2. The Delivery
The Text Book Birth
Some lucky women start labour by themselves, cope really well with TENS, a bit of gas and oxygen, jump in the birthing pool and after 4 hrs push out a beautiful 3.5 kilo baby who hardly touches the sides, cries immediately and jumps straight on the breast. No cut, no tear, like a big Orgasm! (we’re kidding about that bit!)
Dream on, I hear you say, but it does happen. About 20 % of women do not find labour the worst thing that has ever happened and find they can cope with minimal pain relief and can push the baby out with minimal trauma. These women are the ones that write all the books saying childbirth is all about having the correct mental approach and you can just breathe the baby out. Quite annoying really, as in the real world the other 80% are going to find labour one of the most seriously challenging and possibly painful experiences of their life.
The Birth That Wasn’t in Your Birth Plan
We have all heard of the “horror” stories. Waters breaking, the baby is back-to-back , you have to be induced, epidural not fully effective, got fully dilated but baby not safely deliverable vaginally so an emergency C Section after 36 hrs in labour. Not quite as you had outlined in your carefully constructed Birth Plan.
So Why Can’t We Predict The Birth?
You might think that with all the advances in modern midwifery and obstetrics that all of these events might be predictable. But no!
There are simply too many untested variables in a first labour for even the most experienced Midwife or Obstetrician to be able to give any more than an educated guess about how it will go.
Let me explain…
First of all there is the uterus. This is its first real test and its a bit of an experiment! Sure, it may have dealt very well over your life time with two or three hundred periods, but suddenly it’s confronted with a 3.5 k baby, maybe a litre of fluid, and the baby’s baggage! It’s v different and sometimes the poor old uterus does not quite get it right. It can be a little uncoordinated. There are a lot muscles in the uterus and they all need to work together.
Next there are the soft tissues and the good old pelvic floor. Some tissues are more resistant than others, and some just give way with the first decent contraction or push. You actually don’t want all resistance to disappear as, if that’s the case you may find it difficult to get back to normal afterwards. So it’s all about your elastic, which you cannot predict.
Thirdly , there is the baby. Of course you say “it’s the size”. Just look at the fathers head and he’s six foot four and I’m only five foot two! However, it’s the position of the baby rather than the size which is the greater factor in determining the outcome of first labours.
Most women with an average sized pelvis can expect to deliver a baby of up to 9 lbs providing all goes well. Most importantly the baby has to have his head tucked down and pointing in the right direction . Even an Amazonian woman of six feet with size ten shoes is going to have great difficulty with a six pound Baby in the “wrong position’ with his head extended and lying on his back in the wrong position!
It’s true that an experienced midwife or doctor can often spot the abnormal position in the clinic, or with a scan, but it’s in labour when it matters, and often the back-to-back baby is not detected until the waters have gone and you can feel the baby’s head properly.
So…what to do?
Expect the unexpected. Have a flexible approach. Do not get too obsessed with your Birth Plan . Do some good Antenatal Classes and be prepared. You can get amazing surprises, both good ( like a predicted 4 kilo baby in a back-to-back position , that magically pops out with a normal delivery of a 3.2k baby) and more challenging ( like an undiagnosed breech baby that needs an unplanned C Section).