Birth Choices – what is right for you?

Today we have more choices than ever about how we birth. We have the choice of using a doctor or midwife for our practitioner. We have the choice of birthing in the hospital or at home. We can choose who is present at the birth. We can choose to hire a doula. We can choose between a multitude of prenatal classes ranging from hospital-run classes to private classes in Lamaze, the Bradley method or Birthing From Within. We can enroll our older children in Sibling Preparation classes, we can take prenatal yoga or prenatal pilates, we can bring music, pillows and massage oil to the hospital. We can choose to labour in the tub or the shower or on a birth ball. We can play cards or go for a walk. We can birth squatting or standing or via elective cesarean. We can even write up elaborate detailed lists of all of our preferences and give this Birth Plan to our practitioners.

Faced with all of these choices, how do you know what is right for you? How do you know that the choices you made before the big day will still be right when labour starts – especially if you are a first time mom?

Choice, in general, can be a double-edged sword. On the one hand, it is empowering and enriching to be given the opportunity to have a say in what happens to us. On the other, given too many choices or inadequate information to help in our decisions, the process of choosing can cause stress, anxiety and even guilt and depression. And when it comes to birth, it can give the misguided impression of control.

Relinquish Control (even those subconscious thoughts…)
The first thing you can do on your journey towards the right birth for you is to forget about those fantasies of your ideal birth. We all do it: we all have a vision in our heads of the way we hope our birth will proceed. These visions are rarely realistic (unless you imagined in your ideal birth that you would be half-naked on your hands and knees in a roomful of strangers). Birth is a dynamic process and we cannot control what happens. The woman who is determined to get her epidural before she’s finished with the hospital admitting desk may deliver baby at home in the bathroom attended by her partner. The woman who preaches natural birth from before conception may end up with a complication, or labour induction and a cesarean delivery. We’ve all read these stories and hoped it wouldn’t be us. But it could be. So the first step is to let go.

Read everything you can get your hands on
Knowledge is power. If you aren’t a reader, ask questions. Ask all the mothers you know what their experience was like. Ask your practioner all those nagging questions you’re afraid to speak out loud. Explore all the birth possibilities there are. Don’t shy away from those topics that you hope you won’t have to face (like having a long, drawn out back-labour or requiring a cesarean). Don’t write off ideas that are new to you (like homebirth, or hiring a doula). The more you can understand about the way labour progresses (or sometimes doesn’t) and the way labour is managed (or sometimes mis-managed), the better the chance that you will be able to play an active part in the process.

Be Flexible (but know your limits)
That is, be prepared to change your mind. Something that seemed right before birth may no longer be fitting during birth. Hell, something you asked for during one contraction, may not be what you want during the next. Accept the fact that you may need to revise your thinking in the face of new information. However, if at any time, you are uncomfortable with the care you are receiving, be confident that it is okay to assert yourself or have some intervene on your behalf. By trusting your instincts and your birth team, you’ll know when to stand your ground and when to adapt.

Gather good people around you
The people who support you and care for you during labour can make a huge difference. Consider carefully whether you want a doctor or a midwife, whether you will hire a doula and which friends and family members you would like present. Ask your care-givers questions and reserve the right to change your mind if you don’t feel comfortable. The time it takes at first to find good people could make the difference in how your birth unfolds or at least in how you feel (even when things don’t go as planned). Good people will give you information and not rush your decisions, will help keep you focused, will make you feel supported and empowered, will be positive and encouraging and will inspire trust.

Face your Fears
We all go into labour with a mixture of elation and apprehension but it’s good to ask yourself what it is you are afraid of before your water breaks. Hopefully a few weeks before. It’s hard to know how to manage a nebulous, nameless fear. But if you can seriously explore what scares you about birth (and motherhood) before the throes of labour send you into panic mode, the odds are you’ll be better equipped to deal with whatever comes your way. Try, if you can, to go a little deeper into your fears than the obvious like fear of pain or fear of a long labour. What about the pain scares you? Fear of not being strong enough? Fear of losing control? What about a long labour scares you? Facing your fears is emotionally exhausting but it would be a shame to let fear hold you back from the possibility of a truly rewarding experience.

Know yourself, know your situation
This is the easiest part because it might be decided for you. Are you a home-body who feels most comfortable with a few close friends rather than in the middle of a party? Maybe homebirth is an option for you. Are you an analytical person who is comforted by procedures and technology? Are you someone who always wants to be prepared for the worst case scenario? You might feel strongest birthing at a hospital or birth center. Are you totally against medicated birth? Perhaps a water birth is right for you. Is your baby breech? The safest bet for you and your baby could be a cesarean. Was your pregnancy a textbook case or did you suffer from multiple complications? Your health practitioner will be able to explain what your options are based on your personal situation and with a bit of self-analysis and thought, you’ll find the answers you’re looking for.

Often as labour day unfolds, it doesn’t come down to choice at all. We don’t choose when our babies will come or how they will make their entrance. Sometimes, circumstances arise that take the power from the mama and she needs to stretch and bend around the situation she is given. And sometimes, with trust, in our instincts, in ourselves, in our babies, in birth itself, our babies come just the way we knew they would. We do what we need to do and the most right thing of all is that they are safe.

Water During Labour & Birth

Options for labour and birth have expanded over recent years. You can choose between different health care providers and different birth places. You can choose an active birth, a Leboyer birth and now you can choose a waterbirth. The use of water has become increasingly popular as a way of avoiding a high tech birth both in hospital and at home. While the use of water during labour is common place, giving birth to a baby under water is more controversial. A woman can use water during labour and birth in a number of ways. These include:

• A shower
• Hot towels
• Submerging in a bath
• Submerging into a deep pool of water

Some women feel very comfortable in the water during labour and decide to stay in the water to give birth. Giving birth under water raises many questions – How safe is it? Does research support waterbirth? Does water provide effective pain relief? What precautions should be used if a woman labours and/or gives birth in water?

Water, as with many issues during pregnancy and birth, is not very well researched. There needs to be a lot more research before we can accurately answer these and other questions. Some evidence however, is slowly gathering from around the world on the use of water during labour and birth. In the future we will know a lot more.

Waterbirth concerns many people. One common fear is that the baby will drown if born into water. The baby born into water has a diving reflex that helps prevents the inhalation of water into its lungs. Once the baby is exposed to air the receptors in the baby’s face trigger the baby’s breathing. Because of these factors, once the baby is born into water it should be brought gently to the surface and the baby’s face must not be resubmerged under the water.

To make sure that the baby does not get cold after the birth – the baby’s body can stay under the water and the baby’s head can be dried with a warm towel. If the baby is well he/she can stay with the mother in the water.

Whether or not to permit the placenta to be born in the water is another controversial issue. There are some theoretical risks to remaining in the water, however none have ever been proven. Some health care practitioner encourage women to leave the water for the third stage of labour while others are happy for women to remain in the water. If bleeding after the birth seems excessive the woman would be asked to leave the water.

I have heard that using water during labour is helpful, can you explain the reasons why?

Using water during labour and birth encourages:

• Reduction in pain
• Greater mobility that comes with buoyancy
• Induces relaxation
• Reduction in abdominal pressure
• Softening effect on the perineum and vulva can promote stretching during crowing
• Gentle entrance into the world for the baby

One of the most common finding of research is that many women find that being submerged in water enables them to relax and they find the pain of labour lessens. In one study, where women used water during labour only, they found that 80% of the women reported that they would like to use water next time they were in labour.

I like the idea of using water during my labour. I would like to know if it is safe for my baby to be born underwater?

Until more research is completed, we cannot say with any accuracy whether there are any risks associated with the use of water during labour and birth. The limited evidence that is available so far indicates that waterbirth is thought to be safe so long as some simple, sensible guidelines are followed. These guidelines include:

• A skilled practitioner in waterbirth is available
• The pool or bath has been thoroughly cleaned and rinsed
• A normal labour and birth is expected. The use of water is not appropriate if a woman has a fever, there is meconium in the waters, the baby’s heart rate is abnormal or if the woman has had any abnormal bleeding.
• The water temperature is not too hot (‹36 degrees Celsius)
• The woman is at least 6 cm dilated (hopping in before this time is thought to slow labour)
• The woman is well hydrated. It is important to drink lots of fluids when in the water, as dehydration can be a problem
• There are no additives put in the water (these are not helpful and some are potentially harmful)
• The baby is brought to the surface as soon as it is born

As more evidence is revealed, we will know more about the safety or otherwise of water during labour and birth.

I have decided that I would like a waterbirth. Can you tell me how I could organise one?

This will depend on the place that you plan to give birth. A water birth is easily arranged at home. A large bath can be used or it is possible to hire or buy a pool suitable for a water birth. If you plan to give birth in a hospital you will have to find out what facilities are available and what their policies are regarding waterbirth. Some hospital facilities have a waterbirth policy all ready in place whereas others have not had a request for a waterbirth before. Achieving a water birth will also depend on the skills of the midwife or doctor providing your care. If they are not confident with water birth – they may prefer that you give birth on dry land. Most hospital facilities do have water available for use during labour eg. shower, bath or pool.

Setting up a pool at home or in a hospital requires some forethought. Is there space enough for the pool? How will the pool be filled and emptied? Is the hot water service adequate? Is the pool a good height and width? Is the pool comfortable? Are you able to lean on the sides of the pool without it collapsing? Is the floor able to take the weight of a pool filled with water? Make sure that there is safe heating in the room; remember electricity and water do not mix.

The following items are helpful when planning a waterbirth:

• A bath thermometer – this can be used to ensure that the water temperature is not getting too hot.
• A plastic strainer and a bucket – to be used for removing debris from the pool.
• Lots of warm towels for mother and baby.
• A space for you to use – in case you decide to leave the pool at any stage.

Reproduced with permission from midwife Jane Palmer, 2001

Known Benefits of Water Labour & Waterbirth

• Facilitates mobility and enables the mother to assume any position which is comfortable for labor and birth
• Speeds up labor
• Reduces blood pressure
• Gives mother more feelings of control
• Provides significant pain relief
• Promotes relaxation
• Conserves her energy
• Reduces the need for drugs and interventions
• Gives mother a private protected space
• Reduces perineal trauma and eliminates episiotomies
• Reduces cesarean section rates
• Is highly rated by mothers – typically stating they would consider giving birth in water again
• Is highly rated by experienced providers
• Encourages an easier birth for mother and a gentler welcome for baby

Placing a pool of water in a birth room changes the atmosphere immediately. Voices get softer, the mother stays calmer and everyone becomes less stressed.

The effect of buoyancy that deep water immersion creates allows spontaneous movement of the mother. No one has to help the mother get into a new position. She moves as her body and the position of the baby dictate. Movement helps open the pelvis, allowing the baby to descend.

When a woman in labor relaxes in a warm deep bath, free from gravity’s pull on her body, with sensory stimulation reduced, her body is less likely to secrete stress-related hormones. This allows her body to produce the pain inhibitors-endorphins-that complement labor. Noradrenaline and catecholamines, the hormones that are released during stress, actually raise the blood pressure and can inhibit or slow labor. A laboring woman who is able to relax physically, is able to relax mentally as well. Many women, midwives, and doctors acknowledge the analgesic effect of water. Thousands of these mothers state they would never be able to consider laboring without water again.

from Waterbirth International