“You make your choices, and you live with them” — aka, “no crystal ball”

The quote in the title of this post is a line from Groundhog Day with Bill Murray, one of my favorite movies. But I was made to think of it in regards to choices a woman can make during pregnancy or labor that can and will affect both her and her baby, for better or for worse. The “crystal ball” part comes from reading a few different blogs and/or comments from L&D nurses with people asking them things like, “How long will it be before the baby is born?” — The answer is, of course, anyone’s guess — no one has a crystal ball. My favorite response in this vein was told by someone who was a nurse back before most everyone had ultrasounds to find out the baby’s sex, and she said that frequently (usually as the baby was crowning) she or the doctor would be asked, “Is it a boy or a girl?” And that she (or perhaps the doctor) would say, “I don’t know — I can’t tell by the ears!”

But I was made to think more on this topic — of making choices when it is not clear-cut — based on a currently on-going conversation I’m having with one of my friends. She had her first baby naturally (if I remember correctly, she took Bradley classes, so would use the term as I would — namely, no pain meds, and probably no Pitocin), but her second baby flipped around a lot due to her having a lot of amniotic fluid and more space for him to move. When the baby was breech at 38 weeks, a C-section was scheduled, but he flipped vertex prior to the C-section date, so she chose to be induced then with a known vertex presentation and therefore a possibility of vaginal birth, rather than go into labor naturally at a later date, with the baby possibly flipping to transverse or breech before then, and then definitely having a C-section. She dilated completely then pushed for two hours before having a C-section. I don’t know the explicit details of the reason for a C-section — was it just because the doctor or hospital had a policy of no more than 2 hours of pushing? this also leads to the question of whether her pushing was ineffective due to a likely epidural, so if she had just “labored down” instead of pushed, might she have had a vaginal birth instead of a C-section? or was it because the baby was showing signs of not tolerating pushing? was she just tired of pushing with no seeming progress, so she chose a C-section? I don’t know. (Oh, and to add injury to insult, a couple of months after her baby was born, she had to go back for emergency surgery to correct something about the C-section — perhaps painful adhesions, maybe an infection of some sort — that added another C-section type recovery on top of everything else she had endured.)

Recently, we’ve started an email conversation about this topic, so I may have more details to fill in the empty spaces later, but we’ll just go with what we know for now. She said she is sensitive about the whole natural-birthing thing now because of what she missed out with the birth of her son. She felt empowered, as if she had accomplished something with her first birth, and was looking forward to those same feelings the second time, and felt cheated. And like a failure. She wonders if she had just waited to go into labor naturally, if she could have given birth vaginally. I wonder that, too.

Hindsight is 20/20. Nobody has a crystal ball. “You make your choices…” It’s entirely possible that she would have ended up with a C-section for breech presentation had she waited to go into labor naturally. It’s entirely possible that she wouldn’t have, too. It’s also possible that she would have ended up with a C-section with a vertex presentation, even without the induction. Some fellow childbirth instructors and doulas have noted that a disproportionately high number of formerly breech/transverse babies (usually turned with ECV, perhaps the Webster technique or some other method) or even persistent breech or transverse babies have ended up being born by C-section and having one or more cord loops around the body, which led to either fetal distress in labor, or to them not being able to be turned, or even “trapping” them in the uterus (if attempted vaginal birth), or likely would have led to those things had a vaginal birth been attempted. That’s just anecdotal, and certainly not in sufficient numbers to be statistically significant, nor is it meant to scare anyone whose baby is currently breech, because there are many reasons a baby might be breech and cord entanglement is just one of them — but it is a curious observation. Who knows if this might have happened with my friend’s baby?

If you’ve never seen Groundhog Day, let me briefly describe it — Bill Murray plays a Philadelphia weatherman who is required to go to Punxsutawny for the annual Groundhog Day festival (which he hates, detests and despises). While there, he gets trapped in a time warp — he repeats Groundhog Day over and over and over while everyone else in the world does not remember the past months or even years of repetitive Groundhog Days. One thing the repetition does is to allow him to try out different scenarios, knowing that there are no long-lasting side effects (for instance, one scene has him eating one of everything from the local cafe menu, without fear of gaining weight, or cholesterol problems — even boasting, “I don’t even have to floss!”).

Sometimes I would like to have the power to have such a time warp, and then try out all the different possible scenarios to see what really might happen in various births. In the example of my friend, we could see what would happen if she had gone into labor naturally; or if she had declined an induction and her baby had flipped again; or if she had let the epidural wear off before pushing so long; or if she had “purple pushed” the whole time; or if she didn’t push until and unless she felt the urge; or if she was allowed to be in a vertical position; or… or… or…

That is the only real way of knowing what might have happened. In the absence of a time warp or a crystal ball, though, we’re just left to make the best choices we can with the information we have available.

“…And you live with it.” There are no do-overs. We can play the “if only” game until the cows come home, and it still won’t change the past. There can be a certain element of dissecting the past — like performing an autopsy on a person to see what killed him. But at some point there must be acceptance of the past, so that you can look forward to the future without being so weighed down with “if only…” That may take some time — I consider it to be along the lines of working through grief, as of losing someone you loved; sometimes this grief or “wishful thinking” may be milder, needing only a few days or weeks to “get over it.” It may always hurt; sometimes the hurt may even escalate or spike, but hopefully, eventually, it will lessen so that the you can go on with life in a “new normal.” Many women have found that a future birth healed them emotionally — because somehow it rectified the past birth. I’ve seen women say that about VBACs, for instance, or a home birth after a horrible hospital birth, but also an empowering hospital birth after a previous mediocre or bad experience, as well as a repeat C-section which allowed them to accept for the first time that the first C-section was actually necessary. There are all sorts of ways this can work out. Others find healing in religion, meditation, yoga, volunteer work, you name it. And some women are very sanguine and just say, “that’s life,” and go on with barely a hesitation. There are too many variations of people and experience to put down one single way of doing anything.

You can hear pros and cons of various options, but at some point you will have to make your choice among options. I might choose differently, but I’m not in your shoes. Besides, I might choose wrong! I might think that based on this stack of evidence that X is the best choice to make, while you look at that stack of evidence over there, and say, “But what about this outcome? I think this possible negative outcome outweighs all your evidence.” Ok. Your choice. You may be right. I’ll be glad you made your choice based on the best evidence available, even if I disagreed with your interpretation of that evidence. As I said before, sometimes it just comes down to you being in a place of peace about your plans.

3 Responses

  1. Very good point. Educate yourself and then make the best choice for you at that time. That is the best you can ever do! Not just with birth, but with parenting in general.

  2. Yes, yes, yes! This post is promoting healing to me in a variety of ways as I’m processing my recent c-section for a breech, after trying nearly every technique known to mankind to turn our baby vertex. In many ways, though, even though I had a c-section, I felt very empowered b/c I made educated decisions throughout every stage of my pregnancy. (And it should be noted that I had a phenomonal OB who fully supported me, too!) And though I struggled with much sadness and disappointment when it became clear that this baby may not turn, I then was able to step up and make a plan for a mom/baby-friendly c-section. I just thought, though a c-section can never be the same as a normal, vaginal birth, I want to take charge and make it as positive an experience as possible.

    This post is helping me as I’m currently struggling with looking back at times and processing all those “what-ifs.” Thank you!

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