WRITING A BIRTH PLAN

A Birth Plan is an important record of your wishes and needs during the delivery of your baby. If you are expecting to be admitted to hospital prior to labour, write down your requirements for this period of your care as well. Also think carefully about what your wishes will be for your postnatal care. Use this as a guide to help you to write your Plan, or work with your Lead Maternity Carer (LMC), Maternal Mental Health (MMH) worker, or other supportive person, to prepare a plan that you are confident of using.

Begin with your name and contact details

Expected Date of Delivery
This is the birth of your: 1st child / 2nd child / 3rd child / 4th child /…

History of previous birth experiences:
Record some of the key points of things that went wrong, things that were of concern to you, what you liked or disliked about your previous birth.
Record also if you suffered trauma as a result of the previous birth, whether you were diagnosed with PTSD or PND and what treatment (if any) you received.
Include any information that you wish your new carers to know of but try not to be too lengthy or too detailed.

Chosen Place for Birth: Hospital, Home, Birthing Centre?
Chosen Obstetric Care:
Who will be your LMC? Will they deliver where you want them to? (Some GPs only deliver at a specific hospital and will not attend home births.) Are they sympathetic to your needs?
Do they understand the implications of your previous trauma?
In the event of their unavailability, who will deliver in their stead?
If other carers are required, eg. a specialist, who will you use? Will your LMC work alongside?

Chosen Support People:
These days it is pretty much expected that the partner will be present at the birth. In most situations this is what both parties want. However, for some partners, it may not be the right place for them to be for a variety of reasons. Consider how your partner feels too. Was he also traumatised by the previous birth experience and has he had the opportunity to deal with the issues that are relevant to him? Take the time to talk openly and honestly about each other's needs and wishes for the birth and work together to be the best "team" that you can be. If he decides that he really doesn't want to be present, or maybe he needs to know that he will be able to take a break when he needs to, consider asking a close friend or family member to take on the role as primary support person. A friend who has had a baby herself may be of most support because she will probably be able to relate to how it feels to be in labour and what sorts of things she can do to best support you.

Requirements of support people:
What role do you want each support person to play?
In what ways do you want each support person to support you?
In what ways should your support people support each other?
Be specific and clear about what your needs are. For example, do you want your partner to remain close and to give you the emotional support you will need? Holding your hand and telling you he loves you may be the most important and supportive thing he needs to do!
Meanwhile, your other support person could be in charge of keeping a supply of cold flannels to hand, water to sip, homeopathic remedies to administer, rubbing your back, etc… In the eventuality that you will be unable to communicate clearly, (remember, labour pains do leave you speechless!) you will need them to be your advocates.

Special considerations identified by you for the birth and postnatal periods.

Things that you DO require to happen.
Consider things such as pain relief options, birthing positions, continuity of care and the number of people who will be caring for you. Do you want to specify certain people to do your examinations and other invasive procedures?

Things that you DO NOT want to happen / that you will NOT cope with / that you will NOT be able to tolerate for fear of retriggering.
There may be some situations that you know will trigger you or of which you are terrified. There may be some things that happened during your last birth that you were not happy about that you do not want to re-experience.

Fears and Concerns:
Are there certain procedures that terrify you to even think about them? By recording them here you will be highlighting the issue for your carers to take particular care and to treat you with extra empathy and respect.

Your Postnatal Care Requirements:
Consider again the continuity of care, who do you want to be caring for you?
Specify any concerns about your postnatal care last time that was not helpful.
Request to have your partner stay with you in hospital, if this would be beneficial.
What will your decision be regarding feeding the baby? Do you have a plan of what you will do if you strike difficulties and who you will ask for advice? Sometimes advice can come from many sources that is not always helpful in times of stress.

The plan should be copied and sent to the necessary people that will be caring for you, such as your LMC, the ward at the hospital where you will be staying and your MMH team or other support team. By taking the time to prepare a clear and concise plan, you will be ensuring, as much as you are able, that your needs will be met so that you and your partner are able to have a more positive and treasured experience.

The following is a list of some further points you may wish to consider when writing a birth plan. The ** highlight the points which are particularly relevant to a multiple birth.

LABOUR:
Wearing own clothes for as long as is possible
Choosing whether or not to be a teaching patient
Being permitted to return home if not in established labour
Stating what foods/fluids you may or may not wish to be eating or drinking
The choice of external fetal monitoring during labour **
The choice of internal fetal monitoring
The choice of monitoring fetal heart(s) by hand
The freedom of choice of position and activity in labour
Full discussion before a vaginal exam is performed
Full information on benefits and risks of each and every procedure
Full discussion on the need for artificial rupture of membranes
Full discussion on the use and need of oxytocin to boost contractions or induce labour
The use of a shower or bath for pain relief
Full discussion on the preferred pain relief for labour
Full discussion on the need for partner/support person(s) present at all times
Choice of whether children to be present
Interpreter available

BIRTH:
People to be present
People not wanted
People to be present and their roles explained during a caesarean birth
The position/s for birth chosen by mother - seldom an option for multiples **
Pain relief for delivery - preferred option
No time limit on second stage if progressing normally - seldom an option for multiples **
Full discussion on the need for episiotomy
Opportunity and the freedom to touch baby during birth
Midwife to assist baby's birth
The preference for female rather than male medical staff
The preferred choice that baby allowed to take first breath unaided, ie. no immediate suctioning
Skin to skin contact for parents immediately after birth
" Full discussion on managed third staged, eg the choice of oxytocin administered immediately after birth to expel the placenta
Baby(ies) to the breast to stimulate expulsion of placenta **
" The preference that baby be weighed and measured in parent's presence after initial bonding time

POSTNATAL:
Preferred that baby(ies) stay with mother at all times
If one or more babies in NICU or SCBU, alternative caregiver and/or support person to be present when parents unable to be there **
The choice to breast feeding or not from birth
Choice as to whether babies are fed singularly or double breast fed **
Immediate help with beast feeding on request
Support on formula feeding if this is chosen, only supportive staff required at this point
The choice of Vitamin K for baby (ies) - oral or injection
Full discussion on circumcision
Choice of room preference
Assistance with controlling visitor numbers
Co-bedding if possible (two babies sharing the same bed) **
Debriefing/reviewing of labour (what happened and why)
Testing for zygoticity (fraternal or identical twins) **
Discharge from hospital as soon as mother wishes

"Be thou the rainbow to the storms of life,
The evening beam that smiles the clouds away
And tints tomorrow with prophetic ray!"

(Byron -"Bride of Abydos")