I'm in charge - here's my birth plan

Fail to plan - plan to fail

So do you really need a birth plan? If you are birthing in the privacy of your own home then probably not. The midwife is a visitor and should remember she is a guest. It's good to talk through your desires with her and if you feel there would be any doubt write them down.

If you are going to the hospital, then yes you definitely need a well thought out and documented plan. You can find many birth plan templates off the Internet and modify them to your requirements, however they tend to be way too formulaic and each has the failing of giving the hospital leeway to override or ignore.

Ambigious planning can lead to unexpected results.
Shock! Can you believe I did some of my midwifery training at this hospital.

So how do you avoid having your plan steamrollered? Quite simply make your plan short and sweet. Do not compromise anything and don't put in get out clauses for your practitioners. If you have any points that are ambiguous they can often be used to facilitate the policy rather than enhance the plan.

For Example.

Don't say: No VEs (vaginal examination) unless clinically required
Every 4 hours could be seen as clinically required by the institution.

Do say: No VEs
This way if you want one you can just ask and they have to discuss any issues they have if they feel one is necessary.

Don't say: No CTG (continious monitoring) unless there is an issue
They use CTGs on admission to exclude issues, even though we know it's not clinically proven.

Do say: No CTG, only intermittent monitoring (if you want that)
If there is a real issue with the baby you will soon know and can then opt for continuous monitoring if you think necessary.

Don't say: I want to be mobile through out

Do say: Move the bed from the centre of the room because it is not suitable for my needs


When you are considering your birth plan write down in dot point with your birth partner what is really important to you and then turn them into exactly how you can facilitate this.

Main points to cover:

First stage of labour - birth supporters,monitoring baby, VEs, IV infusion, mobility, environment, freedom, water.

Second stage of labour - natural pushing over coached pushing, positions for birthing, listening to baby before birth, catching baby, water.

Immediately after birth - environment, skin to skin, cord clamping.

Third stage of labour - physiological management, active management, lotus birth, keeping the placenta, prints, weighing, measuring, bathing. (All things which can wait while you get to know your baby)

It's important to spend time researching the above points. They are the main considerations for your birth and then convey them as literally as you can. I birthed with a woman who has diabetes in a prearranged hospital birth, her birth plan read like this:

• No VEs.
• No routine IV insertion.
• Do not ask me if I want pain relief.
• I will manage my own diabetes.
• All things go through my midwife.

This a pretty simplistic attitude but EVERYONE at the unit knew her wishes. We took the time to mail the birth plan in advance and then I followed it up with a visit to the unit to talk to the head midwife about how this could be facilitated. The staff on the day may not have agreed but stood by the plan. Mailing the plan into labour ward on coloured paper means the hospital have your information in advance. They always read it and if you put your phone number on there it is common for a follow up phone call from the labour ward.

Lots of women I birth with are HBAC and often chose to have a back up hospital. We use this system of posting the plan as a way of preparing. Write the plan send it off, then birth at home!


Should you make a ceasarian section plan?

It is possible to add in the event of an emergency what you would require. Things to think about are: who will be with you, skin to skin, blood tests, antibiotics, lotus birth.

You may never have thought of these things before, but in the event of your birth not being in your control you'll want to be certain that your wishes are followed. Skin to skin contact is vital after a section. If your baby is in a good condition at birth everything else they may want to do can wait. Being with your baby is the MOST IMPORTANT thing of all.

As with a normal birth research the options so you do not have nasty surprises sprung on you and you are ready with what you want. Especially with blood tests and antibiotics, research the local policy and what is evidence based before you decide what you want in your plan.



Finally

Let me finish with another proverb.

"A lack of planning on your behalf, does not constitute an emergency on my behalf".

Don't let that one get rewritten as: "A lack of planning on your behalf, will constitute an emergency section on my behalf".

Remember you are the customer. Chances are you have paid directly or indirectly for your birth. You wouldn't employ an architect to design your house, only for him to go and build some varient for his convenience. Don't let your birth be any different.