Jessica Florio month 9 of pregnancy

My Birth Plan Didn't Go As Planned—And That Is Perfectly OK

At 40 weeks and five days pregnant with my son, I woke up bright and early at 6 a.m. to head to the hospital for my induction. It was finally time!

While I had hoped to go into labor naturally, our baby was showing no signs of budging anytime soon, and I was ready for this kid to be out. I ran through the Google sheet checklist that I had put together with my husband: pillows, extra-long charger, healthy snacks? Check, check, check. Printed copies of the completed birth plan? Check! 

One piece of pregnancy advice that got drilled into my head early on was to make a birth plan. A birth plan is exactly what it sounds like: an outline for how you’d like your labor and delivery to go. It can include as little or as much information as you’d like. Details may include preferences on pain relief, positions for pushing, how bright the lights are, breastfeeding versus formula, rooming with your baby, and more.

My Birth Plan

  • Start labor naturally
  • Spend early labor at home with a doula and my husband
  • Once closer to active labor, head to the hospital
  • No labor quickening drugs such as Pitocin
  • Open to an epidural, but want to wait as long as possible to get it
  • Vaginal delivery, no instruments, no episiotomy
  • Delayed cord clamping
  • Immediate skin to skin for one hour
  • Initiate breastfeeding

Our doula had given us a template to work with that she personally put together, but a birth plan can be as formal or informal as you'd like. The main thing is to outline and make clear your wishes based on what you find most important in the labor and delivery process. We printed out a few copies of our plan to give to the nurses, but none of that ended up mattering. Because my birth plan did not go as planned.

Right off the bat, I had to accept that my birth plan wasn’t starting out the way I had wanted. As I mentioned, I was hoping very much to go into labor on my own. The first part of my plan was to labor at home, with my doula and my husband, utilizing the natural pain relief techniques that we had practiced and discussed. The list included deep breathing, visualization, soaking in the tub, massage, and acupressure.

Once my contractions picked up speed or if the pain became unbearable, then I would head to the hospital. I very much wanted a vaginal birth and was fearful of causing going to the hospital too soon could cause a cascade of medical interventions that could ultimately lead to a Cesarean section. (It has been found that early arrival to the hospital leads to more medical interventions, which ultimately lead to a higher rate of C-sections.)

C-Section and Medical Interventions

Induction itself is not a cause for increased rates in C-sections. However, in an induction, medical interventions begin right away. Research has shown that more medical interventions do lead to a higher rate of C-sections.

Induction begins with cervical ripening drugs, labor-inducing drugs, and/or mechanical instruments. One of the drugs used to augment labor is Pitocin, a synthetic form of oxytocin that imitates natural labor by causing the uterus to contract. These forced contractions are often more painful and closer together, leaving less time for the parent and baby to recover. This can lead to the need for an epidural if one has not already been given, as well as the need for constant external fetal monitoring. It has been found that both of these medical interventions specifically are linked to an increased risk of C-sections.

C-sections themselves carry risks for both the mother and baby, including maternal death, infection, and postpartum depression.

However, instead of the natural start I had envisioned, I was getting induced. Although I was disappointed, I was happy and relieved to get the birth process going.

I was told by my doctor that based on the conditions of my cervix, the induction would likely take two full days. I relayed this information to my doula, and we decided that she would join me and my husband once I started active labor.

At the start of the induction, I spoke with the doctors and nurses about my birth plan wishes, and we discussed the options I had. The staff wanted to begin with Cytotec (misoprostol) or Cervidil (dinoprostone)—drugs that medically soften and open up the cervix. However, I was not comfortable with those options due to the slight risk of uterine tachysystole (intense uterine contractions which can lead to fetal distress).

My other option was to get a foley bulb catheter, a mechanical device that also opens the cervix. After the bulb is inserted, it slowly dilates the body to 3 centimeters before falling out. You can get an epidural for this, but because I wanted to experience labor as naturally as possible, I went without it. (A word of warning—when the catheter is placed inside the cervix without an epidural, it can be quite excruciating!)

Things weren't going as planned, but having control over how my induction started helped me to feel calm and in control despite the pivot.

Things weren't going as planned, but having control over how my induction started helped me to feel calm and in control despite the pivot. The whole time, I talked on the phone with my doula about what was happening. While she was not physically present yet, she continued to offer guidance and support until it came time for her to head to the hospital. I reminded myself to be flexible and that there were still parts of my birth plan that I could achieve.

After a few hours, the foley bulb fell out. I was just barely dilated to 3 centimeters. During that time, I felt a sense of fullness inside, but no more pain. My contractions were mild and had no real consistency. I thought my water had broken, but that was just me peeing on myself because the bulb made it hard to control my bladder. (Fun!)

I spent the rest of the afternoon walking the hospital halls, bouncing on my exercise ball, and waiting to reach active labor at six centimeters. But by 7 p.m., nearly 11 hours after arriving at the hospital and 10 hours after the bulb insertion, I was still stuck at just barely three centimeters with no consistent contractions, and no water break. The next step was Pitocin, a synthetic form of oxytocin that helps labor along by augmenting contractions and cervical dilation. Definitely not a part of my birth plan!

The nurse and doctor gently explained to me that my body simply wasn't budging. In order to keep with some semblance of a Pitocin-free birth plan, I asked: "Could we do the lowest dose possible?" and they both agreed. The nurse explained the dosage amounts and showed me where I could see how much Pitocin was going in. She promised that every time she raised the amount, she would tell me first.

Expressing my wants and making it clear that I still wanted to feel when it was time to push was a good compromise. I felt empowered, even though it wasn’t my ideal plan.

Over the next few hours, we waited patiently for things to pick up speed. I watched movies with my husband on our laptop and tried to walk around a bit more. My contractions were picking up, but I was still only four centimeters dilated. The pain was bearable, like a very bad period cramp combined with a squeezing sensation. By midnight, I was desperate for sleep, but I knew there was no way I'd sleep through the contractions. My doctor, who had also been my main OB/GYN throughout the pregnancy, leveled with me. She told me that there was no way I'd have the energy to push if I didn't get any sleep. It was time to up the Pitocin and get an epidural. I was so exhausted at this point, I heartily agreed.

I think I knew deep down I would probably get an epidural, but I was very much hoping to be further along in active labor. I wanted to experience as much of the process naturally as possible. (Plus, I had a huge fear of getting a needle in my back!) I was frustrated to be straying from my birth plan but once again instead of losing all hope, I thought of how I could still make it sort of work.

I talked with the anesthesiologist about keeping the epidural dosage low, just as we had with the start of Pitocin. I also told her right away my fears over spinal needles, and I was so thankful that she was able to talk to me not as a patient but as a friend. "Honey, I promise I'm not going to paralyze you, and here are the reasons why!" she said. Expressing my wants and making it clear that I still wanted to feel when it was time to push was a good compromise. I felt empowered, even though it wasn’t my ideal plan. 

Around 1 a.m., the epidural was in, my doula arrived, and I thought I'd be able to relax. But that night, I tossed and turned from anxiety and the contractions I still felt. I ended up asking for the doctor to increase the epidural, so I was able to get a little bit more relief and sleep. Early in the morning, around 5 a.m. or so, I was seven to eight centimeters dilated but my water had still not broken.

I wondered, 'Was I making the right choices? Or was I just trying to speed through the process that I had so desperately wanted to move on its own pace? Would I be disappointed in myself later on for not sticking to my birth plan?'

With my consent, the doctor ruptured the amniotic sac with a long metal tool that looked like a crochet needle. I wondered, "Was I making the right choices? Or was I just trying to speed through the process that I had so desperately wanted to move on its own pace? Would I be disappointed in myself later on for not sticking to my birth plan?" All I could do was hope it would all turn out for the best.

After a restless night, with my doula sleeping in a chair and my husband on a pullout couch, I woke up around 7 a.m., close to 10 centimeters dilated, and feeling good about going into the next day! But the curveballs kept coming. Our postpartum doula (not to be confused with my awesome birth doula) had sent me an email saying that she was severing ties with the agency we found her through, and would no longer be able to work with us. What the heck?! My heart sank, and I tried not to cry. The agency apologized and told us they would send a replacement but it was someone who we’d never met before. My birth doula offered to help, but contractually we had to stick with the replacement or lose our deposit.

A postpartum doula is such an intimate role. While a baby nurse focuses on the newborn, a postpartum doula also tends to the mother and family as a whole. They do things like light cooking and housekeeping, breastfeeding support, and gathering postpartum supplies such as icepacks and pads. They are there for the rawest moments of early motherhood when you are bleeding, leaking, and possibly crying while tending to your newborn. We had interviewed several postpartum doulas for the role, in person, over the course of many months. How was I going to feel comfortable with an absolute stranger in my home?

Thankfully, I had no time to dwell on this drama. I had to refocus and be present because it was time to start pushing! Not exactly the best way to start delivery, but I had no choice.

The next part of the birth plan was coming up—delivery. I wanted a vaginal birth, immediate skin to skin, and delayed cord clamping. I had my birth doula and my husband each by my side, and I was zoned in on finally getting to meet our little guy. Within the first few pushes, the doctor remarked on how well I was doing. It was looking like he’d be out in no time at all. But then, of course, things went awry.

Our son was making his way down the birth canal face up, a.k.a. "sunny side up." When the baby isn’t facing down, it becomes much harder to push, and ups the risk of instrumental birth or a C-section. Just one more hurdle to get through, but I was determined to do it. I pushed for nearly three hours, in all sorts of different positions, and was so worn out towards the end that I was sleeping in between pushes. Thankfully, I had a great team to get me through it, and I was able to vaginally give birth to our son, Edward Joseph.

The very last part of my birth plan for labor included delayed cord clamping, immediate skin-to-skin contact, and trying to get a good first latch. It seemed that this part of the plan was still very much on track, and I was so excited to experience the "golden hour" with my newborn. My husband did get the cut the cord after we waited a minute or two, but of course, the golden hour didn't happen.

After pushing for so long, on a few hours of sleep, I could barely keep my eyes open. I had only spent about 10 minutes with my brand new baby on my chest before I felt myself starting to nod off. I didn't feel safe keeping EJ on me while I slept, so I reluctantly handed him over to my husband, who took off his shirt and placed our tiny human on his chest. While our son did not get much skin-to-skin time with me, he got it with his father instead. We didn't get to initiate breastfeeding until hours later in recovery. Once again, I felt disappointed but knew that it was what was best for us all.

My birth plan did not go as planned, but I'm OK with that. I'm still happy that I made one. It helped me learn what I wanted, and gave me the tools to navigate labor and delivery when my preferred choices were not possible.

My birth plan did not go as planned, but I'm OK with that. I'm still happy that I made one. It helped me learn what I wanted, and gave me the tools to navigate labor and delivery when my preferred choices were not possible.

While I stayed flexible and positive throughout my labor and delivery, I sometimes think back to this time and long to re-do it all. I get wrapped up in how much I strayed from my birth plan. But then I start to think about all of the things that went right. I gave birth to a healthy baby! And ultimately, that was by far the most important part of the plan.

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5 Sources
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By Jessica Florio
Jessica Florio is a blogger and freelance writer as well as a stay-at-home mom.