Writing a birth plan to help you to get what you want
By Madeleine Speed
When you know you are pregnant, you probably have a good idea of where and how you would like to give birth often well before you have re-searched or planned anything. Some women are clear that they want to give birth with their mum present in a big hospital while others know they would prefer to be in a small midwifery-led unit. After talking to other mums and learning more about the options you could choose, you will probably find your plans become clearer and particularly if you have researched birthing positions and ways to give birth that are specifically relevant to PGP. Some positions can be better than others for safeguarding your pelvis and stopping labour from making any PGP symptoms worse. It can be invaluable to share your thoughts about where and how to give birth with your family, midwives and doctors. Whether it is your first baby or your third, it can be very useful to use a birth plan. This is because it enables you to be very clear about what you would like others to know about your labour and birth. In other words, planning ahead and having a birth plan can help you to keep in control of the kind of birth you want.
A birth plan is usually written down ahead of going into labour and includes your plans of where, how and with whom you would like to give birth. It is particularly useful if you have the symptoms of pelvic girdle pain because you can outline actions during labour that will help to avoid any further damage to your pelvic joints and pelvis. This might include positions you would like to avoid (like being on your back or opening your legs too widely) and those that will accommodate your symptoms of PGP (such as using a birthing pool, kneeling or giving birth on your side).
Why does it need to be written down?
It isn’t necessary to write down a birth plan but it can be very useful to have some notes so you don’t need to keep explaining your needs to the professionals caring for you as you prepare for birth, particularly if there is a change of mid-wife or doctor (due to shift working). The plan doesn’t have to be very long and in fact it is probably best if it is simple, clear and relatively short. Your birth plan is specific to you as it outlines your plans and wishes so even if you look at birth plan examples on websites such as the NHS one, make sure you go through it and check that you have made changes and additions that really suit your needs.
Don’t be tempted to rush your birth plan
Allow yourself plenty of time to plan what you want. Include time to pull together as much relevant information as you can. You might want to join a local antenatal class, have some private classes through the National Childbirth Trust and chat to as many new mums as possible about where they gave birth e.g. a hospital birth, a birth centre or a home birth. Find out why they wanted to give birth in a particular setting, how it went for them and what they might have liked to change. You might want your husband or partner with you or you might prefer to have your mum, sister or friend. You might then want to discuss some ideas of your own with your midwife to see what might work for you. If you are interested in a home birth, see if you can talk to someone who has had one and discuss the practicalities for you with your midwife. Sometimes women with PGP believe that it is best if they opt for a caesarean birth as a means of avoiding stressing an already sore pelvis. A caesarean may be an option for you but don’t feel you are being pushed down this road by your midwife or family because a vaginal birth is possible without aggravating PGP symptoms. It just needs a good choice of suitable birth positions and for some women coping with a new baby and PGP can be taxing enough without the additional restrictions and soreness that a caesarean can entail in the weeks following the birth.
The benefit of a flexible birth plan
No-one can predict exactly how labour may develop for you so it’s best to be flexible and include some ideas of what you might like to do if any complications arise. Having gone over these possibilities, even though they may not ever hap-pen in reality, can really make you feel confident that you know how you might proceed if complications did occur. Again, it is very useful to discuss options with your midwife, physiotherapist or doctor about what kind of pain relief you would like and how you might approach various possible situations. So although you need to take on board that flexibility is important, your birth plan can still outline what positions with PGP may be best for you (such as being on all fours, being on your side to limit opening your legs too wide, etc). Sometimes it isn’t until you actually go into labour that you find the positions that really work best for you. So even though you thought you might what to give birth on your side, you might find that kneeling on all fours seems to work best for you on the day!
Discuss all the pros and cons with your midwife
We are all different and one approach doesn’t suit everyone so it is really important to find out as much as you can about what stages are involved in labour and birth. Then discuss all the possible options you might consider and find out the advantages and disadvantages of each so you know what might be involved before making a decision about your own preferences. If you find your midwife doesn’t seem to be aware of your PGP symptoms or isn’t sympathetic to your wishes, you can ask for a Supervisor of Midwives (SoM) to help with a discussion of the options with you and your midwife. Sometimes it is because a midwife is concerned about PGP symptoms that she might be less willing to encourage you to certain sorts of births (e.g. birth at home in a pool) because her experience is limited and she is worried about the standard of care for you and your baby.
Having said that, if you know all the benefits and risks associated with a particular option, your midwife should support your choice of birth, even if it is not her own choice for you. The SoM doesn’t take the place of your midwife but helps you to discuss together the pros and cons of each option so that you can develop a plan together. Water births can be very useful if you have PGP because the water can help to support you and help you to move if you find this difficult on dry land. The warmth of the water can also help you to relax so it is a popular choice during labour to help to manage PGP symptoms. Sometimes hospitals can be unhelpful because they have concerns about getting you in and out of the birthing pool quickly if there is a need to do so. However, they should have a plan for any woman who becomes unwell while in the pool, so PGP is no different, and having PGP should be a reason for being supported to use the pool, not for being told it is not suitable. If you experience difficulties with getting the kind of birth you want, do consider calling the SoM. You can see them in advance of the birth or you can actually call on them during your labour if you feel your wishes and level of support from your midwife isn’t in keeping with what you might reasonably expect.
Choice of birth partner
It can be really useful to have someone you love and trust with you when you are going into labour and preparing to give birth. This person can support you at times when you feel overwhelmed or simply to help reinforce your choices for you. Giving birth can be a very emotional time and it can also make you feel quite vulnerable, so having someone to act on your behalf and to be clear what you do or don’t want can be useful. Think about whether you want your husband, partner, friend or mum to stay with you throughout the labour or whether you would prefer them to be present just for some of the time. Be true to your own feelings and don’t feel pushed into having your mum there if you really don’t think it’s a good idea! If your husband or partner feels upset or scared by hospitals, then you may prefer to have a close friend with you instead for much of the labour and then bring your husband in when the baby is born. It’s really down to you and what you want, so don’t be pressured by family or healthcare professionals to choose what other people may believe is a good birth partner if it isn’t for you. When it works well, partners can be really useful to explain your birth plan, to remind what your choices are and to hand out sheets to other midwives at the end of a shift. There is evidence to suggest that if you know what you might have to face and that you have a loved one with you, you experience slightly reduced levels of pain. Some partners can be very useful if they are trained up to give a back massage as this support, too, can offer a way of providing pain relief and a sense of wellbeing in labour.
Looking ahead of the birth
Sometimes it can be hard to think beyond the birth of your baby because it is such a big and exciting event after nine months of pregnancy! However, your birth plan can also include some ideas of how you want things to go beyond the birth. For example, if you have severe symptoms of PGP and your mobility is limited, you may choose a birth centre birth with extra support on the unit afterwards. You may want to discuss whether it might be possible to have a private room on the ward. You may also want to have your husband, partner, mum or friend help-ing you once the baby is born. If you have limited mobility and your PGP is very painful, you might find it useful to have someone close to you, helping to lift the baby and give it to you for feeding. This is because it of often difficult to find busy staff to help you to manage on the ward before you are able to go home. If you have discussed this ahead of the birth, you might avoid a lot of upset and frustration. If you don’t have someone who can help you on the ward, there may be steps that your midwife can advise to help get your meals to you, take you to the loo and assist you to have a shower – measures that might be very similar to the needs of someone who always uses a wheelchair and would therefore need ex-tra help in a hospital. Similarly, if you opt for a caesarean birth, you may want to make plans early for how you want to manage, given that you won’t be able to lift the baby or carry anything for a while (and this will continue for a good few weeks after you take the baby home). Again, if you can build a picture of what you need to help you manage, you are much more likely to avoid upsetting surprises after the baby is born.
If you feel organised and comfortable about the kind of care you want during labour, you will probably feel more confident and much more able to cope. Do have a look at the topic of birth plans in the main website area which suggests some ideas of what you might include in yours, including useful birthing positions. There are also lots of different templates for birth plans to ‘Google’ that you could use to help you to create your own. These are on various parenting and baby magazine websites as well as the NHS information online.