Wednesday, 22 May 2013

Birth Plan

I'm nearly 36 weeks pregnant and I've had a home birth planned from day 1 and have not thought of any alternatives.  However, at 28 weeks pregnant my iron levels had dropped from 12.3 (measured at my booking in appointment) to 9.9 - below the magic number 10 that my midwives were comfortable with when it came to having a home birth.  So I upped my iron intake using Spatone and paying closer attention to my diet (I'm vegetarian).

My bloods were taken again at 32 weeks and this time the midwife also requested that my B12 and folate levels were also checked (previously only my iron levels were checked). The following day my iron levels came back as having dropped further to 9.5, even with 4 weeks of supplementation.   It took slightly longer for my B12 and folate levels to come back but when they did it was discovered that my B12 levels were below the normal levels.  My GP called me into the surgery and prescribed a course of six B12 injections over a two week period.  I had my first B12 injection at 33 weeks and my last one a week ago.  I had also increased my iron supplementation further in that time.  Now, with my 36week midwife check-up looming tomorrow where I'll have a further blood test to check my iron levels again (I'm starting to feel like a pin cushion!) I'm feeling brighter, with more energy and clearer in the head - I'm hoping my iron levels have now actually been boosted over the magic number 10 and it's not just psychological!

Regardless, I've now written my birth plan for my homebirth.  I never really wrote one last time as I opted for a "go-with-the-flow" approach.  I still have the same approach this time, but it's nice to have some guidelines.......

Birth Plan

Prior to labour - Although I have planned a home birth I am willing to consider hospital if circumstances change, as long as I have been made fully aware of the reasons and/or options and am in agreement that changing location is for the best.

I generally have an open mind and all things stated below are subject to change depending on my mood and how I feel my labour is progressing!

During Labour
  • My husband, Ben, will be my birth partner and will communicate my needs if I feel unable to do so myself.  Depending on the time of day my 4 year old daughter Rhiannon may also be present.  If she is uncomfortable or unhappy with being present at any point then Ben will take her next door to my parent’s house.
  • I hope to keep as active as possible during labour and will choose the position/s I feel are most comfortable for me.
  • I do not want vaginal/internal examinations unless I specifically request them.
  • I would like the minimum amount of fetal heart-rate monitoring.
  • I having been using NatalHypnotherapy through pregnancy to help me manage any pain during labour.  Based on past experience I would like minimum direct interaction with those around me to limit disturbance (total silence won’t be necessary though – feel free to have a cuppa and chat among yourselves!)
  •  I would like Entonox available.  I do not want pethidine.
  •  I have an inflatable birth pool available that I may wish to use for the purposes of pain relief during the first stage of labour.  I would prefer to choose the pool temperature I’m comfortable with.  However, I have no fixed ideas about where I will manage the second stage and I will decide on the day.
  • I do not wish to have an internal examination to confirm whether or not I am 'ready' to push. If last time is anything to go by I will only be pushing when I physically cannot do otherwise! If there is any reason to suspect that I might have a premature pushing urge then I would like to discuss this on the day.
  •  I would like to give birth wherever/whichever room feels right at the time!
  • I hope to give birth in a position to allow maximum room in my pelvis (upright/kneeling/squatting/all fours).  If I feel I’m too tired to stay upright on my own I would like physical support from my birth partner and may request additional support from the midwife/s.  If I’m still too tired even with physical support then I’ll probably need some encouragement at that point to lie on my side (not on my back!).
  • I would like to know when the baby’s head is crowning and would like the opportunity to feel the baby’s head. I would like guidance to allow slow delivery of the head to (hopefully) minimise tearing.  I do not wish an episiotomy unless vital or I decide I’d prefer it to a tear!
During/After the birth
  • I may wish to ‘catch’ my own baby but that will be decided at the time.  Regardless, I would like my baby to be placed immediately onto my tummy/chest without cleaning up or any ‘just-in-case’ suction (obviously if suctioning the nose/mouth is totally necessary then that’s ok!).
  • I would like a fully physiological third stage and do not wish the cord to be cut until the placenta has been delivered (unless the cord is too short to allow the baby to be placed on immediate skin-to-skin or to allow breastfeeding/suckling to encourage expulsion of the placenta, in which case the cord is not to be cut until after it’s finished pulsing).  Ben will cut the cord. Please do not use controlled cord traction or use fundal pressure unless there is a specific need to do so.  
  •  If stitching of the perineum is required, unless a tear is severe I would like this delayed until I’ve had some time with my baby.
  • I would like the placenta kept (it can be passed to my husband).
In Case of Hospital Transfer
  • In the ambulance I do not wish to be strapped on my back – I wish to stay on my side.
  • I want Ben (my husband) in the ambulance with me.
  • Although I am willing to keep an open mind regarding pain relief options I would prefer to avoid pethidine as I have concerns regarding its effect on the baby.  In addition, I have naturally low blood pressure (e.g. it is not unusual for my diastolic pressure to be below 60mmHg) and would hope that an epidural would be a last resort due to the increased risk of hypotension and the associated negative effects.
  • If a ventouse or forceps delivery is required I want immediate skin-to-skin and the cord is not to be cut until it has finished pulsing.
  • If a caesarean section becomes necessary, I would prefer to remain awake with an epidural or spinal block anaesthesia (taking into account the likelihood of hypotension as mentioned above I’ll likely need a bowl to vomit into!). I would like Ben to stay with me at all times, and would like to breastfeed the baby as soon after birth as possible.  If there is likely to be a delay between my baby being born and me being able to hold him/her, then I would like the baby to be passed to my husband asap for skin-to-skin.
  • If I suffer a severe PPH then I do not want a hysterectomy performed unless there is no other course of action, as I have yet to decide if I want more children.
  • Please do not take my baby into the SCBU just for observation – only if there is a medical necessity or a specific reason for concern.  If there is such concern then this needs to be explained fully to myself and/or my husband.
  • I am planning on breastfeeding – please do not give my baby any supplementation without my direct permission.  If I consent to supplementation then this is to be by cup, spoon or syringe and not a bottle.
Hopefully, that covers everything!  Now to see what the midwife says tomorrow :)

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