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What Should You Do When Labor Doesn’t Go as Planned?
Author: Dr. Anna Kaplan
It is good to have a labor plan. You should have one, and your partner or husband should know everything on it. You should give it to your obstetrician and to the nurses at the hospital when you get there. Hopefully, everything will go according to plan.
What if it doesn't? You have to be ready for a change in plans if circumstances dictate a change. How could that happen? There could be some unanticipated reason your doctor can't get there. Maybe he or she has an emergency of their own; maybe your labor goes quickly and the doctor is stuck in traffic. Maybe you have gone to visit someone a couple of hours away, having been told you won't go into labor anytime soon, and you go into labor which comes on so quickly you can't get home. If it is your first baby, you usually have plenty of time to get to the hospital, but there are some women whose first labor is remarkably short, and either they don't get to the hospital or the doctor doesn't get there on time.
Even stranger things could happen, and have happened to women in labor. There could be an earthquake, tornado, or hurricane, depending where you live. When fate or Mother Nature deals you a hand you were not anticipating, you have to be flexible. Try and get whatever help you can to make your labor and delivery what you want as much as possible.
Then there are medical problems, either yours or the baby's, which mandate a change in your plans. All women want a healthy baby, along with a delivery that is normal without complications. Most of the time, that is what happens.
If you have significant medical problems, such as diabetes or high blood pressure, or if you have asthma that is hard to control, you need a doctor that is comfortable managing high risk pregnancies. Often an obstetrician will work with a family practitioner or internist to help with your medical problems. Not every doctor is experienced enough to do this. If you have an unusual medical problem, you may be referred to a large teaching hospital or tertiary care facility, where the doctors have the most experience managing difficult pregnancies. This may limit the choices of where you give birth and how you give birth.
You can develop illnesses during pregnancy, or conditions you already have can get worse. A worsening medical condition can be a risk to the baby, as well as to you. If your life is in danger, or if your body is not able to provide the baby with everything needed through the placenta, sometimes the only solution is to deliver the baby as soon as possible.
If you go into premature labor, your doctor will probably try and stop or delay it if it is a long way from your due date. If labor can't be stopped, there are medications you will be given to help the baby. Very premature infants need to be cared for in a Neonatal ICU (NICU), usually level III. If there is any reason that your doctor thinks you are at risk for preterm labor, he will recommend a hospital with the capability to take care of the baby. This may mean a different hospital than your first choice.
If there is a suspected problem with the baby, the same type of care may be needed. This could be because of something seen on a sonogram or discovered by amniocentesis. It can also be because you are having twins, or any multiple births.
In any situation where the mother or baby is at risk, achieving a good outcome has to be placed as a higher priority than your original birth plan. You can try and keep elements of it intact, but you should understand from the beginning that a plan is not a contract.
There is another way in which labor plans may change. You may change your mind. If this is your first pregnancy, you may discover that you don't want what you thought you wanted. This is often true of pain medication. If you are overwhelmed by pain and want an epidural, for example, you should be able to ask for one. In this case, you should not be disappointed in yourself. You should give yourself the room to change your mind.
Hopefully you have picked an obstetrician who you like, and who knows what you want. He or she should only make changes that are absolutely necessary or that you request. Again, if you have found the right doctor for you, you should have faith in his or her judgment, and be willing to go along with a change in plans if it will get you what you want most, as healthy a baby as possible.
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