Birth plans

Beth and Jonathan Simpson's home birth plan

Previous experience

My previous labour with Jake in December 2000 lasted four hours ten minutes, with a ten minute second stage. I had pre-labour contractions of increasing intensity for six or seven hours prior to that. In early labour I used TENS. I laboured in the bath from 3 to 8cm, gave birth in a water pool and used only that and acupuncture for pain relief. I had a physiological third stage and a small tear that needed stitching, but which has healed perfectly. Jake was born in his caul and he weighed 9lb 13oz but this did not present any problems at all. We were discharged from hospital around six hours after Jake was born.

• I had a wonderful experience of birth with Jake and am looking forward to an equally positive birth this time!
• I have attended both NHS and NCT refresher classes during this pregnancy. I would like to keep intervention to a minimum and have as active a birth as I can.
• I understand that birth does not always go to a plan, and my priority is the delivery of a healthy baby. If labour appears slow for any reason, that's fine by me as long as the baby isn't in distress; please don't suggest transfer to hospital simply because things are slow.

Birth companions:

Husband Jonathan (known as Jo) and acupuncturist Jane Roberts. My mother, Diana Walton, may probably also be in attendance - her primary role is to look after our son Jake, but if he is asleep I may also want her support. If my father Nick Walton is also in the house, I would rather he did not witness my labour and birth!

Early labour and first stage:

Given my previous experience of having plenty of warning before labour established itself, I am planning to cope with my husband or mother as support for as long as possible.

If you arrive before I am 5cm dilated, I plan to continue using the TENS machine, as well as breathing and a variety of different positions. I'd like to try and rest for as long as possible until labour is established; please encourage me to stay on my left side if I want to lie down!

I would prefer not to have my waters broken - I haven't experienced labour with broken waters and am rather anxious that it might be more painful. If you feel it's necessary to break my waters, please can Jo, you and myself discuss other options first?

Once labour is established, I hope to use acupuncture as my main source of pain relief and stress relief. However, I would also like to use a waterpool if it's ready; acupuncture and/or acupressure can be administered while I'm in the pool if necessary.

It's Jo's job to remind me to urinate frequently in the first stage, and to try and keep my jaw relaxed.

Pain relief in first stage:

I hope to manage without any drugs, and would appreciate your encouragement in this. I would like to avoid gas and air if possible as I'm worried it might make me sick… but will try it if I feel I need to.

Under no circumstances at all do I want pethidine, meptid or diamorphine. This is not negotiable, so please don't even suggest it!

Transition:

I understand that it's normal for women in transition stage to behave irrationally and no longer feel that they can cope. If this happens to me, I would like to have as much encouragement and emotional support as possible. If you believe that I'm in transition but neither I, my husband or acupuncturist has recognised it, please alert us.

I understand that it is not unusual for labour to appear to stop for up to an hour between first and second stages. Assuming the baby is not in distress, I would like to avoid any panic or transfer to hospital, and simply let my body get on with the labour at its own pace.

The birth:

If I am in the pool, I imagine I will stay there for delivery. If I am on dry land, I would like to give birth in an upright/kneeling/ /all-fours/supported squatting position to give the baby maximum space to descend through my pelvis. I do not want to be on my back or semi-reclining.

When I'm pushing, please remind me to keep breathing and not to push against my pelvic floor. If I'm on dry land you feel it is appropriate, I would appreciate some help in having my perineum gently stretched to try and avoid a tear.

If the baby appears stuck I would like to try using the 'drop squat' position for a few pushes first, assuming the baby is not in distress.

I would prefer to tear than to have an episiotomy, if this is feasible. But I would appreciate your help to prevent me tearing, perhaps coaching me through the final contractions, panting, or with a perineal compress.

If it's feasible and he's up for it, my husband Jo would like to catch the baby as s/he is born.

I would like to discover the baby's sex for myself, so if you can manage it, I'd rather not hear, 'it's a boy/girl!'!!

Third stage:

I would prefer to have a physiological third stage. If I do have a natural third stage, please do not clamp the cord until it has stopped pulsating, unless its position is a risk to the baby. If we're all in the right frame of mind, I'd like to breastfeed straight away as an aid to delivery of the placenta.

Please offer my husband the opportunity to cut the cord if possible!

We would like to keep the placenta, so don't take it away with you!

After the birth:

I would like the baby to be delivered onto my stomach and to breastfeed him/her as soon as possible after the birth - I don't mind being given a bloody baby! Please keep him/her unclothed, to maximise skin-to-skin contact.

Repair of the perineum, if necessary: I would prefer to avoid having stitches if possible, so if you think any tear will heal without stitches please let me know.

Other:

I agree to a single student midwife being present at the birth. However, I would like their role to be kept to one of observer rather than active participant unless circumstances dictate otherwise.

If labour is simply taking a long time but my baby is not in immediate danger, please would you encourage me to keep going and perhaps to try changes of position or movements that might help before we discuss tranfer to hospital.

I am happy for the baby to be given Vitamin K.

Baby feeding:

I plan to breastfeed and am looking forward to it! - I breastfed Jake for 15 months. If for any reason the baby needs to be fed not from my breast, I'd like him/her to be given my colostrum/milk from a spoon or cup. I do not want my baby to be given formula without my consent.

If transfer to hospital becomes necessary:

Please don't offer me an epidural; if I want one, I'll ask for it! However, I would like to be encouraged to make it through two or three more contractions from when I first request an epidural. I would also like to examined immediately before the epidural is applied, in case I am nearly ready to push by then.

If an epidural becomes necessary, I would like a mobile epidural if possible.

If an epidural slows down labour, I would like to attempt to change positions as much as possible before being given a syntocinon drip or any other form of augmentation. For example, I would like to try being on my side or on all fours, or in a well supported squat, in order to keep the pelvis well open and keep labour moving on as it should.

Under no circumstances at all do I want pethidine or diamorphine. This is not negotiable!

I would like the baby to be monitored using a sonicaid where possible rather than a strap-on monitor, which could prevent me moving around.

I would like labour to go at its own pace as much as possible. For example, assuming the baby is not in distress, I would prefer not to have my waters broken or be given syntocinon to speed things up. If the baby appears to be poorly positioned or labour is not progressing well for some reason, I would appreciate it if you could suggest changes of position or movements that might help before any recourse to drugs is taken.

If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anaesthesia. I would like to breastfeed the baby as soon after birth as possible. If I have to have a general anaesthetic, I would still like the baby to be put to my breast as soon as it is born, if this is feasible while I'm still asleep.

We would like to keep the placenta, so please don't take it away!

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