Who Moved my Birth Stool?

Encountering Unexpected Change During Birth

By Heather Cook

Women facing impending motherhood encounter a plethora of emotions. Whether having their first or fourth child, each pregnancy and birth brings its own unique mix of emotions, physical changes, highs and lows. Yet one characteristic is common in virtually all pregnancies: the desire to plan.

Call it a womanly forte, call it a mother’s prerogative, explain it with hormonal fluctuations; the desire to nest often extends beyond scrubbing floors and organizing nurseries. Women raise the bar and create birth plans.

Often called a wish list, birth plans offer many benefits: they facilitate open communication between mothers and caregivers, they can identify key beliefs, alert caregivers to potential misinformation, and allow the mother to have a sense of control over a situation.

However a birth plan’s best asset is not found in the document itself, but in its creation. The act of analyzing one’s belief system, confidently stating preferences, and considering outcomes, prepares a pregnant woman for the birth of her child in many intangible ways.

Yet one detriment remains in the design of a birth plan. It cannot account for every possible outcome. Because of this, some women do not adequately prepare for the possibility of unexpected change in labour. When change occurs during labour, causing a deviation from a woman’s desired birth plan and outcome, distress can result and have a negative impact on the coping skills of a labouring mother. Distress can cause the release of stress chemicals that can have counterproductive effect on both mother and child such as reduced blood flow to the uterus that may result in ineffective contractions, reduced oxygen transfer from mother to child, and a depressed baby after birth.

There are several ways that you can circumvent the stress and distress associated with a deviation from a desired birth plan or outcome:

Prepare in advance for all possible outcomes. This requires some hard thinking that is not comfortable for the majority of parents, yet is necessary for adequate and realistic labour preparation. Mothers do not have to devote large paragraphs in their birth plans to every possible outcome, but should simply make themselves aware of all possibilities. Speaking with a childbirth educator, doctor, nurse or midwife, can assist in alleviating concerns and educating both mother and partner.

Discuss calming techniques with your labour support person. A mother in labour should identify ways in which her partner, doula or companion can help her to focus and remain calm. These techniques could include hands on methods such as massage, or attention getting methods like ‘in your face’ talking. Phrases and mantras can be used to get a labouring woman to focus on the immediate moment and not the diversion from the desired path. Questions that require a yes or no answer are most effective: “Can you understand me?” “Are you with me?” “Can you look at me?” Identifying the body parts where a woman carries her stress (hands, toes, jaw, shoulders) before the start of labour, can help a labour support person to proactively assist with relaxation.

Think realistically. Every woman knows the type of birth she wants. The desires range from unassisted childbirth to heavily medicated deliveries. Whichever course your birth plan outlines, there is a real possibility that there will be a deviation from it. Perhaps only in small degrees, such as restriction from a birth pool due to occupancy, or in major degrees such as the necessity for emergency caesarean births.

Relinquish control. This is a controversial point. While many women are understandably unwilling to relinquish control to a medical doctor, there is a natural inclination to attempt to control the entire process of birth. This is why some women who have experienced caesarean births may eventually harbour feelings of guilt – feelings that if they had just done something different, the outcome would have been different. Perhaps. You cannot dictate labour to your body; you can only control your body’s response to labour.

Pregnancy, birth and parenthood are intertwined with change. No pregnancy, no birth and no child will allow itself to be completely controlled. Yet with preparation and planning, you can ride the tides of change as they swell and dip, knowing that the journey, the unexpected miracle of it, is what makes it beautiful.