Preparing for Birth – The Birth Plan

Preparing for Birth

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Everyone needs a plan, right? For the big things, for the small things, for the day-to-day mundane things. I’m a big believer in a good plan. Usually my plans take the form of a list; stuff I need to get done. And yes, I’m one of those people who adds extra stuff to the list, purely for the satisfaction of ticking it off. Makes me feel productive.

So when it comes to GIVING BIRTH TO A FULL ON HUMAN BEING, of course I’m all about having a plan. Not only is a plan absolutely necessary in my mind when you’ve got two other kids and logistics to organise (like who will come mind them in the middle of the night?!) but I also believe writing a birth plan (or proposal or set of preferences) is an important and significant step in ensuring you are mentally prepared for birth.

This is because, by drawing up a plan, you are taking time out to really think hard about your birth in a focused way, for perhaps the first time in your pregnancy. It goes without saying that it’s really important to give some serious thought to your birth. Unlike day-to-day parenting, birth is not something you can wing; the more preparation you put in, the better the experience will be and the more you will get out of it. So by taking some time out to draw up your plan, you will be starting to visualise your birth and think about what you want in a really positive way. It’s not all airy-fairy either, you will have a number of things to consider and big decisions to make, from where you want to give birth and if you’d like to to use a birth pool to delayed cord clamping and whether you want a physiological third stage. You will need to research these things and understand the advantages and disadvantages of all your options so you can make informed choices. By drawing up your plan for birth, or at least outlining your preferences, you’re making important decisions for you and your baby, some of which will have a profound and long-lasting effect.

What I will say for those of you reading who like me love a plan, it’s important to realise that birth is unpredictable and doesn’t always go to plan. From when the baby will actually decide to make his/her appearance in that 5 week long period in which he/she is due (the concept of a single due day is such nonsense!) to how quickly you’ll dilate in labour, there are so many unknowns. That’s not to say your birth won’t be beautiful and amazing and empowering and positive, it’s just it might pan out differently to how you expected and you need to be prepared for this. This is why some people prefer to use the term ‘birth proposal‘ or ‘birth preferences‘.

I like the latter best and believe by drawing up my preferences I am making it clear what my first choice is, but also giving some thought to, and allowing there room for movement, if my birth takes a difference course. With this in mind I have a whole section in my birth preferences dedicated to having a caesarean section. Not because I’m planning for one or even thinking I will end up having one, but I’m taking into account it could happen and if it does, I have given thought to it and specified my wishes for how I would like it to be done. This feels empowering and means however my birth goes I will still have made my own choices and will be having the best birth for me on the day.

So to help those who are also nearing the end of their pregnancy (although it’s never too early to start thinking about your birth and researching!!) listed below are the things I believe you need to consider and include in your birth preferences. I have also posted my own birth preferences at the bottom to help you get started, which you’re welcome to use as a template…

THINGS TO CONSIDER/INCLUDE:

* Birth partner details – name, contact number etc.
* Environment – including where you plan to give birth and how you want the space to be
* Positions for labour and birth – as it says on the tin!
* Pain relief – what you think you might want / what you don’t want
* Birth pool – whether you plan on using one for labour and / or birth
* Monitoring – preferences for sonicaid or continuous
* Second stage – how you wish to birth your baby including thoughts on assisted delivery
* Third stage – how you wish to birth your placenta e.g. physiological third stage or active management and if you want delayed cord clamping
* Placenta – state if you plan on keeping your placenta for encapsulation or another reason
* Breastfeeding – whether you plan on breastfeeding and if you’d like support with this
* Special circumstances – your preferences if your birth goes off plan and you decide to transfer in to hospital from home
* Unexpected situations – include preferences for c-section if situation arises
* Vitamin K – confirm that you wish your baby to have this or state if you do not.
* Aftercare – your wishes for afterwards e.g. whether you’d like a private room if on a ward

It’s a really good idea to involve your birth partner in devising a birth plan. Not only so they are involved in the decision making but also because it is their job on the day to ensure your preferences are known, understood and adhered to. It’s a big (and vitally important) job but near-impossible if they are not totally sure what your preferences are! Also, please make sure you do your research before making decisions/writing out your preferences so you are making informed choices that are right for you and your baby. This is most important.

NOTE: I am planning to have a water birth at home and have been practicing hypnobirthing with my birth partner. We have a birth photographer attending and I am having my placenta encapsulated. I also have a history of postpartum haemorrhage and have anaphylaxis. Obviously this is not the case for everyone! You will need to adapt this plan to make it your own and most importantly add any medical information that is relevant for yourself.
 

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Birth Preferences

We wish to have a calm, quiet, water birth at home with no intervention. We are using Hypnobirthing for our birth and therefore the environment and language is very important to us. Please note that we would appreciate it if you could avoid using the words ‘pain’ or ‘contractions’, and instead talk about ‘comfort’ and ‘surges’. I may describe the power and intensity of a surge but I do not wish to think about or feel pain, as I do not believe birth needs to be painful.

Birth Partner

My partner (insert name and phone number) will be my birth companion and we would like to be left alone whenever possible.

Environment

I would like my own choice of music to be playing (including Hypnobirthing audio tracks), candles burning and a birthing ball and aromatherapy oils to use. We would like to take photos and videos throughout and have a birth photographer booked to attend. We will also be using a birthing pool when labour is established and I have a TENS machine to use in early labour.

It is very important to me that the lighting is dimmed throughout.

Positions for Labour and Birth

I would like an active hypnobirth and to use positions that mean I am upright, forward and open which facilitate an easier and quicker birth. I’d like to remain mobile throughout. If I need to rest, I would like to use my birthing ball and lean over the sofa/bed. In the birthing pool I wish to be upright and leaning forward over the side or on all fours.

I do not wish to be lying on my back.

Pain Relief

Please do not offer any pain relief to me.

I DO NOT WISH TO HAVE AN EPIDURAL. I do not want Pethidine/Diamorphine or any other drugs. I do not like Gas and Air because it makes me sick.

***I developed Anaphylaxis to Paracetamol after giving birth previously and carry an epi-pen***

I do not want any drugs introduced during my labour or afterwards.

I have a TENS machine I can use but please do not offer this to me.

Please remind me of the tools I do have which include: my breathing techniques, visualisations (of a balloon filling as I inhale and a golden thread as I exhale), light touch massage, heat pack, cold flannel, essential oils, relaxation scripts, relaxation audio tracks, positive affirmations, the birth pool etc. These will all increase my comfort level.

Please remind me of my desire to feel and experience this birth and of my previous positive birth experience if I have a wobble.

Birthing Pool

I would like to use the birthing pool during labour and would like to give birth in the pool.

Monitoring Baby’s Heart Rate

Sonicaid please. There is no need to ask when you want to listen in. I would prefer not to be asked questions in labour unless necessary.

I wish to be as mobile as possible / in the pool so only continuously monitored if absolutely necessary. If continuous monitoring is necessary and I am therefore in hospital, I would like to use the wireless monitoring if this is available so that I can continue to move about.

Second Stage

I would like to breathe my baby down so he is born gently and calmly. I would like to follow the lead of my body rather than be coached to push.

I would like to be able to bring my baby to my chest immediately after delivery. If it is not possible for me to hold the baby then I would like the baby to have skin to skin time with James.

It is vitally important to me that the calm and intimate environment is maintained after the baby has been born as I have a tendency to lose blood, so plan to do what I can to encourage the flow of oxytocin: baby to breast, a little placenta to place against my gum, calming touch, warmth and reassurance, low lighting, relaxation track playing.

Assisted Delivery

I would rather wait longer than try to rush the process unless the baby is in obvious distress and needs to be born. I will accept assistance if there is no other option.

Third Stage

It is my preference to have a physiological third stage. I would like to birth the placenta without any drugs being introduced to my body. I would like to wait until my baby has received all of his blood before the cord is clamped and cut.

When the cord has stopped pulsating, please assist James in cutting the cord.

I would also like to place a small bit of the placenta once it has been birthed, against my gum to aid the flow of natural oxytocin and encourage my uterus to contract, as it has a tendency to relax after birth.

I am having my placenta encapsulated so please be mindful of this. It will need to be stored in a sterile container which we will provide and placed in the fridge as soon as possible and certainly within half an hour.

In the event that I experience another PPH, I accept that I will need to have the injection. Hopefully this will be enough intervention. If I continue to lose blood then I accept that I will need to transfer to hospital in order to receive syntocinon via a drip.

It is really important that my epi-pen is with me at all time if transferring to hospital and that the hospital staff are aware I have anaphylaxis to paracetamol and am allergic to latex.

Feeding the Baby

I wish for the baby to be put to my breast immediately after delivery.

I feel confident with feeding my baby and do not need assistance with breastfeeding.

Special Circumstances

If I chose to birth my baby in hospital because of special circumstances, I would like to request a private room with a birthing pool. The environment is very important to us so we would like the room to be as similar as possible to our preferences outlined for home birth. Most importantly we would like the room to be dimly lit, quiet and with as few people as possible present. We would like people to knock before entering and to speak in hushed voices. All communication is to go through James please so that I can labour undisturbed.

I do not wish for students to be present, only those who absolutely need to be there.

I do not wish to be cannulated unless it is essential to do so.

Unexpected Situations

If absolutely necessary, I give my permission for an emergency C-section to be performed.

It would be my preference to be awake for this and to receive my baby to my chest immediately after delivery, certainly before weighing him or cleaning him.

Please ensure any electrodes are placed on my back to they are not in the way and do not inhibit skin to skin time.

I wish for only those who are absolutely necessary to be present in theatre. I would like to be able to see my baby be born so would appreciate if the curtain could be lowered at this stage. I would appreciate it if the lights could be dimmed at head end so when the baby is delivered and brought to my chest, he is not subjected to bright light. I would like my choice of music/relaxation track to be playing in theatre during the birth of my baby.

If there is time beforehand, I would like to be given a pack of sterile gauze strips so that I have the opportunity to seed my baby with bacteria and stimulate microbiome development, which would happen if he were born naturally.

I would still like my placenta to be encapsulated after birth, so please bear this in mind and ensure the theatre staff are aware of my wishes. My placenta will need to be stored in a sterile container and kept cool until collected.

If my baby has to be in the Special Care Unit, then I want to be able to care for him as much as possible and to ensure he receives my breast milk. I would like help with making sure this happens.

Vitamin K

I am happy for my baby to be given Vitamin K by injection.

Aftercare

If in hospital, I wish to request a private room if one is available.

 

Thank you for taking the time to read my birth preferences. I am looking forward to the birth of my baby and planning for a positive and empowering birth experience where my baby is born safely and calmly. I believe this is possible however my birth story pans out.

Thank you for supporting us at this very special time in our lives. We will be sure to appreciate all you do for us, now and for the rest of time.

Siobhan and James.

 

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Preparing for Birth – The Shopping List

Preparing for Birth

We all know you need a shedload of equipment for the baby, God, where do I even begin?! Cots, Prams, Car seats, Changing tables… It’s amazing how such a small thing requires such a vast amount of space-stealing equipment! Then comes play mats and baby gyms and baby bouncers and let’s not even start on the Jumperoo! (WHERE DOES IT ALL GO???). But what most people don’t think about is the stuff they might need to buy (or hire) for birth. Luckily you don’t need a lot. In fact, there’s just four things you might want to consider getting and if you’re having a hospital birth, then there’s just three. So please don’t worry, this list is a short one (in numbers, not words).

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First up, a birth ball. I got mine from Birth-Ease and they come in two sizes depending on how tall you are. The 65cm one is for women up to 5’8’’ and the 75cm one is for women over 5’8’’ i.e. the supermodels amongst us! The Birth-Ease birth ball is great because it’s reinforced and designed specially to support the weight of a pregnant woman. And let’s face it, you’re going to be using this ball right up until the end and by then you’re going to feel pretty whale-like (even if you don’t actually look it).

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The birth ball can be used in labour and is one way of resting while remaining ‘active’ and upright. You can bounce on the birth ball or simply sit on it by the side of a bed and lean forward resting your upper chest and head on the mattress/a pillow.

It is important in labour to stay in an upright and forward position for as much as possible. This is because you have gravity on your side which will help the baby descend and be born, which is what we are aiming for after all! Also the weight of the baby’s head will encourage the cervix to open, therefore speeding up the whole process. If you do choose to lie down on the bed, try and avoid lying on your back, as it’s least optimum position. This is because not only do you not have gravity helping you but by lying on your back you prevent your coccyx moving out of the way, which is what it does to create more room in the pelvis for the baby to descend and be born. Clever design our bodies. It’s almost like everything has been thought of!

So using the birth ball is great because it keeps you in this optimum upright forward position without you having to stand the whole time. And there’s something quite therapeutic about bobbing up and down whilst breathing your way through labour.

I was once (9 years ago with my first) told to remember the acronym U.F.O. when in labour and it’s stuck with me. U for Upright, F for Forward and O for open. Any position where you are upright, forward and open is great. By open I mean your legs are apart and you are creating room in your pelvis rather than restricting the space. Upright you obviously have gravity and by leaning forward you’re encouraging baby into the most optimum position for birth, as the weight of the back of the baby’s head will be round to the front of you as opposed to resting against your back. This will all make life, or at least labour, easier for you.

The birth ball is also great in pregnancy for encouraging baby into the most optimum position for birth. If you think about our ancestors they would have always have been in a slightly tilted forward position; walking, cleaning, farming, tending to children etc. In our modern lives we spend more and more time being tilted backwards or reclined; we drive in a slightly reclined position or we slouch on a bus or train seat, we sit at desks and then we come home and flop on to sofas. This is having an effect on the position of our babies in the womb.

The most usual position for birth is a baby that is head down, looking towards mum’s back. So the spine of baby runs almost parallel with the front of mum’s tummy. You may have heard of a back to back baby? This is a baby who is head down but instead of facing mum’s back, they are facing mum’s tummy, meaning their spine is running parallel to mum’s back. There is nothing ‘wrong’ with this position, it’s simply less usual and means the mother is more likely to feel the pressure and sensations of labour more intensely in her back, as opposed to round the front of her uterus. There are also other positions babies can be in such as breech (bum/feet down rather than head) or transverse but we can’t discuss them all here as this blog post would never end!!

How the birth ball helps in regards to the above, is that by sitting on it, as opposed to slouching on a chair at a desk or flopping on a sofa, we are in a more forward position, just like our ancestors were. The heaviest part of the baby is the back of its head so if we spend time in this forward position, gravity will pull this weight down and round to the front, meaning baby is in the most optimum and usual position. If we spend all our time reclined, then gravity will pull the heavy weight that is the back of baby’s head round towards our backs meaning baby will be in the back to back position we have just spoken about.

So the best thing you can do in pregnancy to encourage baby into the optimum position for birth is buy a birth-ease birth ball and use it at work if you can, but certainly at home in the evenings. Again the more you use it and assume this forward position the more effective it will be at encouraging baby into optimum birth position.

Second item on the list is a TENS machine. I have used a TENS machine for both my labours and absolutely love them. Weirdly however when I have tested them (when not in labour), I find them quite irritating with their buzzing and almost too much to bear. But for some reason in labour, that buzzing sensation is comforting and really helpful and I’ve come to rely on it a lot.

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The TENS machine is essentially a form of pain relief but it doesn’t involve any pharmaceuticals, so has no effect on baby and also means the mother is able to be fully present and is not left feeling out of control in any way. It also doesn’t inhibit the mother from being active during labour. It works because the electrical pulses it produces stimulates the body to produce endorphins, which are the body’s natural pain relief and far stronger than morphine. If you use the TENS machine from early on in labour you’re essentially filling your body with endorphins, meaning you can enjoy a more comfortable labour, even when everything is established and surges are coming thick and fast.

The TENS machine also works because it is distracting. This doesn’t sound very scientific but it’s true. If you concentrate on the surge, you will be more aware of its intensity as you’re giving it all of your focus. If you’re using the TENS machine which has a boost button that you can press during a surge, then you are thinking of that and the change of sensation that you will be experiencing when you press the boost, as opposed to solely concentrating on the power of the surge. It’s like if you get a small cut on your finger, sometimes you won’t even notice that it has happened. But as soon you do and you start examining it, it starts hurting. Where you place your focus in labour really matters and has a big effect.

You can buy a TENS machine either new or second hand. I got mine on eBay this time but I’ve got one before at a nearly-new baby sale. They also sell them in places like John Lewis if you’d rather get one new. You can also hire them from the NCT, or sometimes from your local hospital. So ask your midwife or have a Google and give it a go. If you buy one second hand, you can always sell it on afterwards for much the same price, so there really is nothing to lose in giving it a try.

Third on the list: a Birth Pool in a Box. This is the one you won’t need if you’re having a hospital birth. You can pack all kinds of things in your hospital bag but I think the general consensus is that the birth pool and kitchen sink are off limits! Hopefully if you want a water birth, you’ll be able to use a pool at the hospital (just make sure you or your birth partner tell the midwives when you ring up, before going in, so they can get it ready as they do take a long while to fill!).

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However if you’re having a home birth, as I’m planning, then getting a birth pool of your own is definitely a good idea. I use Birth Pool in a Box and you can either buy a single use one new from The Good Birth Company or hire a professional one (just Google for companies that offer this). They come in two sizes – regular or mini. I’ve got a mini one again and it is definitely spacious enough for me. However if you’d like your birth partner to get in too, consider getting the bigger version.

WARNING: If you do get one second hand, you must make sure it is thoroughly cleaned and sterilised (you’ll need to inflate it to do this properly) and that you buy a brand new liner and hose kit. This is really important as you do not want any bad bacteria in the pool! You can buy a liner  and hose kit for The Birth Pool in a Box direct from The Good Birth Company.

Once you’ve got your birth pool, I’d definitely recommend doing a dry run (no need to use the liner for this!). I also like to do a wet run but if you do this it’s recommended that you use a liner which means you’ll need another for the birth. The upside is that if you do a wet run, you can enjoy a little relax in your pool once it’s full. This might be a good time to ‘pretend’ you’re in labour and practice the breathing techniques  and visualisations or the other relaxation tools you’ve got such as light touch massage, relaxation scripts, relaxation tracks etc. You could also try out a few birthing positions in the pool and see how they feel. Basically it’s nice to familiarise yourself with your pool and how it feels to be in water if that’s where you plan to labour and birth.

The other reasons for doing a practice run are that you’ll want to know how long it takes to inflate and fill. Usually inflating doesn’t take very long but the filling can take a couple hours! Another way of working out how long it will take to fill if you don’t fancy the wet run is to time how long it takes to fill your bath. The regular sized birth pool takes approx 4x bath fulls and the mini birth pool takes 2.5x bath fulls. This is actually the reason I didn’t get to have a water birth with my second – my labour was too fast and the pool was not full in time! So it’s good to know how long it will take so you can plan for that in labour. You’ll also want to check your house can produce enough hot water and most importantly that your birth partner knows EXACTLY what he/she is doing because they will be in charge of this on the big day. You’ll also want to know the hose connector for your tap is the right one because there would be nothing worse than discovering this when in labour!! And I’ve been told this happens, all the time.

I will be posting a video to my YouTube channel soon of my pool’s dry and wet run so you can see how to do it! Don’t worry, lots of parts will be sped up so it won’t be a feature length film! You can find my YouTube channel here.

The main benefits of having a birth pool are that women usually relax in warm water when having a bath so we are conditioned to associate warm water with relaxation so the birth pool helps women relax in labour and we know labour is more comfortable, easier and efficient when our bodies are relaxed. The warm water also softens the muscles and tissue making them more relaxed and flexible so the risk of having a tear is reduced when birthing in water. Finally from a psychological perspective, the birth pool is quite nest-like and makes a woman feel safe and protected which, because we are essentially primal mammals, is really important when giving birth. Our bodies won’t birth a baby if there is even the smallest sense of being endangered.

Final note on the birth pool, people often ask how you go about emptying the pool after the baby has been born. It’s really quite easy! You can get a hose kit with the birth pool in a box which has a pump and you just use the same hose you used to fill the pool and simply pump the water out again and it goes down the drain of your sink! It takes a LOT less time to empty than it does to fill.

Fourthly and finally on the birth shopping list: a Birth Photographer! Eyebrows immediately raise. Everyone is thinking the same: YOU WANT SOMEONE PHOTOGRAPHING YOUR VAGINA?!! And I don’t. Not at all. I do however want to document one of the biggest and most significant days of my (and my baby’s) life and have photos to look at it in the future so that I can remember this most special time.

Nobody ever thinks it strange that people getting married hire a photographer or videographer and yet that’s just a wedding. I know I’m cynical but couples can get divorced. But giving birth!! Becoming a mother!! BIRTHING A HUMAN BEING!!! That’s far bigger than any wedding no matter how much cash was splashed. And you can never un-mother yourself. Having a baby and becoming a parent really is for life.

But enough of doom, gloom and divorce rates! Birth photographers! Birth photography! It’s really common in Australia and America to book a birth photographer but less common here. Perhaps because we are all so British and inhibited or possibly because there just aren’t many birth photographers out there? I found it really hard to get one in my area, and I’m in London! But birth photography is beautiful, you only need to look at the winning entries of this recent Birth Photography competition to see that. The images are powerful, raw, magical and the women look incredible.

I want to be able to look back on my birth and remember the day I brought my baby into the world forever and ever, and I’m sure if you think about it and get over the whole vagina thing, you probably would like to be able to do that too. Also I’ve never felt as good as when I had just given birth; I felt invincible, like some kind of awesome superwoman. Now I know the flood of oxytocin helped (not even the best orgasm will produce anywhere near as much oxytocin as giving birth does) but also just the fact I had just produced another human. Birth is amazing and I just think, why would you not want to photograph and treasure that moment?!

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So I’ve met with my birth photographer, the lovely Susie Fisher. She knows my birth plan and how important it is for me to have a calm and quiet environment where I can birth uninterrupted and she is going to respect that and capture my birth story without being intrusive. It’s really important if you are booking a birth photographer to meet with them first so you know you’re a good fit and explain what you want from them and also to give them an idea of how you want your birth to go (because you definitely don’t want to be having to explain when in labour).

Birth photography doesn’t come cheap but it gives you something that will last a lifetime. And there’s not much in life you can buy that comes with that guarantee.

So there we have it; birth balls, birth pools, TENS machines and birth photographers. The four things I believe you need to get when preparing for birth.