When Birth Doesn’t Go As Planned


{A Guide for Birth Workers in the case of necessary medical intervention.}

Trust Birth. 

Two incredibly powerful and true words. In order for a woman to surrender to the unknown that is labor and trust the sensations of her body without fighting them, she must learn to trust birth. This is an essential task along the way for a mom that desires a birth without intervention. But I would argue that as birth workers (doulas, midwives, nurses and birth educators) it is also our duty to teach mothers to TRUST BIRTH even when labor doesn’t go as planned. We must help them TRUST BIRTH even in case of a hospital transfer, need for epidural anesthesia, need for antibiotic therapy or labor augmentation, and even in the case of Cesarean Section.
As a long-time intrapartum (L&D) nurse and doula, I would like to share tools I’ve learned along the way to help empower mothers through this difficult journey.
Home and birth center birth is beautiful, inspiring and life-changing for everyone involved. Prenatal care should be a celebration of everything wonderful and amazing about this experience. At the same, it is important for midwives and doulas to discuss plan “B” (or for some women, plan “Z”, last possible resort). Creating a hospital transfer plan is essential work for an expectant family.
Why? First of all, a hospital transfer plan will answer questions that will make the transfer as smooth and stress-free as necessary. “Where are we going?” “Who from the birth team is going with me?” “What can I anticipate in the case of a necessary C-Section?” “How can I feel autonomous and empowered even if I require a necessary C-Section?”
Also, in creating a Plan B, we can illuminate fears about what many homebirth/birth center moms consider the worst possible scenario. Sometimes releasing fears in this way can be incredibly powerful, and almost protective.
I realize it’s unfeasible for most women’s primary midwife to accompany them to the hospital during transfer, and remain there throughout the safe birth of their baby.
This is the reason why a reliable birth doula is so incredibly important for a mother, regardless of birth setting.
In the hospital where I work, we frequently accept homebirth transfers for prolonged labor or “arrest of dilation”. These moms are typically admitted at 6 cm and will go on to labor an additional 12 hours or more. For a mom who’s already gone through so much, every shift change can be terrifying. Losing a nurse they trust, or even the attending physician who helped them create their plan of care, can create much undue stress that can affect their labor progress.
A wise and adaptable birth doula, skilled in supporting un-medicated labors as well as medicated labor or C-Section, is a godsend to a mom requiring hospital transfer. Doulas skilled in positioning epiduralized moms to facilitate labor progress (see Spinning Babies) can truly make the difference between a vaginal or C-Section birth.
Homebirth moms choose homebirth for good reason. Most of them don’t need to be convinced that it is a good choice. Therefore, it doesn’t diminish their decision to remind them that in case of hospital transfer, a skilled, respectful and responsive team awaits them. “Such-and-such hospital is so wonderful, I always feel safe in the rare case that I need to transfer a mom there.” “The nurses at such-and-such hospital are kind and skillful, they will try very hard to make your experience amazing and empowering.” Once a mom meets her attending physician, it’s helpful to say, “Dr. so-and-so is really great, he really tries whatever it takes to help a mom have a vaginal delivery.” 

Even if you yourself have had a less-than-ideal experience with the hospital, or a nurse, or a physician in the past, it’s important for you to express to the mother that she can feel safe.
One of the hardest things to do in the case of hospital transfer is to help a mother accept the need for medical intervention.
Most likely she has spent 40 weeks (or longer) doing research on epidurals, Pitocin, and C-Sections, and why they are not at all what she desires for her or her baby.
At my hospital I am the “go-to” nurse in the case of homebirth or birth center transfers. The reason why is because my patients tend to respond very well to the unexpected changes in their birth plan. The first thing I do to gain their trust is to tell them how supportive I am of out-of-hospital birth. Then I promise to them that unless it is an absolute emergency, they will have autonomy in every decision that they make. I give them time, space and support in making decisions about their plan of care. It is my hope that they feel that they were offered true informed consent.
I also remind them that every medical intervention, when used consciously and judiciously, can be a tool. Pitocin can be very therapeutic in the case of a mom that has been “stuck” at 7 cm and zero station for the past 10 hours. An epidural can help relax a mom who’s had back labor for four days. There are no hard and fast rules of “Option A is good, Option B is bad”. The plan of care has to be individualized for each mom-baby, and whatever decision the family makes, after informed consent, must be considered the best decision for them.
It’s devastating for a mom to let go of her dreams for her birth. As we must emphasize over and over again, in a million different ways, when it comes to birth a healthy baby is not all that matters. Loss as a form of birth trauma can exist even when a woman and her baby come through birth safe and healthy, and even when a woman is treated with respect during birth. Depression about the loss of an ideal birth can persist years later, and for some women it can affect the relationship with their babies.
The first step in supporting a woman through this loss is to acknowledge it. I tell my homebirth transfer moms that this kind of sense of loss, or even grief, is real, and that any feelings or reactions are ok. Postpartum support, especially 1) counseling to process feelings, 2) postpartum doula support to enhance connection and healing, and 3) postpartum community to help validate women’s feelings as real and appropriate, can all help through this process.
As the amazing PennySimkin teaches, women remember their births for the rest of their lives. Memories from their births form a narrative that women carry with them for as long as their memory is intact (and for some, even longer). This narrative tells them what strength or weakness they possess, what they are capable or incapable of, and even what kind of mother they are.
Mothers who lose their ideal birth can sometimes battle secret fears or beliefs about themselves. “I wasn’t strong enough to have a natural {un-medicated} birth.” “I didn’t eat healthy enough / exercise enough / go to the right body-worker / relax or surrender enough to have a ‘natural’ birth.” “It was wrong for me to trust my body / trust my instincts / trust my self.”
Knowing that women remember their births for the rest of their lives, use this to your advantage. During the birth time, create memories of loving and affirming words that a woman can replay in her mind.

You are strong.
You can do this.
This is one of the hardest things you’ll ever go through, and you’re showing incredible courage.
You trusted your body, and that trust kept your baby safe.
You are amazing.
You are a warrior.

Featured Photograph by Red Plum Photography. 

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