Don’t leave your birth plans to chance

Lately in the UK (or in the group of parents to be and parents that I know anyway), there has been a shift away from planning your birth experience. A lot of mums-to-be especially have said to me that there’s “No point planning for what you can’t control” or that “If I don’t make a plan, I can’t be disappointed”. I should mention a deeper interest here: I teach parents to be about birth for a living – but I’m also a parent and even before I had learnt more about care during labour, I still felt strongly that being engaged in the process would lead to a better outcome.

I would urge any expectant parents to plan for their birth as carefully as possible. After all, many parents spend a lot of time choosing items for their baby’s nursery or their pushchair. I would argue that birth plans are just as good a use of that time.

Whatever you choose to call this plan, it’s worth it

When I teach, I have to be realistic. Not every mother is the same, not every baby will behave as expected, not every birth will follow a particular path. We’re all individuals with different medical backgrounds, different hopes and different bodies. That’s fine. Wonderful even. Conformity is not the point.

I try very much to help parents reach a point where they understand that the birth experience they have, as long as they feel like they understand what happened and why certain choices were made, will absolutely be the right one for them. I would argue that engaging with your caregivers and the information they are giving you so that you can make decisions from a position of focus and knowledge is much more likely to help you feel happy with your birth.

It’s absolutely correct to not be overly attached to your original wishes. They can add an extra layer of stress and tension to what can already feel like a fairly pressurised situation. This shouldn’t stop us from trying for what we hoped for though so use the words that feel right. Birth plan, birth preferences, birth proposal – what really matters is that you’re expressing your wishes.

Making plans together is critical

One of the major benefits of couples taking antenatal classes together and then reflecting on the information afterwards, is that they do it together. This might sound obvious but it’s often not that straightforward. For a birth partner to defer to his partner’s wishes might sound like the ideal but actually, this birth partner might need to be able to explain these choices, to advocate for them and to protect the mum’s birth space. To do this well, it’s essential that both of the couple are as equally well informed and know how the other feels about the choices made.

Mum might want to make sure that not too many people are in the room; the birth partner might not want to cut the umbilical cord. To get a chance to know this about each other, they will need to talk about making a plan and potentially consider the options available. Again, this sounds obvious but it’s a weight off mum’s shoulders to know that the choices are understood then can be protected by someone else and hopefully the birth partner will feel empowered to take a more active role in the birth.

Your caregivers will know what you want

This sounds so simple when I say it but it’s true. If you don’t make a plan and let people know what you’d like to happen, how will they know?

Birth professionals like midwives and obstetrics doctors meet a lot of parents and deliver a lot of babies. Although it would be great if they remembered all of us individually, it’s not likely even if you were definitely going to see the same carers the whole way through. By not making your plans clear, you’re leaving a lot to chance. And why would you want to do that?

Step off the standard pathway

All medical institutions have what are known as standard pathways of care. They are planned out by the heads of the obstetrics and midwifery departments and they follow the principles of defensive medicine. Defensive medicine is exactly what you imagine it to be – assuming the worst case scenario and planning to mitigate that. While there is merit in this approach when something is actually going wrong, if you’re a mum who isn’t likely to need any medical interventions or assistance, the care you are offered can contradict your own plans.

If you don’t express your wishes, you’ll receive standard care and a much more negative approach. In fact, put the bits that matter most to you at the top of your plan, especially if they deviate from the norm.

Consider that you might need a back up plan

Having said all I have, as much as I believe in positivity and an open minded approach to care, I also believe in being informed.

Despite the fact that I was hoping for a home birth in a pool using hypnobirthing, my little girl was running late. She was also in a fairly unusual position for a baby who was looking like they wanted to make a break for it in the near future. By the time I was 9 days over, we were talking about c-sections – probably my very worst nightmare (although as Amy Poehler says “Good for her! Not for me!”) – and I was updating my birth plan to include my preference for a gentle c-section.

As much as I hoped for and visualised my ideal scenario, I found it easier to put aside my fear knowing that I’d covered all eventualities. It calmed me.

Our bodies are amazing and the power of our minds over them can have a profound effect. If you can take the time to plan, be true to your heart and set your worrying 4am mind at ease, you can write the kind of birth plan that any caregiver will be delighted to receive. After all, they’re in their job to support parents at this most incredible time. Make the most of your chance to have things your way – it literally is your moment of magic.

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This post was written for and first appeared on The Natural Parent Magazine.

Sue

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Photo credit: Tim Wright

Sue and I spent 7 years talking. I was allocated to her randomly, but as I’ve always believed, life has a way of bringing you the people you need.

We spoke by arrangement, every week at least, in a room that was cosy and dim in the winter, sticky and dim in the summer.

At first, I didn’t lie on the couch. I could only sit on the chair, avoiding eye contact as much as possible, trying to not let my foot jiggle, trying to to not flick my hair, touch my face constantly.

Together we unpicked the knots I held on to and found the dark spaces I hid in. Sometimes we said almost nothing. Other weeks conversation flowed freely. Over time she came to know my habits, remember the names of my sisters, notice the things I omitted. I noticed when she’d had her hair cut or was wearing a new pair of shoes but never said anything. It wasn’t really like that.

Patiently and lovingly, she sat with me, came to find me when I needed her to and pointed out the flaws in my thinking.

She had tears in her eyes the first time I visited the room after getting out of hospital. Things had been looking up. We’d thought the work was almost done. Instead, it just got more intense.

I told her when we began to try for a baby and I think we both knew it was the beginning of the end for our arrangement. She was wise enough to say it; I was too afraid to admit it. She laughed a kind of ironic laugh just three weeks later when I told her I was pregnant. Typically, it happened the first month we tried.

Our sessions finished by mutual agreement when I was 36 weeks pregnant and my feet were too swollen for me to travel anymore. I tried not to cry all the way home, wondering if I really could think for myself, in the way she had taught me, when there was no straightforward answer.

We had set just one goal for me, for once I became a mother. It’s simple to say, much harder to do. Most of all, I hoped to be able to hold on to reality. To be able to see and know what was true and what wasn’t.

What now for normal birth?

Over the last month in the UK, there has been a lot of news coverage of the Royal College of Midwives’ (RCM) decision to end their campaign for normal birth. It’s been met with a predictably mixed reception – agreement and an outpouring of emphatic support from some and confusion and worry from others. A lot of people, like me, fall somewhere in between.
The Times had it as front page news and then the RCM issued a clarifying statement a couple of days later. Since then, stories of negative birth experiences and sad outcomes have been filtering out, filling the news once again with the most popular view of birth in Western culture – that it’s the most dangerous day of our lives and that medical intervention is a requirement for most.

Full disclosure – I’m a hypnobirthing teacher and I had my baby naturally at home. I know I was extremely lucky to be able to do so. I know this. My heart also goes out to the families who didn’t receive the care they deserved and are still missing their babies who they so rightly had expected to arrive safely in the world. It’s the worst possible outcome to what should be the best day of parents’ lives. I can’t imagine what it is to live with that kind of heartbreak.

As I write this, I also hold in mind all the many, many mothers who didn’t have the kind of birth they had hoped for and still feel the effects of that today. I know full well what it is to live with the small injuries, the changes in how you feel about your body and the shift of emotions you experience – the outright shock of going through such a life changing experience in a way that you don’t feel prepared for at all. I also know how hard those first few months are and that if your early days care with your newborn isn’t as supportive as possible, how that can impact your feelings towards your baby and your new role as a mother for months to come. I understand.

I have to be honest though – I’m worried that natural birth will once again become something that isn’t encouraged and this in turn will have its own negative effect, perhaps exacerbating the problem of women feeling unsupported and steam rollered. That women will stop believing in their ability to deliver their babies and that fear of childbirth will return to previous levels. Being afraid and treating birth as a medical emergency will become normal once again. It seems like a step back in the open and ongoing conversation around finding what’s best for each and every unique case.

I’ll also make clear at this point that hypnobirthing principles hold that women should give birth where and how they feel safest, which means they make all the decisions and can give birth in exactly the way that makes them feel most secure – at home, in hospital, with drugs, without… it all makes no odds. The goal is always a healthy, happy baby and a mum who has felt she was able to do things her way and was empowered in all her choices even if she did have a birth which went off her plan. The emphasis is always on her.

When I hear the stories of births that went wrong, I’m truly shocked. Every midwife I’ve ever met seems so far from the picture built in the media reports and goes above and beyond to support the women they work with. I can also imagine how hard it would be for the mum to not feel informed and like she was able to steer the decisions made too. After all, it’s her body and her baby. She will live with the long term impact of whatever choices are made by her and the team around her.

I also find it pretty tough to swallow when I see Jeremy Hunt jumping in to the fray with a tweet that (whilst it looked like a valid, mainstream opinion) actually makes it seem like he lacks basic understanding of how the system works for most women and that he was commenting on the details of a relatively small unusual set of occurrences.

I have no crystal ball to help me see how this will play out of course. I have a suspicion that the resurfacing of difficult stories will have an impact on pregnant women for a few years to come. Whilst I don’t think we should shun hearing more negative stories (and certainly shouldn’t diminish their impact or tidy them away), we would do better to have a conversation about them to enable the birth professionals in attendance to learn from them and for the mothers to get the support they need.

After all, as Sarah Wickham so succinctly points out, stories really do make a huge difference.