What If Your Birth Plan Can't Be Followed?
Author: Dr. Anna Kaplan
The first thing you have to remember is that a birth plan is a guide and not a guarantee. What you want is a healthy baby and a healthy mom. If something happens to threaten either you or your baby, plans have to be changed. Think of it as making a new birth plan, even if you have to do it really quickly.
It is extremely important that you trust the doctor or midwife that is going to attend your delivery. If circumstances change, you need to know that they are doing the right thing. It is also important to have a partner with you that you trust completely and who can understand what is going on when you may be under stress and in pain. That person has to be prepared to help change the birth plan, if necessary. To help things go smoothly, it is best if you and your partner discuss possible problems beforehand. You don't want to get into an argument in the middle of labor.
Sometimes circumstances dictate a change. What if your baby is breech? If your baby's bottom or legs are the first things that are going to come out, a vaginal delivery may not be safe. While there is debate about the risk of breech vaginal delivery, there is a good chance you will be told you need a C-Section. If this is the case, you may have to change your birth plan.
Unfortunately, there are more serious things that can go wrong. If you develop a condition called eclampsia, you may not be able to follow your birth plan. With eclampsia your blood pressure can get dangerously high, and you can have terrible headaches and problems with your vision. You are at risk of seizures, coma, and death, and it is also dangerous for the baby. The baby has to be delivered the fastest way possible, which will usually be a C-Section.
If your water breaks and you don't go into labor within 24 hours, there is an increased risk of infection for the baby. Most doctors will want you to deliver within 24 hours of your water breaking. If you are at or near your due date, your labor can be started with medication, but it needs to be done in a hospital and needs close monitoring. As labor progresses, the contractions might get stronger than you anticipated, and you may want pain medicine. If you want an epidural, you have to be in a hospital with an anesthesiologist.
One of the most common paths off the birth plan is deciding you want a natural delivery without pain medicine. Then you get into labor and realize you do want pain medicine. There is nothing wrong with that. But if you want what many consider the most effective pain control, which is an epidural, you have to be in the hospital, and you won't be able to give birth in the water.
I had a birth plan. I wanted an epidural. My water broke at 11 PM, and my contractions started right away every 4 minutes. My doctor said I could wait until the morning to go to the hospital. My husband and I got there around 7 AM. The nurse said my cervix was closed; she didn't realize I was in labor. I got really scared thinking, "I am having so much pain and this isn't active labor? I won't get any pain medicine, and I'll be in labor for two days." My doctor got there around 9 AM. I was 4 centimeters dilated. Was I relieved! It was finally time for the epidural. Guess what? The epidural didn't work. The anesthesiologist kept putting more medication in, but I think I had a numb area about the size of a small napkin around my right hip. So I gave birth with essentially no anesthesia. That was not my plan. But once you get started, there is only one way out. Although the labor and delivery did not go as I had planned, the result was a beautiful baby boy, so how could I ask for more?