Oddball labours

Despite modern advances, birth remains a highly unpredictable event. How to prepare? Do your homework, then expect the unexpected

Like all expecting couples, Claire Matthews and Edwin Hubert anticipated the arrival of their first child with a mixture of exhilaration and fear. And, like others, the Victoria, BC pair diligently enrolled in prenatal classes, eager to decode the mysteries of labour and delivery.

Across the country in Orangeville, ON, first-time parents-to-be Andrew and Claire Morris felt and did the same. They too hoped their baby’s entree into the world would be smooth and textbook perfect. Both couples created birth plans outlining their desires for as natural and non-invasive deliveries as possible.

Both couples’ stories have happy endings. Claire and Andrew Morris have a healthy nine-month-old girl; and Matthews and Hubert have a thriving four-year-old girl and a 17-month-old boy.

However, these parents’ adventures in the delivery room were not what they were prepared for. Given what happened, it’s hard to know how they could have prepared.

As Scottish poet Robbie Burns said, the best laid plans of mice and men often go awry.

Anticipating a slow, painful birth process, Matthews and Hubert had crammed two packs full of comfort aids such as soothing music, cooling lotions and scented massage oils. The packs, however, were never even opened.

Where others endure birth marathons, Matthews had a birth moment. Her daughter, Charlotte, arrived in less than four hours. Son Daniel’s advent was even speedier.

“With Daniel, it was 55 minutes from my water breaking to babe in arms,” Matthews says. “One of the nurses had been there when I’d had Charlotte. She said, ‘I don’t ever want to see you again because next time you’re going to have to camp in the hospital parking lot two weeks before your due date.’”

Morris was not so lucky. After 18 hours of active labour, an oxytocin drip, an epidural and nearly seven hours of pushing, she faced her greatest fear — a Caesarean section.

“I really was afraid of being cut open and being awake and being strapped down to a table,” she recalls. “I really wanted to be put to sleep.”

Morris is thankful she was. Her baby daughter, Abby, arrived grey and flaccid and with an APGAR score of one out of a possible 10. (A scoring system for newborns, APGAR stands for activity, pulse, grimace, appearance and respiration.) Andrew Morris says he was terrified when he first saw his daughter, but focused on “the good people working on her” and soon realized she was going to be OK. However, he didn’t tell his wife about Abby’s shaky beginning until the next day. “I just told her it was a girl.”

Despite tremendous advances in maternal and obstetrical care, birth remains a highly unpredictable event. While express deliveries such as Matthews’ and slow, scary ones such as the Morrises’ are uncommon, unexpected birth experiences are not. The fact is most people do not have the labour and delivery they thought they would.

In fact, Canadian Association of Midwives past-president and Abbotsford, BC, midwife Kim Campbell says labouring women undergo such a range of experiences, no one agrees on exactly what normal is. The biggest unknown and biggest source of anxiety for moms, Campbell says, is the length of labour.

“Most women want to know, ‘How long will my labour be?’ But time is the trickiest part; normal can be anywhere from 30 minutes to 24 hours.”

Campbell has seen other quirky occurrences: false labour where contractions start and then vanish days before real labour kicks in; a very long early labour which then proceeds regularly; ruptured membranes that are not immediately followed by contractions. All are perfectly normal.

Rarer but not unknown are women who feel absolutely no pain during the birthing process. Campbell has attended three such moms in her career and marvels, “They looked as cool as a cucumber the whole time.”

Abbotsford mother-of-five Jennifer Strilchuk is one of them. Pregnant with her sixth child, Strilchuk says her no-sweat deliveries are likely part of why she has the number of children she does.

“I’ve tried to analyze it a million times, why I’m so blessed — and I have no idea,” Strilchuk says. “I know what pain feels like — a broken toe is painful. My experiences are definitely intense, I feel heat and extreme concentration… but as far as pain goes, my period cramps are far, far worse.”

Carolyn Lane is a Calgary family physician and member of the Society of Obstetricians and Gynaecologists of Canada. She practises obstetrics exclusively. In 22 years of practice at between 150 and 200 deliveries a year, Lane says she’s seen “absolutely everything.” That includes babies in odd positions, umbilical cords that fall into the birth canal before the baby, placental separations, and birth anomalies that weren’t picked up on ultrasound.

For those approaching their first childbirth, such scenarios seem more than alarming. But keep in mind that the paramount goal of labour and delivery is a healthy babe and healthy mom and Canada has one of the best maternal and infant health records in the world. Nonetheless, giving birth is a transformative experience, and one that people hope will be as positive as possible. Although there are no guarantees, there are things couples can do to make unusual or difficult labours easier to cope with.

Coping Strategies
The right prenatal class
The first step comes soon after a woman knows she’s pregnant. Only three or four generations ago, that was when she turned to sisters, mothers, aunts and grandmothers to learn about what might lie ahead. Now, says Melissa Cowl, an Alliston, Ont. certified childbirth educator, doula and doula trainer, “we don’t learn about birth from anyone but the media and often that’s not realistic.”

Oshawa, Ont. midwife Kristy Hook agrees. “Our birth culture is largely framed by watching A Baby Story on TV, heaven forbid,” Hook says. “Often the first birth a woman is involved with in any way, shape or form is when she’s having her first baby.”

Cowl and Hook say good prenatal classes are essential. That’s where couples learn the basics, not only about the natural processes but about common variations. For example, one misconception dispelled in Cowl’s classes is that labour starts immediately after a woman’s water breaks. In some women it doesn’t, but that does not necessarily mean an induction is in order as labour will likely start spontaneously within 24 hours.

The right caregiver
Prenatal classes aren’t enough. Today’s parents have more obstetrical options than any previous generation and so need more sophisticated information. As well, prenatal classes tend to concentrate on what happens to most women most of the time, leaving out less common scenarios.

For Matthews, classes on how to endure long labours were, she says laughing, “a bit of a waste of money.”

Where prenatal classes leave off, however, the right caregiver can take over. If you have the luxury of choice — and these days many women don’t — choose someone who encourages questions and has time for answers. Knowing you are listened to and believing the information can go a long way to relieve anxiety and fear in a tense situation. It’s also helpful to research your caregiver’s practice history. If you hope to avoid an episiotomy, don’t choose a doctor whose episiotomy rate is 85 percent.

Even though Claire Morris had a C-section and needed an obstetrician, she is grateful she and her husband chose midwives to attend her pregnancy, labour and Abby’s birth. Right from the beginning, the midwives took an interest in Morris’s diet, working conditions and lifestyle.

“And during the labour, they spent a lot of time making sure I had full knowledge of what was happening,” Morris says. “I don’t have any regrets on how things went. It wasn’t what we’d planned, but we had a choice about everything that happened and we had knowledge about all that was done to us.”

Being able to ask questions, get satisfactory answers and feel like you are involved in decisions is critical to having a good birth experience, says midwife Hook. “I see people for their second or third baby and they have no idea why they had to have a Caesarean section,” Hook says. “The key to managing these things is to make informed choices along the way.”

Yet information, no matter how complete, can only go so far. In the grip of unfamiliar pain, worry and fright, emotion trumps intellect every time. Expectant couples know this and often arm themselves with a range of coping aids to help them weather a difficult labour. Lane has seen people enter the delivery room with favourite foods, massage devices, friends, significant pictures and specially selected music.

The right company
The absolute best coping strategy, Lane says, is not an object but a person, someone there not as a spectator or commandant but “someone who knows what you need when you need it, who knows exactly the right things to tell you to reassure you and tell you what a wonderful job you’re doing.”

While husbands and certain friends can sometimes fit that bill, for many women that person is a doula. Several studies show that continuous doula support to a woman during labour, birth and the immediate postpartum period has significant short- and long- term benefits to mother and babe.

“If I told you we had something that gave you shorter labours, less interventions, increased mother-infant bonding, more satisfaction with birth, lower Caesarean rates and lessened drug use, wouldn’t everybody be hopping on board to buy this new drug?” says Cowl, quoting John Kennell who is a founding member of Doulas of North America. “Well, we’ve got it and it’s a doula.”

The right attitude
So you’re equipped with the best knowledge, medical care and emotional support possible. Is that enough? No. The final coping strategy no one anticipating childbirth can be without is an open mind. Birth plans are great for couples wanting to have some input into what may or may not happen in the birthing room. But think of those plans as a wish list. A litany of do’s and don’ts could be a recipe for disappointment.

Asked how expectant couples can best prepare for the unexpected, Lane answers that they need to recognize that labour and delivery are part of life and so can’t be mapped out any more than whole lives can. “Life throws curves at you.”

Another way to view challenging labour experiences is as a rehearsal for the greater challenge ahead — parenting. Sometimes, the secret to success with both, Hook says, is to be able to “relinquish control.”

“Embrace childbirth as an experience that you’re going to be a part of, but don’t think for a moment that you can have control over all of the variables.”