"Birth is an everyday
miracle"
[Samuel at 1 minute old.]
I thought I'd pass on to you all what I learnt about writing
birthplans. I might be a bit too British NHS-orientated, but
it still might be helpful and give you more ideas than just reading
my personal plan. A birthplan is not intended to be anything
more than a "wish list" of what you would or would
not like to happen at your birth. It is not a legal document,
nobody is obliged to stick to it (least of all yourself) and
every birthplan is entirely individual - there is no wrong or
right way to do it. It is not intended to be a professional document
either, just something written by yourself about the issues you
feel are important. If you write things in it which are medically
ill-advised, your doctor will ignore them, so don't be afraid
to just say what you think. It is useful as a way to think about
the issues surrounding birth and what you would or would not
like. It helps you prepare and think about things you may not
have thought about.
Generally, people show their midwives or doctors their birthplans
sometime in the last few weeks of pregnancy, and use it as a
springboard to discuss issues that may be of concern. Many professionals
like you to have a birthplan, but some are still resistant. The
best way to tackle that is to actually show them your birthplan
and ask for comments. You don't have to change anything in the
plan, but it's usually a good idea to get the professionals on
your side as they are more likely to go along with the plan if
at all possible.
I have put all the ideas under headings which come from the
Association of Radical Midwives, in Britain. First of all, some
general tips:
- Don't have too many negatives - "I do not want..."
etc. It'll put people off.
- Go through your birthplan at around 32-34 weeks with your
main caregivers for the birth, and anyone else who will be present.
Iron out any disagreements now.
- Don't make your birthplan so specific that the slightest
problem will cause the whole plan to be ditched ie. "I don't
want an episiotomy for any reason at all".
- Try to respect your caregivers in the plan, peppering it
with "If at all possible..." and "I would like
the midwife/doctor to assist me in..."
My plan uses the word "midwife" for the caregiver
and assumes she is female. I have assumed the baby is male just
to distinguish the baby from me and the midwife.
BIRTHPLAN OF [fill in your full
name]
Summary
Write here a general description of how you'd like your birth
to be and your overall feelings about birth. For instance, "I
would prefer my birth to be with epidural pain relief, if at
all possible" or "I wish to attempt a vaginal birth
after Caesarean" or "I would like to have a natural
birth".
Mention any points you feel very strongly about ie. "I
feel strongly that my child should be born with all his family
around him", or "I feel strongly that birth is a private
experience to be witnessed by only a few" or "I feel
strongly that my child should be fully breastfed".
1. Who's Who
Who would you most like to deliver you - doctor or midwife?
Do you feel strongly about your birth being witnessed by medical
students? If so, how many and are you bothered about male students
or a male midwife? It has been suggested by a British organisation
that one of the problems in training doctors is that they rarely
see a whole labour - just the frantic last half hour, and thus
get a totally skewed idea of birth as 12 hours of huffing, puffing
and yelling (which is not usually the case). They have asked
that you put a clause in their birthplans, to the effect that
you do not want anyone delivering you who has not witnessed a
significant part of the labour, right from first stage. This
is entirely your own decision, but I would ask you to think about
it. I did this, and had an OB student with me for 10 hours. She
was absolutely thrilled to be present for a normal delivery and
said it changed her whole view of birth - mine was the only normal
delivery she'd ever seen and she didn't believe it could be done.
Being there from an early stage helped reinforce this impression,
I believe.
Remember that you can always ask people to leave if you later
discover you don't like them or want to be alone.
Don't forget to list here - and introduce personally as soon
as possible- any alternative practitioners you may be employing
to help you with the labour; aromatherapists, accupuncturists,
independant midwives or whatever.
2. Companions
List the names and relationships of people you would like
to be present, and possibly who might be waiting nearby. Your
SO might not want to be present for the birth if he gets sqeamish
and may ask to step outside. In reality, men rarely do this,
but it can give them confidence if they see the "permission"
written in black and white.
Doulas can be in this section, or the "Who's who"
section.
3. Shaving and Enemas
Most women do not want shaving or an enema, but some women
get very anxious about soiling themselves during birth. Most
of us do it anyway and midwives do not consider it a big deal,
but rather than worrying about it, you can request an enema.
These days, they have "microlet" enemas which are tiny
things.
4. The Delivery
Write down if you would like to deliver in a "non-standard"
position. If you are having an epidural, you might like to consider
delivering on your side rather than on your back, as it widens
the pelvic outlet. It might be a good idea to write "I would
like to deliver in a squatting position, unless I have an epidural,
in which case, I would like to deliver on my side", for
instance. I have a vague phrase about "the position that
feels most comfortable to me" which you can also use.
Would you like your birth partner to cut the baby's cord?
Write down how you'd like the pushing stage to go. For instance,
I do not want the midwife "coaching" me to push, but
you may differ. Don't write this down if you have no strong feelings
either way.
5. Checking the baby's heartbeat
Many women do not want continuous foetal monitoring and research
backs them up for most deliveries. If you don't want CFM, consider
if you'd be happy with a Doppler (SonicAid) or a stethoscope
or one of those trumpet things. Always use the "if at all
possible" phrase - not only might an emergency require CFM,
the caregiver might not be able to use an alternative method
due to lack of experience.
6. Pain relief
Put down here your feelings about various types of pain relief
- epidurals, narcotics, Entonox etc. If you intend to use natural
techniques, TENS, Lamaze, water baths etc. put that down as well,
but remember you might not fancy them at the time so always put
"I may wish to use..." If the technique is radical,
or requires an alternative practitioner to be present, do explain
that you have researched the technique (even more important,
make sure that you have!) and put the practioner on the "who's
who" list. Try and give your caregiver confidence that you
have thought this through.
As regards drugs etc. always mention any problems you may
have had with similar drugs. For instance, warn if you tend to
be drowsy with narcotics or that Entonox may make you sick.
If you have an epidural, think about any special requests
you may have here. For instance, ask that the epidural be turned
down/off for the pushing stage. It is safest if the epidural
is given by a specially trained Obstetric Anaesthetist so maybe
you could request that it is done by such a person "if at
all possible". Try to avoid being "practiced"
on by junior doctors, no matter how advanced their training.
7. Induction and Acceleration of Labour
Mention here your feelings about artificial rupture of the
membranes (my advice is to avoid it if possible, especially if
it's for no better reason other than to "hurry things up
a bit" but we can discuss this another time).
Mention your feelings about Pitocin (oxytocin) drips and perhaps
discuss the kinds of situations in which you would be unhappy
about it's use, for instance, just because your waters have broken
a few hours before (British hospitals leave you 24 hours at least).
8. Cuts and tears
Write down your feelings about episiotomies and tears. For
instance, you may wish your caregiver to use hot compresses or
perineal massage or you may be totally happy with a routine episiotomy.
Beware of using the phrase "I would rather tear than
have an episiotomy" - recent British survey found that women
who wrote this were more likely to tear and have a worse tear
than those who requested that both tears and episiotomies be
avoided. The thinking is that the midwives tended to take this
statement as the woman saying "I don't mind if I tear",
which of course isn't true.
Think about stitches - the advice now is that small tears
heal up better without stitching. In Britain, there has been
a rumpus about the use of catgut suture as opposed to nickle-impregnated
suture. Apparently, the impregnated heals more painfully initially,
but gives a far better scar which is less likely to cause long
term problems. British doctors have been resisting the change
because they find it hard to believe that the greater expense
and initial healing time of the impregnated is worth the cost,
despite all the research saying they are wrong. You might want
to think about that if that is an issue in your country.
You also might want to think about the pain issue. Personally,
I want local anaesthetic but you may not. Also think about who
will do the stitching if it is necessary - I find midwives a
lot better than doctors at this. Stitching can take an hour or
so, so comfort is a big issue.
9. After the birth
Would you like the baby to be delivered straight onto you,
or would you prefer it to be cleaned up first?
Do you want the baby to be wrapped seperately, or would you
prefer to be wrapped together with the baby?
Do you want to delay the cutting of the cord? Perhaps you
would like your birth partner to do this, or to leave the cutting
of the cord until it stops pulsing or even until the placenta
is delivered naturally (which can take anything from a few minutes
to many hours). Be warned that waiting is not possible if you
have had an oxytocin injection or other drugs to facilitate the
seperation of the placenta.
How do you feel about routine post-natal procedures - weighing,
checking, eye drops (in the USA)? Perhaps you would like the
checks to be done later, or basic checks to done with the baby
on your lap. Think about the fact that you might need stitching
and might need someone else to cuddle the baby.
What about the first feed? Bottle or breast? How would you
like to be helped to achieve this? Do you have strong feelings
about midwives touching your breasts or "positioning"
the baby?
Do you have strong feelings about the delivery of the placenta?
Would you be happy for a managed third stage, or do you want
to try for natural delivery?
When would you like other people to be summoned to see the
baby?
Do you want to "room in" with your baby? If you
have to be transported to the post-natal ward, do you want somebody
to go with your baby?
What about cord blood donation? Have you looked into this?
10. Transfer to Hospital and Caesarean
sections
Make it clear that you do not want your birthplan to be abandoned
should this occur.
State your preferences concerning Caesarean - epidural or
general? Birth partner present or not? Who takes the baby if
you are unable to?
11. Special care
Would you like somebody to go with the baby to special care?
Have you any thoughts on how this might affect breastfeeding,
for instance the avoidance of bottles if you are unable to nurse?
If your baby must be formula fed, which formulas do you prefer?
And under what circumstances would you accept formula feeding?
What are your feelings regarding pacifiers (dummies), bearing
in mind that they can interfere with breastfeeding?
12. Breastfeeding
The most important point for successful breastfeeding is the
avoidance of all artificial forms of nipple. Make the point if
you feel strongly about it. Another issue is giving the baby
frequent access to the breast, especially for the first few days
before your milk comes in and not depriving the baby over night.
Also, you may wish to avoid formula or sugar water, as this
can interfere with your milk supply. Make it plain if you are
happy to use a breastpump should things not go well - this often
relaxes the staff.
If you intend to bottle-feed, state what kind of formula you
intend to try, and what kind of bottle you intend to use. Please
make absolutely certain you are making the right decision about
formula feeding - it carries with it significant hazards, and
there are very few circumstances where it is best. Even a few
days of breastfeeding is better than nothing and bottle-feeding
is not a decision easy to reverse.
In some circumstances (HIV positive, active TB etc) it may
be possible to get pasteurised human milk for your baby, from
a breastmilk bank, which will help his immune system and neurological
development.
Compiled by Anna
Hayward (c) 1996.
Disclaimer: This document has not been compiled by a medical
professional. Any opinions expressed are personal and should
not be construed as medical advice. I am not a representative
of any of the companies discussed, nor do I receive any form
of commission. |