If you’re pregnant, you probably have at least some idea of how you’d like to give birth. Are you hoping to be in the comfort of your own home, or is a hospital setting more your scene? Is an epidural a must-have or a last resort? Is your ultimate goal a vaginal birth, or would you prefer to know the exact date of your baby’s arrival with a scheduled C-section? All of these questions and more will likely be answered on your birth plan, a document that you can bring to your birthing team to explain your wishes for your labor and delivery. 

But what happens if you make a very nice, well-thought-out birth plan and then your baby has a completely different agenda? Unsurprisingly, when you’re invested in doing things a certain way and they don’t go according to plan, it can cause some negative feelings to bubble up, says Dr. Kelly Coffman, a reproductive psychiatrist. “A dysphoria can develop when things don’t go the way you want them to, including feeling like it’s your body’s fault or your medical team did the wrong thing,” she says. 

You can’t always head off those emotionally charged experiences—no matter how prepared you are—but practicing a more flexible mindset can help you cope with those twists and turns, as well as knowing that there are ways to work through any feelings that arise from your birth not going exactly how you envisioned it.

Having a Birth Plan Is Good, But Flexibility Is Even Better

There are some people who have the let’s-just-have-a-healthy-mom-and-baby-on-the-other-side kind of outlook. And going with the flow is something all of us—especially those of us who are parents—should cultivate more in our lives. (Though Dr. Coffman says being educated about what can happen and getting clear about your goals is a good idea even if you don’t want to have an official birth plan.)

But if you’re one of those who needs a detailed, well-researched birth plan to help you feel more comfortable, that’s great, too! As humans, we’re wired to want to be in control, and having that birth plan can help ease some of the normal anxiety around labor. “It’s particularly hard as a woman when you’re pregnant and your body goes through all these changes,” Dr. Coffman says. “It can be really disarming to feel like you have no control over what’s going on in your body for such a long period of time.”

But if you are a world-class planner, it’s important to also prepare to be flexible, because giving birth can be wildly unpredictable, says Tapia Stover, a certified nurse midwife and midwife site director with the OB Hospitalist Group in Anchorage Alaska. “We know that birth is dynamic, and there are so many things we can’t see, like how a baby is precisely laying in your pelvis, or the shape of your pelvis, or how much the baby weighs,” she says. These are all things that can throw a wrench in your carefully laid birth plans. 

That said, suddenly becoming more flexible when your entire personality is decidedly not isn’t exactly easy. That’s why Kara Weiland, a maternal mental health therapist, suggests working on this before you’re in the delivery room. “Try to practice giving yourself permission to be flexible moment-to moment," she says. “Say to yourself, ‘I’m giving myself permission to change my mind on what I need based on what my family needs, what my baby needs.”

That mindset came in handy for Jenn Levin when she was at the hospital laboring with her first child. As a hypnotherapist, she’d originally planned to have an unmedicated birth. But as her contractions intensified, she realized she actually did want an epidural—and spoke up. “I was proud of myself for being willing to ask for what I needed and not suffer through the pain,” she says. “It was life-changing.”

If that doesn’t resonate, you can also think about it like this: make a few asterisks in your birth plan that allow for flexibility, says Dr. Tamika Torres, a trauma-informed maternal mental health psychologist. “I’ll have my patients discuss their birthing plan, and then I'll have them make a little asterisk,” she says. “I’ll say, okay, where is the flexibility? Where do you think this is for sure where you can be flexible?”

That way, you may not feel so blindsided if you do have to veer from your birth plan. It also has the added benefit of freeing up brain space to help you process the onslaught of information that comes with rapid—and sometimes scary—changes during childbirth, when you’re already feeling physically and emotionally vulnerable.

Brittany Ouimette, 25, says during her very first pregnancy appointment, a nurse midwife said something that came back to her at a crucial moment: the best births are the flexible ones. Not thinking much of it at the time, she filed it away in the back of her mind. As the months wore on, she began planning for an unmedicated vaginal birth, but in the final weeks before her due date, she got a surprise: her baby was breech. 

Her doctor recommended going to the hospital to try a few things to flip the baby. “I always had that in the back of my mind, that the flexible birth plans are the best ones,” she recalls. “So in the hospital that morning, I was hoping they’d be able to flip her, but I kept having this conversation with myself, that if this other thing happens, it’s going to be okay.”

Ultimately, Ouimette ended up having an epidural and a C-section, and credits that early conversation for helping her find peace with her decision.

It’s Okay If You Feel Upset That Your Birth Didn’t Go to Plan

Even if you do incorporate flexibility into your birth plan and do the work to prepare for the unexpected before labor, that doesn’t mean you won’t feel sad or disappointed—and in some cases, even trauma—if your birth doesn’t happen the way you were expecting. 

One way this can prey on your mental health is the tendency to bring up a woulda–coulda-shoulda thought loop, where people get mad at themselves for doing or not doing certain things that they think could have prevented the change. “I think initially what happens is there is a lot of self-blame, like what if I had just done this to flip the baby or that other thing?” says Rachel Goldberg, a reproductive therapist, “and that feeds those inferior feelings, as if you had some kind of control [over the situation].” 

It’s also important to understand that just about any circumstance can cause trauma, says Dr. Nicole Leistikow, a reproductive psychiatrist and assistant professor of psychiatry at the University of Maryland School of Medicine. It’s really about your subjective experience, not necessarily something that would be deemed objectively traumatic by other people, she says. “It’s really much more about, from your perspective, did things happen where you felt as though control was taken from you?  Were you not consulted or considered or given the opportunity to participate? Was your voice not heard or responded to? Did you not feel safe?” 

In reality, that could mean those objectively terrifying turns of events, like hemorrhaging or being rushed into emergency surgery, but it could also come from things that seem “smaller” like needing a non-emergency C-section when you planned for a vaginal birth, or feeling like something isn’t quite right but your medical team isn’t listening to you. It’s not the event that causes trauma, but how you felt during that time. 

Developing feelings of trauma after giving birth is more likely to occur if you already have a history of sexual trauma, but also if you have a very rigid birth plan and you don’t have a lot of resiliency, says Dr. Leistikow. No matter how you’re feeling—whether that’s sadness, disappointment, or trauma—know that it’s okay, and there are ways to help you process your emotions. Perhaps the most helpful thing to hear? You’re not alone in how you’re feeling. 

How to Work Through Those Feelings

Once you bring home your baby and the dust settles a bit, it’s not uncommon for some of those negative feelings around your birth to start coming to the surface. Taking care of your body, getting some time to yourself, and really being intentional about getting sleep are often the first things you can do for yourself, says Dr. Leistikow. 

If you can’t seem to move on from those emotions, it might be time to reach out to a therapist or other mental health professional, says Goldberg, who first explains that you can’t erase the experience, and it’s part of who you are now. “Accepting that this happened is going to be the way forward,” she says.

The next step is simple: talk about it as much as you want to your therapist. “They might want to rehash it three or four times, and talk about what it felt like in those moments,” says Goldberg. “Just by doing that, by reliving it, they start to realize it wasn’t in their control, and in that moment they made the best decision.”

Over time, the act of being able to talk about it without being judged—and not hearing things like, “You have a healthy baby, get over it!”—is helpful, says Goldberg. Having a therapist validate that you got robbed of an experience you really wanted, and saying it’s understandable to feel that way, and then just letting you feel sad makes it much easier to move on, she says. 

If trauma is there, you may need to do a bit more emotional work. It’s also important to treat postpartum anxiety or depression, if those are present. “You’re not going to be able to recover from trauma if those are active,” says Dr. Leistikow. 

Once you’re in a better place, you can start to confront the trauma with exposure work, she says. For example, maybe you have a box of baby clothes that you’ve been meaning to go through, but it reminds you of a traumatic delivery. When you feel more stable, you can start going through that box and face the feelings that come up. “It retrains your body to distinguish between: that was then and it was a scary experience, and this is now I’m in a different context and I've recovered and my body is no longer under threat,” says Dr. Leistikow. 

Taking the Lesson and Moving Forward

It’s stressful when things don’t go according to plan. But especially so when life and death are quite literally on the line in childbirth. The fact that you can’t control exactly how you have a baby is a hard lesson to learn, but it’s also an important one. Because guess what else you can’t really control? Just about everything that comes with being a mom. 

“It’s good training for being a parent,” says Dr. Leistikow. “All kinds of things happen to our kids that we wish wouldn’t have happened,” she says, “but if you fixate on how you should have prevented every bad thing rather than accepting it, then you aren’t focusing on being present for yourself and your baby.”