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A first-time expectant mom asks:

“Do you recommend any techniques for my upcoming labor and delivery? Does anything, in your experience, make things easier or more manageable in the delivery process? I’m trying to develop my Birth Plan. Thanks for your help!”

Seeing as though we’re expecting my FOURTH labor and delivery in a few weeks, you’d think I’d have loads to suggest to this first-time mom. But you know what? I GOT NOTHIN’. Nothing! Each time I go through it, I’m reminded at how utterly out of control we are…in life in general, but in the birthing process in particular. Now yes, I know there are all sorts of techniques and approaches out there. And I know many of you have fruitfully used Bradley, Lamaze, hypno-birthing….yadda yadda. Whatever. The truth is: NONE OF IT REALLY HELPS. It’s all an illusion to help us feel like we’re more in control.

Well, let me backtrack a little here. See, I’m up at midnight right now with a terrible case of heartburn, an aching back, some weird pregnancy-related skin condition and no way to sleep comfortably. There’s a wriggling, basketball-sized being in my belly, and I’m sick of my maternity clothes, many of which are starting to get tight. So I admit it: I’m a little cranky. But when I get on the topic of labor and the infamous “Birth Plan”, I get a little MORE cranky.

Let me break it down for you: Labor is unpredictable. Labor can be dangerous. Not so long ago, women used to die all the time in labor. The point is this: We shouldn’t get too picky about the labor process. Thankfully, the vast majority of women (in developed countries), today, survive the process just fine. But the notion that we can control for all the possible complications that can happen is just plain wrong. And it’s human nature to react to an out-of-control situation with the fantasy that we really CAN control it. But it’s harmful to mothers out there who buy into the notion that they CAN and SHOULD control their delivery process…because many of us CAN’T, and then feel inadequate as a result.

I’ve heard heartbreaking stories from moms who felt guilty and disappointed because they couldn’t live up to their “Birth Plans”. Moms who felt scolded by their doctors, nurses, or midwives for going against the particular birthing approaches of the practice…mothers who changed their minds about pain control, or what kind of labor support to use, or even whether to scream and yell during labor. Mothers who had to have emergency C-Sections, who delivered prematurely, or who had bleeding problems. A close relative of mine recently delivered and had a really unusual — and completely unpredictable — complication that left her bedridden for more than a week, and on a walker for another two weeks. These things happen, and Birth Planning can’t prevent them. And many moms feel inadequate if they can’t live up to this supposed “ideal”.

There is a mistaken notion that labor and delivery are somehow the culmination — the end point — of a process. After all, we go through a 9-month process to grow and deliver this child, which is truly a miraculous experience. But the truth is, LABOR AND DELIVERY ARE ONLY THE BEGINNING. Choices we make during pregnancy and delivery are actually the first parenting decisions we make. And that’s the beginning of a life-long process; how to best parent this child we deliver, in whatever manner we choose to, on that miraculous day of delivery. And how best to roll with the punches of life, and still feel confident and satisfied with ourselves. After all, that’s an important life lesson to impart to our children — the ability to be flexible and adaptable to life’s curve balls. The attitude that we can and will be “light on our feet” in the face of the unpredictable changes of life.

When seen that way, I think it’s easier to see the process in perspective: The ultimate outcome is what’s most important about labor and delivery. Forget techniques: You want a healthy baby and a healthy mom at the end of it all.

So, if a rigid Birth Plan isn’t helpful, what IS? Here’s what I recommend:

Thorough education about the process of labor and delivery. It really helps to understand what the “transition” phase is, in particular, and how you’re likely to feel during that challenging time. I always vote for more knowledge and education to help get through a novel situation.

First-time parents really benefit from Infant Care classes, at least as much as from Labor and Delivery-type classes. Infant Care class helps answer lots of the questions you’ll have about your new baby, and will take some of the overwhelming mystery out of caring for this new creature. It also helps to keep your focus in perspective; this is all about becoming a parent and taking care of your child, after all. Labor and delivery are just a momentary blip at the beginning of that process. The REAL hard work is the parenting!

Working knowledge of some type of breathing exercises. I’ve tried them all, and for me, the breathing techniques I learned in my regular yoga classes helped the most. Experiment with several. During labor, see what works. Often, breathing techniques are only useful UNTIL you get into “transition”. At that point, do what comes naturally. I recently read a study that says swearing and cussing actually help us decrease our experience of pain. I plan to try that this time!!!

Accept the fact that you’re jumping off a cliff here. Things will feel out of control at some point in your labor and delivery; maybe more so than you’d like. Keep focused on the outcome and don’t worry about the process. It’s temporary!

If you want to read more of my Birth Plan rantings, check out this post here. And I’d love for experienced parents to please post about your birth experiences, and whether your Birth Plan proved useful to you. Also, let us know your suggestions to first-time expectant moms!

Aloha,

Dr. Heather
The BabyShrink

There is a strain of pregnancy propaganda out there that sets new moms up for failure. It says that unless you “achieve” some particular kind of delivery perfection, well, then…you haven’t quite made the cut, as a Mom. And that makes me angry.

It’s in all the standard pregnancy books. Something along the lines of, “Create your own birth plan. Be in charge of your delivery. Don’t let that mean, nasty doctor force you to deliver in some way that’s NOT in your plan. Decide in advance if you want to use pain medications for the delivery….or not.”

What they don’t say is that the birth process is usually so unpredictable that your carefully crafted “Birth Plan” gets left at the bottom of your carefully packed “Going To The Hospital Bag”…that got left at home, in a panic, as you rushed to the hospital.

Now, I’m a recovering control freak, so don’t get me wrong. Anything that’s called “a plan” looks fabulous to me. I did it myself, with our first baby. Here were my rules, when I was cluelessly buying into the notion that I could actually control the birth process by planning for it in advance: No induction. Lovely, inspirational music playing in the background. No pain meds. No pitocin. No c-section. (Oh yeah: no binkies or bottles for the baby either, but that was a different lesson for me to learn, for a different post!)

What happened, you ask? Oh, surely you must have guessed by now. I had it coming to me, big time. The control freak gets hammered. The doctor wanted to induce labor, since the baby was getting big, and she was overdue. But oh no, that was not in my Birth Plan. So we waited. And waited. When labor finally did begin, the early stages went well. But when it came time to push…not so well. I pushed and pushed and pushed…and nothing happened. I stood up to push. I squatted to push. I pushed and pushed for hours. The doctor wanted to add pitocin in order to add strength to the contractions, to help me along. No way. Not in the Birth Plan. She wanted to add an epidural, to relax me. No dice, doc. Finally the doctor had to go and do an emergency c-section on another lady. I had some time. The nurse convinced me to have the epidural and the pitocin, and then our baby was finally born. After four solid hours of pushing.

I was so sore after the delivery I had to sit on two huge pillows for weeks, and I still was miserable. Here are some other examples of “Birth Plans” that didn’t “pan” out:

The alternative-medicine-practitioner who swore she’d never use pain meds, who begged for (and got, with huge relief) an epidural after 12 hours of excruciating labor

My pain-fearing friend who hoped for every drug in the hospital, but delivered in the hallway of the ER while her husband was parking the car

Now, I’m all for planning, to the extent that planning is possible. But I’m really against the notion of feeding new mothers the idea that there is somehow an ideal birthing situation that they should be aiming for…other than the delivery of a healthy baby, with a healthy mother. Because that sets us up for comparisons, judging, and disappointment.
The labor and delivery process is so unpredictable, and so individual and varied, that you really cannot plan for every possibility.

Many of you have expressed sadness, even a sense of failure, because you had to have a c-section. Or if you “caved”, and got an epidural. Unrealistic expectations can lead to big problems. For some, this disappointment can even lead to postpartum depression.

Lamaze Shlamaze; use whatever works.

The breathing techniques I learned in yoga and exercise classes helped me way more than anything I learned in the actual preparation to have a baby. That said, I still pushed for four hours! The only thing that is important in delivering your baby is that both you and baby are healthy. I don’t care if a Martian comes down and performs some kind of weird alien delivery for you, as long as you and your baby are healthy at the end of it.

Did you have any surprises in your delivery? Do tell!

Aloha,

Dr. Heather
The BabyShrink