My birth plan... (by the SoM)

[PeanutBean]

I've just received my birth plan from the SoM and she has invited me to amend or add to it if I wish. I feel I want to post it here to see what people think:

Peanut is planning a home birth for her 2nd child due on 21st April 2011. Peanut’s 1st child Byron was born by ventouse in 2009. (lol actually it was 2008, better get that changed!)

Following an episode of PV bleeding at 24 weeks during this pregnancy, an HVS found Peanut was carrying Group B Strep at that time.

Peanut's specific requests concern the following areas:

Administration of antibiotics in labour
Peanut has looked carefully at all the evidence concerning the administration of antibiotics to women who are known to carry GBS and has decided that UNLESS there are actual risk factors present when she is in labour (e.g. prolonged rupture of her membranes / a raised temperature) she does not wish to have antibiotics. Peanut is aware that if a baby is born with a GBS infection that this can have life-threatening consequences. I have discussed these risks with her and completed a Paediatric Alert so the paediatrician can be informed when Peanut is in labour.

Place of birth
If there are clinical indications that she needs antibiotics to reduce the known risk of infection to the baby, Peanut has seen the Birth Centre and is happy to come in and use the pool here after she has had the antibiotics. (Not sure happy is the word...)

Vaginal examinations
Peanut requests that VEs are performed only if / when absolutely essential and are kept to a minimum as she found them so painful during her last labour: VEs only if clinically indicated or at Peanut’s request.

3rd stage
Physiological and in the pool if possible, unless there are indications to get out.

Care in labour and afterwards
Please keep conversation and disturbance to a minimum in labour.
Peanut has requested that 2 members of staff are not involved in her care during labour or the postnatal period.

I feel weird about it but I don't know why...

 

[DolceBella]

What makes you feel weird? It seems pretty straight forward.

 

[PeanutBean]

I dunno... The GBS stuff. I think it's because of the phone call before I received this rather than the plan itself. (I've mentioned this in the main homebirth thread.)

 

[chuck]

Its very clinical sounding is all.

 

[MummyMagoo]

Aww hun,seems fine to me,i didn't read mine what the SoM did lol x

 

[moomin_troll]

i was about to say it feels/reads very clinical to me, so maybe thats the problem your having with it x

also it doesnt really mention stuff about you and your feelings

 

[PeanutBean]

I don't know... It was only to cover the out of the ordinary things, I don't think it's meant to be a complete plan. I dunno. I'm just so angry with her phoning me with GBS stuff last thing that maybe I can't see through that. She can't send it out til next week so maybe I'll just sit on it a few days while I calm down and go back to it them. Thanks for the feedback ladies.

 

[Bournefree]

I think I know what you mean - It even makes me feel uneasy. I wouldn’t be agreeing to this, or even be seen to be signing off on it…. It could come back to bite you in the bum.

Administration of antibiotics in labour
This is all fine, but should at least be made clear that at the present time it is uncertain if you are infact carrying GBS - as this isn’t mentioned?!

Place of birth
Then there is this.. which is worded incorrectly
"If there are clinical indications that she needs antibiotics to reduce the known risk of infection to the baby, Peanut has seen the Birth Centre and is happy to come in and use the pool here after she has had the antibiotics. (Not sure happy is the word...)"
I would be comfortable with something like..
PB has been made aware that she has the option of attending XBC if clinical presentations arrise, that indicate the administration of IV antibiotics, which are not availible at home. In the event of presenting at XBC PB requests to water birth following administration of IV antibiotics*
You already have a "known risk" of GBS.. (or at least we can say history of), so will that be used to persuade you in?
Also this is a bit of an oxymoron... there is either risk, or something is known.
(*just as a little aside, I don’t think that this is really going to happen if you go in.. afterall once they have you on an IV drip of antibiotics it can take hours to deliver the meds, and I’m pretty sure you will have a fight on your hands to get in the pool with a line in. Unless, are they intra-muscular? And you can just get in right after?)

Vaginal examinations
I don't like the underlying assumptions in this - the main one being that they are allowed to do VE if it is necessary or if you request them.. that sits uneasy with me. Almost all VE requests by MWs WILL be deemed necessary - I wouldn't know a MW who would openly admit they do them willy-nilly.. so I think that the important thing is that you don't have blanket agreement to VE. It should read that “PB requests that expressed consent be obtained for all VE.” End of.

3rd Stage
Physological and in the pool - there doesn’t even have to be the “if possible” bit or indications otherwise.
But if they want the “indications” bit in. it should be “PB is aware that she maybe requested to leave the pool if there are clinical indications for doing so.”

General
I just feel that the "power" of this is all wrong... when it should be with you.
Plus the order is all wrong VE should be top of the list. Then the rest… but that doesn’t matter to much.
I also started to read the bit about the 2 Mws WRONG - thinking why doesn’t she want 2 Mws..? Perhaps she would only like 1? Then I realised that these are specific MWs you wish not to have any involvement in your care. I hope that they are named on the document to be circulated, otherwise it doesn’t make sense.

The more I think about it, the more that is doesn't just make me feel uneasy.. I just think it is plainly wrong and you should insist on some changes. The language is negative and makes some assumptions which I know you are not happy with.
Sorry!
XxX

 

[PeanutBean]

Bourne thank you and yes you are right! I knew it felt wrong but by the time I received it I was already really upset over the GBS stuff so I really do appreciate your comments. I should have some better clarity over it having had a night's sleep and DH and I are going to go through it over the weekend. I'm glad we couldn't do it to her deadline as it gives us all this extra time to think it through.

In response to your posts. You've picked up on some of the niggling things, in particular the GBS. The two members of staff I've asked to not attend (one MW one health practitioner) are going to be listed in my central file and she's going to discuss it with them together with my reasons. She explained this on the phone. I'm happy with that. The mw isn't really about competency so much as style so I don't want her to feel shit tbh but the HP was abominable so I don't care how she feels!

You don't need to worry about their honesty with regards to the pool, even on delivery suite with Byron I used the pool while I was on iv. It was about the only thing I dud right - I insisted I'd only transfer if there was a pool for ms to use. She said it wasn't very common then but lots more women are transferring for iv and coming I to the birth centre to use the pools. I can take that element on more than good faith.

On the VEs you are right and I also requested that I don't get dilation updates as I'm not interested in knowing because I know it disgeartens me. I will do something about that section. At the meeting I explained that to me indications would be like hours of unsuccessful pushing necessitating a check for presentation, cord round neck, that sort of thing but that's not explicit here is it? A mw may well feel that it is necessary to check dilation at some point. I will change to requesting consent if one is deemed necessary and add bits in.

I'm so fed up about it. The meeting was just fine about Byron's birth but has left me feeling worse about this one in the end. DH was furious last night. You girls would all be so proud to hear him! He's going to be my rottweiller at the kitchen door keeping them all away!

 

[Bournefree]

It’s really good that you are going to make them wait the weekend.
Pleased about having a line in, in the pool - that is really good news. I know that my birth centre would balk at the very idea and be more than a little difficult.. But you know me, I’d still be insisting on getting in.

I’m with you on how the VE can make you feel - I’m so pleased that I only had 2 with my DD and those were only really early labour.. The second one was great, because then I knew that something was happening, but didn’t feel the need to get one after that (or did my Mws, as I wasn‘t offered one either) - plus I really can’t imagine it.. I was a little occupied and the thought of laying down for what is at best an uncomfortable examination makes me feel a little sick just thinking about it! ;-) This time, I’ll hopefully know if I’m in labour or not, so might not even have one.

It is such a real shame that after your meeting you felt really good about the mature level of understanding and respect your MW had, and then the phone call and this, is a bit of a slap in the face. I don’t know how making you feel undermined and oppressed achieves anything.. Esp when your well being and that of the baby is the ultimate common goal you and your HP have? I’m sure that they think they are going the extra-mile, but the reality is that if you had this “treatment” in any other part of life, it would be harrasement and bullying.

Go your OH, it is really important to feel supported and protected. Can you get him to pass on some protective aggression to my OH? He is so laid back about everything, as he sees that I’ve got it all in hand, but sometimes, I also need someone else other than me to be fired up about things ;-)
Xxx

 

[KandyKinz]

So it's routine there to have the midwives write YOUR birth plan??? strange though I'm sickly curious to know what my midwives would write about my intentions... and I'd definitly revamp it if it doesn't make you comfortable. Perhaps increase the clarity of your thoughts re: prom & gbs management etc and I agree that mentioning the v/e indications which you accept and reject would be beneficial as well as some midwives firmly believe that v/e's q 4hrs are an essential part of antepartum monitoring. I also noticed there is no mention of things like requests re: newborn procedures and the dreaded in case of cesarean....

 

[PeanutBean]

Kandy she wrote it from notes she made from our debrief session so it came from me, if not my own words... It's meant to cover the out of the ordinary requests in order to alert the team. This is definitely not routine practice! There's a space in my notes where I can put all my 'normal' preferences. Things like skin to skin and bf etc are assumed here, and they ask at the time about vit k and that sort of thing. I suppose you could say this is meant to cover the system fighting stuff but I'm definitely going to amend it and complete the one in my notes with DH this weekend.

I don't know what I'd put about a section or anything serious like that that I don't expect to happen... What would others put?

 

[Bournefree]

I think I would put I don't want one! hahaha
But seriously, I'll cross that bridge if we ever come to it. I know that if I transfer in to hospital, it isn't going to be to a nice birthing centre, it is going to be to the Obst Unit... I'm simply not leaving my house for anything else!.. But I know that I will be f-ing bricking it at the suggestion of a c-section.
XxX

 

[PeanutBean]

Well that's it really. If I have to transfer for a section or something the birth plan will have gone so far out the window I doubt it'll matter. DH is reading the Penny Simkin birth partner book so maybe he can help at the time if things really go that way.

 

[PeanutBean]

Here is our updated version. Feedback would be much appreciated!

Peanut is planning a home birth for her 2nd child due on 21st April 2011. Peanut’s 1st child Byron was born by ventouse in 2008.

Following an episode of PV bleeding at 24 weeks during this pregnancy, an HVS found Peanut was carrying Group B Strep at that time.

Peanut’s specific requests concern the following areas:

Vaginal examinations
Peanut requests that express consent be obtained for all VEs and that they are performed only if absolutely essential as she found them so painful during her last labour. Peanut does not wish to be given dilation updates unless she requests them because they proved so disheartening during her first labour. If VEs are clinically indicated perform ONLY with Peanut’s prior consent.

Administration of antibiotics in labour
Peanut has looked carefully at all the evidence concerning the administration of antibiotics to women who are known to carry GBS and has decided that UNLESS there are actual indications of infection present when she is in labour (e.g. a raised temperature) she does not wish to have antibiotics. Should she have prolonged rupture of membranes (more than 18 hours) she will discuss and consider transfer to hospital birth centre for antibiotics at that time depending upon how the labour is progressing. Peanut is aware that if a baby is born with a GBS infection that this can have life-threatening consequences. She does not wish the baby to receive antibiotics as a precaution, they are only to be administered if there are indications of infection (she does not consider a positive skin/ear swab to be an indication of infection). I have discussed these risks with her and completed a Paediatric Alert so the paediatrician can be informed when Peanut is in labour.

Place of birth
Peanut knows that she has the option of using the pool in the Birth Centre if there are clinical indications that require the use of IV antibiotics unavailable at home. Peanut does not wish to be given deadlines about at what time she is expected to go to the Birth Centre as the stress of performing to a schedule only slowed her first labour.

3rd stage
Physiological and in the pool, unless there are clinical indications to get out. Peanut does not wish to receive the ergometrine injection but will consider this in the case of PPH or no placenta delivery after 2 hours. She does not wish the cord to be clamped until after delivery of the placenta. She does not wish the cord to be cut until she chooses to do so.

Care in labour and afterwards
Please keep conversation and disturbance to a minimum in labour.
Peanut has requested that 2 members of staff are not involved in her care during labour or the postnatal period. The names of the staff are on Triage.

 

[KandyKinz]

I personally have found that the only time a birth plan is really actually needed is when things go astray....

 

[PeanutBean]

I personally have found that the only time a birth plan is really actually needed is when things go astray....

In this case though it's needed to deal with all this GBS crap! I don't want to have to tell every MW I see that no I'm no having antibiotics; I don't want them even to mention it to me. I KNOW it'll ruin my flow if some ignorant MW starts harping on about it all. Apparently it's hugely important paeds are on stand by for me during labour

I've completed bits in my maternity notes that includes some preferences for sections etc. My last job will be to write a full plan looking at as many things as I can think off (!) to append to my notes if only so that DH knows what we both want and can then be my advocate if things go awry and the medics don't even look at my birth plan (which I bet they won't).

 

[Bournefree]

I think the latest version is MUCH better!

.. and only to be pernickety, I would say something about the Birth Place section
Currently
"Place of birth
Peanut knows that she has the option of using the pool in the Birth Centre if there are clinical indications that require the use of IV antibiotics unavailable at home. Peanut does not wish to be given deadlines about at what time she is expected to go to the Birth Centre as the stress of performing to a schedule only slowed her first labour."

There are 3 things missing here:
1 - It doesn't state that you primarily intend to labour and birth at home. (I know it says it at the top, but you should be saying it more than once and esp in this section?)
2 - it doesn't make it clear what you have said about them offering the pool with a line in (which I think is very important) in the unlikely event of you requesting to attend the BC
3 - It needs to be explained about the deadlines they might put on you. This part can be better explained in conjunction with the antibiotics paragraph. (perhaps add it in there? Or in the general section about a hands off approach, reducing pressure) As what you are saying is that in the event of your waters being ruptured for over 18 hours you do not wish to be pressured, reminded that your membranes have been ruptured for x hours, or feel there is a deadline to attend the BC for antiboitics. It is already stated above that you will only transfer if you deem necessary and there are signs of a GBS infection manifesting itself during labour.

All in all though, looking overall better!
XxX