Many hospitals ask to you write a birth plan before you have your baby. But what should you include and will your wishes be taken into account? Christine Hill investigates
What is the point of a plan?
Your midwife is not only anxious to make sure your baby is safely delivered, she wants you to have as good an experience as possible.
A birth plan is useful because it gives her an indication of how well prepared you are and what sort of birth you would like.
It helps her to know if she is caring for a woman with realistic expectations or one with romantic, dogmatic but unrealistic ideals which may jeopardise her baby's well-being.
Making a plan will help you to focus on your baby's birth.
Are there any drawbacks? The only problem with a birth plan is that you can't plan the type of birth you are going to have any more than you can plan the type of baby you will deliver (and be wary of any antenatal teacher who says that you can). It goes without saying that a healthy baby is more important than a certain type of delivery. You must be flexible - you can plan the type of birth you would like to have, just as you can dream about the baby you would like, but things don't always work out the way you intend.
So what should I put on it?
There are two requests that are relevant to everybody:
'I would like to keep an open mind.' By saying this, you are acknowledging that you can't accurately predict how your labour will go. Having said this, you might want to add 'Epidural' or 'A natural birth if possible', depending on what your ideal would be.
'I would like to see a doctor after about an hour's pushing.' Most obstetricians and obstetric physiotherapists believe it's not in the interests of a woman's long-term health to push for too long. An obstetrician will be able to assess that your pelvic floor muscles are not becoming overstretched or damaged.
Emotional and personal issues:
Spending labour in the birthing pool If the hospital has a pool, it's reasonable to state on your birth plan that you would like to use it. But prefix the request with a question mark because, contrary to what you might be told, you won't know if water will suit you during labour until you try it. You don't want the humiliation of insisting on a water birth and then finding you don't find water helpful.
Having the baby delivered onto your tummy Some women want to receive their baby immediately whilst others don't want to hold their baby until he or she is wrapped in a blanket. From your baby's point of view it's irrelevant. Whatever you want will be the right thing for you.
Letting your partner cut the cord If your partner has strong feelings one way or another, mention it to your midwife.
Medical issues:
Episiotomies The decision to do an episiotomy, or to let you tear, is made by the person who delivers you and it's important to trust their judgement. Some people mistakenly believe it is important to avoid an episiotomy at all costs. But a third-degree tear, which involves the anal sphincter muscle, is bad news. An episiotomy should avoid this happening.
Staying mobile during labour Most hospitals monitor the woman for about 40 minutes when she is first admitted to hospital. This is so the midwife can record the baby's heart rate during contractions and check that the baby is well. During this initial monitoring, you are likely to be propped up in bed with a belt around your tummy that's hooked up to a computer. It is not the most comfortable position to be in during early labour but as soon as the midwife is happy that your baby's heart rate is normal, the monitor will come off. Midwives generally encourage you to adopt any position you find comfortable during a contraction. If the midwife insists that you have to stay on a monitor, it is likely to be because she is concerned about your baby's heartbeat - only a fool would want to ignore that.
Having a 'mobile' rather than full epidural Whether you are offered a mobile epidural depends on which hospital you are in and which anaesthetist you have - you may not be able to choose. In any case, the best way to use an epidural is to rest and re-charge your batteries.
Avoiding forceps or ventouse This, again, is not a decision you should make - if your baby needs an assisted delivery, it is usually because he or she needs to be delivered quickly or is stuck.
Syntometrine This is a combination of drugs that is usually given after your baby is born and before the placenta is delivered. It stimulates the uterus so the placenta can be delivered quickly and helps prevent the risk of a dangerous post-partum haemorrhage (PPH). Some people (no-one who is medical) believe it is neither 'natural' or necessary. Studies have shown that you are three times more likely to have a PPH if you do not have Syntometrine.