When birth doesn't go as "planned"

[dharmama]

Although I have yet to give birth I am a strong advocate for natural birth and I truly believe that women's know how to birth if they are given the support and the space to do what they need to do during labor.

In the past with doula clients I have helped them to create birth plans...and in my prenatal yoga classes I choose readings that are inspiring and empowering and that celebrate natural birth.

But now...as I'm starting to gear up for my own labor and birth in a few months I'm starting to approach it a little differently. I don't want to set myself (or any women I work with) up to ever feel like a failure for not following her birth plan or for not achieving her goal of a natural birth.

I've heard from several prenatal yoga students after their births....that the experience "wasn't what I expected." Some have expressed guilt and disappointment about accepting an epidural. One woman talked about feeling depression afterwards because it didn't go at all like she "planned."

So...now I'm trying to reformulate my message to myself...and to my students and clients...I've been thinking more along the lines of creating birth intentions....but not a specific plan. Because I feel on a spiritual level that we cannot "plan" for the future.

We can educate ourselves and make informed choices and surround ourselves with people who's values are similar to ours...but ultimately I think we need to accept that their are forces much larger than ourselves in control.

But I'm not sure how to make this clear (I mean it makes sense to me but I'm not sure I'm articulating it the way I mean to). I remain a strong advocate of natural childbirth. I want all women to know their options, to understand the effects of interventions, to feel empowered to make the choices that are right for her and her baby....but I don't want women to think that they can control their birth as I think that sets her up for guilt, disapointment, anger at herself etc. if her birth does not proceed exactly the way she planned.

Not sure if this is making any sense just thought I'd attempt to put my thoughts into words and put it out there for discussion.

Thanks!

~Erin

[OnTheFence]

Erin,

I think your thoughts on this are so right on.

Kim

[ladylee]

"Because I feel on a spiritual level that we cannot "plan" for the future."

Absolutely. How refreshing to hear your point of view, Erin. The whole spiritual act of surrender, letting go of control, and having faith & trust even in an imperfect experience is a life-altering occasion in itself. Every individual has experiences that they need to go through, and that may very well involve a "disappointing" birth. Who is to say what gifts will come from that. In my personal experience, adversity has brought the greatest rewards.

[1jooj]

The notes I made for my hospital chart (my "birth plan") were pretty much based on the assumption that I could not anticipate what the birth would be like, but I needed and expected every possible help in dealing with what I got.

This was for a second birth--after my first was just what you described as the typical "disappointment."

The second birth was amazing and wonderful.

[cottonwood]

Nothing that I had read described what my labor was actually like, nor explored potential difficulties in dealing with birth attendants. I was expecting it all to be something like what I had read, and when it wasn't, it was like I went into shock. And yet I couldn't sit there and say, "WTF?", and try to wrap my mind around and find a way to deal with it, because here came another contraction. And another. And another. I couldn't get my bearings. It was horrible.

So I get what you're saying. However, I think it's very important to not go to the other extreme and start teaching women that they have no power at all in birth. (Not that you're doing that, I just think it's an important point to make in any discussion on this topic.) For instance, while I could not control how painful my births were, I could control whether or not I would go to the hospital and get drugs. While we cannot predict what will happen in labor, we can still be in control of our choices (unless, of course, we give that control away or someone takes it from us.)

[anothermama]

Erin,
Your thoughts have been going through MY head, and this is my second child.....here's some of what I think........

First of all, I have come to the conclusion that birthing in a hospital is kind of setting yourself up to fail. It's all there...the epidurals, the forcepts....everything. I was watching one of those dumb birth shows on TV and realized...they will often ask a woman in hard labor "So, do you want any pain relief?". And, I guess it makes sense....but asking LABORING WOMAN if she wants that pain to end...well, crap....I'd probably have taken the epidural too. And even if you put in your birth plan "don't offer it" I think that, culturally, it's so ingrained in us women that it's THERE AND WAITING that many women end up asking because they KNOW it's there. My dirty confession? I asked with my daughter...luckily I also had a wonderful skilled doula who killed enough time until my daughter was crowning....I'm so glad I had her there.

And thats just the tip of the iceburg. Birthing in a hospital just makes it so easy to get all those things you didn't want done DONE to you and your baby...they make it seem normal and routine. I talk to mother after mother about it and they all say the same thing....it wasn't till after they got home they got that dissapointment.

So, I know it's a sad and jaded thing to say...but I think that women who try to really idealize birth, and yet birth in a hospital are really getting set up for at least a little bit of dissapointment. Sure, it can happen, and there are women out there who've had GREAT hospital experiences with NO regrets...and unfortunately they are the exception to the rule. I think it's just a really hard thing.

On another note....I think that we live in a culture that for SO LONG hasn't trusted birth or women....and we tend to bog ourselves down with the "what ifs". And it's because we are TAUGHT to think that way from the second we can forumalte cognative thought.

This has been a real thinker for me.....I'm gearing up for the birth of my second child and we're having a homebirth. I'm reading all sorts of inspirational things about birth...and I stopped myself and thought "Oh my goodness....maybe I'm being TOO positive about this...maybe I'm being unrealistic.....maybe *something* will go wrong!!!".

After weeks of these thoughts, what I decided is I'm going to LET myself be NOTHING but optimistic about this. The facts speak for themselves.....it's not AT ALL likely that anything will go really wrong with my birth. But society has trained us all to doubt ourselves....and I'm gonna stop listening.

Birth ISN"T like what you'll expect. I don't think it ever can be. So one must be open to that part, of course. But I think we do ourselves and our babies more harm than good worrying about "what if what if what if?!!".

I don't know if any of that makes sense.....sorry so long winded!!

[Oh the Irony]

What a beautiful and thoughtful post. I think your clients are very lucky.

I trained in the martial art of aikido for three years prior to my first birth--aikido is all about harmonizing with the universe and blending with incoming energy. I believe that this training was a large part of my beautiful birth. Oh, and lots of visualization... Through Bradley classes I educated myself about actual birth and my preferences.

I did see women who took Bradley and didn't have the "perfect birth" get upset. It is like so many other things in life--we have expectations and get attached to certain outcomes. Fear also changes things so much...

If you can help people to have the courage of their convictions (warrior spirit) and maintain open-mindedness and flexibility (w/out being a pushover)you will have really accomplished something. I definately think you are on the right track. Birth is such an incredible, empowering, mind-blowing and opening experience--women deserve to come out of it w/out feeling guilt or depression about how it went.

Women also really have to educate themselves--if they want the non-interventionist birth they need to make damn sure that the any medical or support people involved are supportive of what they want. When I was five months pregnant I asked my doc--who was supposed to be Bradley friendy--about episiotomies and he let me know that yes, that was what he would do to his wife. I quickly switched doctors.

I'm starting to ramble, but I would even suggest reading about the philosophy of aikido--i think you could easily incorporate some into a yoga class.

[Oh the Irony]

Originally posted by ladylee
[. Every individual has experiences that they need to go through, and that may very well involve a "disappointing" birth. Who is to say what gifts will come from that. In my personal experience, adversity has brought the greatest rewards. [/B]

Yes, I totally agree.

[oceanbaby]

I had a wonderful Bradley teacher during my first pregnancy, and she spent a lot of time talking about how while it's important to be educated and to have an idea of how you would like to birth, it's even more important to remember that you can't control birth. You can work on controlling your environment, and making choices that have the best chance of supporting the kind of birth you want. But you can't control the birth itself.

We talked a lot about birth interventions - epidurals, forceps, c-sections, etc. Some of the class would start to talk about how evil they all were, and she made a real point of saying that each and every one of these interventions can be lifesaving and necessary. We talked about how they are grossly overused and even abused in modern medical birth, but that the reality is that each one has a specific purpose, and that if it is used properly and only when needed, it is a good thing.

One of my friends from my class, the staunchest homebirther, ended up transferring to the hospital on day three of her labor. There were no complications per se, but she was so damn exhausted, and starting to get frightened, which was now hindering her labor. She ended up getting an epidural, and I firmly believe it was the right thing to do in her case. She was exhausted and frightened, which was starting to make her body work against her. Once she got the epidural, she relaxed, got some sleep, and then went on to have an intervention free birth to a healthy baby girl. But also very important is that she doesn't feel like she failed - she used her education to make the choices that were best for her particular birth situation. She used the interventions available to her properly, and that's something to be as proud of as not needing or using any interventions.

I was very glad to have a teacher who really made us think and feel confident about our bodies and birth, and having a vision, but also surrendering to the uncontrollable force that is giving birth.

While I didn't need any interventions during my hospital birth, it didn't all go as planned. Ds had an incredibly tight cord around his neck, and it ended up being cut before his body was born. I had planned to let it stop pulsing before cut. I planned on having him immediately given to me and stay on my chest for a good while. Instead, because he was blue and not breathing, he had to be taken to the other side of the room and given oxygen and few other things. (I understand that it's possible for this to be done while he on my chest, but not at the hospital.) I hadn't planned on pushing for 3 hours, and being so incredibly sore and wiped out afterwards that it hurt to even shift positions, which really hindered what I had planned on being a blissful time.

Anyway, I think it's very important to convey the message that having your birth go differently that you had planned is not a failure. Using certain interventions wisely and when needed is not a failure. I am a huge advocate of natural birth, but I think sometimes educators go overboard and inadvertently end up making women feel guilty and ashamed when their births don't go as planned. Because you're right - you can prepare for birth, but you really can't plan it.

[pamamidwife]

This is a great thread.

Many people have ideas that they can control their birth. With birth plans or with doulas, they think that this will 'protect' them from what they deem hostile territory.

Ultimately, we are NOT in control of birth. I have seen empowered births with unexpected hospital tranfers from home that result in cesarean. There is definitely some grieving after the birth (there *has* to be some grief with a loss of what you had planned), but all in all, the biggest feelings of not having that GUILT is based on empowerment. Empowerment comes from asking the right questions each step of the way and being involved in the decision making.

I think our culture does a disservice to so many women's grief - and even anger - when they respond with "At least you have a healthy baby, that's all that matters".

It's not all that matters. We need to validate women's feelings of wanting a particular type of birth - along with their need to process it.

There is another person on the journey. As much as we try to plan for something - and planning is great, as it provides you with a solid foundation of your values and your ideals - the true jist of parenting is that there are TWO involved in this journey. What may not have been in our plan, may have been in this little one's plan. (Or at least, that's my spiritual beliefs)

There is alot of defensiveness about outcomes that didn't go as planned or didn't meet the "ideal". We need to hear these women and really hear their grief over losing one type of birth. HOwever, that's not to say that every woman is upset about her birth as a whole - but we need to be receptive and validating to those that are.

[TurboClaudia]

Erin: Have you ever read the piece of writing called "Welcome to Holland"? Although it deals with parenting a child with a disability (in this case, a boy with Downs syndrome), it is written in a way that can stimulate the reminders that you can't plan for most things. You can find it here: http://www.nas.com/downsyn/holland.html

warmly,
claudia

[1jooj]

I was NAK when I wrote my first reply to this post--and so while I typed about "my second birth," I kind of laughed, because, like pama said, someone else is on the journey. They were my children's births too.

I am pretty sure the babies don't come out feeling disappointment or failure.

Anyway, while reading these awesome replies, I thought about how our real power in birthing IS our ability to react and respond to the birth processes and events, and not to cause, control or stop them.

Kind of a vorspiel for parenting, I guess...

[dharmama]

The whole spiritual act of surrender, letting go of control, and having faith & trust even in an imperfect experience is a life-altering occasion in itself.

Absolutely.

However, I think it's very important to not go to the other extreme and start teaching women that they have no power at all in birth.

I totally agree. I guess that's sort of the crux of the point I was trying to make. I want my work to help women to find their voice, feel empowered, know that they can and SHOULD question medical "authority," that they are the true experts when it comes to their body, to know that they DO have options in birth (location, attendants, the right to refuse interventions etc.) BUT at the same time I'd like to help them accept that labor and birth cannot be orchestrated and controlled and there are times that despite all the mental, spiritual, and physical preparation in the world...the Universe (God/Higher Power) or our baby (very good point Pam ) have a differnt plan for our birth experience.

it's important to be educated and to have an idea of how you would like to birth, it's even more important to remember that you can't control birth.

Exactly. :LOL I think that's what I just tried to say but it took me like 150 words.

anothermama ~ MANY good points. I agree that the location AND the attendants (if you are having attendants) you choose can have a huge impact on your birth experience BUT.....there is still no guarantee of everything following the plan.

Thanks for the link Claudia. I'll check that out!

I really appreciate everyone's thoughts...hope this thread keeps going!

~Erin

[RaisingCaine]

Every individual has experiences that they need to go through, and that may very well involve a "disappointing" birth. Who is to say what gifts will come from that. In my personal experience, adversity has brought the greatest rewards.

I totally agree with this, and find it to be true in the case of my first "disapointing" birth. My first birth did not go at all as I had planed, not because circumstaces got out of control and there was nothing I could do about it, but because I didn't have the back bone to stand up for what I believed in. At first I was very bitter toward my OB, the hospital, the L&D nurses. I put the blame every where but myself, after I calmed down a little :LOL I realized that my birth could have been 100% diffrent if I had stood up for myself from the very begining.

It started with me bowing to pressure from my family to go with an OB instead of midwife, then not talking to my doctor about what kind of birth I wanted and weather she would even be friendly to that. This time I decided that I was going to do every thing in my power to have a natural, no intervention birth, and every one else be damned. I also learned how to stand up for myself in other areas of my life. My first birth was a huge growing experience for me.

[newmainer]

I think its awesome that you are exploring how to help your clients achieve this mindset. I took a Birthing From Within class that did *exactly* this for me. So much so, i am taking the training to teach the classes in April. our instructor always reiterated how you never know what kind of birth you are going to get, but the more you're aware of your options and your preferences (ie, procedures in hospital) the closer you will get to what you want. Through the art exercises in teh class, i really *felt* the sense of not being in control as i tried to respond to a prompt in one way, and my art came out totally different. I mean, sounds weird to compare art to birth, but it was more the xperience of letting go of expectation while retaining vision.

Of course, i didn't really *get* it until after I'd gone through labor myself, which ended up going about as perfect as I coudl have hoped for. But I was prepared for it not to. i had a homebirth and I knew the possibility for transfer was there and I accepted it. Likewise, i think women who are planning a hospital birth but have hopes for drug-free etc... can prepare and accept other outcomes without straying from their intentions. It makes it so much easier in the situation if you had some kind of a clue of what might happen if you need a cesearean, as opposed to if you are ignorant of it. I guess what I'm saying is the more informed and educated a mom is, the more prepared she is. I think sometimes there's a misconception that if you prepare for it, it means it will happen, versus it *might* happen.

well, its 1 am and i fear i might not be staying coherent! Great thread!

[AmyB]

My birth didn't go as "planned" because I had planned to be in a trusting environment with people being nice to mewho had my best interests at heart.

In the hospital that didn't happen. The nurses were not really able to deal with an unmedicated birth. They didn't believe what I told them and didn't know any techniques to make me more comfortable. Things were done to me without informing me what the supposed benifits were or what the side effects would be.

Afterwords I was incredibly angry, and I still am angry when I think about it. I had an unmedicated birth as planned and I have no regrets about that, but I'm still angry about the poor treatment I got at the hospital.

I still think I deserved to give birth as planned, surrounded by loving care. Not in an environment where I felt emotionally ignored and physically attacked.

--AmyB

[newmainer]

Amy-
You definitely deserved to labor surrounded by loving care...i completely understand your anger. The "unplanned" parts of labor should never have to be the attitude and unwillingness and capability of the hospital staff to meet a laboring woman's needs. There is sooooo far to go until birth is a humane experience for the majority.

do you think that if you had been told/prepped in your childbirth classes for an experience like that, it might have helped? For example, if your instructor had said that you should *not* expect the nurses and staff to be able to support you or understand you. I ask because i am going to be teaching childbirth classes, and I know a lot of the class is focused on preparing for the unexpected, I think its more about unplanned procedures, not what you are describing. So I am wondering if that is something I should prepare to present to the expecting parents.

what do you all think?

[oceanbaby]

do you think that if you had been told/prepped in your childbirth classes for an experience like that, it might have helped? For example, if your instructor had said that you should *not* expect the nurses and staff to be able to support you or understand you.

My Bradley teacher did this, and I found it very helpful. We even role played how we would respond to certain things that a nurse or doctor might say in the hospital. I found it very helpful, mainly just being prepared emotionally for the possibility that I might encounter resistance and feeling confident and prepared about how to handle it.

[emmalala]

This is a great thread!

I would also hope that women STAY IN THEIR OWN HEADS. So much of what is written for expectant mothers is written from an observer's point of view - it doesn't talk at all about how it might feel to DO it, not watch it. And birth IMO is something you are and should be so totally occupied with that you have no sense of observation or detachment.

It is still very confusing for me to compare my actual birth experience with what I read - there is hardly any relationship at all, though I have done it twice. Even the birth stories I have read here at MDC often express more clearly how "it" went than what they felt - maybe it is really hard to talk about how it felt??

I had my first unexpectedly early, after 2 childbirth classes. With a loving cnm and dh, I somehow got through, and it almost seems I was better off not even imagining that I knew what was "going on" - I had so little info that I had to be in my own head.

In defense of hospitals: mine has been good to me - 2 unmedicated births so far, immediate nursing, rooming in, baby in bed, all that good stuff. I think there is a real range of attitudes in hospitals and you do have to be very very careful about choosing that option, but it doesn't automatically have to stink.

I would say that the best advice I ever got was from that childbirth class - she said don't go to the hospital until you are really sure that you are definitely in labor.

And Birthing From Within is awesome!!