Expecting the unexpected

By Published On: October 30th, 2012

You’ve loaded a playlist onto your iPod, cemented your stance […]

You’ve loaded a playlist onto your iPod, cemented your stance on pain medication, and practiced your squat in the mirror. But when you’re in the throes of labor, your “givens” may require a little give-and-take. From insisting on silence in the delivery room to giving birth at home as your husband gets coached via 911, your best-laid plans may give way to last-minute reversals, impulsive decisions and high doses of drama. But it is possible to segue into Plan B without too many bumps in the road. Here’s how.
labordelivery_2Plan as best you can
Some aspects of labor and delivery are under your control: how long you labor at home, whether you want pain medication, and your preferred position for pushing. Other factors, however, are anyone’s guess: the length of labor, the pain of contractions, and how well the fetus tolerates labor or fits through the birth canal.
By all means, write down your vision of the ideal birth, but don’t expect labor to stick to the script. Judith Halek, a birth consultant in New York City, recommends a one-page birth plan with short, direct sentences in bullet points, phrased as “I prefer” rather than “I want” or “I don’t want.” “The more simple and concise it is,” she says, “the more likely your care providers will read it.” Your OB will surely appreciate the thought and preparation that goes into the birth plan, but “since labor and delivery are not always predictable, plans should be regarded as preferences subject to change,” says Eva Pressman, MD, director of Maternal Fetal Medicine at the University of Rochester Medical Center. Maintaining this mindset, even during labor, can help you remain flexible enough to shift gears to Plan B calmly. “Consider your birth plan a guide, not an edict,” says Robyn Brancato Ozovek, a midwife in Goshen, New York. “Not only can you not predict what your labor and birth will be like, you also cannot predict what you’ll want to do when you’re actually in the trenches.”
Pick a strategy
“I discourage people from having things written in stone, but you can’t be wishy-washy either—it’s a tough balance,” says Ann Cowlin, a childbirth educator at Yale University. The best way to walk the line is to decide on an overarching strategy—such as natural birth in the hospital or an epidural—without sweating the small details. “If you know you want painkillers,” says Cowlin, “you’ll want to get to the hospital in active labor so an epidural makes sense.” Or, advise your care providers, “Because I prefer a natural birth, I don’t want to be bombarded with questions about painkillers when I’m trying to concentrate.” If you want to deliver at home, research the protocol for home births in your state. If you know the hospital at which you’ll deliver, review its labor and postpartum policies.
Build a team
How can you make sure your Plan B still works for you? “You can stack the odds in your favor by building the right birth team for you—choosing care providers who support your body and baby,” says Jo Anne Lindberg, a birth advocate in Chicago. Ask questions to see if a doctor or midwife’s practice is a good fit for you and your birth plan. What happens if my water breaks before I go into labor? What happens if I carry past my due date? How often do you use Pitocin? What’s your C-section and induction rate? Do you offer water births? “Couples often don’t realize that the type of birth they want is nothing like the typical birth the attendant oversees,” says Ozovek. And once you’re in labor, it’s difficult to even broach the subject, let alone protest. “Personally, I could have never in a million years argued with anyone while I was in labor,” she says. “I would have given up—and I’m a midwife! Attend a friend’s birth to see labor unfold, but avoid binging on [birthing shows that can be] very sensationalized and, quite frankly, scary,” says Ozovek. Don’t forget to brief your husband so you’re on the same page, particularly in emergencies. “The staff may turn to him for a consensus if they don’t want to scare you.”
Fall back on trust
Ultimately, falling back on Plan B requires a foundation of trust in yourself and in your team. “Birth is a very primal experience, and you might not want the music, the videos, the hypnosis,” says Halek. And that’s OK. “You can have a plan and be flexible and realistic as you stay present from moment to moment.” Having confidence in your care providers can also ease the transition. “If something does go awry, you will know your provider will do what is in your best interest and your baby’s, and will place having ‘healthy mom, healthy baby’ as the priority,” says Ozovek. “That is the type of provider you want.”