Childbirth can be awe-inspiring and life changing. At the same time, its challenging experience, especially if you have additional needs which need attention. Planning is key to giving you the best chance of having the experience you want. There are so many different options – from home water births to elective caesarean sections. I’ve tried to cover as many options and considerations to bear in mind when birth planning, but please feel free to comment if I’ve left anything out!
When you’re first referred to a midwife (or looking for an independent one) keep in mind – they are an expert in helping women giving birth, not necessarily in your condition. It may be helpful to go to a first appointment with information regarding your condition. Full disclosure about all your conditions, physical and mental, is vital. Having multiple conditions and medications, it can be easy to forget one or not mention one you feel is irrelevant. I know I have done it a few times! There are now a small but growing number of NHS midwives who specialise in working with disabled women. Your area may have access to one of these midwives so it’s always worth asking.
Unfortunately, many women (especially in the UK) no longer see the same midwife throughout pregnancy and labour. This is where birth plans come into play. They can be a really helpful tool for communicating your wishes for the birth. You can make it as simple or as detailed as you like. Birth plans have become commonplace. They’re an essential tool when you have additional needs or requirements that need communicating clearly. I’ll talk more about the plan itself later on.
The first being whether you want a home or hospital birth. For some this maybe dictated by your condition. Check with both your consultant and obstetrician if you are told this is the only option. Occasionally they suggest a caesarean for reasons other than you or your baby’s health. You are entitled to a second opinion if you disagree with the choices provided. If you have the option, try looking for an obstetrician who has experience of your condition, or is least willing to read up on it!
If you feel that hospital isn’t an option for you, there are lots of home birth information resources here. I was born at home, happy and healthy 27 years ago. In the UK, the NHS is encouraging Home births. Research suggests for women having their second baby they can be just as safe as a hospital birth.
Labour ward vs. Midwife led unit
If you decide hospital is best, and your pregnancy is classed as low risk, there is choice of a midwife led unit and a doctor led unit (sometimes known as the labour ward). In some places the midwife led unit will be next door to the labour ward. Although, they can miles apart, particularly in rural areas.
A midwife led unit will likely have more access to birthing pools/stools/balls and other birthing equipment. You also get to stay in your room until you leave hospital. In most cases your partner can stay with you for the duration of the birth. Some units will allow you to dim lights and play music to relax you. There is research which shows midwife led units are the safest place for straightforward pregnancies. The downside of these units is that many do not offer anaesthetic pain relief such as an epidural. Also, if there were complications you would need transferring to another ward or unit.
If you decide upon a labour ward, another option that may be open to you is a caesarean section. This may be your only option if your condition dictates or you encounter complications. If you are considering this as one of your choices its worth looking at the pros and cons of a C-section. Some positives are that you will know when your baby will be delivered, and you’re less likely to experience tears. But, it is a major operation and has the associated risks involved.
Although in the UK you do not have the right to a C-section (unless you have medical reasons which indicate one – including the phobia of giving birth). Most hospitals are willing to arrange one. As with all operations, there is a recovery time (normally around 6 weeks).
If you have several units or hospitals that cover your area, consider how you will get there and the different facilities they offer. This website is a helpful tool to search for hospitals and units available in your area and what they offer. Most will allow you to visit before you make your final decision. This can be really important to see if they truly are wheelchair accessible! Do they have any equipment you may need (such as a hoist)? Can they obtain it at short notice?
Pain relief and management
First off, check with your condition consultant what could work for you. A preconception counselling session with your consultant before becoming pregnant can be useful. This is a great time to ask about any contraindications or precautions to be taken. Those with my condition (Ehlers Danlos Syndrome) can have issues with local anaesthetic having little to no effect. Stirrups are also a no-no, due to lax joints. Conditions such as Scoliosis can dictate certain methods when citing a local anaesthetic. Yet another reason to mention all your conditions, no matter how much they affect you!
That said there are many other options for you to consider, both pharmaceutical and non-pharmaceutical. This link runs through most of them. What pharmaceutical options they offer to you will depend on a number of factors, but ask for what you feel is best for you. Its important to not feel pressurised into taking a pain relief method you don’t want.
This is again where the birth plan comes into play. Unless you appear to be in state of distress, most midwives will adhere to what you do and don’t want in your birth plan. Although, its worthwhile making them simple and to the point. Epidurals can be difficult for those who find it hard staying in one position for a long time, as they numb everything below the waist. This also restricts you to lying in bed. Some women find moving around and changing positions during labour helpful in reducing pain.
TENS (transcutaneous electro nerve stimulation) is a well-known pain relief device which many mums to be whilst in labour. You can often hire them through your midwife for home births, but are also cheap to buy. They are very safe and are often used throughout labour. Another non-pharmaceutical pain management option is hypnobirthing. This is essentially a method of self-hypnosis. You maintain full awareness of your surroundings and in control but in a state of deep relaxation. It can take the focus away from the pain and more towards breathing.
Back to class for you!
In the UK NHS antenatal classes are widely available and free. But there are also charities and antenatal consultants that offer longer more in-depth classes. NCT (Natural Childbirth Trust) is a well-known charity in the UK that offers antenatal and postnatal classes. They are reasonably priced and also offer a reduced rate to those receiving certain benefits. There are also a wide range of private classes on offer, which vary widely in price and quality. Unfortunately I have been unable to find any providers that specialise in classes for those with chronic health issues, disabilities or sensory impairments. Please let me know if you have come across one!
For most their choice of birth partner is straightforward – the father of their baby. But even if this is your first choice having a backup is helpful! For me the reasoning is two-fold. Partly because labour can be very quick and not give your partner time to get to you. On the other hand, it could be lengthy and your partner may need to rest and freshen up. As my partner is prone to fainting at the sight of blood, I need to make sure I have someone with me at all times. Especially if I have to have an emergency caesarean. A birth partner could be a friend, a relative or even a doula.
Doulas are becoming mainstream. They can help with practical support as well as emotional support. Their services can be helpful to any new mother, but even more so for new mums that need extra downtime to recover from the fatigue of childbirth.
Lying on your back to give birth is one of the most common birthing positions, but it doesn’t automatically mean it’s best for you. One thing that it doesn’t make use of is gravity! There are a huge number of positions, and only you know what physically works for you. There may also be birthing balls, stools and other specialist kit that you can make use of. This video shows a range of different kit and positions.
Communicating your plan and your needs before and during labour and birth
Having a clear method of communication is so vital during birth, especially the later stages of labour. Having a birth plan can be part of that, but if you have additional communication needs, have a plan for how you will communicate. In the UK you have a legal right to an interpreter. Bringing a friend who can communicate for you may work just as well. Large print or braille forms may not be available at short notice, but can be obtained in advance if the midwife is aware of your needs. Make sure someone fully explains the implications of each form. Asking for the detail of the forms to be clarified early in labour (or if possible at an earlier date) can be helpful. No one wants to concentrate on signing forms during contractions!
No one can claim to be fully aware of what people are asking of them when in the full throes of labour! I haven’t yet found a birth plan template I thought really covered all the bases. But this site covers most of the basics and gives space to add the extras.
Go with the flow…
As much as you can plan, birth will take its own course. Thus it’s always helpful to have some backup plans and some things you’ll be flexible on. For me those things would be substituting my mobility scooter for my wheelchair, in case of battery failure, having an additional birth partner, and having my flare up kit (which will be the subject of another blog). The most important thing when giving birth is feeling in control and that those present understand your needs and wishes. Even if it seems like nothing is going to plan, try to stay calm – its best for both you and the baby!