Fantasy vs. Reality: Plan for the Unexpected Birth

by Amy Braman

Every girl imagines her first kiss, her wedding day and what it will feel like to have a baby. In our minds, we visualize these experiences and strive to turn our long held fantasies into realities. These are cherished visions that belong to us and us alone. We plan for these milestones years in advance, adjusting details as we grow and experience life, yet remain true to our ideal. These are the opening words to my birth plan:

"My husband and I are excited about the birth of our first child, whose gender is unknown to us. To summarize our vision for our birth experience would be to describe it as "spa like." It is our wish to have a natural childbirth, meaning, a birth experience free of medical and/or chemical intervention. My ideal birth experience would be a home birth, however, with this being our first child and knowing that unexpected complications could arise, we have chosen to deliver at this hospital to ensure the safety of our child should unforeseen complications arise. Medical and chemical interventions would be considered as a last resort after all other natural interventions have been exhausted."

From the beginning, I only wanted the best for our baby and that included a natural birth, no pain medications of any kind. I wanted to experience my first pregnancy and birth fully, with all my senses. It was very important to me. My birth plan was specific and went on to include items such as dim lights, ambient candles, no unnecessary interruptions, the ability to move freely during labor, use of the labor tub as well as the massage and aroma therapy rooms. Regarding medical intervention, my birth plan went on to read,

"Unless fetal distress is evident, I do not wish to be induced; If chemical induction becomes necessary, we ask that pitocin be used as a last resort and a Cesarean will only be considered if advised by sound medical evidence...."

Since this was my first pregnancy, we opted for an Adventist Health System hospital that offered a birth center and supported natural births and every wish on my birth plan, except for the candles in our room. We felt this hospital was a good compromise. Immediate access to medical assistance, if necessary, yet complete willingness to abide by our wishes. I could not have asked for a more competent medical staff than theirs.

I was thrilled to learn that our hospital staffed a certified nurse midwife. After my doctor closed her practice mid-way through my pregnancy, I immediately transferred to her for the remainder of my care.

Our pain management technique of choice was Hypnobirthing, The Mongan Method™. For nearly six months my husband and I trained and prepared our minds, and I my body, for a beautiful, stress-free and relaxed natural birth. I am a planner. My bags were packed weeks ahead of time and I imagined the moment when I would tell my husband, "I think we need to go to the hospital." I knew the route there and how long it should take to arrive.

I was one of the so-called "lucky ones." I gloried in a symptom-free pregnancy, much to the envy of others. I did not suffer from morning sickness, fatigue, backaches, leg cramps or any of the other discomforts of pregnancy.

Sitting in the window seats of our coffee shop, I told a friend our plans for a natural birth. Three months prior, she had given birth to a lovely baby girl and now her four-year-old was a big brother. Her plans were to have a natural vaginal birth after cesarean (VBAC). She was not as adamant as I was about enduring labor without pain relief though, and opted for an epidural at 8cm dilated. She had learned with her first born that no matter how thoroughly you plan for birth, your plans might suddenly change. Her son's shoulder was stuck. He could not progress through the birth canal and she ended up in an emergency c-section.

She explained how she blamed herself for a period of time even though she knew it was not her fault and not within her control. She had so desired a natural birth that she felt a bit of failure as a new mom who could not bring her son into the world naturally. Inside, I pitied her for missing out on a beautiful birth experience like I would soon have.

Several weeks later, we were speaking again and out of the blue she said, "Oh, I've been meaning to tell you...if things don't go the way you have planned," she paused briefly, yet thoughtfully, "it's okay." For some reason, her words anchored themselves into my mind.

At 38.4 weeks pregnant, I arrived at my nurse midwife's office for my weekly appointment. Feeling fine and excited to learn how far I had dilated beyond the 1 cm from the week before, I sat on the chair to have my vitals checked. My weight was normal, however, my blood pressure was elevated. I explained to the nurse that it was probably because that I was excited about my appointment and that I was feeling a bit winded from walking up the stairs to her office.

I wasn't overly concerned because my blood pressure can rise and fall easily due to "white coat syndrome." By the end of my appointment and four blood pressure checks later my blood pressure was alarmingly worse. My nurse midwife was worried that I was developing pre-eclampsia and decided that I should be admitted to the hospital for 24-hour monitoring. I insisted that once I was able to rest and calm down a bit I'd be fine, but off to the hospital I went, against my will.

I was ordered to bed rest and fitted with an arm cuff to be monitored every fifteen minutes for about four hours. Slowly, my blood pressure dropped to normal. Monitoring was reduced to every half-hour then to every hour for the remainder of my stay. My blood pressure had returned to normal. The fetal monitor showed a robust baby with a strong, steady heartbeat.

I was released from the hospital with orders to return in three days and practice modified bed rest at home. I could only get up to visit the bathroom or to get something to eat: no shopping, no driving, no decorating or cleaning. Although I felt fine and really believed that my elevated blood pressure was a fluke, I complied with the nurse's bed rest orders and returned for my appointment the following Monday.

Monday marked my 39th week of pregnancy and we had planned to go out to eat and see a movie one last time before the baby arrived. We were to begin our celebration immediately following my appointment and were looking forward to our last outing together as a couple. My appointment was to check my blood pressure and monitor the baby for one half hour. Slightly concerned but not enough to be worried, I waited as the cuff tightened around my arm.

"It's still up," my nurse midwife said.

"What?" I shot back completely shocked. "How high?"

"Terrible," she replied. "But that's okay, we'll get you hooked up to the fetal monitor and you can rest in there and we'll check it again."

To me, this was not okay. "What is going on?" I thought. "Why is my blood pressure up?" I had rested and was basically immobile all weekend. It made no sense.

The baby's heart rate and tolerance of Braxton Hicks contractions was strong and steady. When she checked my blood pressure the second time, she simply looked at me and said, “We need to think about inducing."

Talk about a ton of bricks being dropped! Induce? This was not part of my birth plan. I was supposed to go into labor naturally and tell my husband, "I think we need to go to the hospital."

My nurse midwife told me that I did not have pre-eclampsia yet but explained the dangers and was concerned that I could escalate from pre-eclampsia to eclampsia quickly. She felt that inducing labor would be the best and safest option.

Before making the final decision to induce, she chose to monitor my blood pressure again for 24-hours one final time, giving my body the chance to prove her wrong.

"When would you induce, if that's what you decide?" I asked.

"As early as tomorrow morning," she replied.

As my husband drove to the door to pick me up, the tears streaming down my face told him our dinner date was off. "My blood pressure is up again and she's talking about inducing labor," I cried. "I have to go back to the hospital."

This was too much to take in. I was not even allowed to go home and get the bags I had prepared for my hospital stay. Suddenly, we could have a baby within 24-hours and there were still dirty dishes in the sink. The nursery wasn't complete and the house wasn't spotless, as I had desired for our baby's homecoming.

I checked into the hospital, still crying, and was once again fitted with the arm cuff. No matter how immobile I was that night, my blood pressure remained elevated. I was angry. After all, how was I supposed to rest with the blood pressure cuff squeezing my arm every fifteen minutes all night? About 8:30 Tuesday evening my nurse midwife came in and reviewed the blood pressure measurements from the past 24-hours. "I spoke with my doctor," she began, "and we think that we need to go ahead and induce. It's mainly your safety that we are concerned about. The baby looks great."

I began to cry. I did not want to be induced. I wanted our baby to be born when he or she was ready, not by artificial methods. At the same time, I knew it was for my own good and we agreed that I should be induced. My loving husband went home and cleaned the house then brought back the bags I had packed and something for us to eat.

The monitoring continued through the night at one-half hour intervals. At 4:45 Wednesday morning, the nurses arrived to prepare me for induction. By 5:30, pitocin was coursing through my veins and the majority of my birth plan had become null and void.

Now, tethered to an IV pole, I could not use most of the pain management techniques I had expected. Walking outside in the fresh air was out; relaxing in the Jacuzzi tub was out. I was confined to my bed and the maternity ward hall. At least I could dim the lights and listen to the relaxing music I had packed. Knowing my disappointment and upset, my kindhearted nurse midwife sent a massage therapist to help relax me with a one-hour massage.

As the pitocin gradually brought on contractions, my husband and I were able to utilize the relaxation techniques we learned from hypnobirthing to overcome the labor pains. The techniques worked beautifully. I would relax and work with each contraction as my husband lightly stroked my face and spoke gentle, soothing words.

Around eleven hours into labor, I learned that I had dilated only to 4cm with 6cm to go. Sixteen hours into labor, with about six hours of sleep since Monday, I had not dilated beyond the 4cm and could no longer endure the contractions. My husband had grown increasingly worried about my well-being. I was pale, exhausted and barely had the energy to walk to the bathroom.

Our attending nurse spoke to us about the benefits of receiving an epidural, how it would help my labor progress and allow me to rest. After we discussed the option, I reluctantly asked for the epidural.

I so badly wanted to deliver our baby naturally and feel every pain, no matter how hard but the relief the epidural gave was heavenly. I finally rested. I drifted off to sleep for a short period of time before the epidural wore off on my left side leaving me with full force contractions on half of my body. Even when the epidural was administered again, it wore off quickly.

By 1:00 Thursday morning, I was fully dilated to 10cm. They estimated that we would have our baby by 3:00 am. Finally! I do not know why it took so long for me to dilate to 10cm, but I personally believe that it is because my body was being forced into premature labor.

Three o'clock am came and went with no progress whatsoever. Our baby was not progressing through the birth canal. Push after push yielded nothing. Around 8:00 am the doctor with whom my nurse midwife had been consulting came in. Rather sternly she stated, "We have got to have this baby." She was concerned that his head was beginning to swell from the pressure of the pushing and the way I was positioned.

"At this point, you have two choices." she informed us. "One, we can use the vacuum and try to pull him out, but first we have to ask, 'why is he not coming out already?' If we use the vacuum and he comes out part way but gets stuck again, then we have a three minute window and it's a life or death situation. Second, we can do a C-section."

My exhausted mind was swirling and her words began to fade. At that time, the voice of my friend echoed in my mind, "If things don't go the way you have planned, it's okay." Because of the risks to babies, vacuum suction wasn't even an option to us.

She asked us if we needed time to talk about our choices, but I instantly answered, "No, I want a C-section. Just do it. I can't do this anymore." The health and safety of our baby was all that mattered. My birth plan was dead. It was time to move on.

Within fifteen minutes I was prepped and ready for surgery. Because my left side would not hold the epidural, I required a spinal tap. I've never actually wondered what it felt like to be a log, but now I know. So, there I lay, amid a buzzing team of nurses and doctors who'd sprung into action within minutes to save and deliver our precious baby.

A blue sheet angled over my head blocked my view of the surgery and I kept falling asleep from exhaustion as I lay there visibly shivering in the cold room. My husband was at my head in full medical garb.

We had chosen not to discover the gender of our baby until birth. The doctor announced to her staff that the gender was to be revealed to me by my husband only. A few moments later, he was prompted to stand and watch our son emerge into this world. He sat back down at my head and softly said, "It's a boy."

"It's a boy?" I repeated back to him. Tears welled up in my eyes. Our son was here. Safe. Healthy. Strong. Delivered by a phenomenal medical staff that compassionately walked the line between our desires for a natural birth and medical necessity.

I could hear his first cry from across the room and I felt peace. One of the attending doctors appeared at my head, smiling, and said, "He’s beautiful. You couldn't have had him anyway. The cord was wrapped around his neck and under his arm, too."

My husband laid our beautiful son on my chest as the doctors repaired my incision. "He has that little thing on his lip like you do," he said. I smiled and visually examined his face, quietly thanking God for his safe arrival.

For a time after his birth, I felt a bit robbed of the birth experience I had planned and hoped for. Although I had written a birth plan including our desires should unexpected circumstances arise, I did not mentally prepare for the possibility. I wish I had. I had to work at letting go of my fantasy and accept reality. It took time, but now, as I watch our son grow and become aware of his world, I can assuredly pass on these words: If things don't go the way you have planned, it's okay.

Amy Braman is a first-time mother and coffee house owner residing in North Carolina with her husband and newborn son.

© 2009 Amy Braman. Permission to publish granted to Pregnancy.org. Photo credits © Amy Braman.