Unexpected Outcomes of Labor

Section [8] on this website presents variations in the usual progression of labor and the possible medical interventions that could result. The next section discusses cesarean birth. If you are like most expectant parents, you are probably saying, “These situations don’t apply to me.” But the reality is that every labor and birth is unpredictable, and yours may not be the “ideal” experience that you have been hoping for. It is important that while you are designing your birth plan, you discuss all the possibilities and try to conclude how you would respond if confronted with an unexpected outcome.

Any variation from your birth plan is an unexpected outcome. While a labor that goes faster or easier than you planned is an unexpected outcome, most women have positive feelings after that type of experience. When the outcome is not as planned and is very sad or upsetting, you may require help in dealing with your feelings.

An unexpected outcome may be a cesarean delivery when you had planned on having a vaginal birth. It could also be accepting an epidural when you wanted an ™medicated birth. Occasionally, women feel as if they were told one thing by their caregiver before labor and then were treated differently or without regard to their desires once they were admitted to toe hospital. They may have felt rushed or pushed into accepting procedures they did not want.

Women who plan to deliver at a birth center and then require a transfer to a hospital often have to deal with their own feelings while dealing with the questions and comments from family and friends. An unexpected outcome could also be baby-related. The infant may be premature, require treatment in the intensive care nursery, or have a deformity.

At the very least, you can expect to have feelings of disappointment. Get adequate rest and try not to be Superwoman to compensate. Accept offers of help. Guilt and anger are also common emotions at this time. These feelings are normal and should not be minimized. You and your partner should share your feelings with each other. If they persist, attending a new parents’ support group may prove helpful. Get a copy of your medical record. This may give you additional information on the course of your labor. It may also provide you with the knowledge to avoid repeating this experience with a subsequent pregnancy. You may want to avoid certain interventions next time, or change caregivers or place of delivery. And you should eventually come to the realization that, while you may influence, you cannot control all the circumstances during labor.

The ultimate unexpected outcome is the stillbirth or death of a baby, either before, at, or shortly after birth. No amount of preparation can prepare you for dealing with this type of devastating event. It is very important that you express your feelings of grief and be allowed to mourn the loss of your child.

The following are suggestions from parents who have experienced a stillbirth or infant death. They may help you in coping if you have this type of loss. The suggestions are:

□ Give your baby a name. It affirms that you are a parent and that there was a life lost for which you are grieving.
□ Hold and touch your baby. Remove the blanket so you can count the fingers and toes, and get a full image of your child. If you have other children, they and the grandparents may also want to see and hold the baby. This enables all of you to say hello and good-bye, and to acknowledge that you really did have a baby.
□ You may also want to get a lock of the baby’s hair, and have handprints and footprints made.
□ Have a photo taken of your baby, even if he has a physical deformity. If you are not sure that you want to have a picture, have a friend or relative keep the photo until you ask for it.
□ You may want to hold a memorial service with family and close friends. This gives you an opportunity to affirm that this child was born into the family, and it allows others to share in your sorrow and grief.

It goes without saying that you will grieve for the loss of your child. It is very important that you and your partner share your grief openly with each other. Women usually grieve more intensely and for a longer time than men. This is understandable because the woman carries the baby and begins to bond with him long before birth.

You can expect to experience a number of emotions as you go through the process of grieving. Initially, you may be in a state of shock, which is nature’s coping mechanism. This is often followed by denial. Feelings of anxiety and/or depression can be felt for some time after the death. Anger that this could have happened to you is a very common feeling at this time. Feeling guilty and blaming yourself or others for causing toe death are normal. Experiencing some jealousy when you see babies and other pregnant women is not unusual. Some women have difficulty attending baby showers or being around pregnant friends. A future pregnancy may also revive these feelings of sadness and vulnerability. While others may assume that you are happy about being pregnant, it is not unusual for women who have lost a child, either through miscarriage in early pregnancy or a loss in late pregnancy, to experience recurring periods of grief.

Obviously, grieving takes time. For many women, it can take 6 months to a year to reach a point of acceptance that allows them to move forward with their lives. The more open you can be about your feelings, the quicker you will heal. Let others know that it is okay to talk about the baby. You may also find it helpful to join a support group for bereaved families, such as Compassionate Friends or Resolve Through Sharing. Professional counseling or talking to a member of the clergy may also be beneficial. Some families choose to remember the anniversary by donating to a favorite charity in memory of the baby, planting a tree, or just talking about toe event. Some excellent books on the subject of bereavement include Empty Arms by Sherokee Ilse, and Silent Sorrow by Ingrid Kohn and Ferry-Lynn Moffitt.

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