(Originally published by Choices in Childbirth)
Where and with whom should you give birth? With a midwife or an obstetrician? At home, or in a hospital or birth center? Invite a family member or doula to join your birth team? The choices can feel overwhelming!
First and foremost, as you prepare for your birth, I would suggest you clarify for yourself that you are birthing in the place that is right for you, surrounded by people who will offer you the kind of support you are imagining. There is not one best place to birth, but there might be a best place for you. A patient caregiver who is activly supportive and not merely tolerant of your beliefs is one of the most important factors in preparing for a positive birth experience. Remember, if your birth plan is your sword and your doula is your shield, you are probably birthing in the wrong place.
Keep in mind that there is a lot of grey zone in the world of obstetrics: the same bump-in-the-road will be treated quite differently from one provider to another depending on the obstetrician’s or midwife’s philosophy and the protocols of the birth environment. You might like your obstetrician quite a bit, but you may not like how she practices. Ask your questions before labor begins. You have many options to consider.
Homebirth with Midwives
Many couples looking for a normal, physiologic birth and highly individualized care consider homebirth. If you are thinking about this option, get in touch with one or more local midwives and ask your questions. See the documentary film, The Business of Being Born, available at www.thebusinessofbeingborn.com or on Netflix. An extensive study published in the British Medical Journal shows that planned home births are as safe as hospital births for low-risk women in the United States. To learn more, please visit: http://www.bmj.com/cgi/content/full/330/7505/1416?ehom .
Birth Centers with Midwives
For some people, an in- or out-of-hospital birth center is a good choice, combining the more attentive care of midwives with access to an institution. Birth centers may be located near a hospital or even tucked within one. Birth Centers extend much more freedom to a laboring woman than the average Labor and Delivery floor. They usually offer access to water during labor, hand-held intermittent monitoring, uninterrupted contact with the baby afterwards and early discharge. For a sense of how midwives and obstetricians collaborate, watch the documentary The Mama Sherpas, also available at thebusinessofbeingborn.com.
Hospital Labor & Delivery with Midwives or Obstetricians
Ask if midwives deliver at your hospital. If so, consider switching to their care. Midwives are less likely to overuse interventions and research shows that for this reason low- and medium-risk women are safer birthing with midwives.
Ask your midwife or OB all your questions and don’t be slow to switch providers or hosptials if you feel you are not getting the answers you hoped for. If you want sushi, you wouldn’t go to a pizza parlor and expect them to prepare sushi. No. You would go to a sushi restaurant of course. All too often couples seek a kind of birth experience not readily offered by their chosen birth providers or setting. Find the right care for you. It is well-worth the extra effort!
Research your hospital’s intervention and cesarean rates. Studies show that one of the more significant factors predicting your likelihood of giving birth by cesarean, is your careprovider’s cesarean rate.
Tips for how to have a postive hospital experience:
Women need the free-flow of the hormone oxytocin while laboring. We know that silence, darkness, and a sense of privacy and safety help with this flow of oxytocin. However, most hospital Labor and Delivery floors are not set up to offer women silence, darkness and a sense of privacy. Below you will find ways to help create an environment in a hospital setting that is conducive to the free-flow of this important birth hormone.
Getting to the hospital:
Don’t go too early! Labor likes privacy and this is particularly true in early labor. Getting to the hospital too early can make for a longer, slower process. If labor slows as you arrive, head back home or to a nearby hotel.
Make a mental commitment to stay IN your labor on the ride over.
Tune out stimulus: Keep your eyes closed, wear sunglasses or stay plugged in to your music. Watch your feet as you walk up to L&D.
Breathe deeply through contractions to minimize adrenalin levels.
Eat or drink to wake up the baby before entering triage.
Birth Partners: Keep you own adrenalin levels in check. Take it slow. Breathe with your partner.
In active labor, the ride and check-in process are just not fun. But keep in mind that you have chosen this location because you feel safe there and once you get over these hurdles, you will get back to work in a more settled, regular way.
Once you are in your room, don’t be shy about turning off the lights. Bring battery powered candles.
Seek privacy in bathrooms.
Bring your own music – set a tone in your room.
Get a room far away from the nurse’s station and keep the door closed.
Tell the staff you prefer silence; take conversations out in the hall.
Decline resident care if too many doctors are coming and going.
Be creative with furniture. A hospital room is arranged around a bed. For most women, leaning back in a bed makes handling contractions more challenging. Think of creative ways to use the bed and other furniture such as step stools and chairs. Bring a birth ball and yoga mat.
Use essential oils to create a calm feeling in the room. Just a few drops on a paper towel will do the trick.
Invite a doula or other support person to join your birth team. This person can help your partner with the many tasks of supporting you as you labor, avoiding partner burnout and offering you a very high quality of support through the intense work of labor. A doula can also help you stay home longer and transition to the hospital more smoothly. While she can’t speak on your behalf to medical personel, she can help you and your partner navigate the available options. She can remain with you while the partner deals with administrative tasks, ensuring that support is seamless. Numerous studies have shown that doula care reduces interventions.
Proven benefits of Doula Care:
- 28% reduction in cesareans
- Fewer forceps and vacuum births
- Less use of epidurals
- Shorter labors
- Higher APGAR scores for babies
- Increased Breastfeeding Rates
- Improved satisfaction & feelings about the birth (from “Doula Care in New York City,” Choices in Childbirth)
Address any fears and concerns you may have about the hospital environment. Talk about these concerns with your partner and your provider ahead of your birth experience.
Write a birth plan. Keep it brief and highlight your priorities, concerns, phobias, allergies, etc. Go over your birth plan with your provider and all his or her back ups. Learn about routine interventions such as the IV and continual electronic monitoring. If you are interested in moving around throughout your labor, explore options such as a heparin lock in lieu of an IV or intermittent monitoring in place of continuous monitoring. Remember that once in the hospital, these are spoken, face-to-face communications. Your birth plan doesn’t do the talking for you.
Learn the names of nurses and interact with them in positive, respectful ways. However, if you feel you are ill–matched with a nurse, see the head nurse about finding another nurse who more nearly supports your philosophy of birth.
Pain Scale? Some hospitals will insist on intermittently asking you to rate your pain on a scale of 1 to 10. In labor, this is not a particularly helpful way to have to think. Consider just saying “5” whenever you are asked so that you don’t have to think “pain worsening” which, frankly, can worsen your perception of pain! (Thanks to my dear doula friend Bonu deCaires for this tip).
Birth Partners: Tell nurses, residents and doctors how well your laboring partner is doing. (Instead of asking, “how’s she doing?” which can invite a host of opinions, some of which your laboring partner may not appreciate.)
Ask your questions when an intervention is suggested. One way to remember helpful questions is to memorize this simple mnemonic, BRAND:
- B Benefits: What are the benefits?
- R Risks: What are the risks?
- A Alternatives: Are there alternatives we can try?
- N Now: Is it medically necessary that we do this now? Or can we wait an hour/day/week etc?
- D: Decision: Can we have a few minutes alone to make a decision?
Know Your Rights:
Most states offer a Patient’s Bill of Rights. As an example, as a patient in a hospital in New York State where I live, familes have the right to:
-Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation.
-Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment.
-Refuse treatment and be told what effect this may have on your health.
-Participate in all decisions about your treatment and discharge from the hospital.
Wherever and however and with whomever you decide to give birth, all the best!
“Labor is obviously hard and intense work (hence, its English name). It demands all of the mother’s attention and may require hours of work, sweat and heavy breathing. Still, it remains a normal physiological process that human and all other mammalian females have experienced for as long as we have existed.” Ina May Gaskins, Ina May’s Guide to Childbirth
By Mary Esther Malloy, www.mindfulbirthny.com