CREATING A BIRTH PLAN
In order to help and encourage you to think about the options that are available for pain relief during labour, some hospitals encourage you to make up a 'birth plan' before going into labour.
In constructing a birth plan, you simply write down your preferences on a piece of paper and then discuss them with your doctor or midwife. In this way, you will discover what is likely to be available during labour and will feel better prepared to make decisions about matters which are under your own control. Your birth plan should be seen as a guide for your own use, and for those looking after you. As time passes by, you may want (or have) to alter you birth plan. This doesn't matter: after all, plans are not immutable.
In any case, it is always wise to keep your options open. Try and avoid making dogmatic decisions which you may later regret. For example, I was once asked to give an epidural to someone who was very distressed in labour and clearly unable to give her 'fully informed' consent. It was only afterwards, while casually glancing at the her birth plan, that I saw that she had written in block capital letters: 'Definitely do not want an epidural block even if I ask for it!' Once she was comfortable again, and I brought this statement to her attention, she admitted that it was rather a silly thing to have written - but that she had no idea at the time that labour could possibly have been so painful.
Although a birth plan is not a legally-binding document, written statements can create difficulties if you later want to change your mind. In the case described above, for instance, which statement expressed the patient's true position of intent? Was it the one that was written before she went into labour (while she was 'of sound mind'), or the verbal one made when she was under duress and the influence of nitrous oxide? And if it was the latter, did I commit an assault by performing the epidural? You should always be careful, therefore, before putting pen to paper and consider the possible consequences of making irrevocable decisions. Otherwise, you may find that it is not always straightforward if you should want to change your mind. (In the example recounted, I was relieved to discover that the patient was satisfied with the results of my assault!)
Another way to help you prepare for pain and to reach decisions about pain relief, is to make up a balance sheet. This is rather more sophisticated than a birth plan and requires more concentration. To make a balance sheet, you first need to list all of the alternatives that will be available to you in order of preference - remembering that they may not all be available, or that there may be limitations attached to some of them. You should also include in your list those alternatives which do not appeal to you. For example, your list might include: relaxation, being as mobile as possible, having a shower, back massage, TENS, pethidine, nitrous oxide and an epidural.
Having completed your list, you then need to consider the relative merits of each alternative in turn:
These are just some of the basic questions that you ought to consider. There may be others. You might hate the idea of using a face mask, for instance, or (like the author) you may be frightened of needles! A balance sheet at least helps you to identify important issues and to plan ahead. It is hoped that the answers to some of these questions will be found in subsequent pages of this book.
If you are expecting your first baby, it is often helpful to try and imagine yourself being in labour. You might want to include your partner in this exercise. Naturally you will be anticipating pain, but cannot know just how severe it is going to be. It may turn out to be 'a piece of cake', but it could be ghastly. You might recall other painful experiences in your life - period pains, a broken limb, or previous surgery. With these experiences in mind, you can then 'rehearse' some of the options that you have already considered when making up your balance sheet. Ask yourself some hypothetical questions such as:
The first two questions can be answered by making a mark on an imaginary scale as follows:
How much pain do I anticipate?
None at all___________________________ Worst imaginable
How much pain can I cope with by myself?
None at all____________________________Worst imaginable
What shall I do if the pain becomes worse than anticipated?
Now you can list your choices in order of merit, noting the points that you have made in your balance sheet. You might think that there are more exciting things in life than going through a pain rehearsal, but imaginary rehearsals of this kind have been found useful in other situations. (Professional athletes, for example, can improve their track records if they have been taught to rehearse their performance mentally beforehand).
Birth plans and balance sheets help you to make decisions when the time comes because you have already considered the options that are available and balanced the benefits against the costs. Even if you have made up your mind about which kind of pain relief to use, it is still worthwhile examining some of the alternatives. You will then feel more prepared if you should need to change your mind - especially if you have already rehearsed such an eventuality.
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