A Midwife’s Muse

What is a plan? Well, we had an extension built. We employed an architect, we told him what we wanted, he did some lovely drawings, full of measurements, specifications and loadings etc. We spoke to a few builders who looked at all the lovely drawings and few weeks later told us how much it would all cost and how long it would take to do it. Then we sent our drawings to the council, out came a man, he looked around and then wrote us a letter saying we could have what we wanted but due to the soil and how our house, and our neighbours houses looked we would have to make some changes to our plan, not major, we would still end up with the extension but the preparations (footings) and the finishing (rendering) would have to be slightly more intricate. Back to the architect, he made the changes on the drawings, back to the builder, he made adjustments to the costs and the time it would take, both increased. Our plan was ready. Needless to say it took longer and ended up more expensive, both of which we knew would happen. The weather affects the pace of building; third parties like suppliers, sub-contractors and the need for visits at certain times by the building inspector will affect progress if they are late delivering or attending. Did we consider that us or the builder had failed because we hadn’t kept to our plan? No, we were realistic and, most importantly we had the end result that we had desired, our extension.

Back to the eponymous birth plan, I think that that it should be named something different. When my children were younger they had a book called ‘ Would you rather?’ by John Burningham, it posed dilemmas like ‘ would you rather eat spider stew, slug dumplings, mashed worms or drink snail squash?’ ( it is still available but in an updated version ) I think that Birth Plans should be named ‘What I would rather’. It would go along the lines of – I would rather be able to move freely than have to stay on a bed. Or perhaps it should be an informative questionnaire to be filled in by the woman -

• Do you want to be mobile in labour ? Many women find that this helps them to cope better with contractions and can help labour to progress faster. If your baby needs to be continuously monitored it may be difficult to do this if you are moving around.
• Do you want to use gas and air? The research suggests that it does not affect baby. When you stop inhaling it the effects wear off immediately. Some women experience nausea/vomiting when using it.
• Do you want an epidural? The advice is not to have one before you are in active labour. You will need to have a cannula (small plastic tube) put in a vein. Research has shown that they may cause labour to be longer, and make it more likely that you may need help to give birth, but if it works it will get rid of the pain of contractions. Some labour wards have a limit on the number of women on labour ward at any one time who may have an epidural as they need more intensive monitoring. An epidural needs to be put in by an anaesthetist, he may not be immediately available. If the midwives or doctors believe that you may have a longer or more difficult labour they may suggest that you have an epidural.
• Do you want your ‘waters’ to be broken. There is no proven benefit from this procedure if all is straightforward but it may be necessary if you are having an induction of labour or there is need to monitor baby by putting a clip on to his head……..

and so on.

Why this musing? I really hate it when women feel that they have ‘failed’ because their birth didn’t go the way that they had planned and over the last three days I have spent a lot of time de-briefing women because of this disappointment with themselves and/or the staff. Back to our extension, we got what we wanted in the end, we had to compromise on some choices, we can look back and say that it would have been nice if it had finished earlier, that it had kept within budget, but in the end we had a positive outcome. Our plan was flexible, it was a case of ‘we would rather, but we are content’, I wish that birth plans could be viewed in that way and that women could view the outcome, a healthy Mum and baby, in the same way.