By Amber Lewis, staff writer for The Attached Family publications

“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.”
~ Gloria Steinem, Ms. Magazine, April 1981

Most pregnant women will tell you they have a plan for their labor, but just as parents cannot imagine how their children will turn out as they grow and mature, soon-to-be mothers cannot be guaranteed a perfect birth. Labor experiences are as varied and vast as the types of people who go through them and the children those experiences bring into the world. There are just as many emotions involved in this miraculous experience, and while many births are happy and uncomplicated, others can be deeply disappointing for the parents.

This leads to the question: What to do when childbirth does not go as it was planned to?

First, we need to dismiss the notion that a mother can plan her child’s birth. While some aspects can be controlled, the event as a whole is beyond human influence and mothers need to admit that truth first and foremost. A few mothers can do everything “by the book” and still lose their child, and then there are those mothers who seem not to even realize they are pregnant and are eventually presented with a perfect surprise birth that is to be tomorrow’s headline. The reality is, expecting parents must hope for the best while being prepared for the other possible outcomes.

Much of the time, the process of giving birth goes well, and it is a joyful event. Other times, complications arise and leave deep emotional wounds in the birthing mother. Even some births that occur without complications can jolt a mother’s emotions, such as when the pain of labor was greater than imagined. Childbirth can be both terrifying and triumphant in the same instant, and the accompanying emotions can be both empowering and frightening. If you had a disappointing birth experience, it is important not to feel that your labor experience will foreshadow the type of mother you will become.

On the following pages are several of the more common interventions that could arrive during childbirth, possible interventions of those complications, and the ways parents can try to deal with the reality of these interventions. This article is meant to help parents-to-be realize that complications can and do arise at times, but it’s best not to dwell too much on what can go wrong but rather to keep the end goal of labor in mind: a healthy, beautiful, perfect baby and a happy mother.

Episiotomy

What is it?
An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth.

When is it necessary?
Episiotomies are no longer normally preformed (previous school of thought believed them to be beneficial to the mother; however that has been proven incorrect in most cases). They are now only preformed when extensive vaginal tearing is possible, the baby is in an abnormal position for delivery, or when the baby needs to be delivered quickly, as outlined in the MayoClinic.com article, “Episiotomy: Can you deliver a baby without one?”

How will an episiotomy affect your recovery?
There will be some extra pain when sitting or walking, but this may also be painful due to natural tearing during birth. The new mother will have to take extra time to care for the wound, as well, rinsing with warm water after she urinates and soaking the area in warm water. After about two weeks, the incision will usually heal.

How could an episiotomy affect mother-child bonding?
Unless the episiotomy was extensive and/or there was additional tearing, it should not adversely affect mother-child bonding after delivery. If tearing occurs in addition to the episiotomy, the pain can be severe, interrupting sleep and requiring medicated pain relief, which could make the mother drowsy. If tearing was minimal, the mother may feel more pain and discomfort than she would without an episiotomy, depending on the normal trauma the area receives during birth. However, whether this extra pain would affect mother-child bonding depends on each mother’s pain tolerance and individual recovery. Otherwise, the mother may need to take extra time away from the baby to care for the incision, such as taking daily sitz baths.

Cesarean Section

What is it?
A Cesarean section is a surgical procedure where the obstetrician will make an incision in the mother’s abdomen in order to delivery the baby.

When is it necessary?
A Cesarean section is deemed necessary when the risks associated with a vaginal delivery are too high for the mother or child. According to the MayoClinic.com article, “C-section,” the risks increase when the baby is not in the correct position, there is a problem with the placenta, the umbilical cord has slipped through the cervix before the baby, labor is not progressing, the baby is very large, or when the mother has an underlying health condition that makes vaginal delivery dangerous.

How will a Cesarean section affect your recovery?
Full recovery from a Cesarean section takes six to eight weeks. The hospital recovery period is three days — one day longer than that of a normal birth.

How could a Cesarean section affect mother-child bonding?
Depending on the reason for the Cesarean section, a mother may not be able to hold her child immediately upon delivery. At this point — especially after an emergency Cesarean section — it is important to realize the end goal is a healthy mother and child and bonding time that may be lost after delivery can be quickly recovered.

In addition, a Cesarean section may make breastfeeding more difficult. It is very important to seek out a lactation consultant or someone with experience breastfeeding after a Cesarean section. The new mother should experiment with different ways to hold her baby and discuss the pain medications she is taking and the possibility of those passing through the milk. Asking questions and voicing all concerns is important for a new mother, especially after a Cesarean section.

Support after a Cesarean section is essential for the mother so that mother-child bonding can take place. The mother will experience pain and discomfort and difficulty caring for herself for the first couple of weeks. Support of family and friends will be needed to help aid in the healing after a mother returns home, especially if there are older children. The mother will be forbidden to do housework, pick up older children, or do strenuous exercise for at least six weeks. Pain medication can make her drowsy.

Induction

What is it?
When a health care provider induces labor, he uses medical means to encourage your body to begin producing contractions and bring you into labor. According to the BabyCenter.com article, “Inducing Labor: What are some of the Techniques Used to Induce Labor?,” the variety of methods include: prostaglandins (a type of medication inserted into the vagina to help to soften the cervix), a foley catheter (a very small uninflated balloon placed in an already dilated cervix and then inflated with water to put pressure on the cervix to encourage further dilatation), stripping the membranes (when the health care provider manually separates the amniotic sac from the lower part of the uterus), rupturing the membranes (breaking the amniotic sac with a small hook-like instrument), and administering pitocin (a man-made version of the birth-inducing hormone, oxytocin).

For the purposes of this section, consider induction to be administering pitocin. Rupturing the membranes is discussed in detail later in this article.

When is it necessary?
Induction is done when the doctor feels the risks for waiting for labor to naturally begin are greater than the risks for inducing labor. This is usually because there is a problem with the pregnancy or labor is not progressing after the water has broken. When labor doesn’t begin after the membranes have ruptured, the risk of infection increases with every hour the baby remains in the uterus.

Problems with the pregnancy that might require induction are preeclampsia, a low amount of amniotic fluid, the placenta not performing properly, a previous labor that resulted in a stillbirth, or any medical condition that would put the mother or child’s life at risk, such as chronic high blood pressure, diabetes, and kidney disease, according to BabyCenter.com.

How will an induction affect your recovery?
The recovery should not be been any different from that of a natural birth unless another complication arises during the induction.

How could induction affect mother-child bonding?
Complications are rare with inductions; however, there is a small chance of placental abruption (separation of the placenta from the uterus wall) or uterine rupture. Both cases would be serious for the mother and child and could require immediate medical intervention by the way of a Caesarean section and follow-up surgery, depending on the severity of complications. Either of these complications could prevent immediate mother-child bonding, but for the most part, induction should not interfere with the bonding immediately following the delivery.

Rupturing the Membranes (Breaking of the Water)

What is it?
Rupturing the membranes is one of the more common methods health care providers use to help naturally induce contractions. When a mother is in the hospital and a few centimeters dilated, the doctor can insert a small, plastic hook into a mother’s vagina to rupture the amniotic sac.

When is it necessary?
Rupturing the membranes is done when the doctor wants to induce labor without using pitocin. Usually the mother is in the hospital and already dilated and has been for sometime. This can encourage the labor process to speed up to try to avoid tiring the mother.

How will rupturing the membranes affect your recovery?
None, as this is a painless procedure and the amniotic sac must break anyway to allow the baby to be born.

How could rupturing the membranes affect mother-child bonding?
There should not be any complications that would affect mother-child bonding. Occasionally, the water that comes out is yellow or brown in color which indicates the baby has had a bowel movement in the uterus and needs to be delivered quickly in order to avoid infection, which may require an episiotomy or Cesarean section, depending on the circumstances and how quickly the labor progresses naturally. These complications, should they occur, may affect the mother-child bonding.

Epidurals and Other Forms of Pain Relief

What is it?
There are many different types of pain relief for mothers in labor. Some can take all the pain sensations away and others will only dull the pain. According to the University of Michigan article, “Pain Relief During Labor,” at www.med.umich.edu, the classes of pain relief include:

• Systemic analgesics provide pain relief over the entire body without causing loss of consciousness. These types of medication may cause drowsiness and may make it hard to concentrate.
• General anesthesia provides total loss of sensation and is usually reserved for emergency Cesarean delivery.
• An epidural block is a form of regional anesthesia that numbs the lower half of the body to a varying extent, based on the type of drug and dose used.
• A spinal block is similar to an epidural in that it numbs the lower half of the body. However, it is different in that it starts working quickly and is effective in small doses.
• Local anesthesia affects a small area and is commonly used during episiotomies.

When is it necessary?
The use of pain relief is dependent upon the mother’s pain tolerance and the circumstances of the delivery. A mother may be experiencing more pain than she anticipated and request relief. A health care provider may suggest pain relief to help relax the mother, especially if there are complications, or may require quick pain relief in the case of an emergency delivery.

How will pain relief affect your recovery?
There are side effects to any pain medication given. In the mother, these side effects can vary from a headache and nausea to drowsiness and prolonged loss of sensation. The baby may also be drowsy or uninterested in nursing for a short time after birth.

How could pain relief affect mother-child bonding?
The amount of pain medication administered and the time it takes to wear off could possibly affect the mother and child immediately after birth, as they may be drowsy or the mother may not have sensation in her legs and unable to move much. However, no mother should feel guilty about using pain relief during labor, as pain relief can help the mother regain control during labor and birth, and helping her to relax and enjoy the experience more. For some mothers, pain relief may be the mother’s key to leaving the birth experience without fear of having another child.