There are many pregnancy, birth and parenting books available, but some are a little more helpful than others. Below are some books that we recommend parents read in preparation for a natural birth (or if you are interested in learning more about natural birth).
How do you influence your birth experience?
Step three: Your health and fitness during pregnancy can impact your birth!
It is never too late to make a change. Even small things... like one egg a day or 15 minutes of walking per day, can improve your health and the health of your unborn baby.
A little change now can make a big difference!
After reviewing the first two steps for achieving a natural birth (found here and here), some parents opt to explore other options, interview other care providers and even switch to a new provider and/or birth place (sometimes as late as 40 or 42 weeks into their pregnancy). Don't feel bad about switching! This is your birth and you have the right to be supported and comfortable with the provider of your choice. Just as no two accountants, teachers or computer programmers are the same, no two doctors or midwives are the same either. Here are some tips for finding a new provider (and it doesn't hurt to interview several before deciding to stick with your original provider or choose the best of the bunch):
- Ask your childbirth educator, doula, acupuncturist, massage therapist or anyone else who regularly interact with pregnant clients for recommendations.
- Ask you friends who have recently given birth about their experiences and what they liked and didn't like about the location and care provider they chose.
- Search message boards (local community groups or the local groups on national boards like Mothering.com or Baby Center).
- Read reviews of providers on City Search, Insider Pages or other sites.
Step Two: Your Care Provider - a team approach to birth
There are a range of attitudes and beliefs about birth. Your care provider's perspective of the birth process can have a HUGE impact on your birth. Is your care provider supportive and encouraging of the natural process or does he/she prefer the medical approach of a "managed" birth? How do you tell???
The easiest way to identify your care provider's philosophy is to ask questions. Some examples are listed below with an explanation of what your care provider's answers may mean. Please note, the medical degree your care provider holds and their specialty (i.e. Obstetrician, Family Practice, or Midwife) should not be used to assume their perspective on birth. Some midwives practice "managed" care, while some physicians practice "midwifery" care and are very trusting of the natural process. It is up to you to find out what your care provider believes and how they typically practice. You don't want to be in a position to have to fight for your preferences or try to change your care provider's mind during your birth, rather you want someone you trust, who is on the same page and will openly support your choices during your birth. Note: these questions are best used to have an open dialogue, not to grill your care provider. You may wish to choose one or two that are the most meaningful to you and ask for a longer appointment time to discuss your goals and desires for birth.
Here are some questions to ask your care provider:
· What is your after hours procedure? (Will you be able to talk to your personal doctor/midwife or just the person on call?)
· What percentage of your patient's births do you attend? (How individual is the care they offer? Do they make an attempt to attend most of their patient's births themselves.)
· How many partners are in your practice? (If there are 10 doctors who rotate call then your not likely to know the person attending your birth. This also means that you are more likely to encounter someone who does not have the same philosophy about birth).
· What percentage of patients have a cesarean section in your practice? (This doens't tell you the whole story, but it can help you better understand your risk of having a cesarean. Read more about C-section rates on childbirthconnection.org)
· What percentage of patients have episiotomies? What is your suture rate? How do you help women avoid tearing? (Again, this can help you better understand your risks. You can learn how likely they are to provide perineal support, to assist you in finding the best position to avoid an episiotomy and to avoid interventions that increase the chance of having an episiotomy [such as epidurals, forceps or vacuum extraction]).
· What is the most common choice for pain relief amongst your patients? (A provider who encourages medical pain relief or even chastises a woman for not having medication is not supportive of natural birth. There are many alternatives to anesthesia or narcotics to help a woman cope with labor.)
· What percentage of patients have natural, spontaneous childbirth? (The higher the number, the more supportive your provider likely is. Unfortunately, for many care providers this number is quite low.)
· What is your protocol for postdates (i.e. “overdue”)? What percentage of women are induced in your practice? (Do they routinely induce at 40, 41, 42 or more weeks? If the policy is to induce all patients at 40 or 41 weeks, then your chances of a cesarean greatly increase due to a failed induction.)
· What is your protocol for preventing and managing a posterior position? (Knowledge of optimal fetal positioning techniques can help you avoid this presentation. Avoiding interventions [such as induction, augmentation with pitocin, artificially rupturing the membranes, etc] can reduce complications with a mal-positioned baby.)
· How quickly do you clamp and cut the cord? How do you feel about delayed clamping? How much time is allowed for the natural delivery of the placenta? What do you do it this limit has expired? (Assuming a natural birth has occurred, what approach is used during 3rd stage? Is the natural process respected or is there a standard protocol? Are you encouraged to nurse and release your own naturally occurring hormones to help expel the placenta?)
I often get asked by expectant parents how to avoid pitfalls during labor and know if an intervention is truly necessary. They want to set themselves up in the best way possible to have the natural birth they really want. I think there are a few important steps that couples can take well before the birth to ensure the smoothest possible experience. In Denver, we are blessed with many choices for how, where and with whom to birth. Let's explore these options a little further.
Step one: Your choice of birth location really matters and can influence the course of your labor!
The best birth location is the one in which the laboring woman feels most secure and comfortable and offers her the greatest amount of safety, respect, patience and support. Sometimes your choice of location comes along with your choice of your care provider or vice versa. Sometimes it is influenced by insurance or costs (more on that later), location, amenities or necessity. Sometimes it is a gut reaction to the feelings you have while exploring your options. It just feels right. Put some time and thought into your choice because it is one of the most important aspects of having a great birth experience.
There are three main locations that women choose to give birth in:
Each has advantages and drawbacks, but ultimately the choice is yours. Let's explore each option in the following blog posts:
The most common choice for birth location in the United States is a hospital. There are some obvious advantages, but also many drawbacks to consider about your choice to give birth in a hospital. Even if you ultimately decide to give birth in a hospital, it is important to be aware of the pitfalls and avoid hospitals with higher rates of intervention or greater restrictions placed on the laboring mother. Childbirth Connection provides really valuable resources for parents and has a great discussion on choosing your birth place. No two hospitals are alike, so shop around... the closest isn't always the best choice. Ask friends and co-workers to tell you about their experiences. Go on tours and ask questions about the hospital policies. Don't judge a book by it's cover... a pretty room isn't that important during labor, but a supportive nurse and a deep jacuzzi tub may be all you need.
Some of the advantages of a hospital birth may include:
Birth Centers are great options for low-risk women who would like to be close to a hospital, but would like a more home-like and intervention-free environment. Most birth centers are located near hospitals (for quick transfers if needed) and offer most of the comforts of homebirths. Most are staffed by midwives and do not offer pain medication, but instead rely on a variety of other ways of comping labor. In the Denver Metro area, Mountain Midwifery is the only Birth Center and has a wonderful reputation. They do fill-up so don't delay in checking them out if you are interested in this option!
Some of the advantages of a birth center may include:
Giving birth in your own home (or a friend or relatives home) is an increasingly popular option. There are many factors that weight into the decision to have a home birth, with many who choose to give birth at home doing so because they feel it offers them the safest and most respectful environment for birth.
Some of the advantages of a homebirth may include:
There have been a few studies done which looked at the safety of homebirth in the U.S., Canada, the U.K. and other countries. A national study of births in the Netherlands published in 2009 concluded:These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth. They show that planning a home birth is a safe option in a country with a maternity care system, which facilitates this choice through adequate numbers of well-trained midwives who assess the appropriateness of a home birth and through a rapid transportation and an integrated referral system.de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009;116:1177–1184.
While there is some debate about the research both confirming and dismissing the safety of home birth in the United States, there are some considerations to be aware of that can affect the availability and safety of this choice:
The role of a Birth Doula
More and more couples are opting to hire professional labor support for their births... a Birth Doula. A Doula is an independent professional who works for the expectant couple and provides support during pregnancy, is with the couple throughout the entire labor process and provides postpartum follow-up to ensure a smooth transition to parenthood.
Some of the services that a Doula may offer are:
What a Doula does not do:
Ask your friends, neighbors and co-workers if they used a Doula or could recommend someone. Search the Internet for local Doula groups. Often Doulas will host "Meet the Doulas" night to give parents a chance to meet several Doula and ask questions. Ask your care provider if they have any Doulas they recommend. Ask for recommendations from local message boards or groups.
Once you have some potential names, make appointments with several doulas for a free informational interview (which should be standard). Use the DONA guide "Questions to ask a Doula" for help during your interview.
The Doula you hire should be someone who both you and your partner are comfortable being with for long periods of time. She should answer your questions clearly and honestly and make you feel respected. She should be available for two weeks before and two weeks after your due date.
When you have decided to hire someone, it is a good idea to have a signed contract with her. The contract should specify the total fee and the timing of payments. She will usually require a deposit in advance with the balance due near the due date or after the birth. Make sure that you agree with all of the provisions in the contract. If there is anything that you want to alter, request to make these changes before signing the contract.
Make sure you know when and how to contact your Doula if you think you are in labor. Have her phone numbers, your care providers phone numbers and the birth center/hospital phone numbers saved in your phone, listed on the refrigerator and/or in your wallet. This way you and your partner will always be able to get in touch with someone quickly.
Don't hesitate to ask your Doula for recommendations and referrals for other pregnancy, birth and postpartum services. She should have a wealth of information that could help you in many ways. There are also Antenatal/Antepartum and Postpartum Doulas. Antepartum Doulas assist women going through a high-risk or difficult pregnancy. Postpartum Doulas assist new families in the days and weeks after birth.
Most couples who use a Doula rave about the help they received and feel the Doula provided a valuable service during one of the most special times of their lives.