“Birth brings powerful and painful sensations to the most intimate spaces of the female body…I stood transfixed by the life-giving strength found in her feminine power.” –Amy Wright Glenn writing about attending her sister’s birth (Birth, Breath, & Death)

What About Unexpected Outcomes?

If one factor contributing significantly to a woman’s satisfaction with her birth experience is having better than expected outcomes, how then can birth educators prepare women for unexpected outcomes? As Pam England notes, “Many women are conditioned to believe that if they have lots of information, then they will ‘pass the test’ or be able to control their birth outcome” (England, 2007).

Is it possible to truly prepare couples for unexpected outcomes? Though others may disagree with me, I have to wonder if the answer is “no.” (I confess to also wondering the same thing about truly preparing for giving birth!) I used to spend a whole class session on complications/unexpected outcomes, but suddenly awoke to the realization that most people’s whole lives have been a “class” in “birth complications.” Do they really need to hear it from me too or am I undermining the very confidence I seek to build? Undoing the new messages and competencies I’ve tried to instill?

Instead of a whole class on complications, I switched to spending a short section of class asking couples what they were worried about or if they had fears about specific complications. (Since I usually taught classes one-to-one, there was a certain sense of security with sharing vulnerable emotions that may not be present with larger class settings.) Bringing fears out into the open to “look at” helps shift the perspective from “frozen” fears to coping strategies. After they share their concerns, I usually mention maternal or fetal death because I believe it is important to acknowledge this most scary of fears. I also encourage them to include options for unexpected events during labor or with mother or baby on their birth plans (based on the birth planning worksheet in the book Pregnancy, Childbirth, and the Newborn by Penny Simkin). I share that most births—if not all—involve some element of surprise, the unexpected, loss, or grief. It could be as “small” as disappointment with the baby’s appearance or a sense of loss/grief of the specialness of being pregnant or as a big of a surprise as a baby in the NICU or even death of the newborn. It is normal and okay to experience feelings of grief and loss whether the unexpected event is “big” or “small.” It is helpful to have an understanding of the possibility of the unexpected and the emotions that follow.

I believe this acknowledgment and recognition as well as asking for their personal fears is more helpful as reviewing each and every complication of birth (which is how many CBE programs train their educators!), especially given the widely stated observation that couples dismiss and forget information shared during class that feels—consciously or unconsciously—irrelevant to them (this often includes complications or even postpartum and newborn care). I believe that a generally stated recognition of loss in all its forms is more likely to “stick” because it brings it into the couple’s personal sphere instead of being a more academic exploration.

For possible questions for exploring worries see: Worry is the Work of Pregnancy | Talk Birth.

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This post is modified from a sidebar originally published in the International Journal of Childbirth Education accompanying my article about Satisfaction with Birth. I re-post it now in anticipation of a planned post about rituals for coping with unexpected outcomes…