Birth Contingency Plans

I think that one of the healthiest things a woman can do as she prepares for labor and birthing is to go ahead and think about the what-ifs, including the ugly ones. The majority of births happen relatively smoothly, but, for the few that don’t, I believe in being prepared. What if this or that goes wrong and this intervention or that change has to happen? What will she do in that moment when her ideal birth plan is blown out of the water? I know there are several birthing methods (most notably hypnosis-based ones) which insist on thinking only happy thoughts. They don’t want mommy-to-be to even THINK a word like ‘pain’ or to contemplate what she would do if she suddenly had to have an emergency c-section, let alone to consider what her preferences would be if (heaven forbid) her infant died. Honestly I think that’s sadly naive and can do a great disservice to the women involved. While I agree that thinking happy thoughts is good, and avoiding negative influences is also good, there is still something to be said for making thoughtful contingency plans. For those who write up birth plans, I think it’s wise to include a short version of these contingency plans at the end.

When I was expecting Bear, he spent the majority of the pregnancy in a head-up position. The earliest kicks I felt were low and led me to wonder about his positioning, the ultrasound verified that he was breech, and the location of his kicks in subsequent weeks (all in my pelvis) indicated that he seemed inclined to stay that way. As the pregnancy progressed and he got bigger (with less extra room to change position) I started to think a lot about what would happen if he remained breech on his birth day. I researched vaginal breech deliveries, including talking with my provider about whether he was comfortable or experienced with them (he was). That was of some comfort, but I was still troubled at the possibility of needing a c-section.
In my childbirth education class we spent some time visualizing our greatest birth worries—with the intent that we could work through them in class so that they would not haunt us in labor. When I was honest with myself I had to admit that my greatest fear was for things to go wrong, for the baby’s life to be in danger, and to culminate in needing a c-section. Perhaps that sounds quaint to someone who has had one, but I had lost 3 babies in the prior 2 years and was terrified of losing another baby. Having to have a c-section was, for me, a variation of the complete loss of control that I had felt during my miscarriages, and so it terrified me. In class we worked through the emotional side of our fears: visualizing ourselves in the situation, then accepting the facts, trusting my OB to provide appropriate and competent care, and focusing on the good things in the situation rather than on the negative ones. It was a hard day of class to say the least, but I came out of it feeling stronger and more prepared to deal with whatever may come.
In the subsequent weeks I did some studying on c-sections and made decisions about which kind of anesthesia I would prefer and who I wanted present if that was the path we had to follow. At the end of my 2-page birth plan I wrote the following:

If the baby is breech

• I would like to try to deliver vaginally, regardless of presentation
• Even if a cesarean seems necessary, I wish to go into labor on my own, rather than scheduling the surgery in advance.

If a Cesarean become necessary

• I prefer to have a spinal rather than a general anesthesia
• Give the baby immediate skin-to-skin contact—with me or with dad.
• Please ensure that [dad] is able to remain with baby while I am recovering, and let me be with my baby again as soon as is practical.
• Stitch the layers of my uterus separately. [Believe it or not this is an issue, as some OBs prefer to do it in one step, which can increase the risk of uterine rupture for future deliveries.]
• Please adhere as closely as possible to our other ‘after the birth’ wishes.

Thankfully, around 34 weeks Bear decided to flip over into the standard vertex (head-down) position, and I was able to remove the “if the baby is breech” portion from my birth plan before giving it to the hospital staff. I left the cesarean part though. It was not an issue for that birth, but I felt better knowing that it was there, and I have written something similar for this time around.

Of course I hope that my contingency plans never have to be realized, but in case they do, I feel better knowing that I have educated myself about the options. More even than that, I am glad that I have dared to think about the possibilities. I think that one of the most traumatic aspects of a traumatic birth is the shock of it all, but if the mother (and hopefully father too) have emotionally prepared for variations from the ideal plan, then the element of shock is lessened, and thus the trauma can be too.