Make your birth plan come true

When the sight of your feet has become a fading memory, it might be a good time to think about what sort of birth you’re hoping for – and what you can do to achieve it. Because while what actually happens on delivery day is down to a combination of nature, luck and your baby, having a thorough plan outlining how you’d like your labour to progress is really useful, both for you and your midwife. After all, the last thing you want in the middle of a contraction is a lecture on pain-relief options.

‘The best time to write your birth plan is around 32 weeks,’ says Mother & Baby midwife Maureen Royds-Jones. ‘Hopefully you’ll have finished antenatal classes and will have some knowledge of what to expect when labour starts.’ But don’t make your plan too rigid – it should read more like a wish list. ‘The best plans are those that provide your birth partner and medical team with guidance, but also leave your options open,’ says Maureen. Here are some key areas to think about.

You want… a ‘natural’ birth

In other words, a straightforward vaginal delivery with minimal medical interference.

What to do now 

- First and second trimester

Keep fit. ‘Exercise increases suppleness and stamina,’ says midwife Catharine Parker-Littler, co-author of Ask A Midwife (£14.99, Dorling Kindersley). A recent study* also found that fit women were less likely to ask for an epidural. The Royal College of Obstetricians and Gynaecologists advises mums-to-be who are new to exercise start with no more than 15 minutes of continuous gentle exercise per week, increasing gradually to a maximum of four 30-minute sessions. If you exercised regularly before pregnancy, you should be able to carry on as normal.

- Third trimester

Drinking raspberry-leaf tea from 36 weeks is said to help strengthen the muscles of the uterus, helping it contract more efficiently during labour. Also, try ‘expanding’ the skin between your vagina and bottom with perineal massage: using olive oil, gently stretch the skin by inserting your thumb into your vagina and pushing down against the skin from inside. ‘Doing this regularly can reduce the need for episiotomy – a surgical incision to your perineum to aid delivery – and stitches,’ says Maureen.

What to do on the day

Stay active. Walk around so gravity will help you, or sit on a birthing ball – rocking on it gyrates the pelvis and helps get your baby in position for birth. As you gear up for delivery, check your position: the National Childbirth Trust recommends the ‘UFO’ position – Upright, Forward and Open. This encourages the baby’s head to descend and a mother to open her legs and widen her pelvis, making birth easier. Try kneeling up on your delivery bed with your arms on the head of the bed, or squat on the floor and lean over the birthing ball.

When to scrap the plan

Medical complications can force you to abandon your birth plan. ‘Your baby’s safety is key so it’s vital you listen to medical advice while giving birth,’ says paediatrician Dr Su Laurent. For example, you might end up needing a caesarean. ‘Reasons include your baby being in distress or your cervix not dilating enough,’ says Maureen. Likewise, your birth may need medical intervention in the form of forceps or ventouse. Some women prefer to tear naturally than be cut, but an episiotomy may be necessary to speed up the delivery.

You want… the right pain relief for you

Most women opt for some kind of pain relief during labour – usually Entonox (gas and air). Some buy or hire a TENS machine, a device that sends out pain-blocking electronic impulses via pads stuck to your lower back, said to help take the edge off the pain in the early stages (try bootsmaternityrentalproducts.co.uk, where you can rent one for £29.35 for four weeks). However, you may discover your pain threshold is not what you thought – for some it’s better, for others worse – so it’s good to know what else is on offer.

Generally speaking, Entonox gives mild relief, taking the edge off contractions but not killing the pain. Opiate-based drugs, such as pethidine and diamorphine, make even the strongest contractions bearable but don’t totally remove discomfort and are not suitable close to delivery because they cross the placenta into your baby’s bloodstream. Epidurals kill pain totally – and all other sensations – so your delivery will need close management and you will be told when to push. An epidural is administered through an injection into the base of your spine.

What to do now

Get informed. Talk to other mums, your midwife and your birth partner, especially if you’re planning a home birth or delivering in a smaller unit, as some options won’t be available. If you want to hire a TENS machine, book it for around three weeks before you’re due.

What to do on the day

You can manage pain yourself to some extent with rhythmic breathing – breathing steadily in through the nose and out through the mouth while focusing on the ‘out’ breath. ‘This also maximises the amount of oxygen available to you and your baby,’ says midwife Michelle Lyne. ‘Breathing techniques can help you manage your anxiety – studies show that if we control our worry, our perception of pain is lowered and it becomes less intense.’

When to scrap the plan

Don’t feel bad if you suddenly decide that, after all, yes I would like the epidural, thank you very much. It’s better to feel comfortable with what’s happening than be scared just because you had your heart set on doing it all with gas and air. ‘And remember that just because one part of a birth plan changes, it doesn’t mean other areas can’t stay the same,’ says Maureen.

You want… a home birth

For many women, having their baby in comfortable, familiar surroundings is the ultimate dream delivery.

What to do now 

- First trimester As only two per cent of babies in the UK are born at home, you may want to join a special group for encouragement and advice. Gather as much information on what to expect on D-day as you can and make sure you have a supportive, well informed birth partner.

- Second trimester Some health trusts are more supportive than others, so to be sure you get adequate help you may want to book an independent midwife (from £1500, see independentmidwives.org.uk).

- Third trimester At around 28 weeks, talk to your midwife about arranging your home birth. From 37 weeks, think about preparing your birthing room. A midwife will visit you at home to discuss how best to proceed, for example what you can do to protect your mattress.

What to do on the day

Call your midwife when your waters break or your contractions are three minutes apart. ‘She may just drop in to examine you then come back later if you are still in the very early stages of labour,’ says Michelle. ‘Once your labour is established, the midwife will stay with you throughout the rest of your labour and delivery.’

When to scrap the plan

If you have complications in pregnancy or during the birth, you’ll need to think again. ‘Your midwife will organise an ambulance transfer to hospital,’ says Maureen.

You want… a water birth

Warm water is said to ease the pain of childbirth, making it an increasingly popular choice. According to the Royal College of Midwives, 64% of NHS maternity units now have a birthing pool.

What to do now

Tell your midwife you want a water birth. ‘It’s a good idea to let her know before 36 weeks, so she can record it on your notes, although if you’re still not sure you can ask for a water birth once you’re in labour,’ says Maureen. Be aware hospital birthing pools are allocated on a first-come, first-served basis, so if you want to guarantee a water birth you might want to book into a private centre, or elect for a home birth and rent your own pool. Try borninwater.co.uk, which charges from £300 for a four-week hire.

What to do on the day

If you’re at home, call your midwife before you get into the pool; entering the water too early can slow labour down because it relaxes your body, so you should be checked over first. Make sure you also have plenty to drink, as soaking in warm water can dehydrate you and sap energy levels. ‘Dehydration prevents muscles working efficiently and can increase tiredness,’ says Michelle Lyne.

When to scrap the plan

If you have meconium (your baby’s first poo) present when your waters break or your baby is found to be in distress. Likewise if there is heavy bleeding, if the first or second stages of labour are delayed, or if the baby’s head isn’t head down in the optimum position for birth.

You want… to breastfeed

‘Research shows that direct bodily contact immediately after birth will encourage your baby’s feeding instincts,’ says midwife Maureen Royds-Jones.

What to do now

Stock up on the things you’ll need to breastfeed – nursing bra, breast pads and a pump, bottle and sterilising equipment if you’re planning to express. ‘For the delivery, wearing an open-fronted nightshirt that offers easy access to your breasts is a good idea,’ says Su Laurent. You should also find out how breastfeeding works, because many women find it tricky to begin with. There may be a breastfeeding counsellor available at your hospital, or you can contact the National Childbirth Trust (nct.org.uk, 0300 330 0771) for information, advice and support.

What to do on the day

As soon as you can after your baby is born, hold her to your bare chest. ‘Ask your midwife to help your baby latch on if it’s not happening naturally,’ says Su.

When to scrap the plan

If your baby requires special care you may not be able to breastfeed straight away. But you can express breastmilk to give your baby via a bottle and breastfeed later. Make sure your midwife knows your wishes. Some newborns fall asleep straight after birth, so you may have to wait until your baby wakes for a feed. Trust us, it won’t be long!