VBAC birth plan

[mummynmummy2b]

Hey guys,
Was wondering if you would all mind having a glance over my birth plan... I wasnt going to do one but having a VBAC I have unfortunately experienced a lack of support from some consultants and wanted to make sure I had my ideal wishes down in writing!! Perfectly aware that it may well all go out the window and i'll be screaming for an epidural but thats fine as long as it is MY DECISION!! Really dont want to be bullied of pushed into things as I was with my LO. Anyhow, let me know if you think its too demanding, dont want to get their backs up and make them immediately defensive!



After having a previous emergency section with my son in 2008 I am hoping to achieve a VBAC this time, I have done my research and have written a birth plan in accordance with my wishes. If you are to be involved in my care please take the time to read this plan as it is very important to me.


I want to avoid the label of 'high risk' and its associated implications. I have done a lot of research and have seriously considered the pros & cons of having a medically managed VBAC as opposed to a more natural approach. I am happy to listen to advice but will make my own decisions during this process based on how baby and I are doing. I do not want to feel pressured at any point.


Pre-labour
I would like if possible to arrange a late scan (maybe in early labour) to determine the position of my baby if not 100% certain, to allow me to prepare mentally and also adjust my decisions accordingly.


I would wish to avoid induction of labour as long as the baby and I are well. I am happy to be monitored to ensure that baby/placenta are in good condition.


I would not like a stretch and sweep until 40+ unless I request it earlier






Stage 1
Monitoring/VE's
I am happy to be monitored and given a VE on arrival at hospital to check progress and the condition of the baby. If all is well I would like to progress with intermittent monitoring and as few VE's as possible. I am fully aware of the trend to continuously monitor VBAC women and am happy to agree to this in the event of concerns over the babies heart rate but not otherwise.


Positions
I want to be able to labour in whatever position I am most comfortable, staying active and possibly using a pool/bath/shower if I wish.


Pain relief
I do not want to be offered any drugs at all. If I want something I will ask for it. Ideally I would like to use gas and air in conjunction with water/massage/breathing.


ARM
I would like to avoid ARM at any point during labour. And do not give my consent at all if the baby isn't engaged or is in an awkward position.


Augmentation of labour
I do not want to be subject to routine augmentation of labour based on hospital policy time limits etc. If things are progressing slowly I will consider all circumstances individually to make my own decision.
















Stage 2


Positions
I would ideally like to give birth in water with my husband in the pool supporting me. If for any reason I change my mind I would like to be able to adopt any position I feel comfortable.


Time limits
If baby and I are both coping well I do not want to be subject to any arbitrary time limits. I plan to wait until I feel the urge to push even if i'm fully dilated. I hope to follow my own natural instincts in pushing but will happily take direction if needed (Really don't want to be told to push like i'm doing a poo though!!)


Atmosphere
I would like as few people in the room as possible when I give birth, I would like the lights to be dimmed and any encouragement to be given quietly, preferably only by my husband if no direction is needed.


Episiotiomy
I would like to avoid an episiotomy at all costs, If it is deemed necessary then I will give verbal consent at the time.


Instrumental delivery
After a horrific failed rotational forceps with my son I would wish to avoid an instrumental delivery unless it would be very straight forward. Again I will consider this more based on the circumstances.


Delivery
I would ideally like the baby to be delivered directly on to me for skin-skin contact and covered with a blanket to be kept warm. If possible we would like all checks to be carried out with baby still with me. We would like for the cord to be left unclamped/cut until it has naturally stopped pulsing, and then for my husband to cut the cord.


C-section
If I do end up with another emergency section I would like to be awake and my partner be present. I would still like to see the baby immediately after delivery, if possible lifted up over the screen. We would like the opportunity to take photos whilst in theatre and for my husband to be with the baby while all checks are completed.








Stage 3


Placenta
Once the cord is cut I am happy to have a managed 3rd stage if deemed the best option.



Still need to add bits about breastfeeding etc and this is just a first draft so will probably spend the next 10 weeks tweeking.

Cheers guys xxxx

 

[Alibabe]

Looks really good Mummy2b and I think it covers everything. But as an unbiased observer it's a bit long. I don't mean your waffleing Hun ), just that the format you've written it in doesn't make the easiest of reading IMO. Would you consider putting it in a more bullet point type format e.g.

Stage 2
• position - in water, with partner, but option to change as needed
..........

The plan is great and you've really pit a lot of thought into it. I would definatly bring a copy as is to the hossie and if anyone needs you to elaborate on anything you have it there. I just think as ot is you may struggle to get a busy doctor or midwife to give it the time it deserves. Hope I haven't offended Hun, just would like to think you'll have the most successfull attempt at a Vbac you can

 

[titch]

looks really good hun. I would agree with ^^^ about length but maybe have 2 versions. Maybe keep this one to take to consultant appointments and have a bullet point version ready for taking in when youre in labour?

Definately discuss this asap with your consultant, if the hospital policies are too rigid, you can phone around other hopsitals in your area and see if any would be willing to be flexible with their policies.

I agree with you that its not helpful to label a woman "high risk", and unless something seems wrong with you or the baby there is no need to rush

Good luck, I hope you get the support from your hospital let us know how it goes.

 

[Rosie's Mummy]

As a first time VBAC- er I found this really interesting and helpful, its very similar to how I want to express my needs and wishes.

Can I ask you if your consultant has agreed to you labouring in the water? Mine wont hear of it, she said she has seen two uterine scar ruptures; this didnt scare me as I know the risk is tiny. I still might push for it though if I feel as if I want to at the time.

 

[mummynmummy2b]

Should have mentioned that actually this isnt my one for labour, i will do a much more condensed version for that!! This one I am going to take to my consultant appointment to make sure i get everything 'okay'd' first.

Rosies mummy - I'm reallly not sure what they are going to say but.... A woman from my breast feeding group has recently had a VBA2C at the hospital i am going to and she was told she would be allowed to labour in water. I think she ended up dealing directly with the Head of Midwifery though and had to push pretty hard for it. She has told me that the evidence she used to convince them was....

The didnt want her to labour in water as they wanted to continuously monitor her. Her response was that she had a 0.2% chance of a uterine rupture which made her 'high risk' but in fact any woman in labour has a 1.5% chance of a cord prolapse which is just as dangerous as a rupture, but not all women are continuously monitored. I dont know whether i've worded that correctly but basically if they are saying a 0.2% chance of something going wrong is a reason to continuously monitor you then why not all women as all women have a chance of things going wrong.

I will see what they say at my appointment but basically if you can read as much as you can about VBAC and water birth and go armed with all the facts they tend to back down. For example my consultant told me there was a 1.2% chance of rupture, when I questioned where she got that figure from she very quickly agreed that it was not acurate and the chance for a woman with a 2 year old bikini cut scar is closer to 0.2% Some of the higher figures they give you to scare you into doing what they say are collated from statistics gathered when it was still very common to use a vertical cut for a section which is much much more likely to rupture. Dont forget also that women even with no prior sections still have a small chance of a uterine rupture so the increase in chance isnt even as much as 0.2%.

It drives me mad!!!!!! Have you done a birth plan yet

xx

 

[evajo]

Love you comment about not being told to push like your having a poo - great to be specific! All sounds well thought out - well done for thinking and covering all bases x

 

[mummynmummy2b]

Ha ha, i felt a bit silly putting that but my midwife last time was practically screaming it in my ear and it just made me clam up as I was pretty paranoid about doing a poo anyway!! I'm a bit of a poo prude, ha ha!! I really hate all that 'Push push push' encouragement too and know it would put me off so though it best to be specific! If my husband mentions that ive done a poo he will get a slap too and he knows it!!
xx

 

[Rosie's Mummy]

I havent done a birth plan as yet but I have it all in my head - Im not sure I even want to get in the water, I just wanted to know that I have that option. To be honest, if I want to do it at the time they won't stop me, I'll just get in the nearest bath! I have read about waterbirths and VBACS, I subscribed to a Yahoo group about VBACS and there is a lot of info on there and womens' experiences.

 

[evajo]

I'm a poo phobe too - but know i have twice - spent so much time on loo in labour wanting to go before birth - thinking this time that hey ho if it happens it does and am going to try not to get too caught up in it - can't beleive a mw would be shouting that - its probably just as well you were breathing and out of action as she may have had a telling off!