Birth Plans

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Birth plans are the latest craze for expectant mums -- but not all hospitals welcome the carefully plotted demands that some pregnant women make in the maternity ward.

Is a birth plan a sensible thing to research and write in preparation for the big event? Some mums-to-be spend time creating elaborate plans involving requests for dimmed lighting, specific music, birth balls, water births and candles to having a homoeopathist or acupuncturist in the labour ward with them.

However, birth can be an unpredictable business and hospitals can be very busy ...

The article goes on to say why women might be ill-advised to write a birth plan. I'd take the opposite view - write a birth plan and take a private midwife with you to hospital who can advocate on your behalf with evidence to back-up what you're wanting.

So should they bother with them at all, and risk disappointment, or can a well laid-out plan have an impact on the kind of birth the mum experiences?

... Tracy Donegan is a big supporter of birth plans and recommends that mums-to-be should write one and discuss it with their care-giver during their pregnancy.

Prepare

"We cannot predict what will happen on the day but we can prepare for it," says Tracy. "A birth plan is a communication tool that may be helpful to the mum and the hospital. It is not about dictating how the staff do their job; it is to help them understand the kind of birth the mum wants."

... it is important ... to investigate hospital policy before labour commences.

First-time mum-to-be Sarah Power ... hopped on the birth plan bandwagon.

... Sarah is attending Holles St and heard that strength of character would be required on her part to ensure her birth plan be adhered to.

"This disappointed me, as I have been dealing with the most wonderful midwives ... and I got the impression they would do whatever possible to make my labour a great experience for me."

Sarah was worried about how her birth plan would be received as she attended her first ante-natal class recently.

"From what I learned at the hospital last week, women on the Domino scheme are treated differently to women attending the main hospital maternity unit. My labour will be actively managed between the midwife and me on the day and nothing will be prescriptive or enforced ...

... "However, my sister is currently pregnant with her first child, too, and is not on the Domino scheme and she is having a very different experience than me.

Interventions

While most hospitals welcome reasonable birth plans ... midwives and doctors do get concerned if the birth plan is unrealistic and expectations are too high ...

Practice

... "They [doctors] are the experts and have seen every kind of birth a million times over between them. They know that the physiology of the delivery is more important than Mozart playing as the head crowns. So I thought it best not to get hung up on one, as who knows what the actual birth would turn out like. And so how could I possibly plan for it?"

This can be a common statement amongst pregnant women - and one which is more likely to see a woman being wheeled down the corridor for an unnecessary caesarean.

... "Hospital policy at Holles St is to break the woman's water once labour has been diagnosed. This is to check that the water is clear and also can prevent prolonging labour. We also give labouring women an Oxytocin drip if their labour is slow, to help things move along. However, if a mum does not want her waters broken or an Oxytocin drip, she can make her wishes known to us at one of her visits or at an ante-natal class."

Failure

Dr Boylan says the Domino/Community Midwives scheme at Holles St may suit certain mums better, particularly those who want a less 'managed' labour. His worry about birth plans is that mums-to-be, particularly first timers, will create an unrealistic birth plan and set themselves up for failure.

So it seems that birth plans have their place but as a communication tool, and not a guarantee of how a birth should go.

They should be researched and written well before labour starts and any concerns or special requests should be discussed at the ante-natal classes or with a member of staff at the hospital prior to labour. It would not be advisable to turn up on the day with a birth plan all written out and find that the hospital does not support the wishes of the mother.

I'm struggling with this article. It seems to suggest that the knowledge and policies of the hospital - those that result in perhaps a 50% caesarean rate - five times what it should be - are superior to the woman's wishes for her labour. Of course safety is the primary focus, however we have very good evidence that routine interventions in labour - unless they are genuinely necessary - do more harm than good.

Melissa Maimann, Essential Birth Consulting 0400 418 448