Friday, 7 December 2012

Birthing plan


Birth plan notes

A birth plan is a way for you to communicate your wishes to the midwives and doctors who care for you in labour. It tells them about the type of labour and birth you'd like to have, what you want to happen, and what you want to avoid.

A birth plan is not set in stone. It needs to be flexible and acknowledge that things may not go according to plan. Write a plan which means your midwife doesn't feel she has her hands tied if complications arise during your labour.

You don't have to write a birth plan, but if you do, your midwife will help you. If you're not sure about a certain procedure, or if you prefer to keep your options open, talk to your midwife and then write it down.

Your birth plan is personal to you and should reflect your wishes and preferences. You may want to add details about your medical history, but your midwife will have your maternity notes, so will be aware of your circumstances. It's worth taking into account what's available at your local hospital or birth centre when you write your plan.

What research can I do before I start writing?
Gather as much information as you can before you start:
  • Join your local antenatal classes. Your midwife should offer you classes at your local health centre, surgery or hospital. Or there are also private classes available through the NCT. And you can also sign up for BabyCentre's free antenatal classes in our community.
  • Talk to mums who have had a hospital birth or who have had their baby at the birth centre you're going to. And if you're hoping for a home birth, chat to mums and dads who have been through it themselves. That way you'll learn how easy or difficult it was for them to get the kind of care they wanted.
  • Talk to your partner or the person who will be your birth partner. Make sure they fully understand the type of labour and birth you'd like to have. How do they see their role?
Once you've spoken to a few people and researched your choices, jot your birth wishes down on a piece of paper, as they come to mind. You can tidy them up later.

Your midwife may give you a special form for your birth plan, or there may be room in your notes. Keep a copy of your birth plan in your maternity notes so it's easy to find when you go into labour.

What should I include in my plan?
Here are some headings for your birth plan. Use the ones which are important to you and add extra headings for anything that's missing. Have a look in your maternity notes for additional suggestions.

If you've had a baby before and have had any past experiences that may affect this labour and birth, make sure you include them in your plan.

Your birth partner

Say who you want to have with you in labour. Do you want this person to stay with you all the time, or are there certain procedures or stages when you'd prefer them to leave the room? Would you like to talk to your birth partner in private about any interventions that are suggested? And would you like your birth partner to stay with you if you need an assisted birth or a caesarean?

Positions for labour and birth

Mention which positions you would like to use during labour and for your baby's birth. Also say how active you would like to be. Would you like to remain upright and mobile for as long as possible? Or perhaps you'd prefer to be upright in bed with your back propped up with pillows? Or you could specify that you want to lie on your side, be kneeling on all fours or standing or squatting.

Pain relief

Say what kinds of pain relief you would like to use, if any, and in what order. For example, you may prefer to try pethidine before an epidural.

You could mention breathing, relaxation, water, massage or a TENS machine as well as medical pain relief. And if there are any types of pain relief you wish to avoid using, make sure you write them down.

Speeding up labour

If your labour slows down, or is proving to be very long, do you want your midwife to use interventions to speed it up? Or would you prefer to wait and see what happens naturally?

Birth pool

If your hospital or midwife-led unit has a birth pool, or if you are hiring one for home use, write down whether you want to use it for pain relief or to give birth in, or both. Also let your midwife know if you want to have a managed or physiological third stage when you deliver the placenta.

Other equipment

Your hospital or birth centre may have wall bars, birth balls, mats or beanbags for use during labour. Or you may need to bring equipment in from home. Make a note of the type of equipment you would like to use in your plan.

Monitoring your baby's heart rate

If your pregnancy is straightforward your midwife will monitor your baby's heartbeat intermittently, about every 15 minutes, using a handheld device. Write down if you would like intermittent monitoring or continuous electronic monitoring (EFM) during which a belt is strapped around your waist.

Assisted birth

You might want to express a preference for forceps or ventouse if, at the end of labour, you need some help to give birth. Or you may be happy to see what your midwife or doctor recommends when the time comes.

Third stage (delivery of the placenta)

If you give birth in hospital it is likely that you'll be offered an injection to speed up the delivery of the placenta, called a managed third stage. You can choose to have the injection or you may prefer to have a natural third stage without drugs.

If you have a strong preference for someone to cut the umbilical cord, maybe your birth partner, say so. You could also mention if you would prefer delayed cord clamping. Delayed clamping usually happens if you are having a physiological third stage, but may also be possible with a managed third stage.

Skin-to-skin contact

You may wish for your baby to be placed directly onto your tummy straight after birth, or you may prefer for your baby to be cleaned up before she is handed to you.

Feeding your baby

Be clear about whether you want to breastfeed or bottle feed. Also be clear about whether your breastfed baby is allowed to have any bottles of formula. If you definitely don't want her to have formula, say so.

Unexpected situations

You may want to write down what you want to happen if your baby has to go to the special care baby unit (SCBU). Do you wish to care for him yourself as much as possible, and be transferred with him to another hospital if a transfer is necessary?

What if I have particular needs?
You may have special requirements that you want to mention in your birth plan. If you have a disability, write about the help you'll need in labour. Say whether there is any special equipment that would assist you.

If English isn't your first language and you need an interpreter, say so. Also let your midwife know if you need a sign language interpreter.

Include any religious requirements, such as customs you'd like to be carried out when your baby is born. Or you might require a special diet during your hospital stay. Write all of these things down. Health professionals are committed to being culturally sensitive and treating you as an individual.

I've written my plan. What happens next?
Show your birth plan to your midwife and ask her to go through it with you during one of your antenatal appointments, ideally before you are 36 weeks pregnant.

Discussing your plan with your midwife will give you the chance to ask questions and find out more about what will happen when you go into labour. Also, by listening to your preferences, your midwife will get to know you better and understand what's important to you.

Though a birth plan is helpful, labour and birth are unpredictable. Your midwife may need to recommend a course of action at any time which is not what you had originally hoped for. But this will always be in the best interests of you and your baby.


****Taken from BabyCenter**

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