YOUR BIRTH PLAN AND PREFERENCES

It’s a good idea to think about your options for birth, so you can prepare both physically and mentally for birth.

Sometimes called a birth plan, or birth options or choices, this is a way of learning about your options for birth, and thinking about you may or may not like, along with what you might want to do if things deviate from your anticipated birth.

You will be able to discuss your options with your midwife during your appointments.It is important to remember that you can change your mind at any point, even during labour. And even the best thought out ‘plans’ aren’t always possible.

Things to consider in your birth plan or preferences

There are several things to include when thinking about your birth choices. The following suggestions might help you to get started:

• Where you would like to give birth
• Pain relief options
• Who you would like to accompany you for the birth
• What if things deviate from your plan, such as needing a forceps or ventouse
• What if you need a caesarean section
• How you will manage the third stage of labour and deliver the placenta
• Would you like skin to skin with your baby?
• Would you like delayed cord clamping?
• How you would like to feed your baby
• If you would like your baby to have Vitamin K

These are just a few suggestions, you can include as much or as little as you would like.

Choosing the place of birth

There is one than option for deciding on the place of birth.

Home Birth

For most women a planned home birth is a safe option for both themselves and their baby. However, research suggests that first-time mums who decide to have a home birth have a higher chance of being transferred to hospital during labour. If you live some distance from the hospital this could be something to consider. However, for second and subsequent babies a planned home birth is as safe as a planned hospital birth in normal, low-risk pregnancies.*

Pros of a home birth

• You get two midwives to care for you in labour and there is a high probability that at least one of them will have cared for you during the pregnancy
•  You’re able to give birth in a relaxed, familiar environment with your family close by
•  There’s less chance of medical intervention
•   If things don’t go as planned, you will still be able to transfer to hospital
•   You can recover from the birth in your own home
•   You are more likely to breastfeed
• If you have other children, you won’t have to leave them, and your birth partner will not have to adhere to any visiting hours.

Cons of a home birth

•  There are less pain relief options available.
•   A home birth is not advisable if your pregnancy is considered high risk.
•   If you have problems during labour, you may have to transfer to hospital in an ambulance. Your midwife will do a risk assessment during the pregnancy to ensure that emergency services would be able to reach you.

If you want a home birth your midwife can book it for you – it doesn’t commit you to anything and you can still change your mind at any stage during the pregnancy.

Midwife-led units/birth centres

These are led by midwives who care for women with straight forward pregnancies. These units can be within a general hospital along side the obstetric unit, or they may be free standing and built on a separate site.

Pros of a birth centre

• You will give birth in homely surroundings which can make it easier to cope with labour.
• You are more likely to be cared for by a midwife you have got to know during your pregnancy.
• These units are as safe as obstetric units for first-time mums.
• You will have fewer interventions than in an obstetric unit in hospital.
• The midwives will help you to breastfeed before you go home

Cons of a birth centre

• Epidurals and Caesareans are not available.
• You may have to be transferred to an obstetric unit if there are any complications.

Hospital birth

Most women still give birth in a hospital obstetric unit. You are looked after by midwives and doctors are on hand if help is needed. Your midwife can organise this.

Pros of a hospital birth

• Hospitals have the equipment and expertise if complications develop for mum or baby.
• You have more pain relief options, such as an anaesthetist on call for an epidural
• You can stay in hospital for a few hours after your baby is born – and for longer if you have had complications

Cons of a hospital birth

• You’ll give birth in unfamiliar surroundings.
• You may not have met the midwives who care for you during your labour.
• You are more likely to have medical intervention, such as induction.
• If the unit is full you may be sent to another maternity unit in a different hospital to the one where you planned to have your baby.

Pain relief options in labour

You can read more about pain relief options during labour here.

The pain relief options available to you may be different depending on where you choose to give birth, so ask your midwife what is available in your area.

Birth partners

You are usually allowed one or two people to accompany you during birth. Think about who you may wish to have with you.

Many women choose their partners, however choose whoever is going to make you feel the most supported and at ease.

What if things change?

Sometimes a labour or birth can end up needing an intervention that you didn’t foresee. Learning about labour and birth, and the eventualities will help you be more prepared during your own labour.

You can read about a forceps or ventouse birth here, or you can read about a caesarean here.

You may need to be induced, which you can read about here

How will I deliver the placenta?

After you give birth to your baby, you will need to deliver the placenta. This is known as the third stage of labour.

There are some options for managing this. Most women can choose which method they have, but some women who are at risk of heavy bleeding will be advised to have active management.

Active management

After the birth you can have an injection of oxytocin. This helps contract your uterus and expel the placenta. The medication may make you feel or be sick, but does reduce the risk of heavy bleeding after birth. With this method it can take up to 30 minutes for the placenta to be delivered, and the midwife or Doctor gently pulls it out.

Physiological management

With this method, no drugs are used and you wait for the body to expel the placenta by itself. This can take up to an hour, and is not suitable for those who have a higher risk of bleeding. Your midwife will be able to let you know whether this option is suitable for you.

If the placenta isn’t delivered within one hour, or you have heavy bleeding then you will be advised to switch to active management.

If you are having a caesarean the doctor removes the placenta after the baby is born.

Skin to skin

Many women choose to do skin to skin after the birth of their baby. This is where your baby is placed naked on your bare chest. It helps regulate the baby’s breathing, temperature and can help get breastfeeding off to the best start.

You can read about all the benefits of skin to skin here.

Delayed cord clamping

It is recommended after birth that the umbilical cord isn’t cut straight away, and that at least 1 minute passes before cutting the cord. This is to allow extra blood from the placenta to reach the baby.

It may not be possible if you are bleeding heavily, or your baby needs resuscitation, however in most situations it should be achievable.

You can read about the benefits of delayed cord clamping here.

How would you like to feed your baby

You can choose to breastfeed, bottle feed or a combination of the two.You may have a strong preference either way or need to learn more before you make up your mind. You can learn more about breastfeeding here and you can learn about bottle feeding here.

Remember to ask for support from your midwife for help feeding your baby.

Vitamin K

Vitamin K is a vitamin that helps our blood to clot. Some babies are born deficient of this vitamin, putting them at risk of bleeding and developing HDN (Haemorrhagic disease of the newborn – a bleeding disorder). All babies are recommended to have a dose of vitamin K after birth to prevent this from happening.

There are two options for administering Vitamin K.

1. Injection – this is the most effective way to deliver the vitamin. It is a small one off injection delivered into your baby’s thigh.
2. Orally – this is not as effective as baby’s will often vomit or posset, so it’s hard to ensure they receive the dose. They will need 3 doses. One after birth, one a week later, and a final one a month after birth.