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Birth plans
We have attended antenatal classes at UCH as well as NCT classes and a workshop at the Active Birth Centre, and I would like to try to have as active and natural a birth as possible. Despite my high hopes, though, I am keeping an open mind as to pain relief as I can't be sure how I will cope with the pain. Birth companions:Husband Jonathan (known as Jo) and acupuncturist Alison Courtney or, if Alison can't make it, Judy Lassman. Early labour and first stage:I am planning to cope at home for as long as possible before we come into hospital; we have a TENS machine. If we arrive in hospital before I am 5cm dilated, I plan to continue using the TENS machine, as well as breathing techniques and a variety of different positions. I'd like to try and rest for as long as possible until labour is established. But, if I want to lie down, please encourage me to stay off my back. 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 the hospital's waterpool if it is available; acupuncture can be administered while I'm in the pool if necessary. 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. Pain relief in first stage:I hope to manage using only Gas And Air, and would appreciate your encouragement to avoid other drugs. 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 be 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. 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! Transition:I understand that it's normal for women in the transitional 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 rather than being given pain relief or hormones at this stage. 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 drugs at this stage, and simply let my body get on with at its own pace. The birth:Ideally I will get out of the pool before the birth; I would like to give birth in an upright/kneeling/supported squatting/all-fours position to give the baby maximum space to descend through my pelvis. I do not want to be on my back or semi-reclining. If the baby appears stuck and we need to use a ventouse or forceps, I would like to try using the 'drop squat' position for a few pushes first, assuming the baby is not in distress. If I have had an epidural, I would still like as much help as is possible to keep off my back, perhaps being on my side or on all-fours. Third stage:I would prefer to have misoprostil to syntometrine to help with the delivery of the placenta. However, if I have made it through the birth without any drugs, I would like to have a natural 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. Please offer my husband the opportunity to cut the cord if possible, although he may not want to! 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! I would like to breastfeed the baby as soon as possible after the birth, and keep him/her unclothed if this is appropriate, 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 doctor, nurse or midwife being present at the birth. However, I would like their role to be kept to one of observer rather than active participant. 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. 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. Baby feeding:I plan to breastfeed and am looking forward to it! If I have trouble breastfeeding I would greatly appreciate the help of a midwife who is fully supportive of breastfeeding, and would also like to be given contact details for local breastfeeding counsellors. If for any reason the baby needs to be fed not from my breast, I would appreciate it if a cup or spoon could be used over a bottle, if possible. Going home:I would like to go home as soon after the birth as possible - particularly if it's Christmas Eve or Christmas Day!.
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