I’ve talked before about why I think writing a birth plan for every pregnancy is important. Lots of comments said that so many women didn’t bother for subsequent children, especially after a straightforward first birth or they just had a few preferences. I think birth planning becomes a bit more of an obsession when you’ve had a traumatic birth because you want to avoid the same thing happening and ultimately reflect more positively on the situation.
I do agree that birth can be really unpredictable and it is wise to consider options B and C however I personally can not just accept “going with the flow” as it is likely I’ll always be at risk of another c-section for this and future births. It’s very hard for me to just go with the flow when major abdominal surgery will always be part of the plan.
I wanted to share my birth plan for my ideal birth and touch on how I’m trying to turn it into a positive experience however I am also going to share my plans for a hospital transfer and in the case of needing a planned or unplanned c-section. My hope is that you can pick up some of these to add into your own birth plans or there might be some considerations that you hadn’t thought of yet. I’m also currently writing a book on having a high BMI and being pregnant and why individualised care is absolutely key when you’re in that situation.
Creating Birth Plans A, B & C
So birth plan A is a home upright, forward and open VBAC Waterbirth using hypnotherapy and gas and air.
Plan B is an active and upright vaginal birth with or without assistance following a transfer to hospital for whatever reason. I’m still happy for gas and air, Hypnobirthing and might consider pethidine or diamorphine if I feel it’s needed however I want to avoid an epidural.
Plan C is the planned c-section with spinal block at 42 weeks if I am not already in labour or the unplanned c-section with spinal block or general anaesthetic in an emergency following any difficulties and where the safety of myself and my baby are compromised.
Risk of Scar Weakening or Rupture
The risk of scar rupture is around 1 in 200 so it is not common place and the scar is more likely to weaken or slightly open than actually rupture. I need to be aware of:
- Pain in between contractions
- Referred pain in my shoulder
- A sense of feeling of something being wrong or not feeling right
- Vaginal bleeding
Any of these will mean a direct transfer to my booked in hospital. The risk here from home is the transfer time of course and is a risk I acknowledge which is why the midwife attending me at home will be looking for these symptoms closely.
Things that help avoid scar weakening
- Length of time between pregnancy – 8 years
- Placenta away from the scar site – mine is no where near my old very neat scar
- Shorter labours – something I can’t control but as my uterus has done it before there is no reason why my labour should drag on and I should labour just like any other second time mother.
- Positioning – being upright with gravity on my side
- No hormonal/syntocinon/epidural induction.
There aren’t many home birth vbacs in my hospital trust area, especially those with a high BMI so it’s really hard to know what my chances are of a successful vbac however the evidence does suggest that women that do plan a Home birth are more successful at having one and those that plan for a vbac at home are more successful at having them at home or at hospital.i therefore have had three lengthy discussions with a consultant midwife who has put a midwifery care action plan in place for the midwife attending me at a home birth and to help with making my labour positive in hospital.
Guidelines recommend that a VBAC woman comes into hospital for continuous monitoring but if they want to birth at home they can and the transfer threshold to hospital should be lower. In the case of Home births with a high BMI around 58% of women are transferred into hospital at some point either at their own request, prolonged labour or in an emergency. This is why it’s even more important for me to have a birth plan.
Birth Plan A – Home VBAC Waterbirth
Pros – in my own environment, feel safer, no need to rush to and from hospital, can labour and birth in water if I want to.
Cons – transfer time to hospital or waiting for an ambulance.
At home I will have access to water, gas and air, TENS, food and drink. I have bags packed just in case of a transfer and so Adam knows where everything is. We will have shower curtains and tarp to protect furniture. Large TENA pads for the bed and sofa. I will have a fan and portable heater to adjust the temperature in the room. We will have plenty of space in the bathroom to birth the placenta – apparently using a pan and sitting on the loo is a perfect place to do this for a physiological first stage.
Early labour signs that the plan is to have a whole grain carb meal for energy, inform labour line that things are beginning, get adam home and arrange childcare for Evie if needed and inform my Doula, a warm bath, take two paracetamol and go to sleep – labour will wake me up!
Continue to inform labour line whilst contractions progress, watch funny comedy videos on Netflix and build a Lego set. Trust me there is a method to my madness here – anything that makes you feel good will make you labour better. Eat what I want and drink isontonic drinks for energy.
When I need to focus on contractions use birthing ball, TENS and hypnobirthing tracks remain in an upright and active position. Consider filling up the pool at this point and when contractions are three in ten minutes lasting a minute ask for a midwife to attend. Avoid getting in the pool until midwife arrives and allow a cervical examination.
Try and wait until 8cm/transition to get into the pool and remain in active, upright position. It is estimated that a second time mum will dilate from 5cm to 10cm within around five hours or one hour for 1cm.
Birth Plan B – Following Hospital Transfer
Pros – emergency equipment available if needed, no need to wait for transfer time
Cons – unfamiliar, sterile environment, likely to have more interruptions and midwives I’ve never met
If I transfer to hospital I am asking for intermittent monitoring to continue as I feel being strapped to a bed will really limit my ability to labour the way I want as I plan to remain mobile, upright and active. Transferring to hospital usually means no eating in case of an unplanned c-section, so drinking for energy is going to be key. I’ll be bringing isotonic drinks, chewable glucose tablets and honey as well as some chocolate for after birth. I have requested wireless monitoring if continuous monitoring is required and a room with a large shower so that I still have access to water for pain relief. I have also rejected having a cannula inserted as a precaution and do not want an epidural. I am happy to use gas and air and might consider pethidine or diamorphine if labour is taking a long time.
When it comes to assisted delivery I believe remaining upright, forward and open will be the best position for me and my hospital has floor mats and birth balls available. However, if baby needs to be born then I will accept methods of assisted delivery offered.
Birth Plan C – C-Section Birth
Pros – baby is delivered.
Cons – major surgery, more scar tissue, more risk of rupture for subsequent pregnancies, theatre environment, lots of people.
In the event of a c-section I am still requesting the following:
- Optimal cord clamping
- Skin to Skin in theatre
- Delay weighing and measuring until first breastfeed
- Second APGAR on my chest
- Baby born slowly and gently
General Birth Plan and Preferences
1st Stage of Labour – Dialation.
Consider the environment for the best possible production of Oxytocin and base this on my senses. Create space for the birth pool and a birth nest. This can also be transferred into labour ward as much as possible.
Smell – favourite aromatherapy oils
Touch – water, soft textures
See – low lighting, family photos, birth affirmations
Taste – favourite treats, frozen grapes, warm lemon and honey drinks, isotonic drinks
Hear – hypnobirthing track, hushed, empathetic voices
2nd Stage of Labour – Pushing
Breathe Baby Down
No coached pushing
Upright position, preferably in water for buoyancy and most comfort
Skin to skin after birth
3rd Stage of Labour – Physiological (if all is well)
- Birth placenta without injection unless excessive bleeding
- Optimal cord clamping – wait until the cord has changed colour and stopped pulsating
- Golden hour of skin to skin contact, breastfeeding and delay weighing and measuring
For more pregnancy content please head to my hub post which contains links to all my relevant pregnancy based blog posts. My second High Bmi Pregnancy.