Birth Choices: Know Your Options

Congratulations! You have entered a chapter of your life where your healthcare choices may be more important than ever before. Most parents have similar basic goals for birth: a safe, positive experience that results in a healthy baby. However, there are many ideas on what defines safe, positive, and healthy. There are even more ideas on the best ways to make that happen!

There are Many Birthing Options to Consider:

Exploring different approaches and scenarios for birth and identifying your top priorities is going to be helpful in preparing you for your childbirth experience.

There are many things you can do to influence and manage your birth experience but sorting through the huge amounts of available information and misinformation can quickly become overwhelming. While there is no magic formula or single approach that guarantees a safe and positive birth experience, following the steps outlined here will ensure that you are informed and better prepared.

Learning and preparing ahead of time helps you to be proactive, lowers stress, and builds confidence in your abilities to labor, give birth, and be a parent.

Birthing Classes: A Prelude

One of the best ways to learn about your options is to take a childbirth class. Look for a class that is well rounded and in-depth. One that promotes communication and includes partner information and labor support. Doing research, reading, watching videos, hiring a doula, and touring your birthplace are also proactive steps you can take that can help reduce stress while preparing for the arrival of your new baby.

Obeying traffic laws, staying alert, and wearing your seat belt all help reduce accidents and injuries. In birth, there are also risks, but as with driving a car, there are things you and your birth team can do to influence your risk. Sometimes we can do more harm if we overuse or misuse a tool and we can increase risk instead. Wearing a helmet while driving a car provides an added element of protection, but may also hamper your ability to see and make an accident more likely. Only those who are at a higher risk, such as motorcycle riders and race car drivers, wear them. Driving 20 mph below the speed limit may be warranted during a rainstorm, for example, but could be culpable during nonhazardous conditions.

Use an Evidence-Based Birthing Approach:

Medical interventions can be helpful in some situations but can cause harm when overused. An evidence-based approach is always best. It considers the preferences and goals of the parents, the best and most recent research for the situation, and the experience and judgment of the provider.

We are fortunate to have access to many lifesaving medical advancements, but just because we can use a tool doesn’t mean we always should. Medical interventions, tools, technology, and medications are used in most births today but carry risks, and when used inappropriately, can cause harm. Using an evidence-based approach to interventions can help improve outcomes as well as satisfaction.

To meet these goals, they recommend:

• Shared decision-making between parents and providers
• Intermittent fetal monitoring for low-risk women
• Movement and position changes in labor
• Using alternatives to cesareans whenever possible
• Continuous support in labor (physical, mental, emotional & informational)

The effectiveness of many routine medical procedures, such as episiotomy, continuous fetal monitoring, and breaking your water inspires research and debate. These and other procedures were found to lack benefit when used routinely, but many providers and hospitals are slow to change.

Parents have a right to be fully informed about their care in pregnancy and birth. This means you understand ALL available options and are empowered to make the choice best for you. This is the first step toward a positive experience.

Natural vs Medical Managed Births Advantages and Disadvantages:

Approaches to birth consist of physiologic birth or natural birth, and medically managed birth, or a hybrid of the two. The main advantage of a natural birth comes from avoiding the risks from interventions, thus lowering the risk of an assisted or cesarean birth. Disadvantages include that it does require preparation and commitment, risks feeling of disappointment, or grief if interventions become necessary.

Advantages to a medically managed birth are that it allows close monitoring for high-risk situations, provides readily available technology for emergencies or sudden complications, allows more control over the timing of the birth, and can control or lower pain levels.

The main disadvantage of a medically managed birth is that interventions can introduce extra risk. One increased risk increases the potential of the cascade effect where one intervention leads to another. An example of an intervention is opting for an epidural, which can and likely will limit mobility or control over your body.

Interventions:

Deciding if or when to use an intervention involves weighing all the information; the reason for using the interventions, the seriousness of the situation, your preferences, your provider’s recommendations, and the current research on the benefits and risks involved.

Choose an approach that appeals to you but remember that labor is unpredictable, sometimes changing your approach is necessary, and remember to be patient, especially with yourself.

Induction and interventions to speed labor are common. Consider how and when you want labor to begin and progress. Discuss policies and procedures ahead of time with your care provider, including breaking your water, vaginal exams, induction, and pain management.

How do you feel about the following interventions?

• Continuous monitoring
• Intermittent monitoring
• Freedom to move
• Medication to start labor
• Medication to speed up labor
• Frequent vaginal exams
• Breaking your water
• IV Access
• Epidural
• Opioids (narcotics/analgesics)
• Episiotomy
• Vacuum or forceps
• Cesarean section

Hospital Considerations:

Hospitals vary widely in policies and culture, including the freedom to move, reception to doulas, food and drink, visitors, and photography/video. You should also identify amenities or equipment that are important to you such as a shower, tub, pool, or portable fetal monitoring equipment.

Consider your preferences for the birth itself. Do you have strong feelings about pushing? What position would you prefer? Do you have a preference for cord clamping, perineal support, episiotomy vs tearing?

Learn as much as you can about cesarean section policies at your birthplace to be prepared should an emergency arise.

You’ll have options for the baby after birth, sleeping in vs using the nursery, vaccines for your baby, health screenings, baby’s first bath, and when they will happen. Ideally, so long as there is no medical reason not to, you will want a golden hour of skin-to-skin before any procedures to allow bonding and initiation of breastfeeding.

Should you have Labor at Home?

What kind of environment and support do you need during labor? I always recommend to my low-risk clients that they labor at home as long as possible, and to my high-risk clients I have them ask their care providers if they can recommend the same. You want a calm and peaceful space; remember that the hormones necessary for birthing a baby are the same ones we produce when making that baby, so ambiance can be significant. You may want company early on in labor and less distractions and interruptions as labor progresses.

If you do plan to have an epidural, you may still benefit by laboring at home as long as possible, as once the epidural is administered, you will be confined to the bed and hooked up to all the monitors. The sooner you arrive at the hospital, the longer you will be confined to the bed waiting out your labor rather than helping it progress with movement and position change.

The more you can actively help in the birthing process, the shorter your labor will be. That said, having an epidural is said to increase labor by only about 14 minutes, a nominal amount of added time to be assured of the surest pain relief available.

Have you Considered a Doula?

A doula is a trained non-health care professional specializing in birthing. The birth of your child is one of the most important future events of your life. Speaking with a doula is an easy and time-efficient way to go through the birthing process and how it relates to you and your situation. As a certified doula, it is my passion to help any expecting mothers through this overwhelming process to have the best birthing experience possible. Please reach out to me for your FREE consultation and let’s start your journey together!