What Birth Choices Do I Need to Make?
If you have preferences (most pregnant women do) about how you are treated or what happens during labor and delivery, it is best to be informed about the birth choices available to you. If you don’t know about what choices in childbirth are available to you, the truth is that you really don’t have any options.
A recent investigation by USA Today has found the United States to be the “most dangerous place to give birth in the developed world.” More than 50,000 mothers are severely injured during or after childbirth and 700 die every year in the United States. It is believed that 50% of these incidences could have been avoided.
Obviously, sometimes things happen that cannot be avoided. The important takeaway here is to be involved in your own pregnancy health and informed about your birth choices.
So, first you need to learn about birth and the choices and options you’ll have so you can make informed choices for your birth. Take a class, read some books, and ask other parents about their experiences. Once you have an understanding of your options and your desired birth experience, you can put it down in a birth plan. Pregnancy by Design offers free guidance on in our Complete Guide to Writing a Birth Plan.
Should I Choose a Midwife or Doctor?
Your choice of a prenatal care provider is the most important factor you can control. Most of pregnancy and birth is outside of our control, but who you choose to attend your birth and advise during labor is a large determiner of the outcome. Deciding between your current Ob-gyn or having a midwife, choosing your birth provider is an important decision.
If you want a natural childbirth, without unnecessary medical interventions or drugs, choose a health care provider who is good at those things. If you go to a doctor with a 40% c section rate, it’s not just your rotten luck that you ended up with a cesarean. Choose someone who regularly attends the kind of birth you want, whether a drug-free vaginal birth, a waterbirth, etc.
It’s like being a vegan and going to a steakhouse. They may be able to make something work for you, but it’s not likely and it’s not going to be the best experience you could have.
Midwives are specialists in normal pregnancy, labor and delivery. If you don’t have a high risk pregnancy (medical conditions or complications) that require the specialization of an obstetrician, a Midwife is your best bet.
What are My Pain Relief Options For Labor and Delivery?
There are many. Some are drugs and some are drug-free. Let’s take a look at the commonly-used methods to make labor more comfortable.
Epidural anesthesia consists of a narcotic cocktail delivered into the epidural space in your spine. When it works well, it blocks sensation from the waist down. Because of the risks associated with this kind of pain relief, women with an epidural need to be closely monitored for dangerous complications. Here is an article that covers the benefits and risk of Epidurals.
Opioids, such as fentanyl, are sometimes administered as an injection (shot) or through an IV. They’re less likely to interfere with labor progression than an epidural is, but don’t provide the kind of sensation block as drugs administered directly into the spine do. Typically, women feel drowsy and it helps them to rest, but may lead to epidural after the dose wears off.
Nitrous Oxide (Laughing Gas)
If you’re having trouble relaxing your mind (overthinking, worrying), nitrous can help you relax. You hold the mask in your hand and breathe the gas; this gives you about two minutes of brain-free time.
Knowing the basics of what to expect and how people manage their drug-free labors can help you through the process. If you learn from positive teachers and literature, some of the fear around labor and birth will dissipate. When you have less fear, you have less tension and therefore less pain. Whatever you can do to take the fear out of the picture will help.
Your ability to relax your body and mind should be the primary focus of any practice you do. You don’t need to tense your muscles or use your brain to have a baby. Thinking won’t help you. Worrying definitely won’t help you. Test your ability to relax and let go of control.
Many women find warm water (hydrotherapy), either in a shower, birthing pool or tub, helps them to relax during labor. A birth tub also allows a laboring woman to move into different positions more easily. “Waterbirth” is when you give birth to your baby in a tub of water.
Some women choose to labor in a tub of water and get out to deliver their babies. While others decide they are most comfortable staying in the water to deliver their babies. If you are considering waterbirth or laboring in a water, it’s important to find a provider that is skilled in waterbirth and works in a birth location (hospital, birth center or home birth) that allows for waterbirth.
Breathing is very important in labor. The uterine muscle hurts a lot more when it is oxygen deprived. Plus, the only way to get oxygen to your baby is to get oxygen to you!
When we are going through something difficult or scary, we often breathe very shallowly or hold our breath. Slow, deep, methodical breathing can help you stay calm and take some of the pain away from the contraction.
Your body does not want to just lay there in labor. Moving helps the baby come down, rotate, and keep you as comfortable as possible. If you are immobile, the experience is more intense.
Research shows that women who have continuous, caring support during labor have easier, faster births with less intervention. They also report feeling better about what happened during the birth process (no matter what happened!) than those who didn’t have the support of a doula or other supportive, birth-knowledgeable person.
There are as many ways of managing the intensity of labor as there are people laboring. Many people find relief in making low, open sounds like moaning or humming. Some visualize with their eyes closed or focus on a particular spot or picture. Read some uplifting natural birth stories to get more ideas!
Do I Need a Doula for Hospital Birth?
A doula is a good choice for birthing families no matter where they plan to deliver. A doula is a non-medical provider who will provide continuity of care, continuous support and calm to you and your partner. Doulas remind you of what you’ve learned and help you feel good in labor. They support you while the midwife or doctor manages your medical care.
Who Should be There for My Baby’s Birth?
Everyone in the room should make you feel safe, calm, and cared for. If there are people in your life who don’t support your birth choices, don’t invite them. The fewer people who are there to watch you, the more comfortable your experience will be. Carefully choose who you invite to be a part of your labor support team.
How Can I Control the Environment During Delivery?
Depending on where you have your baby, you can control elements of the environment to make labor easier and safer. In a hospital setting there are more rules and restrictions. Birth centers tend to have fewer of these and of course homebirths are pretty free.
You may wish to have music, your own linens, aromatherapy, or pictures and other comfort items.
What are the Choices for Labor Induction?
First of all, labor induction (and every other procedure) is a choice. You retain your bodily autonomy when pregnant and you get to decide who does what. Showing up for a scheduled induction is a choice.
If your doctor or midwife recommends an induction, ask about the benefits and risks, if there are alternatives and what they think about waiting until a few days or a week later.
If you decide to go ahead with an induction, or you decide to have an intervention to help move your labor along, here are some common choices:
Synthetic oxytocin causes uterine contractions. They can start the drip very low and slowly ramp up, which is the safest way to do it. Contractions from synthetic oxytocin are typically much more difficult to manage since it’s not regulated by biofeedback. You don’t get any of the good mood enhancements or endorphins when it doesn’t come from your own body.
Breaking Your Water
Using a long hook, a provider can reach up through your cervix and snag the amniotic sac to release the water. When birth is imminent, this can speed things up. Earlier on, it may not have much effect and increases risk of infection. Contractions feel more intense when the amniotic fluid is not there to ‘cushion.’
Having your nipples stimulated makes natural oxytocin. That’s why it feels good during intimacy and why breastfeeding is relaxing. The more oxytocin you can make, the more contractions you’ll have.
Often called Cervadil, this gel is placed on your cervix (sometimes using a tiny tampon) to help it soften. Sometimes it even starts labor. Sometimes it doesn’t seem to do anything. There are also prostaglandins in semen.
An ulcer drug sometimes used to induce abortion or for miscarriage. The manufacturer uses a very bold warning against the drug’s use on pregnant people because of the risk of uterine rupture and worse.
Because it is often very effective, many doctors and Midwives do still use it to induce labor safely. It is also used effectively to stop postpartum hemorrhage. The pill is swallowed or inserted vaginally.
What Can I Do During Pushing?
Your choices during pushing will affect how easily the baby comes out and the likelihood of tearing.
Talk to your provider about pushing in an upright position or alternate positions to sitting/laying on the bed. Some people feel more comfortable pushing in water.
When you push and how long you push is also up to you. Talk to your provider and the people who will be in the room about how you’d like to be talked to while pushing: not at all, reassuring and supportive, coaching about when and how to push, counting, etc.
If you want to feel your baby’s progress periodically as she emerges or look with a mirror, plan on that. Do you want the midwife or doctor to use hot compresses or rubbing?
How often does your provider perform episiotomies? Are you comfortable with her making the determination about if one is needed?
If they offer a numbing agent for your perineum, do you want to consider it or refuse it due to risks?
What are My Choices Postpartum?
There are choices to make about how your baby is treated as well as your recovery treatment. Consider the following:
- Do you want to hold your baby immediately or after he/she is cleaned/checked?
- How do you feel about immediate vs. delayed cord clamping? Do you plan to bank the cord blood?
- Ask your provider about how they handle bleeding. Do you want a routine pitocin shot? Uterine ‘massage?’
- In case of stitches, would you like extra lidocaine or the use of nitrous oxide?
- Do you want to keep the placenta for any reason?
- Do you have a lactation consultant who you can call? A therapist in case of postpartum mood disorders?
- Do you want baby to stay with you, go to the nursery, or be in the bassinet?
- Do you want the eye ointment or vitamin k shot?
- Would you like baby to be given formula, pacifiers, or water?
- Would you like to bathe the baby yourself or have it done by the staff?
- Is there someone on staff to help you breastfeed?
- Have you researched circumcision?
So remember, take some time to learn about birth and the choices and options you’ll have so you can make informed choices for your birth.
Get started by signing up for Pregnancy by Design’s free Complete Guide to Writing a Birth Plan and take our Birth Profile Assessment to learn about the best birth choices for you based on your unique personality, beliefs about birth, knowledge, health history and more.
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