While some people think that it is important to make a birth plan others believe or are told, that there is no point because the process of labour is unpredictable and you will have to change your plans on the day anyway.
People generally plan for the big occasions in their lives and birth is no different. Most women only give birth a couple of times in their lives, so it is important that your experience of labour and birth meets your expectations as far as is possible. Formulating a birth plan with your LMC midwife or doctor will help your experience to be as close as is reasonably possible to your expectations and needs.
A birth plan cannot ensure that you get the labour and birth experience you want, but if you don’t write a birth plan and get an assurance of support for your preferences from your LMC, you are likely to have the sort of labour and birth your caregiver is most comfortable with facilitating and this may or may not be the birth experience you want.
A birth plan cannot change your LMC’s style of practice or personality and it is unlikely that you’ll be given options for a style of support that is not already a regular part of your LMC’s practice. Creating a birth plan with your midwife or doctor will help you clarify your ideas about labour and birth and assess your LMC’s point of view and willingness to support the choices you make. Discussing your beliefs about birth and your preferred options for birthing is an important part of your relationship with your LMC. Most LMCs are willing to support the choices women and their partners make. It is a good idea to start having these conversations early in your pregnancy so that if your LMC does not feel able to support your choices you have the option of finding a different LMC. You can change your LMC at any time during your pregnancy.
A birth plan is a list of your priorities and wishes for the birth and the time immediately afterwards. You and your partner need to make a list of what is important to you about your baby’s birthday and discuss these with your LMC at your pregnancy check-up visits.
a) Practical Issues
Discussing your Birth Plan with your LMC also gives you the opportunity to clarify what we call “housekeeping” type arrangements e.g.
• When and how to contact your LMC or her/his back-up when you are in labour?
• Will your LMC be with you for the entire active part of your labour (i.e. contractions 5 minutes apart from the beginning of one contraction to the beginning of the next and each contraction lasting a full minute) at home or in hospital? If not, who else will provide your care during labour?
• If you are planning to give birth in a hospital or maternity unit, at what point in your labour do you leave home and how do you contact the facility to let them know that you are on your way?
• Who will be in the room with you during your labour and birth?
• Who will support you during early labour at home? Does your husband/partner/support person/s understand what his/their role is?
• What routine monitoring procedures does your LMC recommend during labour? e.g. monitoring your baby’s heart-rate, your temperature, pulse and blood pressure; vaginal examinations to assess your baby’s position and your labour’s progress etc
• What will you wear during active labour – your own clothes, a hospital gown?
• What will you eat and drink during labour to keep your energy up? (Your Birth Partner will also probably need food and drink.)
• Do you have any cultural or religious requirements that your caregiver should know about?
• What do you need/want to have on hand/take to the hospital during your labour and birth? e.g. massage oil, music, toiletries, camera etc
• Postnatal Care. Most women who give birth in a hospital choose to stay in the hospital for approximately 48 hours after their babies are born. Some women transfer to a maternity unit or go home within hours of giving birth. Discuss your preferences with your LMC and document a plan for ensuring that you can easily access the postnatal care you and baby will need.
• What do you need to take for after your baby is born? e.g. clothes and sleepwear for you, baby clothes, carseat etc?
b) Birth Place
In New Zealand the majority of women currently give birth in a hospital. Many women/couples assume that hospital is the best and safest place to give birth simply because it has become the norm. Sometimes your options for place of birth (unless you choose to homebirth) will be restricted to the local hospital. However, in most places in New Zealand your options for place of birth are:- home, maternity unit/birthing centre, or hospital.
Women/couples often choose to birth their babies in hospital because they are concerned about the complications that can arise or “the pain”. We like to remind women that birth is a normal physiological process designed to ensure the survival of the human species. If your pregnancy has progressed normally and healthily, it is reasonable to expect that your labour and birth will not also be normal, healthy and manageable. There is no reason that healthy women whose babies are full-term should not consider the option of birthing in a Birthing Unit/Maternity Hospital or at home.
A woman’s choice of birthplace often reflects her attitude toward, and beliefs about labour and birth. However, some women’s choice of birthplace is imposed upon them by the attitudes and beliefs of their partners or extended family members or their LMCs. It is important that every woman gives birth in the environment in which she will feel most comfortable, relaxed and supported.
If you live in Auckland, click here for your options for place of birth.
You know what your body is doing during labour and birth, you don’t know how long it is going to take or what it is going to feel like.
c) Labour coping strategies
Most women know that labour is going to become “painful” at some point. It takes a lot of stretching and pressure to for your body to open up and allow a fully formed little human being out. Despite what you may have heard – labour pain is manageable. Birth (like sexual intercourse) is part the human species’ way of ensuring our survival. It would be ridiculous (and totally counter-intuitive) if the process that ensured our survival as a species was not able to be tolerated by most birthing women. Our expectations, preparedness and the type of support our LMC and Birth Partner provide, have a major impact on how “painful” our experience of labour will be. We all experience pain differently, one person’s “sensation” is another person’s “pain”. It is important that you choose and organize your own labour coping strategies, discuss these with your LMC and Birth Partner and enlist their support.
Discuss the benefits and risks of different natural and medical pain management options with your LMC midwife or doctor and your Birth Partner. Write down your preferences and discuss how your LMC will support you with these and help you to cope with the increasing intensity of the contractions needed to birth your baby. e.g.
- “Natural” methods e.g. breathing, relaxation techniques, mobility and changing positions, showering, bathing, immersion in a labour pool, massage etc
- Alternative health care therapies e.g. TENS, homoeopathy, acupuncture, hypnobirthing, aromatherapy etc
- Pain relieving drugs e.g. nitrous oxide (“the gas”) or narcotic pain relief e.g. pethidine
- Regional anaesthesia e.g. epidural or spinal anaesthesia
Once again, if you do not feel that your LMC midwife or doctor has the skills, experience or the inclination to support your choices you should change to another LMC.
d) Medical technology and procedures in labour and birth
During the last 50 – 100 years, a number of technologies and procedures have been developed that can be lifesaving when labour and birth do not proceed normally or if mother and/or baby are unwell. In recent years many of these procedures that were invented to help improve outcomes for mothers and/or babies in high-risk situations, have become routinely used during normal labours. As part of your Birth Planning you need to discuss the possible/routine use of medical interventions in the labouring process. Ask your LMC midwife or doctor about the situations in which they would recommend the following procedures. Remember that these are all medical procedures and cannot be applied to your labour unless you give your informed consent to having them.
- Induction of Labour
- Augmentation of Labour
- Continuous electronic fetal heart monitoring
- Forceps or ventouse assisted birth
- Caesarean Section
- Active Management of the delivery of your placenta
Some women are happy to have their labours medically managed, others prefer to allow labour and birth to progress normally and to avoid the use of medical interventions unless there is a demonstrated need for this. Make sure that you communicate your preference to your LMC midwife or doctor and receive assurance that they are committed to and comfortable with supporting your labour preferences.
e) The first minutes of your baby’s life
- Who will “catch” your baby. Your LMC usually catches your baby as it emerges from your body but it is possible during a normal vaginal birth for the baby’s father or grandmother etc to do this.
- Mother and baby “Skin to Skin” – Most LMCs recognize the importance of the baby being immediately passed to the mother to cuddle against her skin, however it is a good idea to discuss and document your choices about this.
- Cord cutting or not. Again, your LMC will usually cut your baby’s umbilical cord before or after you have delivered your placenta, but some parents like the baby’s father or sibling etc to do this and some parents opt for a “Lotus Birth” where the cord is not cut.
- What will happen to your placenta/whenua? Most parents opt to have the hospital dispose of their placentas but some parents choose to bury the placenta themselves, often planting a tree for their baby on the site. Discuss your preference and if you plan to keep your placenta/whenua decide how you will manage this. (You may want to check out the Capceco Placenta Capsule) .
- Everyone knows that mothers’ milk is the best food for babies. The best way to start breastfeeding is for there to be no separation between mother and baby from birth until after the first breastfeed. (Most babies will be ready to feed for the first time within 20 minutes of being born.) Discuss & document your preferences for managing this first feed with your LMC.
- Ask your LMC about any routine monitoring or procedures that are usually performed during the first minutes/hours of your baby’s life. e.g. full physical examination, umbilical cord blood typing, weighing and measuring, vitamin K administration, cleaning and dressing etc.
- Make sure that you discuss and document any cultural, family or religious practices that need to be accommodated around the time of your baby’s birth, with your LMC and plan how they will fit in with the health checks etc that are usually performed at this time.