Childbirth is a very personal experience for each woman. The following is an overview of some of the options a woman may want to consider or, in some cases, avoid.
Birth Doulas Make a Difference
The knowledge of how to give birth without outside intervention lies deep within each woman. Successful childbirth depends on an acceptance of the process. ~~ Suzanne Arms
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A Doula is a person who attends the birthing family before, during, and just after the birth of the baby. The certified doula is trained to deliver emotional support from home to hospital, ease the transition into the hospital environment and be there through changing hospital shifts and alternating provider schedules. The doula serves as an advocate, labour coach, and information source to give the mother and her partner the added comfort of additional support throughout the entire labour. There are a variety of titles used by women offering these kinds of services such as "birth assistant," "labour support specialist", “labour assistant” and "doula" . What Does a Doula Do? The following is a general description of what you might expect from a CAPPA Canada certified labour doula. Typically, doulas meet with the mom and her spouse/support person/partner in the second or third trimester of pregnancy to get acquainted, to learn about prior birth experiences and the history of this pregnancy. She may help you develop a birth plan, teach relaxation, comfort measures, position changes, visualization and breathing skills useful during labour. Most importantly, the doula will provide comfort, support, and information about birth options, including the risks, benefits and alternatives of medical interventions. A doula can help the woman to determine prelabor from true labour and early labour from active labour. At a point determined by the woman in labour, the doula will come to her and assist her by: · Helping her to rest and relax · Providing support for the woman's spouse/support person/partner · Encouraging nutrition and fluids in early labour. · Assisting her in using a variety of helpful positions and comfort measures. · Constantly focus on the comfort of both the woman and her partner. · Helping the environment to be one in which the woman feels secure and confident. · Providing her with information on birth options. A doula works cooperatively with the healthcare team. In the event of a complication, a doula can be a great help in understanding what is happening and what options the family may have. The doula may also help with initial breastfeeding and in preserving the privacy of the new family during the first 1-2 hour(s) after birth. Information was obtained from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993). |
The value of providing laboring women with continuous emotional support, physical comfort, and encouragement has been recognized worldwide.
Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. Hodnett, E.D. Support from caregivers during childbirth (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly.
A doula provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother. Care in Normal Birth: a Practical Guide. Report of a Technical Working Group. World Health Organization, 1996.
Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item – labor costs… (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to laboring mothers (has been) shown to increase the chance of a cesarean…Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington D.C. 1996
Professionals have paid much attention to innovative technology and the many new options for monitoring and managing labor. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of labor and the non-technical needs of women in labor… Changes that support the patient in labor and reinforce the natural, physiologic process…. Includes providing one-to-one psychological support for patients using nursing staff or doulas. Reducing the Cesarean Section Rates while Maintaining Maternal and Infant Outcomes. Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston, 1997
The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs, which should be designed for the effective prevention, and treatment of dystocia (non-progressive labor). Guidelines on Dystocia. Society of Obstetricians and Gynaecologists of Canada, 1995.
From the website of Doulas of North America - www.dona.org
A midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling and support to a woman and her newborn throughout the childbearing cycle.
A midwife works with each woman and her family to identify their unique physical, social and emotional needs. When the care required is outside the midwife's scope of practice or expertise, the woman is referred to other health care providers for additional consultation or care.
Above information from:
Citizens for Midwifery
P.O.Box 82227
Athens GA 30608-2227
Phone: 1-888-CfM-4880
Midwifery in Alberta
For information on midwifery regulations and educational requirements in our province, please visit the Alberta Association of Midwives
1. "Every study that has compared midwives and obstetricians has found better outcomes for midwives for same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. The superiority and safety of midwifery for most women no longer needs to be proven. It has been well established." (Madrona, Lewis & Morgaine, The Future of Midwifery in the United States, NAPSAC News, Fall-Winter, 1993, p.30)
2. "In the U.S. the national infant mortality rate was 8.9 deaths per 1,000 live births [in 1991]. The worst state was Delaware at 11.8, with the District of Columbia even worse at 21.0. The best state was Vermont, with only 5.8. Vermont also has one of the highest rates of home birth in the country as well as a larger portion of midwife-attended births than most states. " (Stewart, David, International Infant Mortality Rates--U.S. in 22nd Place, NAPSAC News, Fall- Winter, 1993, p.36)
3. "The international standing of the U.S. [in terms of infant mortality rates] did not really begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologist (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950s the U.S. has consistently ranked below 12th place and hasn't been above 16th place since 1975. The relative standing of the U.S. continues to decline even to the present." (Stewart, David, International Infant Mortality Rates--U.S. in 22nd Place, NAPSAC News, Fall-Winter, 1993, p.38)
4. The Texas Department of Health's own statistics show that midwives in Texas have a lower infant mortality rate than physicians. (Texas Lay midwifery Program, Six Year Report, 1983- 1989, Berstein & Bryant, Appendix Vlllf, Texas Department of Health, I 100 West 49th St., Austin, TX 78756-3199.)
5. "Mehl and his colleagues (1975, 1977) reviewed the medical records of 1,146 home births attended by five home delivery services in northern California between 1970 and 1975. These investigators provided detailed descriptions of demography (e.g., urban or rural), attendants, population served, process of care, outcomes, and complications. The incidence of various events among home births was compared to the incidence of similar events in the birth population of the state of California or as reported in the literature. No maternal deaths were noted, and the perinatal mortality rate of 9.5 per 1000 births was lower than the California average." (Research Issues in the Assessment of Birth Settings, Institute of Medicine, National Academy Press, Washington, 1982, p. 76)
6. From the same source (Figure 1, p. 175): In the state of Oregon from 1975-1979, there were approximately 3-4 neonatal deaths per 1000 births in homebirths attended by midwives, as opposed to approximately 9-10 deaths per 1000 births for all residents. The same figure indicates approximately 5 infant deaths per 1000 births in homebirths attended by midwives, as opposed to approximately 12 deaths per 1000 births for all residents. (Research Issues in the Assessment of Birth Settings, Institute of Medicine, National Academy Press, Washington, 1982, p. 175)
7. "Of the 3,189 midwife-assisted deliveries studied, episiotomies were done on 5 percent of the women, the Caesarean section rate varied from 2.2 percent to 8.1 percent, and perinatal mortality (the number of babies who die during or shortly after birth) averaged 5.2 per 1,000. Compare these numbers to those for New Mexico obstetricians and physicians during the same period: nearly routine use of episiotomies in many hospitals, a Caesarean rate that varied from 15 percent to 25 percent,and a perinatal mortality rate of 11.3 per 1,000. Looking at these numbers, Rebecca Watson, the maternal-health program manager at the New Mexico Department of Health commented, 'I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else's. " (Sharon Bloyd- Peshkin, Midwifery: Off to a Good Start, p. 69, Vegetarian Times, December 1992)
8. Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per 1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries. (The place of Birth, Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)
9. "In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland's maternal and infant mortality rates are far lower than in the United States..." ("Midwives Still Hassled by Medical Establishment," Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34)
10. 'Mothering Magazine has calculated that using midwifery care for 75% of the births in the U.S. would save an estimated $8.5 billion per year." (Madrona, Lewis & Morgaine, The Future of Midwifery in the United States, NAPSAC News, Fall-Winter, 1993, p. 15)
The fact is, in spite of all the good that has come from scientific discoveries and experiments, medical science has not been able to improve the human body and the way it was designed to work. Yet when our bodies are not functioning the way they were created to function, we are more fortunate than our ancestors in that modern medical science can sometimes help.
So why are families having homebirths? Though each couple may have individual reasons, most plan homebirths because they believe that most of the time pregnancy and childbirth are normal functions of a healthy body — not a potential life-and-death crisis that requires the supervision of a surgeon.
There are risks involved in childbearing. In a small percentage of cases the skills of an obstetrician/gynecologist and high-tech equipment like ultrasound and fetal monitors are necessary in order for the mother or the baby to survive childbirth without long-term ill effects.
The neonatal mortality rate for the U.S. in 1989 was slightly more than 10 per 1,000 live births. [1] We have the most highly sophisticated and expensive system of maternity care in the world, yet in the same year twenty other countries — countries with less technology than we have in our hospitals and laboratories — had more babies survive their first months of life than our babies (in the United States).
What do they do in those 20 countries to have better outcomes?
With fewer high-tech hospitals and obstetricians available, many of those countries — like Holland, Sweden and Denmark — use midwives as the primary care-givers for healthy women during their pregnancies and births. [2]
1. National Committee to Prevent Infant Mortality, HOMEBIRTH No. 8, Sept/Oct 1990, p. 5.
2. The Five Standards of Safe Childbearing, 1981, Stewart, p. 114.
From www.gentlebirth.org
Water birth is a method of giving birth where the mother gives birth to her child in a bathtub or pool full of warm water. Proponents claim this method has many favorable effects for the mother and child and is a safe alternative to other ways of delivery.
History
Water birth has been used by many communities in the past and isn't an invention of modern medicine.
During the last century, increased obstetric involvement in birth and the down-playing of midwives as carers for birth has replaced natural birth methods like water birth. However, increased scientific research, particularly by French obstetrician Michel Odent has demonstrated the benefits of waterbirth to both the labouring woman and baby..
The warm water eases labour by reducing the tension and pain. The water stimulates the endogenous labour hormones. The elasticity of the perineum is increased, resulting in fewer lacerations and tears.
With decreased gravity the pregnant woman can change her position very easily. In most cases, water births are shorter and less painful and few women need analgesics. Additionally the woman can have eye-contact with her baby during birth—considered by some a special bonding situation which deepens the relationship between mother and child.
Birth is also a strenuous effort to the baby and water eases this exertion. The warm liquid is still familiar to the child and softens light, colors and noises.
From Wikipedia
For more information:
Waterbirth Archives at Gentlebirth.org
Recommended reading:
Gentle Birth Choices - Revised Edition (2005) by Barbara Harper, RN
Birth Reborn (1984) by Dr. Michel Odent
This information has moved to the Cesarean & VBAC page.
Back to TopThis information has moved to the Cesarean & VBAC page.
Epidural anethesia is one of the most popular forms of medication for pain relief in labor and birth. It can be used for a normal vaginal birth, a vaginal birth with forceps or vacuum extraction or even a surgical (cesarean) birth.
Unlike medications previously used or currently used narcotics, the epidural can leave the mother wide awake and mentally aware of everything going on during the birth of her baby. Pain relief varies from mother to mother, some women experience a completely numb feeling from the level of their upper abdomen down to their toes, others feel only pressure during contractions or pushing. What you will experience will depend on the medication used, the placement of the epidural, and other factors. It is important to discuss with your anesthetist what type of feeling you would like to have after the medication is administered.However, as with any medication or procedure there are also risks.
The major complication from epidural anesthesia is a drop in the mother's blood pressure. Most hospitals will try to prevent this by giving the mother IV fluids prior to the administration of the epidural. Sometimes an epidural can lead to fetal distress, fetal malposition (breech or posterior presentations), increased risk of forceps or vacuum extraction, episiotomy and increased risk of cesarean section.
When making the decision about pain medication it is important to keep all of your options open. Learning additional coping techniques can be very useful for the time period prior to/instead of receiving the epidural or if you fall into the 12-20% that have a partial rather than full block. A good childbirth class can teach you these skills and go more in depth about the epidural and it's uses in labor and birth.
From Robin Elise Weiss, LCCE
More on Complications from Epidural Anesthesia
An astounding 96% of all women who get a fever in labor have had an epidural. A tragic 86% of newborns who are put on full-spectrum antibiotics, and have full septic workups while in the ICU have been born to mothers who had epidurals in labor.
Nurses and breastfeeding consultants have observed that babies born following epidurals often seem to be numb around the mouth. This may be the reason why so many babies have difficulty getting breastfeeding started. The domino effect of this one intervention is broad, yet the full information about its adverse effects is seldom given to parents.
From Epidural Anesthesia by Suzanne Arms
Recommended Reading:
Immaculate Deception II: Myth, Magic and Birth - (1994) by Suzanne Arms
The Thinking Woman's Guide to a Better Birth - (1999) by Henci Goer
PLEASE NOTE: All information expressed on the WOMB website and in our workshops, sessions, and/or consultations is to be used for informational purposes only. We are not providing medical advice as we are not licensed medical professionals. Therefore, we cannot be held liable for unforseen outcomes.