Wrong and dangerous birthing and labor positions–especially in Pakistan’s maternity wards

Positioning for Prevention

What image comes to mind when you picture a birth in a hospital?

Most people see a picture of a woman on her back, with her legs raised or perhaps in stirrups. That is the perception that the technological model of birthing has transfixed into our mind’s eye.

The obvious problem is that by lying on one’s back or by sitting semi-reclined on one’s tailbone, the space of the pelvic outlet (birth canal) may be reduced by up to 30%. By adopting a traditional hospital position that is convenient for birthing professionals, one unknowingly reduces the space the baby has to enter this world.

There is no medically sound reason to give birth on one’s back, and there is every reason to give birth in a safer position that works with female anatomy and physiology, in a way that women’s bodies were designed.

It is so easy to open up the birthing canal to help ensure a safer passage for the baby, and to reduce the risk of injury to the mother’s body as well.

By simply rolling over to one’s side, which can be easily accomplished, even with an epidural, allows the sacrum the freedom to move back as the baby is passing through.

What is most important to remember is to get the mother off her back!

Changing positioning during the first and second stages of labor can dramatically reduce the incidence of shoulder dystocia, and thus eliminate the resulting complications
Risks of Traditional Positioning

With positions that close the birthing canal, such as lying down, there may be increased risk to the baby of:

* increased need for forcep or vacuum delivery
* broken clavicle/collarbone
* excessive bruising
* pressure on baby’s neck vertebras
* excessive head molding
* compression of umbilical cord
* stress on baby
* poor position/angle of the fetus in relation to the pelvis
* brachial plexus injury
* broken humerus
* disruption of the baby’s oxygen supply

and increased risk for the mother of:

* less effective contractions
* labor slowing and not progressing
* possible increased hypotension & pregnancy-induced hypertension
* ineffective pushing
* may lead to illusion of cephalo-pelvic disproportioin due to reduced pelvic diameters from poor positioning
* increased risk of need for Cesarean section
* strain and tearing to the mother’s tissues
* episiotomy
* back pain
* fractured coccyx/tailbone

Janet Balaskas, the recognized pioneer of natural childbirth and author of “Active Birth” reiterates the danger of being in a supine position:

“In the semisitting position the mother’s weight rests on her coccyx and the pelvic capacity is reduced.” “In the semireclining position the sacrum is immobile and the pelvic outlet narrows.” “Your coccyx is designed to move out of the way as your baby’s head descends. Sitting on your coccyx during birth restricts the pelvic outlet and can also lead to dislocation of the coccyx, which can be extremely painful for months after the birth.”

The sacrococcygeal joint, the joint between the sacrum and the coccyx or tailbone, also softens in pregnancy; it is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges. Of course, this is impossible if the mother is sitting on her coccyx.
Benefits of Proper Positioning

Opening the birth canal by using positions that support a woman’s anatomy, will decrease the risk of possible trauma to the baby and mother’s body. .Moving around during labor and using birthing positions such as left side-lying, hands and knees, upright, squatting, etc. offer several benefits:

* increased comfort
* reduced pain
* an enhanced sense of control and involvement in the birth
* more effective contractions
* better progression of labor
* baby more likely to descend in an optimal position
* work with gravity instead of against it
* better blood and oxygen supply to the baby

Beyond these advantages, there are equally important effects on the baby and on the progress of labor. Changing positions during labor can change the shape and size of the pelvis, which can help the baby’s head move to the optimal position during first stage labor, and helps the baby with rotation and descent during the second stage.

Swaying motions such as walking, climbing stairs, lunging, and swaying back and forth are especially helpful with this.

Movement and upright positions can help with the frequency, length, and efficiency of contractions. The effects of gravity can help the baby move down more quickly. Changing positions helps to ensure a continuous oxygen supply to the fetus.

“There is evidence to suggest that if the mother lies flat on her back then vena caval compression is increased, resulting in hypotension. This can lead to reduced placental perfusion and diminished fetal oxygenation. The efficiency of uterine contractions may also be reduced”. (Humphrey et al. 1974, Kurz et al. 1982)

Changing position can also reduce the length of labor. Mendez-Bauer and Newton (1986) state that duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in patients who alternated supine and standing with standing and sitting positions.

Another positive outcome from positioning is the reduction of the use of episiotomies and fourth degree tears. Since there will be less dystocias, doctors will not feel inclined to cut the perineum, to give more manipulation room. These have been done for many years without anatomical reason, but more so for legal record.

An ideal position would include:

* opening the pelvic outlet as widely as possible
* providing a better fetal position with a smooth path for the baby to descend through the birth canal
* using the advantages of gravity to help the baby move down
* giving the mother a sense of being safe and in control of the process
* and most importantly, decreasing the risk of injury to the baby and to the mother

http://www.ubpn.org/index.php?option=com_content&view=article&id=67&Itemid=68

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Childbirth Positions: Giving Birth On Your Back Is Just NOT COOL!

It amazes me everyday to see and hear about  women who lay flat on their back while giving birth!

http://naturalchildbirthworld.com/childbirth-positions/

Sadly, though it’s not their fault – it’s what they’re TOLD TO DO! Seriously, it goes against basic anatomy!!! …

You see our birth canal is actually shaped like a “J” … not a straight line (see diagram on the right) … The baby doesn’t just slide straight down and out. It comes down, then up and over the pelvis.

Look at the picture carefully and you’ll understand how that works. Actually, it seems utterly crazy to lay flat on your back with your legs up = expecting the baby to come out at all!

In fact, choosing to lie on your back as your main childbirth positions closes up your pelvic area by about 30%.

Plus if you think about it – you’ll also have gravity working against you. This means when you’re trying to push bub out, you’re pushing down and then UP before he comes out – Can anyone say CRAZY!!!!!

Plus, who the hell wants to do more work than they have to??? – Giving birth is enough of an effort by itself without some idiot telling you to lay flat on your back and open your legs!

** SIDE NOTE FOR CHOOSING CHILDBIRTH POSITIONS

If it feels natural for you and you WANT to lay flat and give birth to your baby that way, then go for it – do what is best for you. But I can suggest a positions that may be easier for you. If you’re a little apprehensive about how you’ll look in those positions – TRUST ME – You won’t care on the day!

So here’s a few childbirth positions you may want to try:

(NOTE: You may want to lie on your back or try other childbirth positions during labor, which can take a few hours, but these positions are to help you specifically in the “Birthing” or “Pushing” phase)

1) Squatting – You can do this on the floor, on a bed, in a birthing pool and use whatever support is necessary ie. bed head, hubby, doula etc. Women who use this position report feeling in control and comfortable in this position. It can help shorten the length of the birth canal, so the baby comes out easier – WOOHOO!

2) All 4′s – Many women (myself included) find getting down on your hands and knees is one of the most natural childbirth positions . It certainly helps in terms of gravity and also opens your hips wide, meaning there’s less pressure on you and your baby.

This can be done on a bed, mats on the floor, in the water or leaning over something like a yoga ball or bed head.

3) Kneeling – Some wome kneel on cushions or on a bed. They can be supported by draping their arms around their partners neck or leaning into a pile of pillows.

4) Lying On Side – Some women find they want to turn to the side to birth their baby. This is completely natural and can be assisted, by the birth partners lifting one of her legs to create enough space for the baby.

5) Birthing Stool – Specially made stools have been used for giving birth for centuries. They are shaped for the mother to sit on and then she is usually supported by her birth partner and/or midwives.  Some women find squatting too tiring on their legs, so a birthing stool is definitely helpful in this regard.

Tracey Rose is a journalist, natural childbirth educator, mother of two and author of “How To LOVE Your Labour: One Woman’s Journey From Freaking Out To Fearless Birth”

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How can water help relieve the pain of labor?

Water has probably been used since the beginning of time to relieve pain during labor. But recently it has become popular once again to use water in labor and birth. Certified Professional Midwife Nina McIndoe explains explains how water can help during labor.
Nina McIndoe

Your question
How can water help relieve the pain of labor?

The expert answers
Although it has surely been used since the beginning of time by laboring women, we are just recently rediscovering water as a very effective pain relief tool in labor. I personally lament the fact that I gave birth to my own babies between these two ages of enlightenment. As a midwife, I have seen over and over again the wonderful effect that water has on the course of labor.
Before we started using tubs and doing underwater births, we discovered if we encouraged mothers to get into the shower or bathtub during labor she usually handled the discomfort of her labor more easily and her labor seemed to move along at a quicker pace. It didn’t take long for us to “send them to the showers.” Very often, the next thing we would hear was “I have to push”!

Labor can be difficult and painful for many women, but the good news is that our bodies do not leave us bereft. Our bodies offer a reward for the exertion of labor — narcotic-like painkilling chemicals called endorphins, or bets-endorphins, that circulate in the blood stream. These natural opiates are also released during other forms of physical exertion such as running, cycling and sexual intercourse. Not only are these chemicals released by the contractions of labor, but according to research with weightlifters, the grimacing and grunting that many women do during birth release endorphins as well. The drugs commonly used to aid in childbirth actually interfere with your body’s ability to release these chemicals.

Most women relax as soon as they enter warm water. It lowers adrenaline and encourages endorphins. Also, positive sensations like warmth and stroking touch, sensations that give comfort, travel to the brain faster than negative sensations like the discomfort of contractions. Therefore the warmth from the water and its relaxing benefits override the negative effects of any of the pain and fear of labor.

Sometimes pain is caused through fear which creates tension and blocks endorphins. The use of water helps to break this fear-tension-pain cycle. The water supports the weight of the baby and eases the many aches and pains of labor and late pregnancy. The support of the water allows the mother to adopt any position which she finds comfortable and enables her to change positions easily. Many midwives use the tub in prodromal labor because often a mother can sleep in the tub when she cannot get rest any other way. Immersing yourself in deep warm water is the best!

Studies have shown it to be as effective at pain relief as an epidural, with no side effects! Our apprentice affectionately referred to her birth tub her wetpidural. Any use of warm water will help, even a normal bathtub, a shower or warm wet washcloths applied to the belly or back. I have know of many hospital births to go very well when the mom spends long periods of time in the shower

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Water Birth – Preparing For Birth in Water By Brenda Manning MIPP (Midwife in Private Practice)

Water Birth – How to Prepare For a Birth in Water

Firstly, you need to prepare your mind (this encompasses the issue of informed consent). Examine your own motivations, incentives and expectations for wanting a water birth. Ask yourself what made you decide to have a water birth and why – is it something you are doing for yourself or are you doing it because someone else expects you to? Remain flexible and let go of your expectations that you must birth your baby in any certain way. Examine how you might feel if your baby is not born in water. Get in touch with your own fears. Most importantly, develop and trust your own intuition.

Choosing a Tub For Your Water Birth

The tub should be big enough to sit in comfortably and deep enough for the water to come up to armpit level, so as to get an adequate degree of buoyancy.

Make sure that your tap adaptor fits the outlet you will be using. Clean the tub with a non-abrasive cleaner, then use 10% solution of bleach and rinse thoroughly.

Consider purchasing 2 hoses, of different colours, one for filling and one for emptying the water. Remember that the water rises by 3 to 4 centimetres for each person who enters the tub and allow for this as you are filling it. Fill the tub to 30 centimetres from the top, then add more water as necessary to avoid spilling over. Do a test run by timing how long it takes to fill the tub so that you already know this when your labour starts. Depending on how quickly you are progressing and how rapidly the tub fills, you may want to start filling the tub when labour begins.

The Water For Your Water Birth

Here’s some tips for the water in your tub:

The water should be clean: if its pure enough to drink, its pure enough to give birth in.
You don’t need additives, but a cup of salt per tub will prevent your skin becoming wrinkly and waterlogged.
Don’t add any essential oils if you are planning to birth in the tub unless you dilute them in 10 mls of milk first.
What Temperature Should The Water Be For a Water Birth?

The water temperature ought to be within 35C – 38C, depending on your preference. Adjust the temperature to your comfort. If the water is too cold, you will lose body heat trying to keep warm, you will become tense if you’re shivering and it’s thought that cold women don’t birth their placentas well. If the water is too hot you’ll feel drowsy, overheated, become dehydrated and as it dilates all your blood vessels. Your blood pressure will drop which can make you feel faint and you’ll have a greater tendency to bleed after the birth. If you just want localised heat, say on your back; use wet, hot nappies or hot packs whilst kneeling in the water. Use a cold washer if needed on your face, have a fan blow on you (turn it off for the birth) and suck ice.

The Birthing Room

The floor should be strong enough to support the weigh of the tub when full. The room should be large enough allow access from all sides. Heat the room to personal comfort, have heated towels and blankets for mother and baby ready.

What to Eat and Drink?

Drink to thirst. Ask your partner to remind you to drink at least 300mls of water every couple of hours to avoid dehydration, which can result in fatigue and a poorly functioning uterus.
Eating and drinking during labour has been shown to reduce the total length of labour by as much as 90 minutes. Eat light, easily digested food.

When Do I Get Into the Tub For My Water Birth?

Wait until you have a strong desire to be in the water. It’s best to wait until your contractions are strongly established. Some recommend waiting until you are at least 5cms dilated, since you want to save the pain relieving effect for the time you need it most – at transition. If labour slows down when you are outside the water, try getting into the tub as this might stimulate labour. If your progress slows down whilst you are in the tub, get out, empty your bladder and move around to stimulate labour. Often it is the CHANGE of environment that gets labour moving again.

What About Debris In The Water?

Use a sieve to remove any old clots, mucous, faeces or vomit from the water as soon as possible. But don’t spend lots of energy worrying about this. Remember that ‘the solution to pollution is dilution’.

Birth Positions For a Water Birth

Experiment with a variety of different positions while in the tub. Try kneeling, squatting, leaning, sitting or lying outstretched (face up or down. Use a snorkel if you like your face to be immersed). Some women prefer their partner to be in the tub with them to hold onto and act as an ‘anchor’ others prefer to be in the tub alone. Put folded towels, waterproof inflatable cushions or a rubber bath mat on the bottom of the tub to cushion your knees.

How Long Should The Baby Stay Under Water?

Discuss with your birth attendants ahead of time. Many people feel comfortable with the time that it takes the mother to reach down and pick the baby up herself (called rapid immersion). Any longer than that is not necessary. Remember that the great benefits of water are achieved as soon as the infant is born into the warm water.

How Does The Baby Breathe During a Water Birth?

The baby doesn’t breathe until after its face leaves the water and its skin comes into contact with the air or it is stimulated. Until then, the baby receives oxygen through its umbilical cord, as it has done during the 9 months of pregnancy. Sometimes the babies are so calm at birth it can appear that they aren’t breathing at all but they just aren’t crying. Their heartbeat will be normal and when you gently rub their back, blow on their face or open their mouth with your finger they will gasp.

What About The Placenta?

Some people choose to stay in the tub after the birth and bond with the baby. They should birth their placentas out of the water due to the ‘theoretical’ risk of a water embolism. This ought to be discussed with your birth attendant ahead of time. If the placenta is slow to come, get out of the tub, put a bowl in the toilet and the placenta will likely come out easily into the bowl whilst you are sitting there with a warm blanket or towel around you.

Could The Mother Get An Infection From The Water?

Dr Michael Rosenthal reports that there have been no incidences of infection in close to 1000 births that he has attended. I’ve certainly never seen one in the thousands I’ve attended. This may be due to the fact that in labour and birth the action is all moving down and out, not up and in. The concentration of bacteria in and around the vagina is well diluted by the water.

Will My Birth Attendants Get Any Infection I Have From The Water?

The infectious diseases we mostly concern ourselves with as birth attendants are Hepatitis A, B, C and HIV. The sheer volume of water these viruses are diluted in at a birth would render them negligible; no one has ever caught these from a waterbirth that we know of. It would take a much more highly concentrated volume of blood to seroconvert for the average well person with good skin integrity. Even so, open abrasions or cuts should not be immersed unless well covered with waterproof dressing (for both your sakes) and long veterinary gloves can be worn by accouchers if they feel they need protection.

(Daniels, 1986; Lichy, 1993; Harper, 1994)

The Many Benefits Of Water For Labour And/Or Birth

Greater comfort and mobility. The mother has much greater ease and freedom to move spontaneously and to change position to aid in descent of the baby.
Reduction of pressure on the abdomen. Buoyancy promotes more efficient uterine contractions and better blood circulation, resulting in better oxygenation of the uterine muscles, less pain for the mother and more oxygen for the baby.
Helps mother to conserve her energy. Immersion reduces opposition to gravity; supporting the mothers weight so that her energy can be used to cope with the contractions
Promotes deeper relaxation. As a woman relaxes deeply in water, her hormones are released and she starts progressing faster with more rhythm: labour becomes more efficient.
Water relaxes the pelvic floor muscles, as it softens the vagina, vulva and perineum leading to fewer injuries to these tissues.
Water minimises the pain so effectively for most women that it reduces or eliminates the need for analgesia.
If analgesia is required it is in lower doses and is potentiated by the effect of the water.
Immersion is more safe and effective than an epidural.
Water stimulates the touch and temperature nerve fibres in the skin. It blocks impulses from the pain fibres, known as the ‘Gate Theory of Pain’.
Facilitates a dysfunctional labour. Water can be an effective way to stimulate dilation of the cervix when the mother has difficulty progressing into the active stage of labour.
Water can reduce the need for drugs to artificially stimulate labour. Often, simply getting into the tub will result in dramatic and rapid progress to full dilation within an hour or two.
Lowering of blood pressure. When anxiety is causing high blood pressure, immersion in water often helps relieve it. The effect is heightened if the room is darkened.
Change of consciousness. Immersion helps relive anxiety and promote relaxation. Water encourages women to let go and focus inward as labour progresses
Easier breathing. Moisture in the air makes it easier to breathe without the mouth becoming dry and is helpful for women with asthma. Also decreases the tendency to hyperventilate.
Facilitates the second stage of labour. Many women are less inhibited in the water.
Many women experience rapid second stages, with the baby emerging minutes after the body begins pushing, also known as the foetus ejection reflex. (see Odent, The Nature of Birth and Breastfeeding)
It reduces the ‘ick’ factor for some women and encourages both parents to touch the baby whilst birthing
Being in the tub reduces the possibility of intervention by birth attendants. Their visibility is reduced and they cannot touch the perineum or baby as it emerges unless the mother chooses to let them.
The ability for birth attendants to intrude is reduced. They are less likely to interfere with the actual birthing without the womans consent and willingness to move and allow access.
Skin to skin time is facilitated.
Initial breast contact is also easier to initiate as the woman is already naked.
The cord continues to pulse strongly for an extended period, resulting in baby receiving his full blood volume.
Birth in water is wholly a somehow softer, more gentle experience.
Resources: Daniels, 1986; Balaskas, 1990; Lichy, 1993: Napierala, 1994

Brenda Manning is an experienced and professional Midwife specialising in wholistic health care for mothers and babies. You can visit her website here. Become a fan of BellyBelly on Facebook or add Kelly as a friend (frequently adding articles and stories). You can also follow BellyBelly on Twitte

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A midwife’s perspective: Labor and birth in the water

Have you considered laboring in a soothing bath, or even an actual waterbirth? Midwife Jill Cohen shares her experience and some of the benefits of this natural pain relief.
Jill Cohen

The benefits of water
It was late in the evening. I sat staring into the fire, waiting as I often do for the phone to ring. Midwives frequently have a sixth sense about birth, and on this particular evening, my senses proved true — at 10:30pm the phone indeed rang.
At first all I heard was the echo of deep breaths and water running. I knew this was labor. Water and labor fit hand-in-hand for most laboring women. The shower or bath warms, secludes and relaxes a woman so she can open more easily at her own pace. It creates a womb-like environment in which a woman can feel safe. It may not take the pain away, but it enables a woman to cope through her intense sensations, relaxed and with least resistance, creating more comfort. Water forms a warm, wet buffer around her, keeping outside forces and interventions at bay. Yet if the woman should need assistance or monitoring it can be accomplished easily in her watery environment.

I waited for the contraction to pass as I listened intently for the mystery woman on the other end of the phone to finally identify herself. I could tell by the echo that she was in her bathroom, and could tell by the sound of running water that she was in the bath. The tempo of her breath told me I would be heading over soon… as soon as I could ascertain who she was! After her breathing slowed and she paused to collect herself, I heard her giggle a “Sorry!” I knew right away it was my dear friend Hazel. This was her fourth child — I was out the door!

Laboring in the water
I walked in to find her children sound asleep and her partner sitting at the edge of their large tub, a glass of cold water and bendable straw in hand to help keep Hazel well-hydrated. Before she could utter a word, another contraction arrived and she went deep into herself. Because water can speed labor along once the woman is over 5 centimeters dilated, and I guessed that Hazel was at least that, I busied myself preparing her birthing room. I then settled into the bathroom with my water Doppler and monitored our little friend. All was well. Hazel needed to pee, so she got out and onto the toilet. Another big contraction, wide eyes and pop went the bag of waters. They were clear and smelled sweetly of baby. It was time to decide where this child would be born.

Without hesitation, Hazel chose the tub. As soon as she was situated, I heard the familiar sound of relief I hear so often when women sink into warm water. It is music to a midwife’s ears, as is the steady heart rate of a baby about to be born. Hazel pushed with the next contraction as she pulled her legs back and sang that magical birth song, low and deep. With that push we saw the baby’s head. Two more pushes and the head was born.

As we waited for the next contraction, we had time to see this little child and appreciate the peacefulness of his/or her entrance. Water is vital to life — we cannot live without it. Its ability to nourish, nurture, propagate and promote life fits so well in the birthing world. I believe that because babies come from a watery environment, when they are born into water it feels familiar to them. Under normal circumstances, babies will not breathe until they hit air. When they emerge into water their house gets bigger, but they still think they are in the womb. This little one was wide-eyed and waiting. It is always amazing to see such peaceful passage.

Within a few moments, another contraction came and the baby was gently born. Hazel instinctively reached down and brought her baby to the surface. There was no need to suction — this little boy flexed, stretched, yawned and pinked up without even crying.

Misperceptions
Misunderstandings abound about the use of water in birth, such as risk of infection, risk to the baby, and lack of ability to monitor effectively. There is now much research-based evidence to indicate that with proper preparation and protocol the risks are no more than for air birth. So for those women and practitioners who choose water to facilitate birth, go for it! But first, be informed: Investigate what standards should be used. Plan what kind of tub you will use, where to put it, and find your water source. Remember that water is a different medium to work with. Familiarize yourself with it; think about its potentials; imagine its relation to birth. Merge with it and feel its effects.

For me, the rewards of using water in labor and birth is summed up in that magic sound of relief in a woman’s moan as she enters the warm water, and the magic moment as baby comes forth with that peaceful look that tells me the passage has been safe and gentle.

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Natural labor support – positions

TIPS ON MANAGING LABOR PAIN DURING CHILDBIRTH NATURALLY, INCLUDING LABOR POSITIONS, DOULAS, WATER BIRTHS, MASSAGE,

Are you looking for ways to manage labor pain naturally? Preparing for the pain associated with labor often leaves many women anxious and uncertain about what to expect. Most women experience pain during labor, but preparing for your labor may alleviate some of the pain and make for a more comfortable experience. There are many traditional and modern choices when it comes to pain management during labor. Natural ways to deal with labor pain range from adjusting the lighting in your room to working with a midwife in water.
Tracy McGinnis

Give yourself plenty of time to review different options available prior to your labor and delivery, and come up with a plan of pain management that’s right for you. Choosing a more natural way to deal with labor doesn’t mean forgoing modern treatments.

Create a relaxing space
One of the easiest ways to create a comfortable space during labor is to make adjustments to the immediate area you’ll be spending time in while in labor. Discuss options with your doctor, nurses, and any family and friends that will be with your during this time to make the space as relaxing as possible.

Consider adjusting the lighting, temperature and noise around you in your birthing room. A quiet, low lit room may help you relax and help you get through some of the pain you’re experiencing.

Music during labor
Music, candles and other additions may be things you’ll want to include to help you relax. Be sure to check with the hospital ahead of time to see what the restrictions are. What might be relaxing for you could be distracting for others in the hospital.

Find out more here on how music can provide a harmonious birth experience.

Plan ahead who will be in the room
Consider who will be in the room with you during delivery – family, friends, hospital staff, doula, mid-wife, etc. Decide on how many people you want to have and what they’re roles will be during the labor process. Try to avoid any unexpected guests during this time, and let loved ones and friends know what your wishes are ahead of time.

One person you may want to consider including in your room is a doula. To find out how a doula can make your birthing experience more enjoyable, read Why doulas are a girl’s best friend.

Consider acupuncture or acupressure
“There are dozens of points on the body that can block pain to the abdomen and uterus which can be stimulated with needles or milder techniques like seeds or acupressure,” says licensed acupuncturist Tom Ingegno, M.S., L.Ac.

“For women who are expected to go into labor I often use press seeds (traditionally seeds but now commonly gold, silver or magnetic beads) or tacks taped on various acupuncture points to increase relaxation in the hips and help manage pain.”

Find out more about pregnancy acupuncture here.

Massage during labor
Massage is another alternative to help alleviate pain symptoms and can be done by a professional or loved one. Massage can help reduce your anxiety, help with contractions, blood flow, and decrease levels of stress and exhaustion, among others. Massage can be most effective when you are not experiencing contractions and can focus on relaxing.

You can switch positions and massage different parts of the body including back, legs and hands, among others, to get the desired effect. For more tips on massage visit with a therapist and understand what your comfort level with massage is while you are pregnant.

Change positions
Changing the way you sit or lay in bed can help increase blood flood and decrease pain. Getting out of bed and walking or moving around your room or hospital floor can help decrease anxiety and relax and prepare your body for labor. Be sure to have someone close by if contractions increase to avoid falling and to get help quick if you need it. You may consider bringing in pillows or using a birthing ball to sit on to help reduce back pain.

Find out here effective birthing positions to help labor and delivery.

Get wet
A shower or bath may be just what your body and mind need to help relax. A warm shower can help relieve back pain experienced during contractions. Birthing tubs allow women to complete submerge in water and helps with the pressure inside the uterus.

Always discuss options with your healthcare provider, and keep in mind, some options, like water, may not be available to you if your water has broken.

For more, read: How can water help relieve the pain of labor?

Shout out loud!
Do you find yourself swearing like a sailor when you stub your toe? It turns out swearing helps diminish pain! A recent study examines the effects of swearing and pain tolerance. Among some of the findings, the study suggests that swearing helped increase pain tolerance and decreased perceived pain. If you’re not one for keeping a quiet room and need to release stress in other forms, consider swearing your way through labor pain. Like you needed an excuse to swear! Just make sure siblings are out of the room and let er’ rip!

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How to prepare for a water birth

http://www.pregnancyandbaby.com

AS PARENTS TODAY, YOU HAVE MANY OPTIONS WHEN CHOOSING A LABOR AND DELIVERY EXPERIENCE. WHETHER YOU CHOOSE TO WELCOME YOUR BUNDLE OF JOY INTO THE WORLD AT HOME, IN A BIRTHING CENTER, OR IN A HOSPITAL, A WATER BIRTH MAY BE THE RIGHT CHOICE FOR YOU AND
As parents today, you have many options when choosing a labor and delivery experience. Whether you choose to welcome your bundle of joy into the world at home, in a birthing center, or in a hospital, a water birth may be the right choice for you and your partner.
Michelle Maffei

Water births are said to benefit both you and baby. “One of the most significant benefits is that that woman becomes more tolerable of the pain and discomfort associated with childbirth,” shares Althea Hrdlichka, birth and postpartum doula. “In many cases, opting for a water birth shortens the woman’s labor, makes it much less stressful for her and baby, and provides baby the ability to emerge into the world in a more natural state (in water) therefore making the transition a relaxing and more enjoyable experience for them both.”

Considering this alternative birthing method? Here are the things you will need to know in order to prepare for your water birth.

Before labor
Find a midwife that has experience performing water births
Create a birthing plan and prepare for alternatives should unforeseen complications occur
Make sure your tub is deep enough to fill to armpit level for buoyancy, and is free from water jets and internal pipes, which may harbor unwanted bacteria
Consider purchasing an inflatable kiddie pool or rent a birthing tub from a local birthing center if your tub will not suffice
Check that the birthing room is big enough for the midwife to set up her equipment with plenty of room to maneuver
Inflate and clean tub with non-abrasive cleaner and rinse very thoroughly in advance of the onset of labor
Consider using two different water-drinking hoses to fill and empty the water, along with a submersible pump for draining out the water easily
Make sure that the tap adaptor fits the faucet you will use to fill the tub
Purchase a clean, sterilized fish net to collect debris in the water that may occur during the labor process, like blood clots and mucus
Practice filling the water before hand to determine how long it takes to fill the tub

Go time
Use clean, pure water that is safe enough to drink to fill the tub
Fill the water with allowance for 1”-2” water rise per person, starting with about 9” of water from the top
Set water temp to your personal comfort level, between 95 and 101 degrees Fahrenheit
Drink plenty of fluids and eat food that is light and easily digestible
Wait until contractions are well established, at about 5 cm or at transition when the pain relieving effect will be maximized, to get into the tub
Get into the tub if labor slows down outside of the water, which may stimulate labor; if labor slows down in the tub, get out and move around to get things going again
Experiment with birthing positions, including your partner both in and out of the water if you prefer

Birth moment
Discuss with your birth attendants prior to your delivery on length of time baby should be under the water
Utilize rapid emersion, taking only long enough for you to reach down and pick up the baby yourself (the benefits of a water birth are accomplished as soon as the baby is delivered into the warm water)
Discuss with your birth attendants prior to your delivery whether or not you will birth your placenta in the water

Ultimately the choice to have a water birth is a personal one, so long as your OB/GYN has cleared you of any unique circumstances with your pregnancy that would make it unsafe to do so. With the right preparation, a supportive partner, and a midwife to ensure the safety of your baby-to-be, you can get the most from this natural birthing method.

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Why doing a water birth?

The Benefits of Water
for Labor and/or Birth

Greater comfort and mobility. The mother has much greater ease and freedom to move spontaneously and to change position to assist the descent of the baby.

Reduction of pressure on the abdomen. Buoyancy promotes more efficient uterine contractions and better blood circulation, resulting in better oxygenation of the uterine muscles, less pain for the mother, and more oxygen for the baby.

Helps mother to conserve her energy. Immersion reduces opposition to gravity; supports the mother’s weight so that her energy can be used to cope with the contractions.

Promotes deeper relaxation. As a woman relaxes deeply in water, her hormones kick in and she starts progressing faster and with more rhythm; labor becomes more efficient.

Water relaxes the pelvic floor muscles.

Water minimizes pain so effectively that for most women other pain control methods are no longer needed.

Water stimulates the touch and temperature nerve fibers in the skin. It blocks impulses from the pain fibers, known as the Gate Theory of Pain.

Immersion is often more effective and safer than an epidural. Some people call waterbirth an “aquadural.”

Facilitates a dysfunctional labor. Water can be an effective way to stimulate dilation of the cervix when the mother has difficulty progressing into the active stage of labor.

Water can reduce the need for drugs to artificially stimulate labor. Often, simply getting into the tub will result in dramatic and rapid progress to full dilation within an hour or two.

Lowering of blood pressure. When anxiety is causing high blood pressure, immersion in water often helps lower it.

Change of consciousness. Immersion helps relieve anxiety and promotes relaxation. Water helps a woman to let go and focus inward as labor strengthens.

Easier breathing. Moisture in the air makes it easier to breathe and can be helpful to women with asthma.

Facilitates the second stage of labor. Many mothers are less inhibited in the water. The warm water softens the vagina, vulva, and perineum, leading to fewer injuries to these tissues.

Many women experience rapid second stages, with the baby emerging minutes after the body starts pushing, also known as the fetus ejection reflex (see Odent, The Nature of Birth and Breastfeeding).

Empowerment of the mother. When a woman delivers her baby while remaining awake, aware and in control, it greatly enhances the birth experience for her and becomes a source of great personal strength and power that enriches her life forever.

Greater involvement of the father. Because the mother’s pain and stress is so greatly reduced, it is much easier for fathers to particpate and take a more active role in the birthing process. Many men are reluctant to become involved in the birth experience when they know that the mother is likely to endure intense pain, trauma and suffering during labor and delivery.

Enhanced family relationships. When the mother’s pain is dramatically reduced, many fathers eagerly take a more active role in the delivery, resulting in a greater family bond. When fathers are more involved it increases the possibility of a joyous birth. Both parents and child get to share a wonderous experience that can enhance their relationships with each other for the rest of their lives.

Better parent-child interactions. A mother who has had a beautiful and empowering birth experience will have an especially positive association in her mind and emotions to that child; and a baby who has had an easy, non-traumatic, not painful, gentle birth will have an especially positive association to the parent. This exceptionally positive start to their relationship will likely enhance the parent-child interactions forever.

Evolving humanity in a positive direction. Many psychologists believe that babies born gently grow up to become more gentle adults, and have a greater ability to deal with problems non-violently.

Resources: Daniels, 1986; Balaskas, 1990; Lichy, 1993; Napierala, 1994.

Thanks to Andrea Eastman of the Gentle Birth Alternatives Home Page for her help in compiling this section.

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Birth without pain medication

How to get through natural childbirth free of pain medication

by Willow Tohi

(NaturalNews) “Life is pain highness; anyone who says differently is selling something.” This line from the movie The Princess Bride is certainly applicable to childbirth. It’s going to hurt. It’s not meant to be easy. However, there are ways to prepare for and manage that pain, which is just one of the challenges of becoming a parent.

Preparation
One of the best ways to get through childbirth without pain medication is to take steps to shorten labor.


* Diet is everything here. Eating lots of greens, drinking lots of good water, and taking/drinking pregnancy supporting herbs go a long way in preparing your body for what’s to come. Equally important is avoiding sugar and other dietary toxins.


* Physical preparation should include daily exercise, stretches, and alternative treatments as needed, such as acupuncture, chiropractic care, or massage. These will help things like alignment and fetal positioning. Emotional and mental preparation is equally important. Athletes who run marathons can tell you how important mental preparation is.


* Educate yourself with The Bradley Method classes. These will give you an understanding of why it is important to try for a medication-free birth, and let you know what to expect. Even though birth is hard, it helps to know the stages you will go through, and that they are normal.


*Read books about natural birth stories, such as Ina May Gaskin’s Spiritual Midwifery. These will give you conviction that you too can do it. Ina May says, “God is not a faulty mechanic and your body is not a lemon.” Fact: if your ancestors hadn’t been able to do it, you wouldn’t be here. (They also breastfed, co-slept, wore their babies, and implemented all the other ‘alternative’ approaches you’re thinking of doing.) 


* It also helps to have a birth plan, and possibly a labor support person such as a doula.

If you do end up needing medical assistance, you’ll feel better if you are informed and prepared.

The main event
This is one time in your life you need to put yourself first.

1. Healthcare provider: Are you truly comfortable with them? Do you have a connection? Hospitals and most doctors are in the business of ‘delivering babies’ – sometimes in spite of parents wishes. Midwives assist you with your birth. Just that small shift in perception can mean a world of difference for your birth experience. Midwives also have non-medication ways of helping with pain management. They use homeopathy, herbs, massage, lots of support, and other tricks of the trade.


2. Location: Where will you be giving birth? Are you comfortable there? The classes and books will help you know what to ask. You need to know if they support natural labor, allow you to move around (without being hooked up to wires), etc.

3. Avoid intervention: Contrary to what you’ve been told, gestation often goes up to 42 weeks, if allowed to do so. The hormonal symphony that is birth needs to be left alone – allowed to begin and progress at its own pace. Don’t focus on the clock. Intervention of any kind almost always leads to more intervention and the next thing you know you didn’t have the birth you wanted. The US has a 36% cesarean rate. The World Health Organization says it should be 3%.


4. Move it: Have you ever witnessed another mammal give birth? If not, visit YouTube. They all move in response to what they are feeling. Giving birth on your back is not natural. If your baby needs to turn, get on your knees and flex your back to give him more room. Walk or sit on an exercise ball to progress labor and get baby moving down the birth canal. Rocking, swaying or dancing, leaning on a wall or exercise ball are all useful for getting through contractions. Large baby? Squatting opens your pelvis, giving junior 20% more room. Gravity is your friend during birth.


5. Trust your body, and your instincts: It knows what to do. Give your body freedom to work. You need energy for this – eat and drink when you want to. Move when you need to. Listen to yourself – don’t be coerced into doing something you aren’t comfortable with because someone scares you in to it. Remember – you can always change your mind later to DO something but not to UNDO it. You don’t have to decide at that moment whether or not to receive medication, circumcise, vaccinate, etc. Take the time you need. 


6. Keep your baby with you. That’s where he is supposed to be. He doesn’t need to be cleaned up right away. He doesn’t have to breathe right away either – he’s still attached to the placenta. What is the first thing you want him to experience? Hearing, smelling, and feeling momma or being rushed off to be scrubbed and sucked and weighed? The skin-to-skin contact helps warm him, regulate his breathing and your hormones, and stimulate breastfeeding.

Don’t be afraid. Pregnancy is not a medical condition, and birth is not a ‘procedure’. You were designed for this. Don’t give away this power. It is an awesome, life-changing experience most of us would not trade.

Sources for this article include:

http://www.pregnancyandbaby.com

Tarr, Katherine. A Guide to Motherhood – Herbs, Helps, & Pressure Points for Pregnancy and Childbirth, p. 37-65. Winona Lake, Indiana: Wendell W. Whitman Company, 2008.

Ody, Penelope. Herbs for a Healthy Pregnancy …from conception to childbirth. p. 53-59. Lincolnwood, Illinois: Keats Publishing, 1999.

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Natural Birthing Options

Natural Birthing Options: Technology in Birth- First Do No Harm

Posted by Dr. Mercola | April 09 2000

By Marsden Wagner. M.D.
Recently a woman in Iowa was referred to a university hospital during her labor because of possible complications. There, it was decided that a cesarean section should be done. After the surgery was completed and the woman was resting post-operatively in her hospital room, she went into shock and died. An autopsy showed that during the cesarean section the surgeon had accidentally nicked the woman’s aorta, the biggest artery in the body, leading to internal hemorrhage, shock and death.
Cesarean section can save the life of the mother or her baby. Cesarean section can also kill a mother or her baby. How can this be? Because every single procedure or technology used during pregnancy and birth carries risks, both for mother and baby. The decision to use technology is a judgment call-it may either make things better or worse.
We are living in the age of technology. Ever since we succeeded in going to the moon, we have believed that technology can do everything to solve all our problems. So it should come as no surprise that doctors and hospitals are using more and more technology on pregnant and birthing women. Has it solved all the problems that can arise during birth? Hardly. Let’s look at the recent track record.
Has the recent increasing use of technology during pregnancy and birth resulted in fewer damaged or dead babies? In the United States there has been no decrease in the past thirty years in the number of babies with cerebral palsy. The biggest killer of newborn babies is a birth weight that is too low, but the number of too-small babies born has not decreased the past twenty years. The number of babies who die while still in the womb has not decreased in over a decade. While the past ten years has seen a slight drop in the number of babies who die during their first week after birth, the scientific data suggest an increase in the number of babies who survive the first week but have permanent brain damage.
Is the increasing use of technology saving the lives of more pregnant and birthing women? In the United States the scientific data show no decrease during the past ten years in the number of women who die around the time of birth (maternal mortality). In fact, recent data suggest a frightening increase in the number of women dying during pregnancy and birth in the United States. So it may be that the increase in use of birth technologies is not only not saving more women’s lives but is killing more women. This possibility has a reasonable scientific explanation: cesarean section and epidural anesthesia have both been used more and more in this country and we know that both cesarean section and epidural block can result in death.
We should not be surprised with the recent poor track record of high tech birth. For many decades in the middle of the twentieth century the number of babies dying around the time of birth was decreasing but this was due not to medical advances but mainly to social advances such as less severe poverty, better nutrition, better housing and, most importantly, to family planning resulting in fewer women with many pregnancies and births. Medical care also was responsible for some of the decreasing mortality of babies but not because of high tech interventions but because of basic medical advances such as the discovery of antibiotics and the ability to give safe blood transfusion. There has never been any scientific evidence that high tech interventions such as the routine use of electronic fetal monitoring during labor decrease the mortality rate of babies.
What this means is that putting yourself in the hands of a high tech doctor and a high tech hospital does not guarantee you the safest birth. You must yourself take responsibility for your own birth, including the decision to have technology used on you and your baby. Remember, technology is not good or bad. How technology is used can be good or bad. Airplanes can be used to carry you to visit your family or can be used to drop bombs on women and children. How technology is used on you during pregnancy and birth is of great importance because it can help you and your baby or harm you and your baby.
How to Get the Right Technology
1. Choosing Your Maternity Care Provider
How do you go about being pregnancy and giving birth where the use of technology is appropriate and right for you, your baby and your family? The first step is to get the right health care professional to assist you during the pregnancy and birth. A key decision is to decide if your primary maternity care provider is to be a midwife, a family physician or an obstetrician.
The United States and Canada are the only countries in the world where highly trained surgeons called obstetricians attend the majority of normal births. The American obstetrician is to be pitied. He or she is trying to be all things to all women — primary maternity care provider for normal, healthy pregnant and birthing women, specialist in complications of pregnancy and birth, specialist in women’s diseases, and highly skilled surgeon. No other doctor anywhere in the realm of healthcare tries to maintain competence at all these levels and in so many areas because it is totally unreasonable to expect this from one human being. Can an obstetrician do a six hour “pelvic clean out” gynecological surgical procedure on a woman with extensive cancer, then rush to his or her office and do the best job quietly and patiently counseling a pregnant woman about her sex life? Not likely.
While American obstetricians have worked hard to convince the public they are the safest person to assist at all births, the scientific evidence does not support them. For example, a large scientific study published in 1998 looked at all births in the United States in one year-over four million births. Because doctors really do need to manage the few births that develop serious complications, the study eliminated complicated births and only looked at low risk births. Compared with physician attended low risk births, midwife attended low risk births thirty-three percent (one-third) fewer deaths among newborn infants. Furthermore, midwife attended births have thirty-one percent (nearly one-third) fewer babies born too small, which means fewer retarded and brain damaged infants.
There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low risk or normal pregnancy and birth. So if you are among the over seventy-five percent of all women with a normal pregnancy, the safest birth attendant for you is not a doctor but a midwife.
If you are considering a hospital birth with an obstetrician as your primary birth attendant, ask him or her how much time he or she will spend with you during your labor. One of the reasons a midwife is generally a better choice to attend your hospital birth than an obstetrician is because the midwife is there in the hospital with you during your labor while the obstetrician is not. It is an incredible irony that the obstetrician insists that the woman who is his or her client give birth only in the hospital while the obstetrician who should attend her birth is not in the hospital. If your obstetrician is not with you in the hospital during labor, then where is your obstetrician?
For fifty years now the United States has had a system of maternity care in which the woman goes into labor, goes to the hospital, is admitted by the labor and delivery nurse (L & D nurse) who examines the woman, then calls the obstetrician who is either home or in his or her office (usually seeing normal, healthy pregnant women). The obstetrician gives orders over the telephone to the nurse, who then assists the woman during her labor. The obstetrician may or may not come by the hospital sometime during the labor to briefly check the woman. But it is the job of the L & D nurse to monitor the labor and call the obstetrician when the birth is imminent so the doctor can rush in, catch the baby at the last minute and get all the credit (and money) for “delivering” the baby. If the nurse calls the obstetrician too soon and the doctor has to hang around the hospital waiting for the birth, the doctor is angry with the nurse for wasting his time. But if the nurse calls the obstetrician too late and the baby is born before the doctor gets there, the doctor is furious with the nurse.
Why is it important to insist that your obstetrician be with you during your labor as well as at the birth? In a study of obstetrical malpractice cases involving permanent brain damage of the baby, the absence of the obstetrician from the hospital during the labor played a central role in causing the tragedy in approximately two-thirds of the cases. This research showed that telephone conversations during a hospital birth between nurses at the hospital and the doctor who was not in the hospital gave rise to misunderstanding or miscommunication that caused adverse effects for the mother or baby. If you choose an obstetrician as your primary birth attendant and he/she cannot guarantee that he/she or another obstetrician will be physically present (not just on call) during your labor as well as the birth, you are wasting your money and putting your baby in danger, and you need to get another birth attendant.
If you doubt this description of hospital birth, ask any of the over twenty-five thousand L & D nurses in the United States. These nurses are highly skilled professionals who do what is really an impossible job. They must monitor the laboring woman and assist at the birth, all the while keeping the doctor happy and covering up for the fact that the doctor is not there most of the time and in most cases makes a minor contribution to the birth. The fact that defines and limits these nurses is that they have no autonomy and can do nothing without doctors’ orders.
Because American obstetricians have always had L & D nurses to do their bidding, and now that midwifery is gradually but steadily returning in this country, obstetricians have developed a distorted understanding of midwifery. Obstetricians believe midwives are obstetrical assistants and keep trying to give them orders. But the practice of midwifery is very different from the practice of nursing.
Midwives are autonomous professionals who provide primary maternity care and are analogous to family physicians who provide primary healthcare. If the family physician hears a heart murmur and refers the patient to a specialist cardiologist, this does not mean the family physician is the cardiologist’s assistant and somehow less competent, but only that the cardiologist has a different expertise than the family physician-an expertise for certain complications. The cardiologist makes suggestions for treatment of the family physician’s patient which the family physician and patient may or may not choose to follow. The cardiologist and the family physician are professional equals who collaborate with mutual respect in order to provide the best quality care for the patient.
By the same token, a specialist obstetrician does not give orders to a midwife any more than a cardiologist gives orders to a family physician. The midwife may refer a woman to an obstetrician because of a complication but this does not make her the obstetrician’s assistant. The midwife and obstetrician then collaborate as professional equals.
Too many obstetricians still don’t get it and continue trying to boss midwives around, hiring and firing them from their practices, pushing them off hospital staffs and accusing them of practicing medicine without a license. If you are pregnant, don’t allow yourself to get in the middle of this professional turf struggle. If you want a midwife to provide your primary maternity care, find one who has as much autonomy as possible in her practice. If you are considering having a particular obstetrician provide your primary maternity care, a good way to measure that doctor’s openness and attitude toward you and women in general is to inquire what his or her opinion is of midwifery.
Another reason midwives are safer than doctors is because midwives use far less unnecessary technology. Because obstetricians are surgeons, they turn birth into a surgical procedure. Proof of this is that the birthing woman is treated as though she is a surgical patient: she is put on her back in a bed that is really a modified surgical table, often with her legs up in surgical stirrups. For over twenty-five years we have known scientifically that this is the worst of all possible positions for a woman giving birth; in this position the baby’s head compresses the woman’s main blood vessel that supplies the womb and the baby and reduces the blood and oxygen going to the baby. If the woman is in a vertical position (sitting, squatting or standing) more blood and oxygen flows to the baby, the woman’s bony pelvis opens more to let the baby out and she gives birth downhill instead of uphill against gravity. One way to find out if a hospital is practicing modern maternity care or not is simply to see what position women are put in during birth. If hospital staff are still putting women on their backs during birth, they are ignoring all scientific data and still pretending birth is a surgical procedure.
Between fifty percent and eighty percent of births in most American hospitals involve one or more surgical procedures, further proof that obstetricians have turned birth into a surgical event. Those procedures include drugs to start or speed up labor, episiotomy (cutting the genitals with surgical scissors to widen the vaginal opening), placing metal forceps or a vacuum extractor on the baby’s head to pull the baby out (you can imagine the risks involved in this), and cesarean section to cut the baby out. In reality, any of these surgical procedures is necessary in no more than twenty percent of all births. And since all surgical procedures carry risks, the high frequency of their unnecessary use in physician attended births leads to more dead and damaged babies than would ever occur in midwife attended births. Large numbers of research reports document that midwives use far fewer surgical interventions than doctors. A case in point is the use of episiotomy. From half to three-quarters of all women in America birthing their first baby in the hospital with the assistance of a doctor have this surgical cut done to their genitals. It is scientifically proven that no more than twenty percent of women will need this cut; the best rate is about 5 percent. Among midwives in independent practice in the United States ( that is, when doctors are not ordering midwives what to do), between two percent and twenty percent undergo episiotomy.
Is the fact that midwives cut far fewer episiotomies than doctors important? Scientific evidence shows that having an episiotomy means more bleeding, more pain, more permanent deformity of the vagina, more painful sexual intercourse for months or even years. As well, unnecessary episiotomy is a form of sexual abuse. Some women’s groups in America are rightly concerned about the practice of female genital mutilation in parts of Africa. They need to be equally concerned about the millions of American women who have suffered female genital mutilation-unnecessary cutting of the genitals at birth at the hands of doctors.
While midwives trust women’s bodies, use low tech assistance such as the skilled use of their hands, and understand the importance of preserving normalcy, doctors in general do not trust women but trust drugs and machines, use high tech assistance and focus on the pursuit of abnormality. So having a highly trained surgeon obstetrician assist at your birth is about as sensible as hiring a pediatric surgeon as a baby sitter for your healthy two year old when you go out in the evening. Like the obstetric surgeon who gives the normal woman a shot to hurry her labor, the pediatric surgeon baby sitting your normal child will focus on medical management: when your robust two year old gets tired and fussy, the pediatric surgeon will give him or her a shot to hurry the child to sleep. The result? In the one case the medicalization of birth (remember, birth is not an illness) with a lot of unnecessary risky interventions and very expensive medical care, and in the other case the medicalization of childhood (being two years old is also not an illness) with unnecessary risky interventions and very expensive baby sitting.
When deciding on your primary maternity care provider, it is important to ask midwives or doctors about their practices: find out if they prefer to put you on your back during birth, how often they do episiotomy, forceps or vacuum extraction, and cesarean section. If they don’t know their rates of surgical interventions or refuse to tell you what their rates are, look out! Beware of any tendency to patronize you, to suggest that you cannot possibly understand all this technical stuff, or that you should just ” trust me, I’m the doctor.”
2. Choosing the Right Place to Give Birth
An important decision to make is whether to have your birth at home, a free standing birth center or a hospital. Overwhelming scientific evidence shows that the home is a perfectly safe place to give birth if you are one of the more than 80 percent of women who have had no serious medical complications during pregnancy. The evidence indicates that it is important to have a trained birth attendant for your homebirth, be it non-nurse midwife, nurse midwife or doctor. Your place of birth should also be within thirty minutes of the nearest hospital. The single most important advantage of homebirth is that the birthing woman is in control. Another important advantage is that in homebirth there is far less unnecessary use of technology. For a hospital to say it can be “home like” is like the sign in the bakery window: “We sell home baked bread.”
A free standing birth center staffed with midwives is also a perfectly legitimate choice for the great majority of women who have had no serious complications during their pregnancy. But don’t be fooled by the hospital that advertises its “birth center.” If the birth center is not free standing-i.e. outside the hospital-it will still be under the supervision of the hospital and the doctors, and the birthing woman will not be in control. Plenty of scientific evidence confirms that a free standing birth center with midwives is a safe option. For example, a study of over ten thousand women giving birth in over eighty free standing birth centers in the United States showed birth in these centers to be just as safe as a matched group of low risk hospital births.

Be sure to investigate the practices in any hospital you may consider for your birth. Would you have the freedom to have the kind of birth you wish? Remember, freedom means being in control of everything that happens to you. Freedom is not being given permission to do this but not that. Can you invite anyone you want to be present at the birth? Some hospitals will limit who you can bring. Meanwhile they can-without asking you-bring anyone they want to your birth including, for example, a bunch of doctors in training. Can you come with a written birth plan which they will respect and honor or will they have an obvious attitude about such plans and consider you a “bad patient”? Many hospitals are competing for patients and will show pregnant women beautiful “birthing rooms.” Remember, what is important is not a rocking chair and pretty curtains but whether or not you can be in control.
Always be aware that hospitals are under the absolute control of doctors and that the rules and regulations are for the convenience of the staff, not you. Hospitals are designed to care for sick people and since a birthing woman is not sick, much of what goes on in the hospital doesn’t fit her needs. One simple example: Most birth takes from ten to twenty hours, during which there is one or more turnover of staff who are on eight hour shifts. While the data show the overwhelming importance of a woman having the continuous assistance of someone she knows throughout her labor, during your hospital birth you are likely to have to cope with one or more staff changes and lots of strangers coming into your room.
Ask the hospital if women are put on their backs during birth. Ask for the hospital’s rates of episiotomy, forceps deliveries and cesarean section. Don’t be satisfied with the usual answer-”it varies by doctor.” Don’t believe them if they say they don’

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