Revised birth plan

[ailbhe]

General - vaginal or c-section

• Under no circumstances do I want to see or hear the obstetrician who did Linnea's birth. Rob can check corridors to make sure he's not around before I go from one room to another.
• My birthing partners will be my husband (Rob Collier), my midwife (Fiona), and possibly my mother (Niamh Leamy).
• I do not consent to any medical students or student midwives being present.
• I want the absolute minimum number of staff in the room at all stages, and I want them all to introduce themselves to me and my birthing partner(s) by name and position.
• I want to avoid vaginal exams.
• I want immediate skin-to-skin contact with my baby, before the umbilical cord is cut.
• I want the umbilical stump tied, not clamped.
• I do not consent to any treatment or examination of the baby unless s/he is in my sight.
• If it is necessary to take my new baby to SCBU or similar, s/he is to be accompanied by my husband at all times and I am to be brought to him/her as soon as I can be wheeled there.
• I don’t need an audience for breastfeeding or cuddling my newborn.
• I want Rob and myself left alone with the new baby in a private room for about an hour after the birth, so I can try to feed it and we can coo over it.
• I want my older daughter, Linnea, to visit us - me and the new baby - as soon as possible after the birth. The recovery room would be ideal.
• I do not want anyone on the postnatal ward nagging me to walk. I will get up and walk when I feel ready. I have had surgery twice since my previous birth, and both times I insisted on getting up to walk earlier than the nursing staff thought appropriate. If I can walk, I will. If I can't, don't nag me.
• I want to feel confident, the day I leave hospital, that I am well enough to do so, and that I have medical support available to me after I leave if I need it.

---

Trial of labour

• What can I try without a drip and without continuous monitoring?
  • Oral medication?
  • Membrane sweep?
  • Artificial rupture of membranes?
  • Medication inserted into the vagina?
• I want to be mobile during labour.
• I do not consent to an epidural.
• I do not consent to augmentation of labour with a syntocinon drip.
• I’m quite happy to use pethidine as pain relief if I need more than gas and air. I will ask for it if I need it.

"Elective" C-Section

Before the operation

• If pre-scheduled, I want to have the baby in the morning. I want the whole family to go to a private room at the hospital to await pre-op stuff together, and then someone (probably my mother) can take Linnea away while Rob and I go to theatre, and then Linnea will be brought back to meet the baby.
• I require an outpatient appointment to see the surgeon prior to the operation who will be prepared to discuss my concerns and be familiar with my obstetric history.
• I want to meet the anaesthetist before the day of birth to discuss anaesthesia options and the importance of these to my mental state. I do not yet know whether I would prefer a spinal or an epidural, but as soon as I am ready for a c-section I must be guaranteed no pain, immediately. I can’t endure pain in theatre.
• I want gas and air available for the siting of IV drips, administration of epidural/ spinal block, and vaginal examinations.
• I want my husband and my community midwife with me at all times. Under no circumstances is anything to be done to me while my husband or midwife is not present, however trivial.
• I do not consent to be prepped for the operation unless my husband is present.
• If I have to have a catheter, and I'm sure I have, I don't want to see it, feel it, or have to carry it around. If I am mobile, no catheter. There has to be a way to arrange this.

---

"Elective" C-Section cont.

During the operation

• I want the minimum of flesh exposed during the operation.
• I want at least one hand free during the operation this time. I want to avoid having my legs restrained.
• I do not wish to see the incision at any point during the operation.
• I want to breastfeed as soon as physically possible – not practical, but possible, after the birth - preferably while being sewn up again.

After the birth

• I want to know that I have EXCELLENT pain relief available for as soon as the anaesthetic wears off and for the weeks after the birth - most women I've met who had c-sections got decent pain relief for a very few days and then had to go to paracetemol. I refuse to experience serious pain after a birth again. Not happening.
• I want a follow-up appointment with the ob who does the op a week or less after the birth to have my stitches and incision checked for soundness, in addition to the regular 6-week check with a GP.
• I want access to a lactation consultant. I explicitly do not want anyone to even SUGGEST formula-feeding unless an actual paediatrician examines the baby and finds a problem, and then they'd better suggest some other things first. There's a milk bank in Oxford, for a start.
• But mainly I want to have no pain. No pain, no pain, no pain.

Yes, it's three pages long, but I think I've put the main things on page 1, and I've tried to highlight...

Comments

[hobbitbabe.livejournal.com]

What a lot of organized thinking about difficult stuff!

When I read the previous edition, I felt kinda funny about the "I don't need an audience of strangers", but then I wondered whether that might be a cultural disconnect - that what sounds sarcastic to me (a literal-minded Canadian) might be completely judgement-free and easy to understand for people who work in English hospitals.

[ailbhe]

It's very *mild* sarcasm. I edited out most of the serious stuff. It might even be humourous.

[sidheag.livejournal.com]

FWIW, this is the thing that most jarred to me too, and I'm English, and I use sarcasm, but I wouldn't use it here. I don't think it comes across as humorous, sorry. I'd recommend being as straightforward and serious as possible, since you're asking for people to pay a lot of attention to things they normally neglect (however inexcusable that might be) and in some cases even asking for things they can't possibly promise (a guarantee of no pain, for example). You've moved a long way in that direction, but I think you could go further. If you try to be humorous/sarcastic/whatever, I think you run more risk of people not taking you seriously. JM2pW.

A trivial point: in the real thing, you will name the obstetrician in the first point, won't you?

[ailbhe]

I've changed it! I've changed it!

And someone else will have to write the ob's name in, because I can't. Rob or Fiona will.

[ai731.livejournal.com]

"I don’t need an audience of strangers..." The word 'strangers' might be too vague. I'm assuming you mean anyone except Rob, your mum, and your midwife, but 'strangers' could be taken to mean any medical staff that you haven't previously met, if you see what I mean.

[iuil.livejournal.com]

Yes, I would leave out "of strangers". Leaving it at "I don't need an audience" is far stronger.

I probably know why you haven't, but could you name and shame in first line? That way there's no ambiguity about who you mean and there's no chance of "Ooops, we didn't know that was who you meant" ocurring. If you can't yourself, could Rob handwrite in the name after you've printed it off?

[ailbhe]

I don't know his name. I've *seen* it lots of times, but I don't know it. I don't read it when I see it, I don't remember it afterwards. I also don't know what he looks like and couldn't describe him.

Someone - Rob or Fiona - can find his name for me and write it in somewhere I don't have to see it, like on the copies that get given to other people.

[buzzy-bee.livejournal.com]

I think the page headers work well. FWIW mine was I think four pages long with headers indicating what scenario it was for (with repitition as appropriate).

[clare-s.livejournal.com]

I think you maybe done on this.

I agree with the other commenters get Rob to name the consultant on the birth plan being issued to others.

[sshi.livejournal.com]

The only comment that I would add (from a structural, writing point of view) is that you say that you do not consent to an epidural in the section about labour and then in the next section, it mentions gas and air for epidural/ spinal block. I've no clue about having babies, and I'm thinking these sections are mutually exclusive (i.e. only epidural if c-section), but it might be a good thing to make that clear?

[k425.livejournal.com]

The only change I would make would be in the Trial of Labour section. Something like "in the event of trial of labour I do not consent to an epidural", to clarify that the bit about not having an epidural applies only to this situation.

This has been a huge job and you're right to get bullet one completed by Rob or Fiona.

[lovingboth]

Good luck.

Losing the sarcasm was a very good idea. Unfortunately, there will be people who will look at the list and go 'Oh ghod, one of those', so the less they have to object to, the better.

So I'd change "I don’t need an audience" to "I don't want anyone other than..."

Again, good luck.

[hypatia.livejournal.com]

So I'd change "I don’t need an audience" to "I don't want anyone other than..."
I echo that comment.
Also you probably know this but artificial rupture can increase the likelihood of the drip because they get so damned twitchy about the number of hours and sometimes it doesn't actually induce anything.

The other thing regarding pethidine is that you can ask for half doses or reduced doses and take more as you need it - if you have any reason to believe pethidine might give you a bad reaction.