Birth plans are the latest craze for expectant mums -- but not all hospitals welcome the carefully plotted demands that some pregnant women make in the maternity ward.

Is a birth plan a sensible thing to research and write in preparation for the big event? Some mums-to-be spend time creating elaborate plans involving requests for dimmed lighting, specific music, birth balls, water births and candles to having a homoeopathist or acupuncturist in the labour ward with them.

However, birth can be an unpredictable business and hospitals can be very busy, so some of the requests mums make may not be feasible when the time comes. If a plan cannot be adhered to for medical or other reasons, the mum may often feel disappointed afterwards.

So should they bother with them at all, and risk disappointment, or can a well laid-out plan have an impact on the kind of birth the mum experiences?

Birth expert and author of The Better Birth Book, Tracy Donegan, is a big supporter of birth plans and recommends that mums-to-be should write one and discuss it with their care-giver during their pregnancy.

Prepare

"We cannot predict what will happen on the day but we can prepare for it," says Tracy. "A birth plan is a communication tool that may be helpful to the mum and the hospital. It is not about dictating how the staff do their job; it is to help them understand the kind of birth the mum wants."

Tracy suggests mums-to-be research the policies at the hospital they are attending and prepare themselves accordingly.

"Different hospitals have different policies and mums need to know this. For example, women in labour at the Coombe and Holles St are encouraged not to eat or drink but women in labour at the Rotunda can eat and drink.

"Another policy to be aware of is active management of labour. In some Irish hospitals, women in labour have their waters broken and have other routine interventions that they may not want -- this is why it is important for them to investigate hospital policy before labour commences."

First-time mum-to-be Sarah Power, from Bray, Co Wicklow, is due to give birth in a few weeks and, like many women in her position, hopped on the birth plan bandwagon.

"I sourced the type of information I needed from internet chat forums and books," she says.

Sarah is attending Holles St and heard that strength of character would be required on her part to ensure her birth plan be adhered to.

"This disappointed me, as I have been dealing with the most wonderful midwives from Holles St on the Community Midwives/Domino Scheme and I got the impression they would do whatever possible to make my labour a great experience for me."

Sarah was worried about how her birth plan would be received as she attended her first ante-natal class recently.

"From what I learned at the hospital last week, women on the Domino scheme are treated differently to women attending the main hospital maternity unit. My labour will be actively managed between the midwife and me on the day and nothing will be prescriptive or enforced. It is all about mum and delivering a healthy, happy baby the best way possible."

Sarah was delighted to get such reassurances. "The way I understand it, nothing happens unless I am happy with it," she says. "However, my sister is currently pregnant with her first child, too, and is not on the Domino scheme and she is having a very different experience than me.

Interventions

"I have given her my birth plan to help her get the type of birth she wants without routine interventions.

"As she is attending the main hospital, it seems she needs it more than me."

Experienced midwife Susan Cooney says a birth plan can be a good idea, as long as it is reasonable and has been discussed with the hospital beforehand.

"A birth plan that is written from the heart, including small thoughts that are important to the mother, such as dimmed lights in the labour ward, if everything is going OK, is fine to have."

However, mothers need to be aware of hospital protocols.

"If something is worrying her, she should speak to the maternity manager, a midwife in the ante-natal clinic she, or a practice nurse who is a midwife as well."

Susan suggests the best time for broaching the subject of birth plans is after attending ante-natal classes or from 30 weeks onward, when thoughts are beginning to focus on labour.

"The benefits of a birth plan include when the mum is in labour and unable to talk, it gives the midwife caring for her an idea of what will give the mother a good experience, if possible."

While most hospitals welcome reasonable birth plans, Susan admits that midwives and doctors do get concerned if the birth plan is unrealistic and expectations are too high. Therefore, communication before the event is key in order to make sure everyone has the same understanding of what to expect.

But not all mums believe in birth plans. Mum of two from Co Louth, Heather Strickland, did not bother with birth plans and feels this did not hamper her in any way.

Practice

"I did everything properly when pregnant, including ante-natal classes, check-ups and maintaining good health. At the time, birth plans were all the rage but they were the only part of my ante-natal practice I felt distinctly uneasy about. I actually felt that the doctors would not give two hoots about a birth plan and I also felt they were an insult to midwives.

"They are the experts and have seen every kind of birth a million times over between them. They know that the physiology of the delivery is more important than Mozart playing as the head crowns. So I thought it best not to get hung up on one, as who knows what the actual birth would turn out like. And so how could I possibly plan for it?"

Dr Peter Boylan, author of the Irish Pregnancy Book and former Master at Holles St hospital, suggests that birth plans should "be regarded as aspirational".

Dr Boylan advises mums to make themselves aware of the hospital's birth policies prior to labour.

"This is discussed at ante-natal classes, which is why it is so important for women to attend. Lots of first-time mums prepare birth plans and some can contain irritating language. For example, some ask that the baby be handled with care. This suggests the staff may not handle the baby carefully and can be insulting to staff. Everyone at the hospital is working to help the mother so this type of request is not necessary." Dr Boylan does not approve of candles in the labour ward, as they can be dangerous.

However, he says if women do not want their labour managed as per hospital policy, they can refuse certain measures.

"Hospital policy at Holles St is to break the woman's water once labour has been diagnosed. This is to check that the water is clear and also can prevent prolonging labour. We also give labouring women an Oxytocin drip if their labour is slow, to help things move along. However, if a mum does not want her waters broken or an Oxytocin drip, she can make her wishes known to us at one of her visits or at an ante-natal class."

Failure

Dr Boylan says the Domino/Community Midwives scheme at Holles St may suit certain mums better, particularly those who want a less 'managed' labour. His worry about birth plans is that mums-to-be, particularly first timers, will create an unrealistic birth plan and set themselves up for failure.

So it seems that birth plans have their place but as a communication tool, and not a guarantee of how a birth should go.

They should be researched and written well before labour starts and any concerns or special requests should be discussed at the ante-natal classes or with a member of staff at the hospital prior to labour. It would not be advisable to turn up on the day with a birth plan all written out and find that the hospital does not support the wishes of the mother.

In a way, giving birth can be compared to planning a wedding. It is one of the biggest days of a woman's life and should be prepared for accordingly.

As with planning a wedding, a lot of thought should go into the venue and what they offer and also, there should be a level of flexibility, as things may not go the way the mum wants and she needs to be open to changes where necessary.

- Siobhan O'Neill-White

Irish Independent