Writing Your Birth Plan
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Getting ready to write your birth plan
Women preparing for giving birth do so in a variety of ways. Some choose to approach it intuitively, feeling that nature and instinct will be all the guides they needs as they approach labour. Others arm themselves with a mountain of information through book and website research. And yet others talk the event through with their partners, their own mums, friends, anyone, in fact, who will share their birth story. And of course there are the professional perspectives to be gained by going through your thoughts with your midwife or antenatal class leader. We'd like to suggest that all of these routes to birth preparation are legitimate, and that you may benefit from actually pursuing all four courses of action. Feel what is right for you, research to gain informed perspectives, discuss to hear all the angles, and attend to the views of the medical professionals who have seen hundreds of babies into this world.
What a birth plan will do for you
Ultimately a birth plan will give you a sense of clarity around your impending labour. It is empowering to know that you have made choices and decisions. It may increase your confidence as the event approaches, and help you to focus in on what matters to you. Your birth plan will be your voice during those times in labour where communicating feels otherwise impossible!
What to include in your plan
As a minimum, make sure your birth plan makes reference to the eight topics listed below.
- Where you want to be. Do you want a home birth, or to be in hospital? Prior to the advent of the NHS most babies were born at home, and politicians repeatedly talk about giving women genuine choices around home births. In reality, midwife shortages may be a factor in your area, or you may live very rurally (thus making it difficult to get help if things don't go to plan). You really need to discuss this option with your medical team. You may feel that you'd like the calmness of a home birth, but to know that a hospital is not far away should events take a difficult turn. Or you may feel comforted by the prospect of being in hospital right from the start of your labour. Be aware that many maternity units do send women home again if they arrive 'too early' in the hospital and things progress slowly. This can be frustrating, so again, discuss the issue with your midwife or antenatal class leader.
- Who you want with you. The natural choice for many women is their partner, while others choose their own mothers or sisters, or a doula. Include details in your plan of whether you will appreciate efforts on the part of the medical team to keep the room as quiet and people-free as possible.
- What sorts of pain relief you might want to use. Your antenatal classes should give you ample information about the wide variety of pain relief options on offer to you. In maternity units your choices will generally range from simple gas and air, through pethadine and other drugs, to epidurals, which are administered by an anaesthetist directly into the spinal cord. Keep your mind open, but learn about the possible effects of these drugs on your baby and consider your choices carefully.
- What other 'aids' to labour you want to employ. Conventional drugs are not your only option when it comes to finding relief during labour. Increasingly women are using a range of other methods for getting themselves through the tougher moments. Find out about relaxation and hypnotherapy techniques, tens machines, birthing balls and beanbags, massage, homeopathy and the use of water (in a birthing pool or bath); they all have something to offer the labouring woman. Your birthing partner can also be a real help when it comes to the management of pain, as the presence of another who follows a supportive 'script' is psychologically very soothing. You can discuss with them beforehand the kinds of things you'd like them to say to you if you are struggling.
- Which positions you'd like to use as you labour. There is a plethora of information out there about positions for labour. We only started lying on our backs on beds a relatively short time ago, in response to one of the King Louis' of France wanting to see his wife give birth, or so goes the urban myth! Do your homework and talk to others about what worked for them. Remember, harnessing the power of gravity is not to be sniffed at! You may find you want to respond to the different stages of labour with a variety of positions and aids, and it is perfectly acceptable for you to note these differences in your birth plan. Bear in mind that if a level of intervention becomes necessary, or you have an epidural, your movement will be restricted. This does not mean you have to feel disempowered; the mind is a powerful tool and can help you achieve the levels of calm and relaxation you seek even if you are being told how and where to lie.
- How you want your baby monitored. The medical team taking care of you as you labour will have a range of approaches to monitoring your baby. They need to make sure that your child is not becoming distressed, particularly if your labour is long and slow to progress. There are handheld devices that can be pressed on to your abdomen to hear the baby's heart rate, and others than can be strapped on to give a more constant feedback. Others still are attached to the scalp of your baby, and these tend to be used when there is an increased possibility of your baby becoming distressed. There is no lasting harm done to your child by the use of these devices, but the sound of your baby's heartbeat amplified in your delivery room can be unnerving, especially if the rate is altering as the baby endures strong contractions. Listen to what the medical team advise and keep calm, though this is possibly easier said than done.
- What action you want taken if problems arise. While having a clear, focussed idea of how you would like your labour to progress is a positive thing, it is wise to be accepting that it may not go to plan. Make sure your birth plan makes reference to the kinds of measures you are willing to accede to, such as an epidural, induction, forceps, ventouse, episiotomy and 'managed' third stage (where a drug is administered to precipitate the placenta's removal). You should also consider who you want present if you are advised to have an emergency caesarean, and whether you'd like to be awake or anaesthetised for this procedure.
- What you want to happen once your baby is born. The majority opinion is that as soon as your baby is delivered, skin-to- skin contact with you is the best way forward. You may have a view on who cuts the cord or who else can hold your baby. The team caring for you both will want to check your baby's vitals, but they are generally skilled in getting their job done without hindering your first moments together too much. Consider whether you plan to breast feed or bottle fed your baby, and indicate your plans so that the team supporting you can help you latch, or prepare a feed for your child. You will also be asked if you want a Vitamin K shot administered to your child. New-borns have a reduced blood-clotting capacity, and Vitamin K is thought to alleviate this. There is also a possible link between Vitamin K deficiency and childhood leukaemia.
Finally, keep your birth plan short, simple and easy to understand, and make your language assertive and clear. If you find expressing yourself through written words, get someone to work with you on it. The midwife or doctor caring for you will be reading it alongside absorbing a lot of other information, and will appreciate being able to speedily digest its content.
What to do with your birth plan
In short, the answer to this question is; 'Share it!' Make sure an up to date copy is kept by your home phone, with your birthing partner, your midwife and in your hospital notes. Make sure you are familiar with it too, as it can be much harder to think - or read - during the intensity of contractions.
Beyond your birth plan
As a generation of mothers, modern mums are, it seems, less inclined than previous generations to accept the unpredictability of labour, birth and caring for a baby. We are so used to running our lives with efficiency and clockwork precision that the patience and stoicism required for a long labour are 'unused muscles' for us, and it's hard to adapt. You will help yourself considerably if you think on this issue during your pregnancy, and prepare yourself somehow for the unexpected. Practice going with the flow; it will be good preparation for when your child is finally here!