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How Birth Preferences Can Help You Have The Best Possible Birth

Birth preferences are a relatively new addition to Irish maternity services and a welcome change for midwives working in our busy labour wards who’ve never met you before. They are an important part of your clinical and holistic care on the big day when your baby is coming, says midwife and eumom pregnancy and birth expert Tracy Donegan.

You've got a million things to think about and prepare for before your baby arrives, from cots and buggies to nappies and vests – but have you thought about your birth preferences?

Birth preferences are not a contract or guarantee that everything will happen perfectly, but it is a flexible communication tool to help you have the most positive experience possible if you and your baby are well. If you knew your caregiver in advance, you could discuss all of this at leisure during your pregnancy, but since you most likely won’t know your midwife before you go into labour and your consultant won’t be with you for the majority of it, one of the functions of the birth preference sheet is to get you acquainted and make communication with your midwife a lot easier at a time when you’ll need to stay focused.

Birth preferences are not a guarantee that everything will happen perfectly, but it is a communication tool to help you have the most positive experience possible

The other important benefit of birth preferences is that not all of the standard procedures in hospital are evidence-based. This is surprising to most first-time moms who expect that all hospital procedures are necessary. Writing birth preferences ensures you and your baby get evidence-based care that is safer for you both.

Some of the most common routine procedures ('routine' meaning not medically necessary) are:

  • Admission CTG (electronic foetal monitoring) – best practice is intermittent listening in with a Doppler as per 2012 HSE Obstetric Guidelines.
  • Breaking of waters in labour.
  • Routine use of synthetic oxytocin (Syntocinon.)
  • Restriction of food (birth can be hard work – keep your energy levels up!)
  • Time limits on the dilation and pushing stage.
  • Episiotomy.
  • Immediate cord clamping.

Find out what the routine procedures are in the hospital you are attending. Do they routinely release the waters artificially? The recommendations of the 2013 Cochrane review are that amniotomy (breaking the waters) is not performed routinely and "the results show a trend towards an increase in the risk of a Caesarean section which neared significance in women who have amniotomy." The report also recommends providing women will all of the information about amniotomy so they can make an informed decision.

Other items to include could be that as long as you and your baby is well, you do not want to have your labour speeded up with synthetic hormones. These hormones artificially drive your labour and can make it more difficult to cope without an epidural, and it can also make it harder for your baby to cope.

As a midwife, my advice to any mom planning an active natural birth with as little unnecessary intervention as possible is to prepare yourself both physically and mentally, prepare your partner to advocate for you on the day and have written birth preferences. In the event of an emergency, it does of course make sense to be flexible and trust the staff to do what's necessary – but if all is well with you and your baby (as it usually is) then having written birth preferences will help you avoid the routine procedures, such as breaking the waters, which can derail your plans for a natural birth and increase the likelihood of having an unnecessary Caesarean section.

Help your midwives to help you by having thought out written birth preferences. Without birth preferences your midwife has to follow the routine hospital policies, which in most cases are not based on international best practice and come with well documented risks for you and your baby. Make sure your partner understands all of your preferences and can advocate for you on the day, if you are being offered interventions that are not part of your preferences.

This is not about telling your midwife how to do her job – it helps me to do my job better!

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About the Author

I’m Tracy Donegan, registered midwife and mum to 2 gorgeous boys. I’ve been working in Irish maternity services since 2005 and really enjoy helping Irish families have the best experiences possible. You may be familiar with my books – The Irish Better Birth Book and The Irish Caesarean and VBAC Guide, as well as the very popular GentleBirth Positive Birth app.

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