Before I had my first baby, Mathilda, I knew exactly how my labor and delivery would go. I wouldn't use drugs, I'd remember my breathing techniques, and my husband, Tony, would be right there by my side, cutting the umbilical cord and presenting me with an adorable cherub.
Well... not exactly. My exhausting and painful labor -- bring on the Demerol, stat! -- ended with three hours of pushing and a baby who wasn't budging, followed by an emergency c-section as my blood pressure spiked. I barely remember Tony being there. About the only thing that went according to plan was I ended up with an adorable, healthy baby. The lesson? While it's fine to have a birth plan, sometimes sticking to it isn't an option. Read on for a look at some of the most common snags in labor and delivery, and why it's not the end of the world if they happen to you.
Surprise!: You Need Pain Medication
No matter how many books you read, websites you visit, or classes you take, you don't know what your labor is going to feel like until it happens. "Throughout my pregnancy, I was determined to have a drug-free birth," says Cincinnati mom Marcy Hawkins. "My mother and sister gave birth without drugs, and I was certain I could too." But after eight hours of excruciating back labor with her son, Jackson, Hawkins had a major change of heart. "I remember looking at my husband and saying, 'I don't think I can do this anymore.'" She asked for an epidural and soon after, her son Jackson was born -- and the pain was much more bearable.
If it happens to you: Repeat this mantra: There is no one right way to give birth. "We're taught that if we breathe right, it won't hurt," says clinical psychologist Shoshana Bennett, Ph.D., author of Pregnant on Prozac and past president of Postpartum Support International. "There is absolutely no failure in asking for an epidural. Many women are so relieved once they get it that they start to enjoy labor, and are able to participate more. Having some medication can be the smartest thing to do." Once her son was born, Hawkins felt an overwhelming sense of joy -- not guilt. Her advice for other moms-to-be? "Listen to your body. It's okay to change your mind about using or not using drugs. None of that matters after you hold your healthy, beautiful baby for the first time."
Yikes!: You Need a C-Section
Like it or not, cesarean births are at an all-time high -- a whopping 31 percent of U.S. births in 2006 (the most recent figures available), according to the U.S. Dept of Health and Human Services. Elective c-sections are on the rise, says Pamela Berens, M.D., associate professor of obstetrics and gynecology at the University of Texas Medical School, Houston. "Some moms are requesting to schedule c-sections instead of going into labor," she says. "It's a trend that's growing in some parts of the country." There are also many medically necessary reasons for having a cesarean, including fetal distress, breech presentation, abnormally placed placenta, or labor that simply isn't progressing.
If it happens to you: If you're disappointed that you didn't deliver vaginally, look at the big picture: you did what it took to have a safe birth. "Any way that you end up with a healthy baby and mom is fine," says Berens. "We don't get to choose what labor is like, and the experience is very seldom what moms think it's going to be." Instead of dwelling on what didn't happen, focus on the positives, she says. For one thing, you've got permission to take it easy for a few weeks. "I try to discuss recovery after a c-section with the whole family present," Berens notes. "For six weeks after the birth, a c-section mom should recover, sleep, and nurse the baby. That's her job, period. It's someone else's job to cook, clean, and entertain out-of-town relatives."
Whoa...: Your Baby is Born Prematurely
With my second child, A.J., I developed a sudden case of severe preeclampsia. Waiting to deliver wasn't an option, so I had another c-section at barely 32 weeks. I'm not alone. Birth rates for preemies (considered less than 37 weeks gestation) have been rising for the past 40 years, says Errol Norwitz, M.D., professor at Yale School of Medicine and co-director of the Division of Maternal-Fetal Medicine. "In 2007, 12.7 percent of all babies in the U.S. were born prematurely. That's nearly one in eight," he states. Two major factors are largely responsible: giving birth at an older age, and higher incidence of multiples from fertility treatments. Lack of prenatal care, low maternal weight, smoking, drug use, and having a prior pre-term delivery can also up the ante, says Norwitz. But the majority of women who deliver preemies (like me) have no known risk factor. "I tell people all the time, 'This is not your fault,'" says Norwitz. "In the vast majority of cases, the mom didn't cause the premature birth, and there's nothing she could have done to prevent it."
If it happens to you: Don't panic. Most late preterm infants (34 to 37 weeks) do just as well as their full-term counterparts, says Norwitz. "The most important factor is the baby's gestational age," he explains. "By 28 weeks, the vast majority survive, and babies born after 34 weeks do almost as well as full-term babies. [Ana: This last line repeats the line after 'Don't panic']" If your baby needs to stay in the hospital after you're discharged, you can still bond and be involved in his care. Visit and hold him as much as possible. "The more skin-to-skin contact, the better for mom and baby," says Norwitz. Even if he needs to be in an incubator most of the day, you can usually hold his hand. Pumping breast milk every few hours is another way to help your baby and feel close to him; he may be able to ingest it through a gastric tube if he's not yet strong enough to suck. Make a piece of clothing for the baby, bring in a toy to place on the incubator, and by all means take a photo home -- all of those things can help you feel closer. Another huge help: "Make friends with the team of nurses and doctors who'll be taking care of your baby," says Norwitz. "For a short time, you're giving your baby up to them."
Plan B: You Need to Be Induced
Sometimes, labor just doesn't happen on time. Or there's some medical reason that makes it necessary to deliver the baby early. Cathy Hale's doctor decided to induce her two weeks before her due date because she was suffering from PUPPP, a condition that causes severe itching and is only relieved by delivering the baby. "I was nervous about being induced because I had heard bad stories about labor with Pitocin," says the Austin, Texas woman. "I was also sad that it wouldn't happen naturally." After taking Pitocin, Cathy's water broke. "The contractions were fast and furious and completely overwhelmed me," she recalls. "I had no idea what to expect."
If it happens to you: Inductions are becoming more and more frequent: 23 percent of births in 2006. Doctors will induce labor when there's a medical condition that puts mom or baby at risk, i.e. preeclampsia, diabetes, or an abruption of the placenta. Moms who get to 41 or 42 weeks of gestation are also likely to be induced. And in recent years, says Berens, many women want to schedule their due date and are asking to be induced.
Whatever the reason, the drug Pitocin is generally used to bring on contractions. "[Pitocin-induced contractions] tend to be closer together and much more regular than natural contractions," says Berens, who has experienced both natural and induced deliveries with her four children. "With Pitocin, you get strong contractions 2 to 3 minutes apart, as opposed to contractions of varying strength 3 to 5 minutes apart." Fortunately, Pitocin is a short-acting drug and the aftereffects are minimal, notes Berens. Moms who are induced should be able to breastfeed and bond with their babies the same as someone who had a natural labor.
Uh-Oh: You're Having Trouble Breastfeeding
Breastfeeding is not as simple as it looks; it can take weeks to get the hang of it. For some moms, it just doesn't work at all. Jamie Farrell had a difficult delivery, with the sudden onset of HELLP Syndrome (a condition similar to preeclampsia) and an emergency c-section. "My body was so traumatized that I never produced milk," says the Revere, Massachusetts mom. Farrell met with a lactation consultant, rented a medical grade pump, and asked mom friends to help. "Everyone was encouraging, everyone had advice," she says. "But the fact was, I just wasn't making milk."
If it happens to you: Breastfeeding can be a wonderful experience, but not for everyone, says Bennett. If you have trouble nursing, first identify the problem with a lactation expert. "It could be as simple as the baby not latching on properly," explains Bennett. But if it's truly not working, give yourself permission to quit. "It's a myth that a good mom is a breastfeeding mom," says Bennett. "You can absolutely bond without it. If you needed breastfeeding to bond, most adopted babies would never bond to their mothers." If you feel like you're missing out on skin-to-skin contact, she adds, you can always unbutton your shirt and hold your baby against your body when you bottle-feed. Above all, let go of any regret and start enjoying your baby, which should be the goal of every new mom.