Why you may have to be prepared to ditch your birth plan

Photo: Shutterstock
Photo: Shutterstock 

It is 18 years now since I gave birth to my first child, but seeing the picture of Meghan and Harry, joyfully showing off their new baby last week, took me right back to that moment.

The overwhelming emotions, wonderment and exhaustion, mixed with fear at how you will cope parenting something so incredibly tiny. 

I am thrilled that they took a bit of time to recover after the birth and be with their wee son, before feeling the need to show him off to the world – from memory I didn't feel able to get off the couch for about a week, so having to put on makeup, dress-up and face a crowd of paparazzi must be daunting to say the least.

When I think back to my first baby, I often have a wry smile remembering the antenatal classes I attended. We were a very mixed bunch, from all walks of life, but bonded over this new and exciting experience. We had fabulous catch-ups every week and became firm friends and the only time there was any heated discussion was when it came to "birth plans".

I had spent some time working in a delivery suite at our local hospital and had absolutely no illusions when it came to how difficult childbirth can be for some women. I had also seen the harsh reality for many soon-to-be mums, who arrived with firm ideas about how their birth would go and became incredibly distressed when all didn't go according to plan.

I was sitting firmly at one end of a spectrum when it came to planning – whatever needed to happen to deliver my baby safely and healthily (hopefully with the least amount of pain possible) was all I wanted.

Some of my friends in the group were definitely not of the same mindset – dolphin music, aromatherapy, lots of cushions and absolutely no medical intervention at all seemed to be the most common themes.

I am being slightly facetious here of course, as I am sure that all of them would have dropped their plans in a heartbeat if their baby's health had ever been in question, but for me it felt better to be realistically prepared for the possibility that all may not go quite as I wished, before actually arriving on the doorstep of the delivery suite.

So if you are having a baby and are thinking through your options for childbirth, here is a realist's guide to what might eventuate:

Advertisement

Home vs hospital

This is a very personal choice and one I wouldn't attempt to sway you on. However, from a doctor's perspective, if this is your first baby, or you have had any difficulty with childbirth before, I would definitely think very carefully through the pros and cons.

If anything doesn't go according to plan, you need to be close enough to get to specialist help quickly and I would advise making sure you have a midwife who has heaps of experience, so that they can detect any issues early on. Either way, be guided by your healthcare team – if at any stage they advise you that a homebirth doesn't feel like the safest or best option, I would strongly advocate for taking their advice.

Pain relief or not

Again, this is a personal choice and very dependent on the individual situation. There are all sorts of options available for pain relief, from TENS machines and soaking in lovely warm baths, through to pethidine injections, epidural and spinal blocks. Over the course of my three labours, I think I tried them all. 

If you feel strongly about pain relief, let your delivery team know well in advance – but again, try to retain some flexibility in your planning. Labour very rarely goes as expected – if your baby takes a long time to come out, is in a difficult position, or your contractions are particularly hard to cope with, there is absolutely no shame in getting something that will help you feel more comfortable.

During childbirth, the partnership between you and your midwife or obstetrician is really important – and trusting that they will only recommend things that are safe for both you and your baby is key in helping you make the best decision at the time.

"Normal" delivery

I don't like this phrase as it implies that other types of delivery aren't normal, but essentially this is a delivery that doesn't require any medical "assistance", such as forceps or caesarean section.

For most women, this would be the ideal, but for many it simply won't be an option – this might be because they have needed to have caesarean sections before, and trying for a normal delivery could be risky, or because the baby is in a position where "normal" delivery isn't possible (e.g some breech pregnancies).

For some women, they will start out hoping for a normal delivery, but it may become clear along the way that some sort of assistance is going to be needed for the safety of mum, baby or both. If vaginal delivery is possible, it is definitely the more natural option for both mum and baby and generally the recovery time post-birth is much shorter and easier.

Assisted delivery

 If your baby becomes stuck and your labour isn't progressing as expected, or for any reason the healthcare team need to get your baby out in a hurry, you may need to have assistance. This is usually done with either forceps or a device known as a ventouse, both of which bring the baby into the world more quickly than would have happened otherwise.

There are downsides: I had both a ventouse and forceps at different times and the discomfort and stitches afterwards were no fun at all; I don't think anyone would choose these options over a natural birth, but when the possible health of your baby is at risk, the decision is actually very easy to make.

Another situation requires assistance is if your labour is progressing really slowly – eventually this can lead to exhaustion, both for you and your baby, so if that is becoming a concern your midwife or doctor might suggest putting a drip in and giving you a medication to make your contractions stronger or faster.

Caesarean sections

Most women wouldn't choose this option, particularly not for their first baby, but for many this becomes the reality. A planned section is when you know ahead of time that this will be the mode of delivery for you (e.g. if you are unwell and labour might be dangerous for you, or your baby/babies are in a position that can make vaginal delivery impossible); this will usually be done close to full-term, so around 38 or 39 weeks of pregnancy and is a short, safe procedure, with a couple of days rest in hospital afterwards.

Many women who haven't planned for a caesarean also end up delivering this way, as the vaginal delivery they had hoped for just doesn't happen, for a range of reasons. Again, trusting in your health team here is crucial – they will take into account your wishes, but will also make a judgement based on the safety of you and your baby.

No matter how far you stray from your birth plan, if you are blessed enough to have a healthy baby at the end of it all, try make that your focus – I have seen so many women over the years chastise themselves and grieve for a labour that didn't go as they had hoped.

It's important to recognise this sadness, but try to keep it in perspective and enjoy the next big stage of life…..for which there is probably no plan at all.

Stuff