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Birth Preferences
Choosing and communicating what you want


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#1 LittleSpoon

Posted 30 October 2012 - 07:25 PM

Hi Ladies,

I have been following the Birth Plan conversation on the main thread with much interest and jumped on the opportunity to start a new thread (hope that's ok redmum!).  So let's chat....

I decided to call it Birth Preferences as is seems that not all of us have a Birth 'Plan' as such.  Also, I think some medical staff get their back up very quickly at the mention of a Birth Plan.  I have written a Birth Plan at spoke to the midwife at my OBs today and was met with a very quick "but it doesn't always go to plan".  I get that, as I'm sure you all do too, but I certainly think it's important to articulate your preferences.  So I think when I get to speak to my OB next time I will call my 'plan' a 'list of preferences'  wink.gif

My preferences are for a natural, intervention-free birth.  Of course I want a healthy baby and my baby's safety is my first priority.  Having said that though, there does seem to be a lot of non-essential intervention.  I think some of the intervention is for convenience and ill-considered hospital/doctor policy.  But I think largely the intervention comes from the doctors and hospitals erring on the side of caution.  I understand why they do that, but it also makes me unsure about how I can judge what is essential intervention and what is a preventative preference.  

I read Ina May's Guide to Childbirth (I highly recommend it if you are interested in midwife-led, minimal intervention practice) - which really highlighted to bm how a positive environment, knowledgeable midwives, a good state of mind and time can result in a MUCH lower rate of intervention.  So I am trying to work out how to give myself the best chance at having a intervention-free birth as possible.  Some things I am doing are: hiring a doula, reading to better understand the process of birth, asking lots of questions and writing my Birth Preferences out.  

But I would love to hear others thoughts...
How did you increase your chances at getting the birth you wanted?  What was the best way to communicate your preferences with your medical provider?

Sorry for the waffle blush.gif

Edited by LittleSpoon, 30 October 2012 - 07:39 PM.


#2 whitemailbox

Posted 30 October 2012 - 07:30 PM

I'm not supposed to be in this forum....but I just wanted to say that I think the term 'Birth Preferences' is a brilliant description!

#3 greenthumbs

Posted 30 October 2012 - 07:36 PM

Sorry, I don't belong either, but just wanted to add - I really enjoyed Ina May's guide too! and agree with a lot of what you're saying.

Next labour I hope to have a doula or even better, an independent midwife (only because I can't afford home birth  happy.gif ).

So, doula would be a great idea if that's up your alley! And researching lots is good too. Good luck!

#4 emelsy

Posted 30 October 2012 - 07:47 PM

Don't belong either!
I had a birth plan. I tried to make it just like a conversation I'd have (but wouldn't be in a state to converse with everyone who might have treated me).
All my providers read it, I know this because some mentioned it (I put something funny in it) and all my 'really would like' things were done.
Like most, I didn't have an ideal birth, had lots of interventions but staff took on board my wish to not have a c section unless absolutely necessary.

#5 Anna_in_Canberra

Posted 30 October 2012 - 07:53 PM

I had a long-ish list of birth preferences with my first baby and short lists with my second and (soon-to-arrive) third. I'd recommend going for a shorter list and emphasising the things that are really important to you. It can be useful to talk with your caregiver about the circumstances in which your most important preferences may or may not be able to be accommodated, so that you're prepared for that.

#6 LittleSpoon

Posted 30 October 2012 - 07:54 PM

Thanks aleitheka, greenthumbs and emelsy.  

As you say, I think a list of preferences can be good for letting the medical staff know what you want when you can't communicate effectively.  Because I'm sure there are some people that would want intervention as SOON as there is sign of trouble, whereas others would be prefer to wait and see.  So it's good for them to know which you are.

Also, I want my preferences to be taken into account when my behaviour in labour might suggest I want otherwise.  Ie.  I can see myself screaming out "I can't do this, make it stop."  Which might sound like I want drugs or intervention, when really what I want is someone confidently telling me "You can do it, try doing XYZ" etc.

emelsy - can I ask, did you have a c-section?  Did they talk to you about that as a possibility?  How did you know you to judge if you did/did not need it?

#7 1miss2littlemen

Posted 30 October 2012 - 07:56 PM

LOL I cant wait to give birth again, this is my last chance to have a  drug free birth biggrin.gif
I will stay at home as long as possible and use the birthing ball in the shower.  hands.gif that I can stick it out and get to the hospital just in time biggrin.gif

#8 emelsy

Posted 31 October 2012 - 04:49 AM

I didn't have a CS. They let me push for 3 hours then said enough. They prepped me for theatre and took me there and said they'd try forceps before CS

#9 clm1982

Posted 31 October 2012 - 08:21 AM

OK so this time i plan to stay at home as long as possible, prefer to have my waters broken at the very end rather than earlier. Still happy to have drugs if needed. Thats it really, i found with my DD once my waters were broken at 5cm the pain became much more intense i was coping with the pain before hand. The only thing is im about 45mins to an hour away from the hospital now so ill have to try and give myself enough time to get there.

#10 stickymicky

Posted 31 October 2012 - 10:54 AM

I had a drug free vaginal birth with DD and aiming for the same again, but there are a few things I want to improve on this time.

1. I want to avoid episiotomy. Looking back I think if someone had suggested I try some different positions (squatting etc) it may have been avoided.. So have been researching this myself this time round.

2. I would love water birth.. am booked into Birth Centre with birth pool so fingers crossed! Was transferred from birth centre to main hospital last time for continuous monitoring of babies HB due to some light vag bleeding so really hoping that can be doesnt happen this time.. Never found out what cause was and DD HB remain strong and steady throughout.

3. Want delayed cord clamping, would like it to finish pulsing before being cut! This was actually in my birth plan last time but didn't happen because it was a short cord so had to be cut so I could hold her..? (does that sound right? My memory is hazy.. Will ask them to double check my notes when I go back for spot next week)

4. Want DH to be the one who tells me it's a boy or girl (unless I see it first) Can't wait for that magic moment!!

5. Skin on Skin. When DD was born she was given APGAR of 9 but they thought her breathing maybe sounded a bit funny so they snatched her off me after only 5 mins of skin time and whisked her away to special care nursery for 3 days of antibiotics sad.gif  I believe if I'd been in birth centre they wouldn't have been so hasty to hook her up to drugs. I KNEW in my heart of hearts that she was okay and if something similar happens I will be more assertive this time.. Eg negotiate with Dr for 1hr of skin on skin and if breathing hasn't improved on its own then antibiotics etc.

My first labour was actually fairly quick (very first contraction at 6pm, contractions 4 mins apart at midnight, went to birth centre at 1.30am, gave birth at 3am) so although I plan to labour at home for majority of time will need to balance that with leaving myself enough time to actually get there, if 2nd labour goes faster than last one.

Overall I'm really excited about labour and can't wait to experience it again!

#11 Cloria

Posted 31 October 2012 - 11:32 AM

QUOTE (stickymicky @ 31/10/2012, 10:54 AM) <{POST_SNAPBACK}>
1. I want to avoid episiotomy. Looking back I think if someone had suggested I try some different positions (squatting etc) it may have been avoided.. So have been researching this myself this time round.


This is high on my priority list too! I have heard about perineal massage and basically tools that help you to stretch those bits. There is something called an Epi No which is meant to help build pelvic floor in the early stages, and later develops into exercises to prepare the perineum for a natural birth.
(they look a bit pricey for what looks like a balloon on a cord! haha but I guess if they work, well worth it!)

#12 *Katey*

Posted 31 October 2012 - 11:47 AM

QUOTE (Cloria @ 31/10/2012, 11:32 AM) <{POST_SNAPBACK}>
This is high on my priority list too! I have heard about perineal massage and basically tools that help you to stretch those bits. There is something called an Epi No which is meant to help build pelvic floor in the early stages, and later develops into exercises to prepare the perineum for a natural birth.
(they look a bit pricey for what looks like a balloon on a cord! haha but I guess if they work, well worth it!)


In regards to just the perineum, I asked my OB and midwife about the epi no's. They said not to waste your money and that your fingers can do exactly the same job, by doing massage and stretches. Get a bit of lube and press both of your thumbs down into yourself and stretch down and outwards until you feel a slight sting, and then hold for 30 seconds. Repeat 5 - 10 times. Once a day original.gif

Edited by *Katey*, 31 October 2012 - 11:52 AM.


#13 lozoodle

Posted 31 October 2012 - 11:47 AM

I wanted a drug free birth, and intervention free as much as possible and that is what I had. I just told my midwife that is what I was hoping for, but at the same time I researched pain relief options and ways to deal with pain just so I could be sort of prepared all round.

It was good telling them up front I wanted no drugs, as it meant I wasn't having them offered to me constantly. I was given the option when I arrived at hospital, I said no, and it was never mentioned again though I'm sure I would have been able to get something had I have changed my mind. But having them respect my choices and not even bring it up helped.

I think the best thing you can do is just keep an open mind. Know what you want but don't be 100% set in your ways, and go with the flow a bit. Drug free birth is totally doable, you just need to have trust in yourself. Staying home as long as possible really helped me as well, with both kids it was only 2-3 hours between arrival at hospital and birth, so I just laboured while going about my normal every day business.

#14 Alxeen

Posted 31 October 2012 - 12:00 PM

Love love LOVE your terminology of "birth preferences" LittleSpoon!!

I find saying the word "plan" makes it sound, well....like a plan, which is of course silly when there are so many ways, methods and means of getting a baby into the world and "plan" makes it sounds like you are rigid and inflexible which is not what it's about. I am totally going to use this instead of "plan" now. Sure it's just a title, but it sets the scene  tthumbs.gif

#15 *Katey*

Posted 31 October 2012 - 12:08 PM

I think I talked a bit in the other thread about my lack of birth plan, but I'll pop it in here too.

We don't really have many preferences. Which is actually quite odd for me, as I'm a natural born planner. I tend to plan and organise everything I can, in as much detail as I can.

However, after trying to plan, plan, plan, and plan in the last year, and getting slapped in the face over and over again and having our plans jump out the window (with having ectopics, miscarriages, fertility issues), we've just learnt that fate does whatever the hell it wants, regardless of how much or how little you plan. And to be honest, we're just tired of planning and being kicked in the butt over and over again.

I'd like DH to cut the cord, and I'd like skin-on-skin contact as soon as possible. That's about the only preferences we have at the moment. But if either of those 2 things aren't possible for whatever reason, for the safetly and wellbeing of baby and I, then so be it.

I really don't care how much or how little intervention there is by medical staff, I don't care if it ends up being natural and drug free or if I want drugs, I don't care if it's vaginal or c section, I don't have any preferences in regards to birthing positions, music, the vibe in the room, I don't care how many staff are in the room, I honestly don't even care how long I'm in the hospital for or how long I stay at home for ect ect.

I've discussed all of this several times with my OB, my assigned midwife and my Mum (who is a nurse and plans to be there on the day), and we all agree that for our paticular situation and frame of mind, we'll just go with the flow and do what we need to on the day, whatever that may be.

We'll see what happens, and if for some reason something isn't working, we'll change it and move on to the next suggestion. If problems arise, I've already given permission to my OB to do whatever she can/wants, to get the baby out of me and keep us both healthy.

I've developed a very good relationship with my OB over the last year, and over the last 4 months have also grown very close to my midwife, so I trust both of them, and of course I trust my Mum. So if any of them tell me we need to do something/change something, I'm going to listen to them. And until that moment, I'm just going to let my body do what it needs to, and go with the flow.

I can appreicate that everyone is different though, and everyone has different experiences and circumstances. But for us, I believe what we are doing is the right thing to do at the moment original.gif

Edited by *Katey*, 31 October 2012 - 12:11 PM.


#16 Cloria

Posted 31 October 2012 - 12:32 PM

katey - re the perineum, did they indicate at what stage of the pregnancy you should start doing that? I understand you could do it yourself but I wonder if it's physically difficult once you get a bit big?

#17 *Katey*

Posted 31 October 2012 - 01:05 PM

QUOTE (Cloria @ 31/10/2012, 12:32 PM) <{POST_SNAPBACK}>
katey - re the perineum, did they indicate at what stage of the pregnancy you should start doing that? I understand you could do it yourself but I wonder if it's physically difficult once you get a bit big?


From memory, for a full term birth, they suggested starting around 32 weeks (or it might have been 34 weeks, I can't quite remember). I think I'll probably start from 30 weeks, just to be safe and maybe get a bit of extra time to stretch in.

I've not been that big before, so I can't tell you if it gets difficult.... but my SIL who just had her bub, used that method and she didn't have any problems at all doing it (in regards to belly getting in the way). She had an all natural, drug (painkiller) free, vaginal birth and she swears by the perineum massage/stretching technique. Apparently the midwives on the day asked her if she had done it, asked how many cms she was able to stretch to, and they congratulated her on it, and she swears it's the reason she didn't tear or need a cut original.gif



#18 Alxeen

Posted 31 October 2012 - 01:10 PM

I'm going to try doing perineum massage, probably from 30 weeks (but I'll go earlier). Fingers and lube is all that's required, and you can still 'toilet' yourself when your that big so getting hands down there will be ok.

Interesting question though - has anyone discussed the midwife doing the massage during labour?

#19 Katie_bella

Posted 31 October 2012 - 01:26 PM

I don't belong in this thread but i just wanted to add....

Talk to your DH or birth partner.

While it's important to talk to your midwife/Ob about what you want (and don't want) your DH will be your ears and voice on the day.
I couldn't string more than a few words together (and most of those should never be repeated rolleyes.gif )when labour really got going but knowing that my DH knew what i wanted and was happy to let the midwife/ob know was so reassuring.

I also agree with PP and decide what things are most important to you and then cut down your list. Two/three page birthplans can get ridiculous, you want your midwife to be looking at you, working with you and making decisions as the need arises, not standing in the corridor reading your novel of a birthplan.

#20 *Katey*

Posted 31 October 2012 - 01:32 PM

Oh yeah, I agree, talking to your birth partner about what you want is very important and goes without saying original.gif

I'm super lucky in that my DH and I are on the same page, and he comes to every OB and midwife appointment with me, so he's always very involved in all discussions between everyone.

He was also my voice when I was drugged up and couldn't speak/think properly and in huge amounts of pain when I was in hospital for 3 days with my rupturing tube, ectopic pregnancy and surgery, so we've had a bit of practice in regards to that kind of thing already, which I think has prepared us a little in regards to team work.

Edited by *Katey*, 31 October 2012 - 01:36 PM.


#21 livvie7586

Posted 31 October 2012 - 01:37 PM

i have a grand total of one preference this time around, which has been discussed with the clinic midwife, is now officially in my notes, and my husband knows about it (i react badly to syntocin, and do not want it unless absolutely necessary. seeing as i've had the same reaction with both children, we're now going to try a physiological 3rd stage).  i'm also old enough and wise enough now to fight for what i want, and DH also knows exactly what it is i prefer

Otherwise i know by now that i would rather go with the flow, and not have anything set down (i know what my body can handle, i know what drugs work etc).  i've seen too many people disappointed by things not going to 'plan'.

#22 Tesseract

Posted 31 October 2012 - 01:40 PM

QUOTE (LittleSpoon @ 30/10/2012, 08:25 PM) <{POST_SNAPBACK}>
But I would love to hear others thoughts...
How did you increase your chances at getting the birth you wanted?  What was the best way to communicate your preferences with your medical provider?


The best thing I did to achieve my intervention-free birth was a Calm Birth course. Hands down, the best thing we did.

Other thing I did was see a pregnancy-specialising osteopath regularly throughout my pregnancy. For the next bub I will also be looking into optimal fetal positioning (see www.spinningbabies.com) as I had a posterior labour (which was fine, because of Calm Birth, but I can understand why people don't like it!)

Your DH really needs to be on board, although having a doula also helps take the pressure off him so he can just focus on you.

Saying straight up that you don't want to be offered drugs.

I had a 'birth preferences' list too, it was only one page of dot points. It included stuff about the normal birth (don't offer drugs, keep it quiet etc) but that stuff is the kind of stuff your partner/doula can easily put in place. I also wanted a physiological third stage and delayed cord clamping which I got (after some discussion). With a preferences list I think it's important to list your preferences in the instance that things DON'T go according to plan. For example, if you have a c-section you want skin-to-skin straight away if baby's health allows it.

#23 Cloria

Posted 31 October 2012 - 01:43 PM

QUOTE (*Katey* @ 31/10/2012, 01:05 PM) <{POST_SNAPBACK}>
From memory, for a full term birth, they suggested starting around 32 weeks (or it might have been 34 weeks, I can't quite remember). I think I'll probably start from 30 weeks, just to be safe and maybe get a bit of extra time to stretch in.

I've not been that big before, so I can't tell you if it gets difficult.... but my SIL who just had her bub, used that method and she didn't have any problems at all doing it (in regards to belly getting in the way). She had an all natural, drug (painkiller) free, vaginal birth and she swears by the perineum massage/stretching technique. Apparently the midwives on the day asked her if she had done it, asked how many cms she was able to stretch to, and they congratulated her on it, and she swears it's the reason she didn't tear or need a cut original.gif



If you do it with your fingers how do you know how far you've stretched?


#24 *Katey*

Posted 31 October 2012 - 02:03 PM

QUOTE (Cloria @ 31/10/2012, 01:43 PM) <{POST_SNAPBACK}>
If you do it with your fingers how do you know how far you've stretched?


In regards to cms? With a ruler original.gif

Stretch yourself with your pointer finger and thumb, and measure the distance inbetween with a ruler.

I measured the other day, just out of curiosity. Easy peasy original.gif

Edited by *Katey*, 31 October 2012 - 02:09 PM.


#25 nikkibaby1

Posted 31 October 2012 - 02:37 PM

haven't read the whole thread but after complications and an emergency c section with ds i have asked for an elective c section. Of course the midwives at the hospital have tried to convince me otherwise even booking me into a vbac class but when i see OB on thursday i am going to let him know i 100% want an elective c section.




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