Modern times: Don't be so pushy

Making a "birth plan" is about more than being prepared. It's about being in control. Here's why letting go of all that is way harder – and that much better

A lot of women don’t, but I looked forward to prenatal classes at my midwife’s clinic when I was pregnant with my first child. My inner Tracy Flick liked being a student again, scribbling notes and taking my first public stand in favour of being A Good Mother. At one point, I raised (okay, possibly waved) my hand and asked: “When do we do our birth plans?” To my surprise, the woman running the class – a lovely maternal type wearing a caftan – shook her head and told me to give it up. The best plan, she said, is no plan at all.

That’s not a common refrain these days. Birth is the greatest of the great unknowns, the most uncontrollable event of one’s life. I, perhaps like many women, tend not to do well with words like unknown and uncontrollable. I’m a writer, and my first instinct is to research a problem into submission, to plan the hell out of what’s ahead, and thereby conquer it. Let’s just say I like Google.

And so women prepare and prepare and prepare for the big moment: On one end of the spectrum is the ultimate birth strategy, the scheduled C-section; on the other is the doula-assisted “birth experience,” where moms-to-be role-play the birth. One couple I know were asked to draw pictures of what they imagined “the moment” would be like – in metaphor (“a lot of water imagery,” says my friend now, one C-section later).

Of course, preparation or no, when it happens, birth is usually a big, bloody mess. Is that gap between the dream and the reality the reason why so many women talk about the birth of their children with such disappointment?
Gillian, a social worker from Toronto, took prenatal yoga classes three times a week, enlisted a midwife and planned to labour at home and deliver in the hospital.

“I had the yoga mat, the medicine ball, The Birth Partner by Penny Simkin. We had a tape of soothing music from our yoga classes. I made my own massage oil, with essential oils,” she says, laughing. “How did I have time to do all that? What was I thinking?”

When the labour started, Gillian called her midwife, who told her to relax and try to rest. As the contractions started coming closer together, Gillian called back and was told, again, to rest and relax. She ended up delivering her daughter in a five-by-five bathroom, with her husband squatting in front of her, calling on his football-player past to catch the baby. In the months following, she tried to make sense of the trauma, and also grieved the ideal birth she never had. “The idea of expectation is faulty,” she says. “I wonder if it can breed disappointment.”

Perhaps no group is more vulnerable to disappointment than women who birth via non-elective Caesarean section. The Society of Obstetricians and Gynaecologists of Canada recently sounded the alarm over the rising rate of C-sections: Between 1993 and 2006, Canada’s C-section rate increased from 17.6 percent to 26.3 percent. The repercussions of a C-section culture are physical (women are three times more likely to die having a C-section than delivering vaginally) and economic (C-sections cost 50 percent more than vaginal births), but what about the emotional toll of an unscheduled, surprise C-section? Studies show that unplanned C-sections can lead to sadness, disappointment and guilt.

Judith, a Toronto architect (my friend who had the Caesarean birth after doing her water-imagery sketches), says, “I’ve gone over it a thousand times and I still do, and my kid is two. I had expected something heroic, meaningful, empowering. The romanticization of the birth moment is not good for women.”
Ellen Hodnett, a professor of nursing specializing in childbirth at the University of Toronto, says that when women report disappointment after a birth, it has little to do with the plan, and everything to do with feeling like they received impersonal care. “Over and over, when women say they’re disappointed, it’s not, ‘Did I get the water birth,’ or, ‘Were the lights down low,’ it’s about, ‘Did I feel I got the best possible support and involvement in decision making?'”

Yet there is no time when it’s more difficult to advocate for oneself than during childbirth. Most women are out of their heads with labour and, given a list of choices – induce? epidural? wait? – they will take their caregivers’ advice, and later feel guilty for not returning to Google to make the most informed decision. The pressure to construct the perfect birth is massive, but is it something that – with all the best intentions – we’ve brought upon ourselves? That our children’s births have somehow become yet another measure of our inadequacy is part and parcel of a larger phenomenon of mass perfectionism outlined in the new book Be Happy Without Being Perfect, by Harvard psychologist Alice Domar. Domar writes that women are trapped by a myth of perfectibility: Not only do we expect to keep our domestic and professional lives shiny and flawlessly ordered, but the self-improvement industry tells us it’s time to fluff up the spirit in between. (Thanks for the tip/pressure, Oprah.) This quest for perfection is eroding women’s happiness, writes Domar, who suggests the obvious: Let it go.

When my water broke while I was walking home from buying a Christmas tree, I knew we were up against the birth. But, as per The Caftan’s advice, I had no plan. I was open to drugs, but hoped not to have them. I wanted to end up in a hospital, but did most of the labour at home with just my partner and my midwife, both of whom were calm, present and, best of all, really quiet. (Oh God, I wanted quiet.) By the time we made it to the hospital, I had passed the point of drugs, and I did get to experience the moment of childbirth, something I didn’t even know I wanted. It was the most shattering, profound event of my life. I certainly don’t think that natural is the only way to go, but for me, that moment of giving over to the pain, the fear, the unknown mattered hugely; I felt like I had birthed the universe. I was completely and totally out of control, but that moment of submission – totally without any expectation of anything – held the greatest power I’ve ever experienced. What I could never have planned for was exactly what I needed.