The Unexpected Pivot Is Not Your Fault

We don’t spend enough time in our country preparing mothers for the reality of birth. Many times, women have a very idealized birth plan. The reality is that about a third of all births in America take place via C-section. Many of these are unplanned.

These idealized birth plans are often romanticized, almost like a wedding. Picture this: you’ve spent years planning your storybook destination wedding on the beach of a beautiful tropical island. You have all the details planned down to the minute. You aren’t aware that there’s a 1 in 3 chance your wedding could be rained out. Then, when you arrive there, a hurricane hits and all the power goes out.

You never considered this scenario. You have no backup plan from your beautiful destination wedding; it’s not hurricane season! Because you have no backup plan, you end up getting married in the kitchen of the hotel very hurriedly by the chef, without any of the beauty or fanfare you envisioned. This is a little bit what it’s like to have an unexpected c-section. Or not to be able to breastfeed exclusively like you envisioned.

When a Plan is Not a Plan but Becomes a Plan

I think this idealized vision of birth and breastfeeding was part of how I developed such severe postpartum anxiety after my first child. As a doctor, I did not have any specific, “crunchy” birth plan. I knew that I didn’t need to be attached to any one outcome emotionally, because medically it would take place as it should. And indeed, my birth was typical: my baby was born healthy and I was fine medically.

I had not originally planned to breast- or bottle-feed either way; any way it happened would be fine with me. However, I was working 80-hour weeks with a newborn. The only way I felt like I could really be connected to my baby and provide for her was to breastfeed exclusively.

So I set about pumping as frequently as I could, while utterly exhausted. I had assigned a heavy meaning to breastfeeding out of desperation. I felt guilty about not being present for my baby because of my job, the job that I loved. #lovemyjob. I was all about proclaiming the glory of being an OB-GYN despite my punishing schedule and having very little support.

At the moment when my plan fell apart and didn’t serve me anymore, I became the mother that I was intended to be. And she wasn’t the mother I had envisioned in my narrative, which was jarring. But that mother was who I needed to become for myself and my baby.

Responding to the Unexpected

The finance book I’m currently reading describes historical investors who considered whether to pivot their plans when the unexpected occurred. And, it describes how they didn’t pivot and later regretted it. In this, I see a parallel to birth plans and feeding plans.

During labor and delivery, events happen very quickly, and the mother is in a very vulnerable place, both mentally and physically. You may get worried about how you and the baby are doing. Your pain may be so great that you end up needing pain medication, which you had not intended. You may have wanted a natural birth, but you end up with a c-section due to circumstances beyond your control. Or you wanted to breastfeed exclusively, but your baby has a latch issue.

After all these unexpected events occur, you feel like a failure. Like it’s your fault things did not go “according to plan.” You feel sad and anxious and uncomfortable.

I wonder how much of postpartum depression and anxiety, which are more common in our country than gestational diabetes, can be attributed to these false expectations. Or maybe the fact that people are not well-educated about the likelihood of plans changing. Because without the information ahead of time, you can’t possibly make a decision about what will serve you and your baby best.

Making Mothers Aware

It’s understandable that depression and anxiety might follow from shattered expectations, without knowing there was ever another scenario to begin with. I want to validate that condition for others, because I have been there too. More importantly, we need to begin educating mothers better in our country about birth and feeding plans, so they have more information and hopefully less shame when things do not go “according to plan.”

4:26 And now you’re depressed and you’re sad and you’re uncomfortable. Like, these are real things that change the scenario. As my therapist would say, it’s data.

4:36 It’s data and the more data you get, the more you understand, you know, what you like and what you don’t like.

4:42 And, you know, she told me this in the context of dating after divorce, but I think it applies here, too, that without all that information, you can’t.

4:49 Can’t possibly make an informed decision about what will serve you best. And so, I’m just here to validate that, I guess.

4:55 Okay, gotta go, bye.