What Happens When Your Birth Plan Gets Tossed Out

Despite the best intentions of most new parents-to-be, childbirth rarely goes exactly as planned. “Labor is too unpredictable,” says Grace Godwin, a registered nurse certified in obstetrics who works in labor and delivery. The good news is that just because labor doesn’t go according to the couple’s birth plan, doesn’t mean it hasn’t been a successful, healthy birth. “What we consider simple, routine occurrences in childbirth, like intervening to break the water, can be a huge hurdle for the couple because it’s not what they planned,” says Godwin. “But it’s not actually any kind of emergency. Medical emergencies in birth are thankfully very rare.”

The two most common occurrences in childbirth that derail a couple’s original plan are needing to induce labor and switching gears from a vaginal delivery to a cesarean delivery. Godwin, who runs the site Labor Mom & Beyond, says that most women (and men) have the idea that a woman’s body is just going to go into labor naturally. That’s not always the case, especially for brand new parents.

For example, a woman’s water (the amniotic sac that holds the baby) can break but then contractions don’t begin. This opens up both mom and baby to an increased risk of infection. It’s not a medical emergency, but the more time that passes, the greater the risk of mom or baby contracting an infection. An induction makes sense in this situation, and several others like when the woman’s blood pressure is too high, even if a couple’s birth plan is to labor without intervention.

Similarly, there are a couple instances where a C-section will make sense over a vaginal delivery. The most typical, according to Godwin, is that labor is progressing very slowly, hours and hours and hours, and the baby, via the fetal heart rate monitor, begins to show signs of stress, or what doctors and nurses call “not tolerating labor.” Again, this isn’t a medical emergency — despite the fact that new moms who underwent an unplanned C-section often say, “I needed an emergency C-section” — it’s just a situation that changes the safety odds to favor a C-section delivery over a vaginal delivery.

While these situations are mentally tough to handle for new expecting parents, who were determined to stick to a so-called natural birth plan, they are a normal part of labor and delivery in the eyes of Godwin and her colleagues. “I know how hard it is when reality doesn’t match your expectations,” she says. “One thing that can help is to ask questions. We (your nurses, doctors, and midwives) don’t know what you are struggling with until you tell us.”

What’s technically more challenging for the mom-to-be (and the dad-to-be in the support role), is the flip side: When a woman is expecting to deliver with pain management assistance has to go natural. “One of the hardest labors I ever did was someone who had planned on an epidural, but because her platelet count was too low she was unable to get one safely,” says Godwin. “It was super hard, as her nurse, to help her to get through that. She hadn’t done any mental preparations to give birth unmedicated.” Fortunately, this scenario is also rare. The vast majority are couples planning on no interventions who end up hitting a minor, relatively speaking, a complication that changes their course.

For those expecting parents, Godwin cautions about taking a hard line on the birth plan. She says to have an idea, in general, of how you’d like childbirth to go, what main things are important to you, but to leave some wiggle room for the unexpected. “I feel like if they can relinquish a little bit of that control in the beginning, like a don’t-sweat-the-small-stuff type of philosophy, that overall they’re going to be a lot more pleased with the way things turn out,” she says.

Ultimately, the labor and delivery are important, but it’s one day in a nine-month pregnancy, and then the first day in the rest of that family’s collective life. Godwin encourages new parents-to-be to put just as much effort and emphasis on what they’re going to do when they leave the hospital or birthing center and bring that baby home, as they do on planning the birth. Perhaps even more.