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.
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.
My partner (insert name and phone number) will be my birth companion and we would like to be left alone whenever possible.
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.
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.
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.
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.
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.
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.
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.
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.
I am happy for my baby to be given Vitamin K by injection.
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.