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One of the biggest worries that often crops up, is the feeling of not knowing what is going to happen during birth. That it is unpredictable. This can lead to a feeling of not having any control over the experience. It can also mean we don't see the point in a birth plan - as plans can change.
But two things can be true at the same time: Yes, birth is unpredictable, and Yes, you can have control.
So when it comes to taking control in birth, here are my 4 top tips.
1. The Journey to Birth Planning
Let's imagine you are driving to a restaurant in Edinburgh or Glasgow that you haven't been to before. So you pop it into Google Maps on your phone and it gives you 3 options with varying times and routes. You choose the one that is right for you - perhaps the quickest route or the one that seems the simplest. Off you go on your preferred route.
But every journey is unpredictable - a little like birth! It might go perfectly to plan and you reach your destination. Or you might come across something unexpected - a crash, road works, or just very heavy traffic on your preferred route. Your rational brain runs through options - stay in your lane, it may take a bit longer, or head off following a suggested diversion that your phone recommends. Whichever option you take - you will reach your destination and you know this.
You remain in control - the choice is yours.
At no point when planning your journey, would you decide to drive to the restaurant via every back road possible, just in case there were roadworks or a crash.
Your birth plan is similar. You should absolutely plan your ideal birth and if that doesn't work out, in that moment you adapt, like the capable woman you are. It is your decision to make, and yours alone. At no point should you assume the worst will happen and so jump straight to an emergency c-section from the moment you arrive at the hospital!
If you don't have a plan, its a bit like calling a taxi - yes you will ultimately reach your destination, but you will have absolutely no control of the journey. The taxi driver will make that plan for you. In birth, your taxi driver is the midwife, and with the best intentions, they will make a plan for you. From where you give birth to how your placenta is birthed, they will decide. And once they do it is far harder to take back control in the moment. If they show you through to the delivery suite on the labour ward to the room they have prepared, it is harder to then request a water birth on the AMU between contractions.
On my course I recommend you write 3 birth plans and we spend time in the class doing this:
Plan A - your Absolute ideal birth plan, the preferred route.
Plan B - your Back up options.
Plan C - Caesarean. Just in case your route should lead you here, it is always worth understanding the choices and options you have in this case.
Please don't expect your midwife to do this with you at an appointment - they don't have time for that between urine samples and blood tests so it is up to you to write it and then you can discuss it together. You might have seen lovely visual birth plans, but write your plan in the NHS Badger Notes App. This is the best way to get it seen by all on your care team. I have an interactive e-book available here that will take you through all 25 questions asked in the App - you get this free on the course.
Just remember, you are in control of writing your plan and of any changes to it.
2. Your Birth, Your Choices, Your Consent
We can't know every choice we may have in labour - but recognise that they are all YOURS to make. Midwives, Doctors, Students, everyone and anyone need YOUR INFORMED CONSENT before any intervention. You may not even realise as they sometimes don't ask but tell - "We are just going to pop this CTG Monitor on to keep an eye on the baby's heart rate." You can say no. Also notice - 'informed' consent. You have the right to ask questions to better understand what they are offering and why. For example, 'What is CTG Monitoring?' 'Why do you want me to have it?' 'What is the evidence for your reasoning?' 'Are there alternative options to this?' If you don't understand, it is not informed consent. Simple.
And just because you have agreed to something, you also have the right to change your mind and withdraw your consent. Just knowing this can help you retain control.
3. Learn how to say 'no'.
It used to be called 'refusing' an intervention, now it is called 'declining' and is becoming more acceptable and expected of birthing women. But that doesn't mean it is any easier. Firstly, recognise that interventions are often offered routinely - rather than from a place of personalised care. For example, an induction is offered routinely to women who go over 41 weeks pregnant. When asking why YOU specifically are recommended it, being told 'because we offer this to everyone' is not a good enough response. If you are being offered an intervention - make sure first and foremost it takes account of who you are and is individualised. BMI, Age, Race, Gestational Diabetes are labels not reasons.
The best and easiest way to decline an intervention, is to ask for time to discuss it with your partner. Whatever is being offered, it is easy to find yourself nodding along and agreeing to something you didn't even mean to. Have an agreed plan with your birth partner that whatever they offer, you 'Take Time To Talk' first. TTTT.
Once you have decided you are declining, here are some ways to do it:
Thank you for that recommendation, we will discuss it and let you know if we would like to go with that option.
I don't want a routine intervention but I'll consider things that are right for me and my circumstances.
I appreciate your opinion, but I would like to go with the decision I've made.
It is good to know that is an option too, we will let you know if its the one I pick.
We have decided the best option for us is the one we have already chosen. We will let you know if that changes.
I would like to do things this way and would be grateful for your support with that.
Declining an intervention doesn't always mean an absolute 'no'. You can also say 'We want to wait and see.' You can change your mind.
4. Take a course.
Knowledge is power. Understanding your choices and options means not only do you have more say in labour, you will feel more confident standing up for yourself. Lets take fetal monitoring. It is recommended that your babies heart rate be monitored during labour. But how would you like that? A Doppler? CTG? Fetal Scalp Electrode? What does each involve? Are their consequences to your answer? A doppler is used every 15minutes to listen in. A CTG can be in place continuously but can restrict your movement. A scalp electrode is quite invasive. A course will help you understand the research and evidence for not only these interventions, but all things birth, and support you to make your decisions confidently. This means you do not need to rely on someone else to guide you and give over your control.
"You have put my mind at ease, knowing I will make an informed decision which is best for me and my baby. Thanks again." Natalie, First Time Mum-to-be.
"Thank you so much, Heather, for everything you taught us in the class. It got me through some really tough challenges. I could not have got myself into that place of empowerment without your course. Thank you." Alisha, Second Time Mum.
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