Hospital Breech Birth Plan

Summary : Natural Physiological Birth / Midwifery Led / All Fours / Hands off Breech Birth<

Ideally we were hoping for a natural home delivery. Due to breech circumstances we feel it best to be in the hospital and to be supported in our plans for a natural physiological breech birth.

We wish our care to be midwifery led, to be able to position freely / on all fours during labour and delivery with a hands off / no interventions approach. In the case of things going wrong and the baby showing distress and you advise it, I would then at that time, agree fully and completely to a caesarean section.

I understand that this birth plan will be somewhat outside the norms of a hospital delivery regardless of the breech presentation. I have read extensively regarding normal and safe breech delivery and I feel that the approach outlined below affords the best approach for myself and my baby. I wish my hospital birth to have a “home style” feel, and I would ask for your support and assistance to make this birth the special event it should ultimately be when we welcome our baby into the world and our family. We want this birth to be memorable for all the right reasons!

Midwifery Led Care

I request my care and management be led by an experienced midwife who is confident in her ability to help me achieve an as natural a birth as possible and who is comfortable with a “hands off” approach.

Mary Cronk “Keep Your Hands off the Breech” (attached). I would like my birth to follow these guidelines and principles to be managed as a “physiological birth” as opposed to a “delivery” or “extraction.”

Hospital staffing attendance kept to a minimum and obstetricians only involved, if required. If you feel additional staff may be required including paediatricians at the time of delivery I would ask that these personnel be on hand but outside the delivery room. I understand that a breech birth may have additional complications requiring more care but unless they are actually needed I would like to have mine and my partners privacy respected in this special time.

I consent to have student midwifes present as I realise this birth may represent a valuable learning experience for them.

Interventions

  • No ‘breaking’ of my waters (ARM).
  • No augmentation of labour artificially.
  • No venflon or catheterisation unless required for C. Section.

Monitoring

Monitoring kept to a minimum and to not restrict my movements. I consent to a period of CTG monitoring on admission of 20 minutes to be discontinued unless a problem is found. I am aware that you may advise/prefer continuous monitoring, however upon research on this point I understand that there is no evidence that routine use of continuous electronic fetal heart rate monitoring itself results in better outcomes for breech babies, or indeed any babies. In fact, the Term Breech Trial found that continuous monitoring was not associated with improved outcomes for breech babies (Su et al 2003). I have found continuous monitoring in the past to be very restrictive of my natural and instinctive movements which has lead to a more stressful birth for myself and also made labour more painful. I request intermittent monitoring with doppler only, unless a problem is suspected.

Vaginal Examinations

Vaginal examination performed only at my request. In past labours I have found that I do not usually dilate in a conventional pattern of 1cm per hour. In fact I seem to get to around 4cm and get stuck at that point for a while and then suddenly fully dilate very quickly. Therefore vaginal examinations are not hugely useful to assess my progress in labour. I believe it should be obvious to myself and my care providers though observations of other signs of progress in labour and the strength, power and frequency of my contractions that my labour is progressing well or not as the case may be. If you consider that an examination will be particularly useful at any stage please discuss this with me at the time.

Water

Access to water, not to give birth in, but to labour in. I am unaware whether CDS has a birth pool available. It is very important to me to be able to labour in water for pain relief and support of an active birth. I had purchased a “la bassine” birth pool for use during my labour at home. If no hospital pool would be available to me I would ask that I be able to bring this with me for my use during my labour.

I would require some room to place the pool in, access to hot/cold water and a waste outlet and access to an electrical point (for the air pump and water pump for emptying). I can provide everything that will be needed for the pool and my husband would take full responsibility for the set up and maintenance of the pool during my stay.

I plan to get out of the pool for the birth as I understand that it will assist you to observe the delivery and perform any manouvres should they be necessary.

Active Birth/Pain Relief

I would like to be encouraged to have an active and instinctive birth, for me to be able to decide on my own positioning during labour including use of a pool.

I would also like the use of a birth ball which I can provide if necessary.

Able to snack and drink if I desire.

I will be using natal hypnotherapy techniques to help me to cope with the labour. I would like to be able to play music during the labour, if you can provide a CD player, if not please advise me and I will bring one with me for use.

I will also like the option of using gas and air should I request it.

Epidural only in the event of a C.Section.

Second Stage of Labour

I will adopt the all fours position.

I would like to have skin to skin contact with baby immediately after delivery

I do not want an episiotomy; I prefer to tear where my body sees fit if necessary. From everything I have read about breech births I feel very strongly that I want staff to be as hands-off as possible so that I can listen to my body and let my baby be born in the most natural way. I believe that this offers her and me the best chance of coming out the other side in good condition and only if my baby becomes distressed do I want any form of intervention.

Please do not cut the cord until it has stopped pulsating. I feel very strongly that the baby should receive all the blood the placenta can deliver. My husband would like to cut the cord.

If resuscitation is necessary / bag and air resuscitation should be available while baby is still connected to the placenta.

Third Stage

Natural delivery of the placenta and synotmetrine only if necessary.

I plan to breastfeed asap after delivery to help with this rather than relying on artifical means. However in event of haemorrhage then please hold my baby down low to allow the cord to drain thoroughly before cutting it and injecting syntometrine. I am very keen that she be allowed to have the cord drain before she is cut from me.

Care of Baby

I wish my baby to receive an injection of Vitamin K

I do not wish my baby to be bathed to allow any vernix present to absorb naturally

I do not wish my baby to receive any formula milk unless myself or my husband consent to it having heard any reasoning for doing so.

I would like to have a short stay at hospital and to return home as soon as possible.

I do not want to deviate away from this plan unless:

  • I request to do so.
  • I am incapacitated and unable to make an informed decision, in which case my partner will make any decisions.
  • The situation becomes an emergency.

I would like to thank you for reading this detailed and lengthy birth plan and for all your efforts in helping us to create an ideal birthing environment and most special experience.

I would encourage you to discuss any aspects of this plan with me and my partner and welcome discussion, your views and advice. However I am aware that ultimately it is mine and my partners decision whether to accept any advice given, we do not wish to seem awkward for the sake of it but we ask you to respect that this is a momentous occasion in our lives where we meet our baby and welcome her into the world and our family, it is VERY important to us and we have thought a lot about the kind of birth that we would like to achieve.