Your Birth Plan/ Preferences
One of the things pregnant mums have to consider is what type of birth they would like to have. It is important to know about the types of delivery, pain relief, and choices you may be asked to make regarding your newborn.
It is perhaps better to use the term 'Birth Preferences' instead, as a plan suggests that any deviation from this may not be a positive thing.
There are two important points to make before we explore this topic further:
By all means, identify your birth preferences. Seek support and get informed (hopefully this page will help!) to maximise your chances of being able to have the birth you want.
And then remember, things don't always go to plan! But this doesn't have to equal a negative experience... And hopefully this page will help with that too!
Whilst this page will discuss when things do not go to plan, and will talk about the role of medical professionals, it is really important to note that you have many rights when it comes to giving birth.
Safe maternity care is personalised care, You are allowed to make choices regarding your birth and the care your newborn receives.
Some people like to term 'Informed Choices' for their baby, to make it clear that these wishes must not be ignored
When a deviation from your plan is suggested, you will want to ask questions before making a decision to change your birth or the care your newborn receives. You have the right to be fully informed and give consent at every stage and with every aspect.
TOP TIP from Sling Swing Plymouth:
When deciding on the possibility of using medical intervention in a non-emergency situation, it may be helpful for couples to use the BRAIN acronym.
B: Benefits—What are the benefits of doing this procedure?
R: Risks—What are the risks involved?
A: Alternatives—Are there any alternatives?
I: Intuition—What is my gut feeling? Does this procedure make sense?
N: Nothing or Next—What would happen if we did nothing or waited a while?
Check out: www.aims.org.uk for a comprehensive overview of each of your rights, and how to seek support if you feel your wishes are not being respected.
Birth can be unpredictable. Whilst you may dream of a certain kind of delivery, your baby may have other ideas! This is not meant to scare you further, but to encourage you to embrace whatever type of delivery you have.
It is important to remember the end goal: that your baby is delivered safely. This means that both yours and the baby's safety is of paramount importance, and so sometimes doctors/midwives may suggest a route that you hadn't previously planned on in order to ensure that both you and your baby are safe.
The reason we stress this point is that it is not uncommon for women to feel unhappy about their birth experience if things have not gone to plan. You may have dreamed of a certain type of birth, and if circumstances dictate a very different kind of birth, it may be hard to reconcile your 'dream' with the 'reality'. Negative feelings around the birth can lead to baby blues, or even post-natal depression, something we will be covering in more depth soon on our dedicated page.
The main thing is that you are informed. You should know about the different choices available and the possible outcomes so that you are able to contribute to discussions about the birth. This ensures that if you do have to deviate from your stated birth preferences, you will feel confident it is because all parties have decided this is the best option for you and the baby (use the BRAIN acronym above). You have to consent to any aspect of your care, and you do not have to take the advice of medical staff. It is your body. Knowing you have a voice and options will help you to feel more positive about whatever birth you have, even if you vow to try and do things differently with a subsequent child.
The last point to note is that the birth partner is key in this process. You may be exhausted, you may have side effects from drugs you have taken, or you may feel overwhelmed. If you and your birth partner have thoroughly discussed each option then they can be your calm voice in that moment and can also encourage you and ask the questions you both may have. There will soon be a page to cover the role of the birth partner', but for now 'you' in any section below should apply to you and your birth partner.
You do not have to have a written birth plan but you may wish to record a few key ideas in your hospital notes. Some things may not ever change e.g. whether or not you want your baby to have Vitamin K when they are born; whether or not you want a sweep. These choices must be honoured.
This menu gives you some ideas about what aspects you might consider for your birth 'plan'.
Where to Give Birth
Any woman, whether she is expecting her first baby, second, third or more, has the right to choose where she wants to give birth. Depending on where you live it may be easier to access some options than others. The main options are:
A Homebirth. Women giving birth at home are usually cared for by either NHS or Independent midwives. Mothers can hire a birth pool and use whatever methods they want for managing labour. Midwives usually carry Entonox (“gas and air”) and sometimes opiate drugs if wanted, but if a woman decides to have epidural analgesia she needs to transfer to a hospital obstetric unit. The decision whether or not to have a home birth rests with the mother, and no-one else. The decision is hers alone. Midwives, GPs or obstetricians have no authority to agree or deny anyone a home birth, they are there to ADVISE. Whether or not you accept their advice is entirely up to you. Even if a doctor has defined your pregnancy as 'high risk' you are still entitled to midwifery care and to have your baby at home if you wish.
A Birth Centre (sometimes called a Midwife-led unit or MLU) where all care is provided by midwives. They focus on maximising the chances of a straightforward birth, and usually have a homelike setting with birth-pools in all or most rooms. Normally all forms of medical pain relief are available apart from epidural analgesia, and some offer alternative therapies such as aromatherapy. They usually have a homelike setting to encourage relaxation and the flow of hormones that help labour to progress. There are two types of Birth Centre:
A Free-standing Midwife-led Unit (FMU) is on a separate site, not attached to a hospital with an obstetric unit
An Alongside Midwife-led unit (AMU) is on the same site as a hospital with an obstetric unit, often in the same building, but sometimes a separate one.
An Obstetric Unit (OU) is a maternity unit within a hospital where doctors are available to provide medical care if needed. Doctors will usually only be involved if there are medical complications. Otherwise, women who choose to give birth in an OU will be cared for by midwives. It’s possible for a woman to choose epidural analgesia though it may not be available 24 hours a day, or exactly when she wants it. Availability of birth-pools varies a lot, and there may be strict guidelines on who can use them. The environment within an obstetric unit is usually more medical then in birth centres, and this can inhibit the helpful labour hormones. On the other hand, some women feel safer having doctors closer by.
Women are often advised to give birth in an Obstetric Unit if there are concerns over the health of mother or baby, or if there are any factors that might make complications in labour more likely. You may be happy with this. If not, you still have the right to choose a homebirth, but may find that your Hospital Trust is reluctant to support this.
If you have been advised to birth in an OU but want to consider other options; or if you’ve been told that a Homebirth service or Birth Centre are not available in your area, the first step would be a discussion with your midwife or consultant.
If you are not happy with the outcome of the discussion, you could ask to speak to a Consultant Midwife or the Head of Midwifery. It might also be possible to transfer to another Hospital Trust that offers the services you want.
If you are keen to have a Homebirth and your Hospital Trust is reluctant to support you, another option is to hire an Independent Midwife to provide your care. (link to IMUK) and in some areas private companies are offering midwifery services, some of which are paid for by the NHS.
Some women choose to birth at home without midwife support (known as free-birthing). This is legal. It is also legal for a relative or friend to support a woman who is labouring without a midwife present, as long as they are not acting in the capacity of a health professional or giving medical or midwifery care.
AIMS can provide information and support for negotiating the choices that you feel are right for you.
Choices during labour/vaginal delivery
For more information on a vaginal delivery, check out our dedicated page.
In your birth plan, you may wish to record your preferences on the following aspects:
Where you would like to give birth (see above)
Pain relief (see below)
Examinations during labour
Your position during labour i.e. lying down, use of stirrups
Interventions from medical staff
Monitoring of your baby
Pain Relief during vaginal delivery
Labour can be painful – it can help to learn about all the ways you can relieve the pain. It's also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you.
Different pain relief comes with different side effects. If you are aware of these effects, you can make informed choices about the type of delivery you would prefer.
Check out our page on pain relief for more information about these types of pain relief:
Ask your midwife or doctor to explain what's available so you can decide what's best for you. Write down your wishes in your birth plan, but remember you need to keep an open mind. You may find you want more pain relief than you'd planned, or your doctor or midwife may suggest more effective pain relief to help the delivery.
A caesarean section can be performed electively or in an emergency.
As a caesarean is major surgery, most mums will not prefer to deliver their baby this way. However, in rare cases a woman may not feel able to deliver their baby vaginally, due to a physical and/or psycological need, and so may want to discuss an elective caesarean with a consultant and usually a counsellor. There is more on this on our dedicated page. If you are struggling to get your needs for a caesarean respected, you may also find this Birthrights fact sheet useful.
Therefore, most elective caesareans are just in fact 'planned' caesareans due to medical needs - even if this wasn't your original preference for delivery. These may be planned months in advance if there is a known medical condition that would make it safer to deliver the baby this way, or it may be planned with only a short wait time. This may be due to the baby's position at the last scan for example.
An emergency caesarean would be considered if there was a last-minute concern about a vaginal delivery. This may be because the labour was not progressing as well as the doctors would help. Only a small number of emergency caesareans are urgent and the term ‘crash section’ may be used to describe this urgent surgery. Most emergency caesarean are not urgent and there is time to agree what you want for the birth of your baby. Consent forms would need to be signed and your birth partner may have a vital role here communicating with the doctors if you are feeling unwell.
The main thing is that if you are advised by a doctor to have a caesarean section, that you feel fully informed about why they consider this the best choice for you and your baby. You should feel confident that this is the right choice for you and your baby, even if it wasn't your original preference.
Our dedicated page will give you more factual information about a caesarean from the NHS, including information on the possible preparation for the surgery as well as the recovery.
Can you make a caesarean birth plan?
It is totally possible to have a caesarean birth plan.
As very few caesarean need to be done in a rush and many are planned well before the birth, there is usually time to consider what you want to happen when your baby is born. Most obstetricians are happy to work with women to make a caesarean birth a positive experience. It is usual for the baby’s father and/or a birth supporter to be in theatre for the birth and for the parents to be able to greet their baby and have skin to skin contact, providing the baby is well.
Other options for the birth might include:
lowering the screen so the mother can see her baby born
delaying cord clamping (usually about a minute, so less than optimal cord clamping)
facilitating resuscitation of the baby, if required, at the side of the operating table without cutting the cord
lotus birth may be supported
If you are having a planned caesarean and are not being supported with your birth plan you have a right to be referred to someone else who will. For more idea of what you might like for the birth see here.
For a positive caesarean birthing story, check out our blog.
Skin to skin
For more information on the benefit of skin to skin, check out our dedicated page.
In terms of whether anything about this is stated in your birth preferences, this is one aspect that can usually be accommodated no matter what kind of delivery you have. Even with a caesarean, skin to skin can be offered once the baby is born. If you are not feeling able to to have that skin to skin yourself, your birth partner may be able to hold your baby until you feel able, and your baby will still benefit from this time.
Regardless of the type of delivery you have, Vitamin K can be offered to your baby so feel free to record this on your birth preferences and you can feel confident that it can be followed. For more on the benefits of Vitamin K, check out our dedicated page.
This is another aspect that can be followed regardless of the delivery.
Your newborn baby will be offered some screening tests in their first 6 to 8 weeks. Most babies are healthy and won't have any of the conditions the screening tests are looking for. But for those babies who do have a health problem, the benefits of screening can be enormous.
Early treatment can improve their health and prevent severe disability or even death.
The screening tests are quick and simple, and won't harm your baby in any way.
It's recommended that your baby has the tests, but you can decline them if you wish; state this clearly on your birth preferences if this is the case. Check out our dedicated page for more information on the checks.
Download a birth plan template
Click here for a downloadable birth plan template from NHS Choices. You can customise this as necessary, adding sections as applicable.
Source: NHS, www.aims.org.uk, NCT.org.uk
Information accurate at the time of publication.
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