I woke up this morning trying to solve the dilemma I was left with at the end of yesterday’s post. After 25 years of being an obstetrician, you’d think I’d have these things figured out, but for the moment they seem elusive. Seeing Ricky Lake’s film The Business of Being Born was the catalyst for a bit of soul searching.

Some pregnancies become complicated by medical events: pre-eclampsia (a condition characterized by high blood pressure, protein in the urine, and swelling), a huge baby (that is at risk of birth trauma), a small baby (due to a malfunctioning placenta), gestational diabetes, for example. All of these situations are medical complications, and require at least somewhat of a medical approach. When pregnancy becomes medically complicated, you need to have a good enough relationship with your team that you trust them to do their best for you and the baby, and you need to let go of some of the ideals you may have had about the experience of giving birth. Goals have to change. Sometimes a healthy mom and healthy baby is all you can ask for, and the experience is crappy.  Alanis Morisette sang about it in Ironic: Like rain on your wedding day…(which isn’t actually ironic, just a pity).

But chance favors the prepared mind. I believe that if you take great care of yourself during pregnancy–exercise and don’t gain excess weight, if you have readied yourself for childbirth–with education, relaxation techniques, coaches that “get it”, and if you choose a birth setting and team who support natural childbirth, you are more likely to have a more natural experience than if you come in to the hospital with a totally open mind. This is not “hope for the best and prepare for the worst”–because for natural childbirth you need to prepare for the best! But an attitude of acceptance also helps you get set to adapt to whatever occurs after you have done your due dilligence. Labor isn’t predictable, and sometimes things do become medical. We don’t want to go back to the obstetric outcomes of early history, when babies and moms often didn’t survive. That is why you get obstetrical care.

I think the key lies in good preparation and good communication with your team. I have seen a mom who had what most would consider a terrible experience (loss of a baby in mid pregnancy) who felt good about the way things were handled, and about how she and her marriage grew from this tragedy. I have also seen moms who were dissatisfied with experiences that other people would fight to have–an uncomplicated cesarean, a healthy baby–because they felt they didn’t fully participate in decisions.

So each mom (each family, really) needs to find where that balance is for them. If a natural, low tech, ”normal birth” experience is important to you, you have to prepare for it and seek it out. Low tech will not just come to most moms in today’s birth settings. And a positive mindset will help you achieve your goals. But you also have to be open to all experiences, and to keep your eyes on the prize–your baby and your family. And I hope over time the pendulum will swing back, and more birth options will be consistently available to mothers-to-be, without heroic measures to keep “normal birth” normal.