit. Having a baby is such a life changing thing, and after 9 months of feeling every movement, every discomfort, every wriggle, every hiccup, why would I want to detach myself from feeling my baby being born?

In the event of a medical circumstance arising, you will have our full cooperation subject to having discussed things.

I felt it was really important to include this - at no point during my labour do I want decisions being taken out of our hands. We've spent a long time looking forward to this moment and although we hope nothing adverse happens, we acknowledge it is a possibility and would want to be involved in any conversations or decisions. This isn't because we don't trust that the midwives know what they're doing, its more to do with how we understand the process of birth and how our feeling may differ from those of the midwife. Rather than being told 'this is whats happening' its important for us to be treated as equals, after all, its our baby - and the evidence has proven that following an 'intervention' its likely more will follow. Interventions include things like, giving drugs to speed up labour, having a sweep or your waters broken, administering pain relief, using forceps, electronically monitoring the baby and of course, c-sections.

Throughout all stages of labour:

- I would like the lights to be kept low, the room quiet and plan to use a birthing pool.

Keeping the room dark and quiet will help me remain relaxed and focused on whats happening to my body. Ideally, only one other person will be in the room at any one time and thats purely to check I'm ok. Using water during birth has been proven to help with pain management, reduces the length of labour and the liklihood of tearing or needing an episiotomy (where they cut you to help the baby come out). Babies born in water have higher Apgar scores after birth and are often more placid, relaxed babies due to the fact they've had a relaxed entry into the world.

- Please address any questions or issues to my partner in the first instance with conversations taking place away from the birthing room where possible.

This is so I don't need to be distracted. I've given the midwife permission to check my pulse and blood pressure when she needs to, and to use a hand held sonic aid (with the sound off) to monitor the babys heartbeat when necessary. This means that if He wants to know how things are progressing, or the midwife has any concerns, I don't need to know and I can concentrate on birthing my baby.

- Anything not natural, we would prefer not to have (No electronic foetal monitoring, no internal examinations unless requested, no pethedine or synotocinon, no gas and air unless requested, no breaking waters and no time pressures)

These interventions are very common during labour. Quite often midwives will say 'oh its been 4 hours, not much is happening, maybe we should try and speed things up' which often has a negative impact on the womans frame of mind. I don't care how long it takes, I don't want anyone telling me it needs to be quicker - my baby will take as long as it takes to be born, thats the way it should be. Administering drugs to speed up the process often interfere with natural hormones that are produced during labour which could actually slow things down, or distress the baby. See my previous blog on internal examinations to see why I don't think this is necessary.

- I would prefer not to be offered pain relief at any time (even if I am transferred to hospital for any reason)

When a woman is in labour, her body produces oxytocin exponentially and this has an anaesthetic effect on the body. Administering pain relief stops this happening. Pethedin, the most common drug given, makes the baby drowsy, makes mum sick and prone to hallucinating and can slow labour down. The uterus is designed to contract in a way that will naturally push the baby out - administering pain relief numbs the muscles stopping them from working properly, inevitably making labour longer and it more likely for stronger drugs to be needed, or a c-section.

- As long as all is well, we are happy to wait and would prefer no inferences based on the passing of time.

- There is no need to ask permission to listen to the babys heartbeat

- In the event of an internal examination, I would prefer not to know the outcome.

In the second stage:

- please allow a passive hour to enable me to stay relaxed and listen to my bodys cues as to when to help the baby out.

During labour, it is really common for it to look like everything has stopped. This usually occurs in the 'transition phase' when the cervix is fully dilated and the 'pushing' begins. It's normal for it to appear that everything has stopped - this phase allows mum to rest and regain her strength and enables baby to move itself into the right position to be born. Too often, this is the stage when the forceps are brought out, or mum is encouraged to start pushing which inevitably won't work because her and baby aren't ready. It's very common for baby's heartbeat to dip slightly, as its resting too, but this is usually seen as a sign of distress and mum is rushed off to surgery. If after an hour or so has passed, and it looks like nothing is happening we would discuss the possiblity of transfer to hospital with the midwife.

- Please no suggestions that I should push

This is partly because I don't to be 'pushed' towards trying to get the baby out before its ready, and also because I trust that my body will breathe the baby out itself and I will intuitively know when this is happening.

- I would like to receive and sex the baby myself – My partner can cut the cord if he wishes. If not, I have no preference

This is really important for me. We've spent 9 months waiting for this baby, its been growing in my tummy and I've been forming an amazing bond with it, so I want to be the first person to touch it - and we want to be the first to learn if its a boy or a girl. Both my midwives have said how lovely it is that I've put this in the birth plan because so many women just expect that its the midwifes job to 'catch' and sex the baby that they wouldn't dream of doing it themselves.

- I would like the baby delivered straight onto my chest and a towel provided, but no drying or rubbing please.

Having the baby straight onto my chest is very important in helping us to bond, and hopefully baby will want to feed straight away (which helps the uterus continue to contract to deliver the placenta) The reason I don't want the baby rubbing is so the vernix covering its skin can be absorbed by the baby helping moisturise and nourish it.

- Please allow the cord to stop pulsating before cutting.

This is so all the oxygen in the placenta can be delivered to the baby, while its lungs are still getting going.

- Please leave an hour after birth before weighing/measuring the baby

This to help me and baby to bond, and hopefully to allow a feed to take place. Once the placenta has been delivered I would be happy for the midwifes to do their checks.

Third stage:

- I would like a physiological third stage please with lights kept low and skin to skin contact maintained throughout.

Quite often, an injection is given into the thigh almost immediately after birth to help the placenta detach and be delivered. As I am having a completely natural labour, it seems counter-intuitive to then have the last stage chemically enhanced. Keeping the baby close to me, and hopefully having it feed will keep my uterus contracting and should speed up the process. If after an hour, the placenta has not been delivered, I would be happy to have the injection, as the cervix would start to close by this point, and there is a risk that the placenta may not separate properly. In many water births, it the action of getting out of the pool that causes the placenta to be delivered.

In the event of transfer to hospital, we would prefer to keep things as natural as possible with one of us remaining with the baby at all times.

Thankyou for taking the time to read this and for helping us to have the birthing experience we are hoping for.

So there, you have it, our birth plan. It looks very different to one which is based on a hospital birth, or on the assumption that pain relief would be administered. Many pregnancy books and even iphone apps have templates assuming birth will be in hospital so had I decided to do that, I would have used one of those to guide me.

Now we just need to keep our fingers crossed that everything goes to plan - tomorrow I will be 37 weeks which means we will be allowed to have our water birth at home - I can't wait!!

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