A new mom I know pretty well, who I'll call Jane, had a baby by unexpected cesarean a few weeks ago. She'd had a doula there for her birth because she had clear ideas of how she wanted her baby to come.
Jane had prepared for natural childbirth with hypnobirthing techniques and felt she had a high pain tolerance that would help her to get through it. She had a good relationship with her OB, who she hoped would be there for the birth, although she understood that one of her OB's colleagues would probably be covering. All in all, Jane felt she had done everything within her control to set the scene for a good experience.
When labor began, the doula Jane had engaged wasn't available, so a backup doula arrived. This doula was very helpful, but wasn't as assertive as the doula Jane and her husband Steve had hired. As labor progressed, Jane decided to get an epidural.
Labor was more intense than she'd expected, and she didn't see a real reason not to take available pain relief. The epidural helped with comfort and relaxation, and made the vaginal examinations more tolerable. When Jane got to complete dilation, she was excited to finally be able to push her baby out into the world.
Three hours of hard work passed, and the baby wasn't yet born. The covering physician came in and said that the baby didn't seem to be coming vaginally, and that either vacuum delivery or cesarean would be needed. Three hours was this doctor's limit for pushing. Jane felt she still had strength to continue, but was worried by the doctor telling her that a decision needed to be made right away.
The doctor did not recommend vacuum delivery in this situation, and a cesarean was done. Afterwards, Jane wondered if she should have asked more questions or requested a second opinion. She had a healthy baby, and was recovering from surgery at a normal pace, but she felt unsettled with her own decisions.
We talked about her birth experience. Jane and Steve had done everything that I usually recommend to try to assure that things go well. With only one doctor from her OB's practice on call at a given time, getting a second opinion would have required changing practice groups at the very last moment, if a doctor from another practice was even there at the hospital to provide care. The covering doctor was not comfortable with any option at that point other than cesarean, and this doctor was responsible for Jane and her baby.
What do you do in this sort of situation? Really, I don't think Jane and Steve had any great options for achieving their desired vaginal birth. In retrospect, Jane may have been better off going to a group of nurse-midwives, in which every practitioner might have been less rigid about how long you can push.
Or maybe this baby just wasn't going to come out from below, and the covering OB saved Jane from further exhaustion, and from other complications of an extended labor and unsuccessful vacuum delivery. I guess we'll never know. All the planning in the world doesn't control the exact course of events. Jane and her baby are healthy and doing well, both good outcomes in the end.
