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How to Handle the Unexpected When Giving Birth

Before I had my first baby, 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 by my side, cutting the cord and presenting me with an adorable cherub. Well, not exactly. My exhausting and painful labor — bring on the Demerol, stat! — ended with an emergency Caesarean section as my blood pressure spiked. I barely remember Tony being there. About the only thing that went according to plan was ending 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 want pain meds. No matter how many books you read, websites you visit or classes you take, you don't know what 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 the pain was much more bearable. Soon after, her son Jackson was born.

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 (postpartum.net). “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 OK to change your mind about using or not using drugs. None of that matters after you hold your baby for the first time.”

Yikes! You need a C-section. Like it or not, Caesarean births are still near an all-time high — a whopping 33 percent of U.S. births in 2010 (the most recent figures available), says the U.S. Department of Health and Human Services. Even elective C-sections are on the rise, says Pamela Berens M.D., 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 Caesarean, including fetal distress, breech presentation, an 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 is fine,” says Dr. 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. “I try to discuss recovery after a C-section with the whole family present,” Dr. 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 relatives.”

Oh no! 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 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, mom. “I was also sad that it wouldn't happen naturally.” After she took Pitocin, Hale'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: more than 22 percent of births between 1990 and 2006. Doctors will induce labor when there's a medical condition that puts mom or baby at risk, for example, pre-eclampsia, 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 Dr. Berens, some women want to choose their due dates, so they ask 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 Dr. Berens, who has experienced both natural and induced deliveries with her four children. Fortunately, Pitocin is a short-acting drug, and the aftereffects are minimal, notes Dr. Berens.

Whoa! Your baby is born prematurely. With my second child, A.J., I developed a sudden case of severe pre-eclampsia. 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 (babies born at less than 37 weeks' gestation) have been rising for 40 years, says Errol Norwitz M.D., chairman of the Department of Obstetrics and Gynecology at Tufts Medical Center. About 13 percent of babies in the United States are born prematurely. That's nearly one in eight, says the March of Dimes. Two major factors are largely responsible: giving birth at an older age and the higher incidence of multiples births resulting from fertility treatments. But most women who deliver preemies (like me) have no known risk factor. “I tell people all the time, ‘This is not your fault,’” says Dr. Norwitz.

If it happens to you: Don't panic. Most late preterm infants (34 to 37 weeks) do almost as well as their full-term counterparts, says Dr. 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.” 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 Dr. 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. “Make friends with the team of nurses and doctors who'll be taking care of your baby,” says Dr. Norwitz. “For a short time, you're giving your baby up to them.”

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