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Confessions of a Birth Plan Sceptic

The best birth plan that was suggested to me by a midwife many years ago was – “Roll with the punches.” I could end this blog now and would be happy that I had given you some very valuable advice. But I won’t. As my wife would be more than happy to tell you, my “stories” tend to drag on and on and so I feel at least a little obliged to add a bit of puff to this piece.

My introduction to Obstetrics as a very junior doctor was terrifying. I used to hate labour ward. There was all this noise from women who were clearly not having a fun time. There were midwives who seemed to revel in those cries of anguish. Of course now the same noises that used to horrify me now make me think “Alrighty!!! Sounds like she’s labouring well in there.”

Each and every one of those women in my early labour ward days represented to me a very large question mark. What was going to happen? Would she have a normal delivery? Would she have a caesarean section? Would she require an oxytocin drip? Would she (God forbid) need some assistance at delivery? Most of my terror was born from the fact that I could do bugger all on labour ward. If some sort of active intervention was required – I was useless. The boss would have to be called, sometimes in the dead of night and I would then await their arrival sincerely dreading that something might happen in the intervening time. Of course, it never did.

I’ve become more astute in recognising patterns of labour (the women of Hobart breathe a collective sigh of relief). I’ve become skilled in the arts of operative delivery (forceps, Ventouse, caesareans). I’ve learnt to rely on the intuition of midwives. However, there is one thing that I have learnt over the years - anything can happen at any time, sometimes when you least expect it. Just when you think you have a handle on the whole labour thing, nature will throw you a curve ball, just to keep you on your toes.

The chances of having an “Oh man” moment is much more likely at the time of delivery. Just when you think that the labour is all but over. That’s why whenever I’m doing a caesarean or a forceps or anything where I’m having to interfere with the wonderfully amazing natural process known as birth – my coronary arteries are just a little more constricted than usual – just a little. After a particularly difficult delivery I often think of what’s transpired as a mini exercise stress test for my heart. I’d have to say that even after 15 years of experience in obstetrics I still have moments where I silently think to myself, “I did NOT expect that.”

On a day to day basis I still find it amazing that women having their first babies go through the process of labour and delivery with no “hands on” experience. I’m sure that most of your who have been through this process will agree that no amount of reading, discussing with your friends or antenatal classes REALLY prepares you for birth. When that process goes well (which it does in the majority of cases) it can be an amazing and empowering experience. When it doesn’t go so well it can be the complete opposite.

The day of your newborns birth is (if you’re lucky) 24 hours out of your life where anything could happen. It could be an elective caesarean which starts at 8am, is done and dusted in less than hour and you spend the rest of the day basking in the reflective glow of the wonderfulness of your newborn baby. It could be a day where you feel like you have taken a badly guided tour through the nine circles of Dante’s Hell which ends up with a caesarean section at 3am in the morning.

One couple I looked after had a long labour but the mum coped amazingly. In the wee hours of the morning she was fully dilated but things were progressing slowly. After some time I made the decision that we should go to theatre. I attempted to delivery her baby vaginally but it would not come down and ultimately she needed a caesarean section. Everyone was a little deflated to say the least. Mum and baby were fine but there was disappointment that her wish for a vaginal delivery could not be attained. After the caesarean I was getting dressed with the dad in the change room. I could tell he wasn’t happy and we chatted about what had happened. He said to me “I’m not angry with you but I’m just disappointed and a little cross with how things turned out.” I replied to him that unfortunately that’s the process of labour – you don’t really know where you’re going to end up until you actually get to the end. He replied, “That might be the case but it’s a pretty stuffed up process.”

Some of the most disappointed women that I have helped care for over the years have been those going through Birth Centres. Some (and I stress only some) of the couples delivering through Birth Centres have very long birth plans. Some of these Birth Plans could almost be called Birth Theses. Pages of detailed instructions outlining minutiae of allowed or disallowed interventions, drugs, examinations, monitoring etc etc etc. When these births culminate in caesarean sections sometimes the women blame themselves for what has happened. They see themselves as having failed. They’ve failed their partners. They’ve failed their babies. Sometimes it appears that they think they’ve destabilised the delicate balance of the universe itself.

Is your baby alive? – YES. Are you alive? – YES. You have not failed. The exact mechanism by which your baby arrived may not be your first choice but guess what – you’ve got at least 18 years of nurturing, educating and worrying about your child to make it up to them.

Some of the easiest women that I’ve helped look after during their labours were those who had little or no idea of what they were in for. They trusted their midwife implicitly. They just went with the flow and when that flow bumped them into the flotsam and jetsam of labour complications they got help from the staff around them and kept on going. Some of those women also ended up with caesareans but they didn’t end up with the guilt trip quite so often.

Am I saying that you should go into labour without any preconceived ideas of what to expect or what you want. Of course not! Educate yourself – to the level that you want to be educated. Antenatal classes are a good start. If you want delayed cord clamping- ask for it. It should be standard care at most hospitals anyway. Do you want skin to skin contact immediately after birth – of course, unless your baby needs resuscitation.

Most requests that I have seen on birth plans don’t actually need to be there – they’re standard at most hospitals. The most important thing is that you actually discuss your birth plan with your obstetrician before the day of your baby’s arrival. Occasionally the first time I see a birth plan is when the Mum arrives on labour ward having a contraction every 3 minutes – not the greatest time to be having a detailed discussion on the merits or otherwise of a physiological third stage.

It is good to have some idea of what you want or not want in labour. However, bear in mind that even after 15 plus years of obstetric experience I still occasionally have “What the…” moments during a labour and birth. If that can happen to me then clearly the preconceived notions of what you think might happen on the day of your babys birth may not necessarily be what ACTUALLY will happen. If that’s the case you can get angry, get depressed or you can just – Roll with the punches!

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