These days, many moms are very particular about how they want their birth experience to go. After foregoing anything unhealthy for the past nine months, many want to skip the drugs for fear that it could hurt the baby. They want everything to go smoothly, and as much as they know that labor and delivery will hurt, they want to do everything they can to make themselves more comfortable. That's why they create a birth plan — a listing of the preferences for labor and delivery that can go from the briefest communication to a litany of likes and dislikes.
Mostly, though, they want control. Sorry, ladies, we have bad news. Much of labor and delivery — just like parenthood — is out of the mother's control. She can't control when her labor will start or her water will break. A woman may dread the possibility of a Cesarean, but she can't control conditions like placenta previa or a breech baby. She has no choice in whether her pelvis is too small or her baby is too large. Despite her best efforts, she can't control if her blood pressure spikes or the baby's heartbeat dips. All of these things can put a wrench into the birth plan.
A fast labor can make a woman hoping for pain relief to miss her epidural; a slow one can lead to a recommendation of pitocin. While doctors often can't force a woman to do something she doesn't want to do, the choices are limited when there is a risk to the mother or baby. Every woman should look at her birth plan as a wish list because there are so many factors out of her control.
Here 15 decisions you don't make in labor and delivery.
15 When It Starts
Newly pregnant women tend to circle their due date on the calendar, but it's very unlikely that it is actually going to be the big day. A due date is just an estimate of when the baby will be full term, and very rarely does a baby actually arrive on that date.
A baby can come at any time; unfortunately some don't even wait until the third trimester. Doctors aren't sure what causes some babies to come early, although they have identified some risk factors, including the age of the mother at conception, smoking and multiples.
Then again, there are other babies that seem to be in no hurry to arrive. Many women, especially in first pregnancies, can go past their due dates, although doctors can be cautious of waiting more than two weeks. Even women with scheduled C-sections can be surprised when labor begins before the appointment time. A woman can't decide when her labor begins.
14 If There Is A Clear Path Out
Many women have no choice but to head immediately into the operating room because there is no clear path out. There are several complications that can start the situation off with limited decisions, including fibroids that can block the baby's exit.
There is also a condition called placenta previa, where the placenta blocks the opening of the cervix. It can detach to make way, but that is also a very dangerous situation likely to result in the death of the mother and the baby. If the placenta detaches for any reason, called a placental abruption, the baby is deprived of oxygen and the mother can suffer severe bleeding. At that point, it is an emergency, and the baby must be delivered in the fastest way possible — through an emergency C-section.
Also, if the water breaks before the baby is in place, the umbilical cord can slip out of the cervix. If that happens, there is a danger that the oxygen supply will be cut off during labor and delivery, so the only safe option is for a C-section.
13 How Much It Hurts
It's hard to measure how much pain a woman endures during labor. For the most part, it is determined on a pain scale of 1 to 10, where much of the interpretation is left to the mother. Some women start off with mild contractions that can go on for hours until the really painful time hits during transition, the stage toward the end when the cervix quickly dilates from 7 to 10 centimeters.
Other women are in an incredible amount of pain from the get-go. They can't imagine the contractions getting worse because they are already experiencing the worst pains of their lives when the cervix is still at a 2. And some women go through back labor, which can also be incredibly painful.
A woman can't decide how much her labor hurts, although she can choose several different ways to deal with it, from trying different breathing methods to going with pain medication. One thing is for certain, it will hurt, and she doesn't have a decision in that.
12 How Big The Baby is
One of the many reasons that women can struggle during labor and especially the pushing phase is because the baby is big. The average baby is 7 pounds, but a baby is diagnosed with macrosomia if it is larger than 8 pounds, 13 ounces. That can be hard to diagnose on an ultrasound, but a big baby is a big risk. There are many reasons why a baby can be extra large, and a woman does have some control over the situation, but not much.
The baby can be bigger based on a genetic predisposition, or factors in the womb can cause the baby to get bigger. Mothers with uncontrolled gestational diabetes or polyhydramnios can grow larger, and so can babies past their due date.
A big baby doesn't necessarily require a C-section, but it does put the baby at risk for getting stuck or having issues during a vaginal delivery. Sometimes, it's safer to try a C-section, and the doctor can recommend going into surgery to avoid any problems. Sometimes there isn't much of a decision involved.
11 How Small The Mom's Pelvis Is
On the flip side, some mothers can struggle with delivering even an average sized baby if their pelvis is too small. A woman has little control over her genetics, but sometimes it can impact her labor and delivery.
During pregnancy, hormones can work magic to loosen the ligaments and allow a woman's pelvis to open up a bit to let a baby out. But sometimes it's just to small. Cephalopelvic disproportion can happen because of genetics or because of an accident that has caused surgery to stabilize the pelvis. It isn't necessarily related to hip size, but it's more related to the overall structure of the pelvis, which has to loosen to allow a baby to pass through the cervix. A small one can cause a woman's doctor to recommend she have a C-section.
Recent research studies have found that the size of women's pelvises have gotten smaller through the generations, a trait that scientists believe may have been a negative response to the increase in the use of C-sections.
10 When The Water Breaks
A woman's can break any time, any where. It can happen in a big gush out of no where, but it is more likely to come later on, after the contractions have come. Sometimes it happens in a slow leak that a woman doesn't even notice. The premature rupture of membranes can cause issues, especially if it comes before the baby has reached full term. But if the baby has reached 37 weeks gestation, even if contractions don't come right away, many doctors believe that the baby needs to be delivered within the next 24 hours to reduce the risk of infection. On the flip side, sometimes the water never breaks and the baby is born with the bag intact.
Some women are able to decide when their amniotic sac breaks, as some doctors recommend breaking it to speed up labor. If so, then they go through a procedure called an amniotomy where a small hook is inserted in the cervix to create a small hole. But for most, the sac breaks on its own and a mom-to-be has no choice in the matter.
9 If You Make A Mess
Even more than the pain, one of the biggest fears that women have about labor and delivery is that they will poop on the delivery table. Women hear that it is a possibility, and they can't imagine living through that kind of humiliation. Unfortunately, there is little a woman can do to avoid it.
Doctors used to encourage enemas prior to labor, but they found it a bit risky without much reward, so it is no longer common place. It is common for a bit of diarrhea just before labor begins, but sometimes there is still some stuff in the intestines during labor, and as the baby moves down, it can move out.
Rest assured that while a woman doesn't have a decision about making a mess during labor she usually doesn't even notice when it happens. Nurses are quick to clean it up and there are other traumatic things going on that make it lower on the priority skill by the end.
8 If The Baby Is Breech
Babies typically move into position to head out of the cervix during the last trimester, but if they don't flip to where their head is down by a certain point, there is little room for the baby to turn. That can result in a breech delivery. While the bones in a baby's head are designed to make delivery easier, the pelvis is not, so a breech delivery can be incredibly difficult and painful and the baby could get stuck. If the head gets stuck, that can be deadly.
Before labor begins, a healthcare practitioner will try several methods to try to get the baby to turn, including an external version, which is a manual pushing that can hurt and start labor and it doesn't always work. Some doctors and midwives will allow a woman to attempt a vaginal delivery with a breech baby, but most of the time those attempts results in a C-section. For many, there isn't much of a decision about how the baby will be born.
7 If There Are Multiples
Twins and multiples have been on the rise in recent years because of the use of fertility treatments, but while the treatment can be a cause, a mom doesn't really have a choice in how many babies are in her belly. And the number can be a factor in how the labor and delivery will go.
Twins or even triplets don't guarantee a trip to the OR for a C-section, but they increase the likelihood greatly. If the first baby is head down, even if the next one is breech, a doctor may allow a woman to attempt a vaginal delivery. That's because the second baby often flips after the first one is delivered.
However, there are a lot of risks to delivering twins and multiples, including the possibility that babies' cords could get tangled or one could get compressed. Many doctors — and many women — would prefer to avoid the risks and they believe there isn't a choice but to go the safest route for delivery.
6 How Long It Takes
Labor and delivery takes as long as it takes. There is no rule for the length, although there is an eight-hour average for active labor for first-time moms. Early labor — the first stage where contractions aren't regular and the cervix is less than four centimeters — can add on hours or even days.
Some women experience incredibly fast labor, and the baby arrives within a few hours, and others can suffer through labor for 24-72 hours. The longer labors can require a lot of endurance while the shorter ones can ram a lot of pain into a short period of time and be traumatic.
In general, doctors and midwives don't limit the time that it takes to allow labor to progress, unless the labor stops entirely or the baby or the mother show signs of distress. However, once a woman's water breaks, doctors try to make sure that the baby is born within 24 hours and may recommend pitocin to get things going. That is because of the increased likelihood of infection.
5 If The Baby Goes Into Distress
Labor can be hard on a baby. It is not only exhausting to the mother but also a difficult journey for the baby, and some don't handle it well. Sometimes that has to do with the way that the cord is wrapped around the baby — if it's around the neck, it could cut off the oxygen supply, and it could also have dangerous knots in it. The cord could also slip into the cervix and become compressed, cutting off the baby's oxygen.
If the baby's heart rate drops or accelerates during labor, a doctor may feel like the safest option is to get the baby delivered quickly via C-section. At that point a mother may feel like her only possible decision is to look out for the health of her baby and head to the operating room. While some moms have rigid birth plans and they would prefer a medication-free, vaginal labor, there is no better decision than to look out for the health of a child.
4 If The Mom's Blood Pressure Goes Up
There are many complications that can arise in pregnancy that can lead a change in the birth plan, and we've listed several of them here. But one very serious complication can come up before labor even begins. Preeclampsia is a condition that can include high blood pressure, kidney problems that can be detected by protein in the urine, headaches, nausea and edema.
Preeclampsia is a sign that the mother and the baby are in trouble, and the only cure is to deliver the baby right away. Many times that leads doctors to recommend pitocin to start labor, and if things don't progress quickly, it can also lead to a C-section.
High blood pressure can be dangerous alone, but with the other symptoms of preeclampsia, doctors know that tragedy could be just around a corner. A mom-to-be will have no choice but to listen to her doctor or risk her own life or the life of her baby.
3 How Long It Takes To Push
Some women have an easy time pushing the baby out, and some have a more difficult time. No woman makes a decision that she will have a hard time, but it does happen. Sometimes the baby hasn't dropped all the way down into the cervix when she reaches 10 centimeters, and sometimes after an especially long and draining labor, she doesn't have much energy to devote to pushing.
The American College of Obstetricians and Gynecologists has said that a pushing phase of three or more hours is normal for a first-time mom, as long as the mother and baby aren't showing signs of distress. If a woman has an epidural, her doctor may allow a break in the pushing, although that is less likely in a non-medicated birth because the pain of contractions doesn't allow a break.
A big worry during the pushing phase is oxygen deprivation, so many doctors could become concerned if the pushing phase does not seem to progress. At that point, there isn't much of a choice for a mom; it's time to get the baby out.
2 If There's Tearing
There are a lot of factors that determine whether or not a mother will tear during a vaginal delivery, and there is very little choice in any of them. The baby's size and position can obviously determine how much the skin between the vagina and perineum has to stretch, and the speed of labor and pushing can also factor in. Both very fast labors and very slow ones can result in tearing.
Some healthcare practitioners believe in perineal massage, a method that involves placing a digit in the vagina and stretching it down during the last trimester and in early labor. But many women tear regardless of whether they tried the massage or not. In fact 95 percent of first-time moms tear at least a little during childbirth.
Some vaginal tears are worse than others, and many involve stitches, which can be uncomfortable just after the baby is born. It can also make postpartum recovery even more difficult.
1 How You Will Feel When You Hold The Baby
The moment that a woman meets her new baby can be magical. Some women see their new child and feel their heart leap — or they feel like they are recognizing a person they have known their entire life. Or they can feel like the little human is a total stranger.
Some women don't feel the instant connection that they dream about with their baby. After a long exhausting labor and delivery or the trauma of a surgery, it can be hard to feel the love immediately. For some families it can take weeks to feel the connection, and that is normal.
Just like every other thing that she doesn't have control over during labor and delivery, a woman can not control how she will feel in that moment, and she shouldn't feel bad about it. Too many women suffer from birth regret, which can lead to or contribute to postpartum depression, but we believe that a woman should never feel guilty or judged about how her labor and delivery happened. There are so many things she doesn't have control over, but we hope that she can decide that the best outcome is a healthy baby and mother and anything else that strays from the plan is all right in the end.