Every birth is different, and before you've had a baby you may have little idea of what is going to happen. Taking time to make a birth plan is a good way of informing yourself about the options available and how you may want the birth to prgress.
But birth is of course one of those times in life when events can overtake even the best laid plans. Which is why it's important to think about your ‘ideal birth' before you go into labour, as well as the choices you may have to make about your baby's birth if the unexpected happens.
Points to think about
NCT antenatal teacher Gillian Fletcher suggests mums-to-be think about the following points when writing up a birth plan.
‘A birth plan helps you and your partner decide what you do and don't want during labour. It will also help you communicate better with the medical team.
‘But plan for the unexpected and keep your options open. Birth is unpredictable and may not be straightforward, and if your birth plan is too rigid you're more likely to be disappointed.'
9 things to remember
- Write your birth plan six to eight weeks before your due date.
- Keep it short - your midwife won't have time to read pages and pages.
- List any specific things you really want to happen, such as birth positions and holding your baby straight away.
- List any specific things you don't want to happen.
- Mention any special needs you have, such as a disability or a medical condition.
- Show a draft to your partner, friends and relatives for feedback.
- Make sure your birth partner is familiar with your plan.
- Give one copy to your midwife a few weeks before your due date and take a few others into hospital with you to hand over once your labour begins.
- Remember, it's fine to change your mind. You won't know until your labour begins how you are going to feel. Nothing is set in stone.
Writing your birth plan
Consider carefully the main points below. You may find you want to change your mind about something closer to your due date.
Where do you want to give birth?
You have a number of options, so make sure you know what they entail and what services are offered. Click below for detailed information:
- The Good Birth Guide: for information about services and standards at all birthing units in your area.
Who do you want as your birth partner?
Research shows that having the right birth partner can mean less medical intervention, so think hard before you decide who you want to have with you through the birth.
For most women, it is their partner, but there are other options. Read about it in detail here:
Get the right birth partner
What pain relief do you want?
For the majority of pregnant women, anxiety about how much the birth will hurt and whether they will cope is the biggest worry as the due date approaches.
Informing yourself about the options for pain relief should help allay these fears. Until you've been through it, you probably have little idea about how high your pain threshold is.
Check out babyexpert's section on pain relief for information on all your options.
Which medical routines do and don't you want? * Internal examinations - As well as feeling your stomach to find out which way round your baby is, your midwife will ask your permission to do an internal (vaginal examination). If you don't want this, say so. This will mean you won't know how many centimetres your cervix has dilated, but a skilled midwife will still be able to tell you roughly how far advanced your labour is.
* Induction of labour - One in five labours are induced, or started artificially. Labour can be induced by your midwife sweeping the membranes surrounding your baby with her finger, inserting a prostaglandins gel or tablet into the vagina to soften the cervix, or use of the drug syntocinon via a drug to speed up labour. If you've already had prostaglandins, syntocinon should not usually be given for at least six hours. If you're given syntocinon, you're more likely to have an epidural to help with pain. Your baby's heartbeat will be monitored throughout the rest of your labour.
Read the facts about inductions here.
* Foetal heart monitoring - This allows early detection of possible complications. Your midwife can monitor your baby's heartbeat with a hand-held Sonicaid, or by continuous monitoring where two sensors are held in place by straps around your stomach. You will be able to move around more if your midwife uses a Sonicaid.
* Foetal scalp monitor - If your baby's heart rate suddenly dips, or if there are other signs of foetal distress, a small electrode will be attached to your baby's scalp via your vagina. Your baby may have a small bruise or scratch where the electrode was attached but this will heal soon. This will help a doctor to get an accurate picture of how your baby is coping with the labour.
Click here for more information about how your baby may be monitored during labour.
* Breaking your waters - If you've been induced and your waters haven't broken, your midwife or doctor may make a hole in your membrane to release (break) the waters. This procedure is done through your vagina and cervix using an instrument that looks alarmingly like a knitting needle. This won't harm your baby, but may cause you some discomfort.
What sort of birth do you want?
* Positions - Do you want an active birth where you are free to move around? Try out different positions, such as a supported stranding squat, rocking on all fours, or leaning against a beanbag in advance during your antenatal classes and find out what's most comfortable. Of course, you can lie down if you don't want an active labour.
* Pushing - Do you want to push on demand or spontaneously when you feel the urge?
* Partner to help cut the cord - Do you want him ‘up top' with you, or down where the action is when your baby comes out?
* Baby delivered on to your stomach - Do you want your baby placed on to your stomach straight away, or do you want him cleaned up before you see him?
* Episiotomy - If your baby is stuck, in distress, or if your midwife is worried you might tear badly, you'll be offered an episiotomy - a surgical cut to the perineum, the muscular area between the vagina and the back passage. The area is numbed so it won't hurt, but healing can be a painful process. If you really don't want one, discuss this with your midwife.
* Use of ventouse or forceps - Between 5 and 20 per cent of all births require the help of forceps or the ventouse cap (suction cap). An instrumental delivery is performed by an obstetrician if your baby is in distress, you're exhausted and can no longer push, nothing is happening or the baby's head is an unusual position. If your baby is in distress, you may not have a choice about an instrumental delivery, but if you feel you want to be given sufficient chance to push your baby out on your own, discuss this with your midwife. If you have a preference for one instrument or the other, write this down on your plan.
* Syntometrine injection to speed delivery of placenta - Your midwife will ask if you want an injection to allow for a quicker delivery of the placenta, or if you want to deliver it naturally. Possible side effects of syntometrine are that it can make you sick, raise your blood pressure or give you a headache. Without the injection, it can take up to an hour to deliver the placenta and you're likely to lose more blood.
How do you want to feed your baby?
* Breast or bottle - Be clear about whether you hope your baby will breast or bottle feed. If you don't want your breastfed baby to be given a bottle, then say so.
* Putting baby to the breast on delivery? Think about whether you would like to breastfeed your baby straight away. Newborns have a quiet, alert period after birth when they are especially receptive to breastfeeding. If you or your baby are too tired, you can always try again later.
What do you want to do if there's a problem?
* Would you like you or your partner to be kept fully informed if a Caesarean is necessary - Do you want to nominate your birth partner to be your advocate in the event you don't feel able to make a decision?
* Would you prefer an epidural or general anaesthetic if you need a Caesarean - Most caesareans are done with an epidural, which means you're conscious throughout and can hold your baby straight away. An alternative is a spinal anaesthetic, which also allows you to stay awake. In an emergency your doctor may not feel he has no time to wait for an epidural to take effect, and you'll be given a general anaesthetic. You can ask for a general if you're worried about having an epidural.
How long do you want to stay in hospital?
* Do you want an overnight stay or same day discharge - if you've had a straightforward delivery, your minimum length of stay will be six hours after the birth. If there were complications, your baby requires a stay in special care, or if you had a C-section, that may vary.
Ready to write your own birth plan? If you have already signed in, please click on 'My birth plan' on your membership panel to fill in your personalised interactive checklist which you can fill in, save, then print out to give to your midwife.
If not, please register now to access this and many more of our interactive tools.
