The birth of your baby, whether it’s your first or your ninth, is always a momentous occasion. It’s something you’ve been thinking of for at least the duration of the pregnancy, and for many women a lot longer. How will it go? Will I cope with the pain? There is a lot of fear around childbirth in the western world, particularly as we now generally have smaller families, and not such big communities. We grow up not seeing birth around us, only what is represented in the media – don’t get me started on that! Then there are the stories from friends and family, a lot of them dubbed ‘horror stories,’ which sounds awful in itself. If not that, then there is societal and peer pressure to have a perfect drug free, pain free ‘normal’ birth. In truth, birth is normal. If all goes well, it’s the most natural thing in the world, and you need very little, if any, intervention. So why should we plan for it?
I’ve attended lots of home births and birthing centre births, and when all remains low risk, my job was mainly to sit back, support where needed and carry out routine observations. When it came to the birth, all I would do is gently direct and support the second stage (the pushing part) and take notes of times and heart rates, then guide the baby to mum as it comes out. The skill comes when there are changes, little things that indicate there may be problems ahead, knowing when adjustments need to be made or ask for assistance from the medical team. If you end up needing intervention, then that becomes normal too.
The best advice I can give you to be prepared for birth is to be informed. You can plan everything down to all the music you want played and the exact atmosphere conducive to help labour progress, but if the baby is getting it’s cord compressed causing distress, or a myriad of other factors, you have to be able to adapt. Talking through your fears and expectations before the birth with your midwife will help, rather than feeling panicked and scared in the middle of labour. I wouldn’t expect everyone to study all the things that can happen and plan for every eventuality either. That’s the job of the midwives and medical team that you put your trust into. What I think is important, is knowing the basics. That’s what I’m going to lay out for you, in particular what you should include in your birth plan. You can of course, be as elaborate as you like, or not have a birth plan at all – it will help the midwives though, if you’ve jotted down the basics, plus you won’t have to have lengthy discussions whilst you’re concentrating on the contractions. In the next part of the series, I’m going to give you an example birth plan for twins.
Basics to include on your birth plan
Medical and pregnancy issues/complications
If you have your pregnancy notes, then this information should be highlighted in those, but if there are particular issues, particularly those affecting the birth and baby directly, then by all means put them in. A simple sentence, for example: ‘I have a heart condition, please see my notes for more information’ will do, and ensures nothing gets looked over.
Pain relief options you’re open to trying
Here’s where you can list what you’d like to use if anything, including water, massage, TENS and any others (see here for a full list of options with pros and cons). It’s not set in stone, so don’t feel you have to stick to it when the time comes.
Pain relief options you’d prefer to avoid
Here you can put what you’d rather not use, most women are a little frightened of having an epidural for example, it’s a really common procedure though, so don’t feel bad if you have one. Some women put it on their list of must haves, so everyone’s different. Others prefer not to have opiate pain relief, or remember feeling sick from using gas and air, so if there’s something you don’t even want to consider, put it here. Again, you can change your mind at the time.
Your Birth Partners
Most hospitals and birth centres will have some sort of policy on how many birth partners you can have, so check this before the birth if possible. It’s usually restricted to 2 people maximum. You can always swap people in and out if you want. It’s best not to have too many people around you anyway, it might put you off your stride and you end up feeling like a performing monkey! Put their names down and the relationship to you, it helps us forgetful midwives who can’t remember people’s names once introduced and need a reminder without feeling awkward. Asking for a friend.
Intended Feeding Method
Breast or bottle, and any issues go here. If you’re planning on breastfeeding but have inverted nipples, or a previous breast operation, or the baby has a known issue that could affect feeding like a cleft lip, put those here. If you intend to bottle feed, put it down and the brand of formula you want to use. Most hospitals now ask you to bring in your own bottles and formula, but it’s worth noting the details down.
Third Stage Management
If you’ve got this preference down, you get a gold star from the midwife. It’s better if you’ve thought about it beforehand, and had a discussion with your community midwife. There are 2 options: active management and physiological. In the active third stage, as soon as the baby is born, an injection of synthetic hormone is injected into your leg muscle (you hardly notice it) which helps the uterus clamp down and is said to reduce the risk of haemorrhage. A few minutes after the birth, the midwife will assist the delivery of the placenta by gently pulling on the cord once signs of separation have occurred and guiding it out. With a physiological third stage, no drugs are given and the placenta separates when it’s ready. Once the cord has stopped pulsating, the cord can be cut if desired and then your uterus contracts (a lot gentler than for the baby) and you push the placenta out with the midwife helping to guide it. There are pros and cons to both methods, most women tend to opt for the active management, as it’s over quicker and reduces the risk of haemorrhage, but the drug can raise your blood pressure and make you feel sick. With both methods the cord clamping can be delayed to give the baby the important blood and stem cells it needs. With active management, a maximum of three minutes delayed cord clamping is recommended.
Vitamin K for Baby
Once the baby is born, you’ll need to make a decision about vitamin K. Two gold stars if you’ve written this down. It’s usually given as an injection to babies within the first 2 hours of birth. It’s a substance all babies are deficient in, and for most it isn’t a problem, but for some it can cause internal bleeding, brain damage and even death, in a condition called haemorrhagic disease of the newborn, therefore it’s currently recommended by paediatricians that all babies have the vitamin K supplement via injection. It can be given orally, but it is not as well absorbed by the baby, and they will need a follow up dose at 7 and 21 days old. You can also opt to decline the supplement.
Any other notes
Here you can put down any notes you want the midwife and medical team to know about. If an emergency situation arises, the whole team won’t be reading your birth plan first, so keep it brief. You’re better off writing a separate list with your birth partner and going over it with them so they know any particular preferences, so they can advocate on your behalf if necessary. The midwife and medical staff should not do anything without prior consent and discussion, even in an emergency. This is very important, and will help you feel in control. You have the final say, unless you or your baby are in a life threatening situation.
The Basic Birth Plan Template
I have designed a simple birth plan template that is enough for most pregnancies. It has a pretty, neutral design and has all the basic points above to include. You can print it out and write your own details on it. It is free to download when you sign up to my mailing list – I email once a week with my latest articles and goings on, together with exclusives and free gifts for you. I don’t pass on your details and there will be no spam.
If you would like or need more customisation, why not ask me to make you a personalised birth plan? I can work with you to discuss and fine tune your birth plan whatever your needs. I also have other designs available. Contact me on firstname.lastname@example.org for a free initial consultation.