Expert / 4 November, 2019 / Dr Will Dooley

Expectation v Experience: Do You Have A Birth Plan?

Hello, I’m Will. I’m an obstetric doctor and support women and their partners through their pregnancies and birth. I’m also a dad of two daughters, one is two years old and the other is just four weeks old. So, I know what it’s like to be on the “other side.”

The expectations and experiences of birth

It’s always an honour to be in people’s lives at such a special time, although I completely understand why most people don’t picture their ideal birth experience as one that involves an obstetrician. When I read people’s birth plans, nearly every one describes an uncomplicated vaginal delivery. Rarely do I see one that includes plans for if an intervention is required.

NHS birth statistics

But looking at the NHS statistics for last year, more than 4 in 10 babies were delivered by either Caesarean section (28%) or instrumental delivery (13% with forceps or ventouse).

If this number was lower, say 10%, then maybe it would be reasonable not to plan for these types of deliveries and simply hope they wouldn’t be needed. But as almost half of women did have assisted births in the UK last year, I really do think there is so much benefit if we open up the conversation, help reduce women’s anxieties and show it’s possible to have a positive birth experience, regardless of the type of delivery.

When I discuss anxieties surrounding interventions, they usually stem from fear of the unknown, loss of control or concerns about the reasons that these deliveries may be required. Women have often heard or read negative stories.

Positive birth experience

There’s a really progressive movement at the moment focussing on achieving a ‘Positive Birth Experience,’ whatever type of birth you may have. The main principles are being realistic, knowing your options and personalising your experience, whatever it may be. These principles should not be limited to uncomplicated vaginal deliveries, and arguably the values are even more important if you require an intervention.

The challenge that we have as obstetricians is that we often meet women for the first time when they are in labour. This isn’t the best time to be having conversations for the first time. There’s not always lots of time to listen to all the fears women may have and help them feel confident about their deliveries. So, I believe we should be having these conversations much earlier on.

By no means do I feel we need to hide from the fact that there are risks involved with medical interventions. But we should talk more openly about how the decisions we make are based on a balance of risks. If the risk of doing nothing is greater that the risks of intervening, then we consider intervening; if it’s not, we don’t. This is to simplify the work we do and the interpretation of risk is not always easy. Every person will place different levels of importance on these risks.

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So if you are expecting a baby and writing your birth preferences, here is some food for thought:

Know your options

It’s great to make a birth plan and to have visualised your ‘ideal’ birth. But it’s equally important to know all your options and plan for the unexpected. I prefer to call this process one of understanding your birth ‘preferences.’ This makes it feel like a less rigid process and allows you to prepare for more scenarios. Make sure you understand the medical options that may be considered in labour, either by attending an antenatal class that is honest and non-judgemental, and run by people who work in the field of delivering babies, so they can answer your questions in depth and detail. Research your options online but remember to use reputable sources.

Keep an open mind

It’s impossible to know for certain what your journey will look like. For example, with pain relief during labour, there are many options there for you if you were to need them. By discussing the options, it doesn’t make you a failure or increase the chance of you using them; rather empowers you with choices and helps you feel confident and in control, if you decide you need them.

Make the birth process your own

Some people feel that if an intervention is needed, then their ability to personalise their birth experience is taken away. This does not need to be the case. For example, I often meet women who are disappointed they have been advised to give birth on labour ward rather than the birthing centre. But with planning there is lots you can do to make this environment special and your experience positive. For example, bringing your own music or battery-operated candles into the room.

Talk

If the people who are caring for you don’t know what you want and how you feel then it’s difficult for them to help you achieve your perfect birth. It’s okay to ask questions to fully understand the decision-making process. In fact, questions are very much encouraged. In the context of interventions, it’s right that you ask why; what are the risks of the plan being proposed; but also, what are the risks of doing nothing?

Get Closure

Even if things have gone exactly as you imagined, always try to get someone to debrief with you after. Ask questions and make sure you’ve understood the rationale behind the decisions that were made. This is useful for when you are recollecting your birth experience; but also valuable for your future pregnancies, when your past experiences will likely re-surface.

Involve your birth partner

During delivery your birth partner will become your biggest supporter and your advocate. If they have not been part of the process in planning for your birth, then it won’t be easy for them to do a good job. Write your

birth preferences together, so during labour, they can ensure that everything is happening the way you wanted.

I have written a Birth Preferences document, which you can find here. This includes options you have to personalise all types of delivery, including instrumental delivery and Caesarean sections. I hope you find it useful and I wish you a positive experience, whatever your birth may bring.

By William Dooley, obstetric doctor and co-founder of Happy Parents. Happy Baby. Antenatal classes and speaker at The Baby Show.

Find more information at Happy Parents Happy Baby or happyparents.happybaby on Instagram.

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