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When Your Birth Plan Doesn’t Go According To Plan

If I tell you that things went horribly wrong when I gave birth to my daughter, I am not overreacting. I’m not talking about a poor maternal or foetal outcome here, since both Eryn and I were perfectly healthy throughout the labour process. I’m talking about my birth plan, and somehow I doubt I’m not the only one who had her entire birth plan turned upside down.

If you have only ever read one pregnancy book while pregnant, one of the key messages is always to have a birth plan. In fact you can even download templates online – three-page birth plans, which you have to copy and give to your husband, midwife or gynae and anyone else involved in your labour process.

Birth plans are not altogether a bad thing. They allow you to do some research. To research every labour technique and every pain intervention that exists. This way, you know all of your options going in, so during labour you can panic less about the unknown.

This was my plan… I wanted a NVD (normal vaginal delivery), and I did not want any analgesia and most definitely not an epidural. Yes, I basically wanted to be Wonder Woman. I have seen so many women in labour over the years and thought that it was very doable without any intervention. Of course, my gynae thought I was being ridiculous and asked me at every antenatal visit whether or not I had changed my mind, especially given my advanced maternal age (yep, 35 is OLD). I never did. I had done my homework, and this was my birth plan.

I did buy myself a TENS machine for during labour. These machines provide a drug-free kind of pain relief for the early stages of labour by delivering small pulses of electrical current to the body, which supposedly blocks pain signals. The research here is still not conclusive, but I didn’t care, I was going with it.

The day I went in for my 38-week appointment, my gynae and I established that if I was to wait until 40 weeks, there was no way I would be able to push Eryn out since she was already 3.5 kgs. So, we decided I would come back to the hospital the next morning for an induction. I suppose this was the start of my birth plan derailing. The next morning I woke up at 04h30 with the worst Braxton Hicks, which by the time I reached the hospital were no longer teaser contractions but the real deal.

At around 13h00 in the afternoon, I was a good 5 cm and bouncing quite comfortably on my exercise ball with the TENS machine firmly attached. Come 16h00, I was still 5 cm, and at that point, my gynae wanted to get involved. We decided to augment my contractions (make them stronger since they were clearly not doing the job judging by the relatively pain-free experience I was having). So they put up a drip and gave me the mother of all drugs, Pitocin, which I now have a newfound respect for. I have prescribed this drug many times in the past and had absolutely no idea how strong it was. I went from hero to zero in a minute and demanded painkillers. Then that question popped up… do you want an epidural? I declined the offer and instead opted for Pethidine. This was the biggest waste of time, and after 30 minutes, I was crying for that epidural. The anaesthetist had a tough time getting the needle into the right place since I couldn’t sit still because of the strong contractions I was having, so its no wonder she managed to pierce my dura (more about this to follow later).

After the epidural was given, I managed to dilate fully in under two hours. This meant that when the time came for me to push, I couldn’t feel a thing. I was not able to sense when I needed to push, and so my gynae had to guide myself and my piles through the whole experience.

When I eventually managed to deliver Eryn, things became really blurry. The Pethidine had by now gone to my head, and I was vomiting bile. I was unable to hold my daughter because I was shaking so much that I missed out on that precious skin to skin moment post-delivery. At some point, I succumbed to my numbness and must have fallen asleep, because the next thing I remembered, I woke up alone in a room with a catheter in-situ and no baby in sight. Panic set in and after pressing the emergency button for way too long, a nurse eventually came to remove the catheter and take me to the nursery where I laid clear eyes on my daughter for the first time, some eight hours after giving birth to her.

Unfortunately, my eyes weren’t clear for very long because I ended up developing a spinal headache. The epidural had gone wrong, and I had fluid leaking from my spine. This headache was so bad all I could do was lie flat in bed in one position and drink copious amounts of Redbull. Yes, this was prescribed! I eventually ended up in theatre for a procedure and was discharged three days later. What was supposed to be a short two days in hospital ended up being five very long days.

The bottom line is that labour is unpredictable, and each birth story is unique. Sometimes a magical experience starts off like a nightmare. So yes, research everything there is to know about how you will be able to get your baby out of your womb in a way that speaks to your values but allow yourself some flexibility. The most important thing is that you deliver a healthy little human who you will spend your entire life explaining to why life doesn’t always go according to plan.

Shouldn’t It Be “Fed Is Best”?

This post is a little different to my others because it is personal. I want to share more of my momlife journey with you so where better to start than at the beginning, with one of the first challenges I had to deal with when becoming a mom.

No one tells you before having kids how difficult breastfeeding really is. The phrase “breast is best” is one I have constantly heard over the years and one that I myself have drummed into my patients. My breastfeeding journey was a time in my life when I have never felt more incompetent. I have spent so much time over the years ‘lecturing’ expectant parents and new moms about the benefits of breastfeeding and even shown some moms how to latch correctly. I would have thought that with all my knowledge I would grasp this breastfeeding skill from the beginning, but I did not.

It took two midwives and three lactation specialists to finally tell me I had flat nipples. Clearly, I have never looked at my breasts properly. With this newfound information I went out to buy a range of different nipple shields thinking this would solve my problem. After 2 weeks of becoming obsessed with breastfeeding I realised my daughter was not gaining any weight and was in fact losing it. So I decided to scrap the shields and embrace my breastpump.

I exclusively pumped for three very long months. I sometimes think that this required even more effort than the breastfeeding. I had to pump at regular intervals throughout the day and night to ensure a good milk supply, since the suction from a pump is not as efficient as the suction from a baby in stimulating milk production. After three months, I went back to work. The pumping was going to be even more difficult and to be honest I was a bit over constantly having to sterilise the parts. And so began my quest to find the best formula.

I remember staring at that formula aisle for a really long time feeling overwhelmed by all the options available. Of course I knew some names like NAN, Isomil and S-26, but there were so many more. I had no idea what the difference between all of them was (they don’t teach us this at med school) so I asked someone for help. You know what I was told? “I am not allowed to tell you anything about formula”. I was now really confused and very angry.

Before the 80’s, women were encouraged to formula feed (obviously to the benefit of the big pharmas). Unfortunately such messages were exploited in underprivaledged communities. This had devastating consequences with rising infant mortality rates in these areas. I won’t go into any detail about the Nestlé formula scandal but it did cause a global uproar and now there is a code in place which restricts the marketing of breast-milk substitutes worldwide in order to protect breastfeeding. South Africa has incorporated this code into legislation and this is why it is so damn hard to get any information about formula. Our former health minister, Dr Aaron Motsoaledi, even suggested formula be banned throughout the world stating it is “no different from skin lightening creams”.  Yes, seriously, this comparison was made.

As if being a mother isn’t hard enough, we now have to find time to do our own research or pay to get this information by going to see our Paediatricians (and I don’t even think they know everything there is to know about formula). If breast is best and if this code is so effective then why are we constantly being bombarded with confusing messages. On one end breastfeeding in public is still very much taboo yet everyone tells us we need to breastfeed. On the other end we should not formula feed our babies yet bottle feeding is easier on the eye and we all need to go out and buy those new self-warming bottles.

Shortly after I stopped pumping I took Eryn to a birthday party. Most of the moms there were successfully breastfeeding either their infants or toddlers. All these women spoke about the entire morning was breastfeeding. I never said a word because I felt ashamed and excluded. In hindsight, I am angry at myself for having felt that way. I was sitting there with a very healthy baby girl on my lap and so what if she was being formula-fed.

I’m sure we can all agree that breast is best but I think we are taking things a little too far. I would like to see the narrative change to “fed is best”. I don’t deny the benefits of breastmilk but this may not work for everyone. The success of breastfeeding is a complex combination of many factors. All it takes is for one wheel to come off and then the whole ride can become very bumpy.

We live in a society where freedom of choice is celebrated. Why then are mothers judged so harshly for the feeding methods they choose? Since becoming a mom I have learnt that mothers are the harshest critics and supreme court judges. We really need to take a step back and start to create a safer all-inclusive space for mothers to exist. A space where single, divorced and widowed moms, breast and formula feeding moms, moms with post-partum depression and anxiety, adoptive and foster moms, working and stay at home moms, biological and stepmoms can all be celebrated as the real mothers they are.

RESOURCES

https://www.who.int/elena/bbc/regulation_breast-milk_substitutes/en/

https://www.news24.com/SouthAfrica/Politics/Ban-infant-formula-Motsoaledi-20100513

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