As it stands, the segment on birth plans that I was interviewed for will be aired on GMA tomorrow, Sunday, between 8 and 9 AM (barring any breaking news). I haven’t seen the whole show, so I will be watching it for the first time tomorrow, too. I hope what I meant to say will get across! For more information on birth plans, search www.drspock.com, or check out what I blogged here on March 26.

Working Mother Magazine just posted an article on their website based on my tips for managing those first days at home. Check it out!

Last year I had a conversation with a new mom who was just tortured about going back to work. She felt like she was doing something terrible, leaving the baby with a sitter while she returned to teaching at a local college. On the other hand, when we explored the alternative (taking a leave of absence from her job) she didn’t feel that was acceptable either. They couldn’t really afford it, and she felt she had worked so hard to get to this level, she didn’t want her career to falter. Then we talked about what she wanted her daughter to learn from her, and it was clear that she hoped that her daughter would “make something of herself” and also would be proud of her mom’s achievements. She seemed to feel better thinking that being a role model for her daughter was doing something for her, something she couldn’t do by staying home. She did go back to work, and after a few months she was glad to be working. Not that it wasn’t a hard adjustment, and not that she didn’t frequently have pangs of guilt, but the decision felt right.

Some moms always planned to stay home when the kids were little (if finances allowed it); alternatively other moms knew from the start that they were better off dividing their time between paid work and parenting. For these families the decisions may be fairly easy. But many moms struggle with these choices, or can’t do what they really want due to financial constraints. It can be hard to find a balance that is right for the family.

For more on this issue, including thoughts on a future when this discussion will apply to both moms and dads, read what 40 women from different backgrounds had to say in the last chapter of The Working Woman’s Pregnancy Book: Finding Your Balance.

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.

I am trying something new with this blog–using women’s words from The Working Woman’s Pregnancy Book to generate a discussion of some aspect of pregnancy, birth, or working. Here’s entry number one.

Page 365: “I pushed for two hours and then had to have a cesarean. I was frustrated with myself. I am kind of a competitive person, and I was frustrated that other people had easier experiences.” (Sherri M. sales rep).

Sherri M. had an unexpected cesarean, which occurs more than most parents-to-be expect. Clearly she feels she failed in some way, even though she doesn’t exactly say that. Rare? No!

I have spent a lot of time talking to women struggling to come to terms with the events of labor and birth. Even when we know it is unpredictable, we often come to childbirth with ideals. Some women seek out the most natural, spontaneous, intense peak experience; others just hope they don’t suffer too much and the baby is OK. Most people want to feel cared for, and want to enjoy their new baby. Some women are very aware of their desires and spend a lot of energy preparing to meet their goals, while others pretty much hand themselves over to the hospital team and hope for the best.

I have mixed feelings about the whole concept of having “goals” for the birth process. On one hand, it is pretty difficult to have a natural experience in the hospital without really preparing for it–taking classes so you understand the birth process and gain coping skills; bringing labor coaches who can help you get through; and being psychologically prepared for a challenge. Yet if you prepare hard, you are likely to feel disappointed or a failure if things become medical, which they sometimes do. On the other hand, if you plan to just go with the flow and you aren’t attached to the experience, the normal process in the hospital is quite medical, and the incidence of cesarean is (in my opinion) very high. There is nothing wrong with a cesarean that is necessary, but it is hard to believe that we need to do quite this many. So I struggle with how to help people prepare (which I think does help to make things go well) without setting themselves up for disappointment or feelings of failure if they don’t “succeed.” I’d love to hear how other coaches deal with this issue…

Well the camera crew came to our suburban office Monday and taped me answering questions (via an earpiece) from the Good Morning America producer in California, while her kids were napping, I believe. Such a great working mom moment, but this piece isn’t about the book. They will identify me as “author of” the WWPB, even though the segment is about birth plans, so that should be good publicity for The Book. I hope it came off OK. I know how things can be taken out of context, and I really want this to be a good story, and of course I want to come off well. We can hope. One of my agreeable, supportive patients came back to the office in the late afternoon so they could shoot B roll, and they got me doing her appointment. That part was fun, and she looked totally adorable.

I will probably post when the segment will be aired, but if you want to get updates, please get on my mailing list.

So here is a surprising twist in the Greenfield birthplan saga. I got a message Friday to call a producer for GMA who wanted to ask me some questions for a birthplan story she is developing. You might not be surprised to hear that I called her back pretty quickly! We spoke for a while and then she said she wanted to send a film crew out so she could interview me this week; we arranged it for tomorrow at our suburban practice office. She didn’t even know about the Working Woman’s Pregnancy Book, but of course the publisher overnighted her a copy immediately. We are in the office because they want to show me in my natural habitat. They may want some “b” roll of me talking to a patient too, so if you are one of my patients and read this feel free to call the office in the morning. Otherwise I will try to talk one of my morning patients into coming back in the afternoon. Shouldn’t be too hard a sell, most people like the idea of being on national television. Wish me luck!