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First Impressions
At the age of 22, fresh out of college, I worked my first
“real” job as a graphic artist. My boss, the Creative
Director, was a rather eccentric fellow. He told me once that
he and his wife were seeing a midwife and were having their
third child at home. It all sounded a bit crazy to me. A midwife?
Do people still use midwives? At the time I had never heard
of anyone giving birth outside of a hospital and probably
the newness of this idea combined with the fact that I already
thought that my boss was a little different led me to believe
that this was a bad choice. I made a mental note that when
it was time for me to have children, I would have them at
a hospital like a normal person.
Fast forward five years, I was married and we
were getting ready to start a family. I had mentally planned
that when we had our first baby, we would do so at the hospital
that was very close to the spot where my husband and I met
and got married. This was a romantic thought, but when I became
pregnant, it was time to examine my choices and really think
about the reasons behind them.
Trial and Error
When I first became pregnant, I knew nothing about pregnancy,
labor and delivery, so I started reading as much as I could.
I knew I wanted a natural birth and, at my prenatal appointments,
I began asking questions about some of my preferred options.
I wanted to eat and drink during labor, avoid an IV, be mobile,
etc. I had chosen my OB based on proximity to my house rather
than on her commitment to natural birth and, although she
seemed like she would go along with some of the things we
wanted to do, there were other things that she felt she couldn’t
compromise on. By the time I was 20 weeks along we began to
see some of the other doctors in her group practice. We met
with one doctor who had her hand on the doorknob the entire
time my husband and I were talking to her. She made us feel
like we were inconveniencing her by asking questions and,
for us, that was the last straw. We decided to tour our local
birth center.
The local birth center was in a quaint and inviting
office park and felt more like a cabin in the woods than a
medical office. The midwife there felt like an old friend.
After talking to her about her training and skills as a midwife,
and the safety of out-of-hospital births we decided to switch
care providers. The birth center also offered homebirth as
an option. My husband, who was incredibly supportive through
all this, asked me if I wanted to birth at home. I am adverse
to change and my natural reaction is to immediately dismiss
new ideas until I have had some time to absorb them. I said
no and made some comment about not wanting to clean up the
mess afterwards. As I continued going to my prenatal appointments
it occurred to me that there was really no difference between
the type of equipment that was at the birth center and what
would be available at home. The birth center was, after all,
basically just a house and the midwife could bring all her
equipment with her. The only difference I saw between the
two, was that I would have to get in the car and drive to
the birth center during my labor, and then drive back afterwards
with our newborn baby. After mulling it over I decided I did
want a homebirth.
Things don’t go as planned
We planned for a homebirth but at 36 weeks I was in labor.
Our biggest concern was that I would have to transfer to a
hospital. Our midwife examined an ultrasound from 20 weeks
gestation and, based on the ultrasound, I was 36 weeks and
5 days. The consulting OB suggested I go to a hospital but
also said he would approve a birth at the birth center if
we wanted to stay. My husband and I discussed it and we decided
that my body knew what it was doing and, since I was in labor,
our son Marc must be mature enough and ready to come out.
I had not had a home visit with our midwife yet (she usually
visits the home of homebirth clients to make sure they have
adequate living conditions. Our home visit was scheduled for
that week but Marc was coming early.) Our midwife also had
some prenatal appointments at the birthing center that morning
which made it necessary for us to birth there and not at home.
Although not what we planned, we had a wonderful birth at
the birth center.
Next Time Around
With my second pregnancy we again planned a homebirth. At
21 weeks we chose to have an ultrasound scan. The ultrasound
technician put the wand on my belly and we looked at the monitor.
My husband said (sort of kiddingly), “Hey, it looks
like two heads!” The technician told us that two heads
was exactly what we were seeing and that I was pregnant with
twins. The pregnancy turned out to be high risk because my
identical girls were not sharing their placenta evenly. One
baby was 25% smaller than the other. Because of the risks
of carrying multiples, plus the added risk of the placental
problems, a birth center or home birth were not safe options
for us. We worked hard to find a supportive birth team and
had a natural birth in a hospital. Our daughters Lily and
Logan were born at 32 weeks. They spent 4 weeks in the NICU
but had no major health problems; they just needed some time
to grow.
Third Time’s a Charm
With my third pregnancy we again planned a homebirth. I was
a bit concerned with my history of preterm labor; I needed
to make it to 37 weeks to have my homebirth. I did a lot of
positive visualizations of my pregnancy continuing past 37
weeks. Either it worked or I shouldn’t have worried
because our daughter, Addison, was born at home at 40 weeks
and 2 days. We finally got our homebirth. It was wonderful
being at home where I felt comfortable and I loved that our
three older children were able to participate in the birth.
The birth was a wonderful experience for our whole family.
Making Your Decision
Wherever you choose to give birth, make sure you are making
choices for the right reasons. My original idea of choosing
a setting based on where it was located, and its proximity
to where my husband and I got married, was not a good reason.
It’s important to make thoughtful choices rather than
to choose a setting based on proximity or because you know
someone else who had their baby there. Also remember that
looks can be deceiving. For example, a hospital might have
beautiful birthing tubs, but are they ever used? Find out
how often women actually use them for labor, what restrictions
exist on their use and if they are used for delivery. It is
important to do some research and put a lot of thought behind
your decision.
Let’s think about buying a car as an analogy…
Mandy & Doug want to buy a minivan. They could buy an
X or a Y. The price is the same, both can seat eight people,
both have twenty-six cup holders and both are rated equal
for safety. Mandy and Doug are positive they want an X. Three
of their friends just got an X and are happy with them. Mandy
& Doug have never seen a Y, they don’t know anyone
who drives a Y and, until they saw something about it on TV
a few months ago, they didn’t even know brand Y existed.
Yet, how can they make their BEST decision without ever seeing
a Y? How do they know they are getting the right car for them?
Why not just look at a Y? If nothing else, it will reaffirm
the fact that the X is the right car for them. And who knows,
maybe they will like the Y. Maybe they will see something
in the Y car that they never even considered before! Also,
think about how much time and energy a person puts into researching
the purchase of a new car: internet research, going to car
lots, going for test drives. Having a baby is a much bigger
deal than buying a new car. A person should put more time
and energy in selecting a care provider for the birth of their
baby than they do in selecting a new car to purchase. Even
if someone doesn’t think an out-of-hospital birth is
right for them, they should consider touring a birth center
and/or interviewing a homebirth midwife so they are fully
aware of their options and can make the best possible choice
for their situation.
So What’s a Birth Center Anyway?
A birth center is a freestanding facility where women with
a low-risk pregnancy can receive prenatal care and birth their
babies with the help of licensed midwives. For low-risk women,
birthing at a birth center is equally as safe as birthing
in a hospital; however, the woman who births at a birth center
is much less likely to receive medical interventions. Where
it is typical for a hospital to have a c-section rate of 30-40%
or even higher, most birth centers have very low rates, 3
- 8% is typical1. It is also important to note that cesarean
sections cannot be performed at a birthing center. In the
event a woman does need a cesarean section, she is transferred
to a hospital. Also, epidural anesthesia and narcotics for
pain management are not available at a birth center. Women
who birth at birth centers do so without pain medication and
rely on techniques such as relaxation, visualization, movement
and water for pain management.
Do People Really Give Birth At Home?
The other option for an out-of-hospital birth is a homebirth,
which is also attended by a licensed midwife. Home is the
environment where most women feel the most relaxed and in
control. All other mammals birth in places they feel safe
and secure, it makes sense that women would choose to give
birth at home. Studies have shown that for low-risk women
home births are also just as safe, if not safer, than hospital
births.1, 2 As I mentioned, there is nothing at a birth center
that can’t be brought to your house. Homebirth midwives
pack all the necessary equipment including oxygen, IV fluid,
antibiotics, pitocin (in case of hemorrhaging after the birth),
and neo-natal respirators in case of need.
What are the Benefits of Birthing Out-of-Hospital?
There are many benefits to mom and baby of birthing out-of-hospital
and there is a quality of care you can get out-of-hospital
that you might not get in-hospital. The following list offers
examples and advantages that you might get out-of-hospital
and includes some personal experiences and some experiences
from other mothers. These are generalizations and may not
be true 100% of the time but should spark some questions for
interviewing care providers.
1. Less Risk of Medical Intervention.
One of the biggest reasons women choose to birth out-of-hospital
is to avoid unnecessary medical intervention. Epidurals, narcotics
and labor-inducing drugs are not an option at an out-of-hospital
birth. C-sections are not performed out-of-hospital. Because
these are not even options, a mother who chooses to birth
out-of-hospital is not likely to receive any of these medical
interventions, and WILL NOT receive them unless she is transferred
to a hospital.
The World Health Organization (WHO) has suggested
that a country’s c-section rate should be between 1-15%
and that the best results seem to be somewhere around 5-10%3.
What this means is that if a country has a c-section rate
of less than 1%, moms and/or babies are dying who might have
been saved if a c-section was available. It also means that
if a country’s c-section rate is over 15% (the rate
in the US is currently about 33%4) that some of the c-sections
being performed are unnecessary and are doing more harm than
good. Remember, if a procedure is done unnecessarily, all
of the risks still exist but you get none of the benefits.
Out-of-hospital providers are likely to have
a c-section rate in the 1-10% range.5 Although the average
c-section rate in this country is about 33%, some hospitals
have rates that are much higher. Locally, in 2007, an area
hospital had a c-section rate of about 43%6 and an area birth
center had a rate of about 4%. If we think of this in reverse,
at the birth center, 96% of women had a vaginal birth and
at the hospital, 57% of women had a vaginal birth. If you
were gambling, would you rather place all your money on something
with a 96% chance or with a 57% chance? No matter what the
parents do to prepare, take classes, hire a doula, read books,
etc., if they want a natural birth and go to a place with
a 43% c-section rate, they are making it harder on themselves.
2. Trusting Your Care Provider.
I had a mother call me once to tell me that she was bleeding
from her vagina and I told her she needed to let her OB know.
She said she was scared to call her OB because she was worried
he’d want to induce her labor. Whenever a mother withholds
information from her care provider, there is a possibility
that she is compromising the safety of her baby. I’ve
had other mothers tell me that they lied to their care provider
about their last menstrual period, or did not tell their care
provider that their bag of waters broke until labor was well
underway. If a mother feels the need to lie or withhold information
from her care provider, it is a sign that she has not chosen
the right person to provide her with prenatal care or to help
her birth her baby.
Many women who plan natural births in a hospital
feel that they are fighting an uphill battle. When labors
are routinely induced days after a due date, when over 90%
of woman at a particular hospital receive an epidural, when
more than one in three women have a surgical birth, what are
the chances that a mother planning a natural birth is going
to get the support she needs?
Sometimes interventions are necessary. If a
woman is with an OB who performs a c-section 43% of the time,
and this OB tells her that she needs a c-section, is the woman
going to believe that this is what she really needs? When
the OB says it’s “for the safety of the baby,”
the woman is probably going to consent to it because she wants
her baby to be safe, but afterwards, she may question whether
it was really necessary. There’s no doubt that there
are some unnecessary c-sections preformed in this country;
what is that doctor telling the women in these situations?
How can you be sure that you won’t be one of these women?
If the mother starts out planning an out-of-hospital birth
with a midwife whose c-section rate is less than 5%, and this
midwife tells her that she does need a c-section and explains
why, the mother will trust her midwife. This mother is going
to get her questions answered and make the best choices she
can in her situation.
Birth is a natural and instinctive process and
if a woman feels she is in an unsupportive, unsafe environment,
this can hinder the process. Trust is an important part of
feeling safe. Feeling unsafe or unsupported can cause the
body to release adrenaline which can slow or stop labor. Also,
if a woman feels unsupported, she is less likely to listen
to her body and trust her instincts as to which positions
to choose for labor, which can also slow the progress of her
labor.
3. An Expert on Normal Birth.
Many hospital care providers have never seen a natural birth
from start to finish. Many have no idea of what a natural
birth can be like. Obstetricians are highly trained surgeons
and are experts on what can go wrong during labor. Many OBs
treat a pregnancy as a medical condition that must be managed
and treat a laboring woman as a surgical patient. They may
introduce one intervention, and then need to introduce another
one to compensate for the side effects of the first. Marsden
Wagner, the former director of Women's and Children's Health
for the World Health Organization, states in one of his books,
"Having an obstetric surgeon attend a healthy birth is
like having a pediatric surgeon baby-sit a healthy two-year
old. Both are going to be tempted to apply medical solutions
to everyday situations, such as using drugs to stimulate normal
labor or narcotics to put a fussy toddler to sleep. Unfortunately,
using highly trained surgeons to handle normal life experiences,
such as childbirth, increases unnecessary and risky interventions,
decreases women's satisfaction, and wastes huge amounts of
money."7
Where OBs are experts on surgery, midwives are
experts on normal labor. A midwife must attend at least fifty
births before taking her national exam. Ironically, many doctors
finish medical school having only attended one or two births.
In general, midwives differ from OBs in that they view birth
as a normal process instead of a condition that needs to be
managed. Because she is an expert at normal birth, the midwife
can give the kind of support a mother needs during her labor,
and at the same time empower the mother to listen to her body,
trust the birth process and have the birth she desires.
4. Individual Attention.
I transferred to a midwife’s care during my first pregnancy
because our OB didn’t take the time to answer our questions.
When we made the switch, we felt that our midwife would take
any amount of time we wanted to answer ALL of our questions.
Generally, midwives allow much more time for prenatal appointments,
and are eager to take the time to answer any questions a couple
might have. A midwife is also more likely to take the time
to talk to the mother about diet and exercise, about any emotional
issues that might impact labor, and about how the mother is
preparing both mentally and physically for the birth.
Studies have shown that during labor, continuous
one-to-one emotional support is very beneficial to the mother
and results in less use of medical interventions.8 In a hospital,
unless the couple hires a doula (which is a great idea) they
do not have continuous one-to-one support. The labor and delivery
nurse is there supporting them but she has other patients
to care for and there is often a shift change. The doctor
checks on the mother a few times and is updated by the labor
& delivery nurse and may not even enter the until the
baby’s head is crowning. A midwife is with the mother
throughout the labor offering emotional support and physical
comfort.
More individual attention could ensure a safer
birth experience for mother and baby. I know a mother who
had a cesarean section and after she returned home, she felt
that her pain level was telling her that something was not
right. Her husband called the OB and they were told it was
normal and that she wasn’t on strong enough pain medications.
It turned out she had a blood clot forming under her incision
and she had to be re-hospitalized. If this couple had not
trusted their instincts and been persistent, it could have
been much more serious than it already was. Because a midwife
offers more individual attention, she is more likely to take
a client’s concerns seriously and act if there are signs
that something is not right.
5. Easier to Avoid Induction and
Avoid Pressure to Induce. Labor begins when
the baby is fully developed and it is believed that when the
baby is ready, he or she sends a signal to the mother’s
brain and the hormone oxytocin is released thus starting labor.
The lungs are one of the last things to develop and one risk
of inducing labor is always a baby who is not ready to be
born; not fully developed and more likely to need help breathing.
Pitocin is the synthetic form of the hormone
oxytocin and is often used for inducing labors. Induction
of labor with pitocin makes contractions stronger, last longer
and come more frequently, all of which are harder on mom and
harder on baby. Because contractions are so strong, the mom
on pitocin is more likely to request an epidural than a mother
laboring naturally. Risks of pitocin are it doubles the odds
the baby will be born in poor condition; it increases postpartum
blood loss and increases newborn jaundice. Also, because pitocin
is harder on the baby, the baby is more likely to experience
fetal distress, so when a mother is induced with pitocin,
it increases the likelihood of a cesarean section.9
It’s not unusual now for doctors to induce
women a couple of days past a “due date”, whereas
midwifes, depending on the state in which she practices and
the laws of that state, will care for a women until she reaches
at least 42 weeks. (Some states have strict guidelines and
require a midwife to transfer a mother’s care to that
of an OB once she reaches 42 weeks.) It’s important
to remember that without intervention, the average first-time
mom delivers at 41 1/7 weeks.10 The out-of-hospital midwives
are more likely to consider the last due date (sometimes mothers
will have several due dates: one based on last menstrual period,
one based on ovulation, and one (or more) based on an ultrasound.)
If a mother is getting close to the 42 week point, out-of-hospital
midwives are more likely to suggest gentler ways of helping
the body to go into labor such as herbs, acupuncture, chiropractic,
reflexology, etc.
Another common reason women are induced is
if their bag of water breaks and labor doesn’t start
or doesn’t progress as quickly as their doctor would
like. (Good nutrition, especially adequate amounts of Vitamin
C in the diet, can help build a strong bag of waters and reduce
the likelihood of premature rupture of the membranes.) Once
the bag of water breaks, the main concern is infection, so
it’s best to avoid vaginal exams especially if you are
not in labor. According to Marsden Wagner, if the bag of waters
breaks, “watchful waiting is a good approach that is
underused. With no signs of infection, it is usually safe
to wait at least forty-eight hours before considering induction.”11
However, once the water breaks, many OBs want labor to start
right away and some will insist the baby be born no more than
24 hours after the membranes rupture. At an out-of-hospital
birth, midwives commonly use the ‘watch and wait’
approach and, if things aren’t happening, suggest more
natural ways to get labor started such as herbs, positioning,
nipple stimulation, etc.
6. Easier to Avoid Pain Medication.
I had a student who, on the first day of class, told the other
students that one reason she was planning an out-of-hospital
birth was because she did not want an epidural during her
labor, and that she knew if an epidural was available, she
would ask for it. Sure enough, during her labor she demanded
to be taken to the hospital so she could get an epidural.
Her partner and her midwife encouraged her and told her she
was doing great, and she birthed her son at the birth center.
After the birth she was just thrilled; she was so proud of
her accomplishment and so glad she did not go to the hospital.
At an out-of-hospital birth, a mom has an easier
time avoiding pain medication simply because it’s not
available, but also because there is no one there suggesting
she might need it. Out-of-hospital, there is no one there
questioning whether she is capable of laboring without pain
medication or suggesting that she’s crazy for even wanting
to labor without pain medication. At a hospital, a mother
might get comments such as, “I don’t know why
you would want do this to yourself,” or “you don’t
have to be superwoman.” These types of comments are
dismissive of the mother’s goals for her birth and make
an unmedicated birth seem an unobtainable and/or selfish goal
and it certainly is neither.
7. Monitoring During Labor.
Monitoring during labor refers to checking the baby’s
heart tones during the labor and this is done both in hospital
and out-of-hospital. However, there are different methods
of monitoring and different types of monitoring devices. Constant
or continuous monitoring is when the monitoring occurs during
the entire labor, and intermittent monitoring is when the
baby’s heart tones are checked periodically. Studies
have shown that both types of monitoring have the same outcomes
for babies (meaning both are equally as safe); however, a
mother is much more likely to deliver via cesarean section
if she is being continuously monitored.12
Types of monitors can also affect how a woman
labors. Electronic fetal monitors used at a hospital require
a mother to wear two belts around her abdomen, one belt has
a sensor to monitor contractions, the other has a sensor to
monitor the baby’s heartbeat. The belts are tethered
with wires to a machine that records the readings. The belts
themselves can be irritating but they also restrict the mother’s
movements since she can only walk as far as the length of
the wires. Also, mothers on electronic fetal monitors are
sometimes encouraged to be still because when they move, the
monitors slip and the nurse has to come and reposition them.
During an out-of-hospital birth, a hand-held
doppler is usually used to intermittently monitor the baby.
Often, this is not an option at a hospital simply because
of the patient-to-nurse ratio – monitoring with a doptone
requires 1:1 care. The intermittent monitoring with the doptone
allows the mother more comfort, more freedom of movement and
decreases the likelihood of a cesarean section.
8. Eating & Drinking
During Labor. Labor is like running a marathon.
Imagine running a marathon on only ice chips. Yet hospitals
do not let a laboring woman eat, and most also do not let
her drink – it’s ice chips only.
Usually women are hungry early in labor, and
it’s a good idea to eat something easily digestible.
Later in labor, most women are not hungry; however, a woman
might have low blood sugar and need a pick-me up. In this
case, honey, hard candy, lollipops, sports drink, juice, etc.
are good choices. It’s also important to stay hydrated
during labor because the mother will experience less pain
and the hormones progressing her labor will be released most
efficiently if she’s properly hydrated. Becoming dehydrated
can cause a lack of energy and inefficient contractions.
In a hospital, food and drink are restricted
because the mom is being treated as a surgical patient in
the off-chance that she needs an emergency c-section with
general anesthesia. (Most c-sections are done with spinal
or epidural anesthesia and not general anesthesia. General
anesthesia is only used in a true time-critical emergency.
Most so called “emergency c-sections” aren’t
actually time-critical.) If an emergency does occur and general
anesthesia is used, if there is food in the mother’s
stomach, there is a chance that she could vomit and then aspirate
on her vomit (get it in her lungs.) This is not a very likely
scenario. It is true that aspirating on vomit could be dangerous;
however, it is unlikely and anesthesiologists are trained
to deal with it.
During an out-of-hospital birth, mom is encouraged
to eat and drink throughout her labor. During a long labor,
mom may certainly want a snack. She is encouraged to eat if
she’s hungry. Mom is also encouraged to take fluid by
mouth.
9. Freedom to Move and Choice of
Positions. During labor and birth, the baby
moves down the mother’s pelvis and out of the birth
canal. In order to do so, the baby needs to turn and navigate
through the pelvis like a key in a lock. A mother can help
by listening to her body for determining what positions to
use for labor – often the position that feels the best
is the best one to help the baby move down. Walking early
in labor is great because the motion helps open the inlet
of the pelvis and helps the baby enter the pelvis. Squatting
later in labor helps open the outlet of the pelvis and it’s
a good position to use for pushing. Activities such as lunging
and stair walking can help open one side of the pelvis and
can help the baby’s head straighten out. A hands-and-knees
position can help a baby turn if he or she is facing out instead
of in towards the mother’s spine. The mother who is
tethered to the bed with an IV and monitors doesn’t
have the freedom to use these positions. The mother with an
epidural cannot use these positions because she is temporarily
paralyzed from the waist down.
Of course it is possible to move and use different
positions in a hospital setting and women should be encouraged
to do so, but often they are not. An out-of-hospital setting
usually has more room for a mother to move around. A mom in
a hospital can walk the halls, but this is not very private.
At a birthing center or her own home, there may be larger
areas of private space she can utilize. Also, out-of-hospital
care providers, being more familiar with normal birth, will
encourage the mother to listen to her body and choose different
positions, or even suggest positions that can help the baby
move down.
In a hospital, a drug or intervention is more
likely to be recommended than changing position if things
are not progressing “normally”. Pitocin is often
suggested to speed labor instead of walking, trying different
positions or just letting labor happen at its own pace. One
mother was at a hospital and her baby was having heart decelerations
during her contractions. Her doctor wanted to give her a drug
to slow her contractions. Instead she tried the hands and
knees position and the baby’s heartbeat recovered and
she went on to have a wonderful vaginal birth. The doctor
commented that the position was “not very lady-like.”
Other mothers have wanted to push in a squatting
position, or a position other than the classic semi-sitting
position that is the norm for a hospital birth. Several of
these mothers were told by their doctor that they had to push
in the semi-sitting position because that’s the only
way the doctor knew how to deliver a baby. A midwife is more
likely to support a woman pushing in whatever position she
feels comfortable in.
10. Less Risk of Infection.
Hospitals are for sick people. A pregnant woman is not sick.
Being a “sick house”, a hospital can be home to
some pretty scary bacteria such as antibiotic-resistant bacteria.
It is less likely that a birth center or a home would carry
these dangerous types of bacteria. Many feel home is the safest
place to birth because a woman is used to the bacteria present
in her own home and is less likely to develop an infection.
Also, a woman is more likely to develop an infection after
a surgical birth (cesarean section) which is more likely to
occur when she chooses a hospital.13
11. Easier Bonding with Baby and
More Time to do so. The period after birth is
a time for mother and baby to bond and for attachments to
form between mother and baby. Having an unmedicated birth
will help the bonding process, and that is more likely to
happen out-of-hospital. With an unmedicated birth, the mother’s
brain releases a cocktail of hormones designed to promote
attachment. These hormones make mom fall in love with her
new baby and this is a process designed by nature so that
the mother will protect her new baby.
Sometimes the importance of bonding isn’t
emphasized as much as it should be. Animals whose young are
separated from them immediately after birth often reject them
when they are reintroduced. Imagine that you and your partner
are just about to share your first kiss when someone steps
in to measure the circumference of your partner’s head.
You will probably still fall in love but that special moment
was interrupted and you will never get it back.
In an out-of-hospital birth, the midwife cares
for mother and baby as a unit and recognizes their need for
one another. An out-of-hospital midwife is more likely to
give the mother and baby time to bond. Also, out-of-hospital,
moms are encouraged to care for their own babies, where in
the hospital, a nurse might do some of the baby care duties
such as giving a first bath, the first diaper, etc. Often
in a hospital, the baby is “cleaned up” before
mom holds the baby. In nature, other mammals clean their own
babies. For other mammals, cleaning their babies and smelling
the scents of the birth is part of the bonding process and
it may be important for humans too.
It is also easier to bond with a baby in a homelike
environment because mother feels more relaxed and in her own
element. Birth centers also have a more home-like feel than
hospitals. Hospitals usually have policies in place which
can interfere with bonding, such as a baby going to a nursery
for a test or procedure, or a mother not being able to carry
her own baby in the hallway of the hospital (mothers may need
to wheel their babies around in their portable bassinet instead,)
or just the constant interruption of someone coming in to
take the mother’s vital signs. A hospital is also more
likely to frown upon a mother sharing her bed with her baby.
12. Newborn Care Your Way.
Parents have many choices concerning their babies once he
or she is born. These things are not always presented as an
option, but parents have the right to consent to or refuse
any procedure done to their newborn. Parents may have many
preferences including if the baby is routinely aspirated;
if and when the umbilical cord is clamped and cut; how much
uninterrupted skin-to-skin contact occurs between mother and
baby before the newborn exam is done; use of a warmer; whether
they administer eye ointment or a vitamin K injection; whether
the baby receives a hepatitis B vaccine; and when, how and
by whom the first bath is given.
After the birth, if a baby and mother have skin-to-skin
contact, not only can the mother and baby bond, but the baby
is better able to regulate his temperature and glucose levels
than if he’s placed in a warmer.14 It is standard in
many hospitals for a baby to be removed from his mother’s
arms a few minutes after birth for newborn tests. A hospital
has a set of standard procedures for what happens to the baby
after he or she is born, it often feels like an assembly line.
Some hospitals and staff are fine with deviating from the
normal protocol. Others have a very difficult time deviating.
At the hospital and with an OB, the doctor will be caring
for the mother and (usually) a pediatric nurse will be taking
care of the baby. With two separate people caring for the
mother-baby, it’s easier for them to become separated
and it’s easier for parents to forget to assert their
wishes, especially in the excitement of seeing their child
for the first time. A midwife out-of-hospital treats the mother-baby
as a unit and will be more flexible and understanding if parents
want to delay or refuse certain tests or procedures. Newborn
tests and procedures are done when mom and baby are ready,
usually at least an hour after the birth, and many of tests
can be done while the baby is in the mother’s arms.
13. Reduced Likelihood of Postpartum
Depression. Anytime a new mother experiences
depression, it can be harmful to the mother, the baby and/or
the family. Studies have shown that women who feel informed
and in control of their care usually feel satisfied with the
care they received and are less likely to experience postpartum
depression. One study showed that the incidence and severity
of postpartum depression was highest in women who had c-sections.
It was higher in women who birthed vaginally in a hospital
than in women who birthed at home.15 Another study showed
that women who were cared for by midwives during their prenatal
period were more likely to report satisfaction with their
care and were less likely to experience postpartum depression
than women under an OB’s care.16
Because mothers are less likely to receive medical
intervention and are more likely to feel informed and in control
of their care in an out-of-hospital birth setting, they are
less likely to experience postpartum depression.
14. Breastfeeding support.
A midwife at an out-of-hospital birth assumes a mother is
going to breastfeed. The midwife has confidence in the new
mother’s ability to feed her baby and this, in turn,
gives the new mother confidence in her ability. If the mother
does encounter difficulty in breastfeeding, the midwife can
point the mother in the right direction to get the help she
needs.
Hospital policy is not always breastfeeding-friendly.
Locally, some mothers have encountered staff who were not
supportive, or even undermined breastfeeding. I’ve heard
from mothers who were told that they were starving their babies
and that their babies were too big and that their colostrum
was not enough (not true!) A new mother is very impressionable
and even if she doesn’t believe this criticism, it is
likely to affect her confidence. No new mother wants to hear
that her baby is starving. Also, a hospital is more likely
to routinely test the baby’s blood sugar (affecting
mother’s confidence) and suggest glucose water or formula
be given if levels are low, a practice that is counterproductive
in babies who are not showing symptoms of hypoglycemia.17
When my twins were born at 32 weeks they spent
4 weeks in the NICU where they were fed only my milk, at first
by tube, then by bottle and occasionally at my breast. The
discharge instructions when they finally came home were, “Logan
was fed at 2:00, so feed her again at 5:00, Lily was fed at
3:00, so feed her at 6:00.” Fortunately I had previous
experience nursing my son and I knew that breastfed babies
nursed more frequently than every 3 hours. I took them home
and put them on the breast and there they stayed for the next
2 years. If I had not had this experience and confidence,
I would have been set up for failure at breastfeeding because
of the bad advice at discharge.
Studies have shown that if a baby can self-attach
to the breast after birth, breastfeeding is more likely to
be successful. Two things are very important for self-attachment:
an unmedicated birth and uninterrupted skin-to-skin contact
between mother and baby until the first breastfeeding session.
If the baby is taken away for newborn tests such as height
and weight, this process is interrupted.18 A hospital may
interrupt this time for skin-to-skin contact and mother-infant
bonding immediately after birth, and thus, can interfere with
breastfeeding.
Medical interventions such as epidurals, pitocin
and a cesarean section can also interfere with the natural
release of hormones in the mother and can cause problems with
breastfeeding. Any drugs that the mother receives also reach
the baby and can cause the baby to be sleepy and have a dry
mouth, both of which make initial latch-on difficult. A mother
will more commonly experience such medical interventions if
she started off at a hospital.
Note: Some women must deliver in a hospital
because they have a risk factor that makes an out-of-hospital
birth unsafe. If this is the case, it’s best to look
for a hospital that is Baby-Friendly. This means the hospital
has practices and policies in place that are supportive of
breastfeeding. For more information go to www.babyfriendlyusa.org.
15. Empowerment.
The more in control a mother feels during her birth, the more
empowering it can be. If the mother feels that she birthed
on her own, that body and mind knew what to do and did the
job well, she is going to feel empowered.
If a mother feels that the doctor managed the
labor and delivered the baby, or possibly even saved the mother
and the baby, then the mother is less likely to feel this
sense of empowerment. If the mother felt that she could not
have given birth on her own because her body didn’t
work right, or if she had to be told how to do things, or
if she felt like things were done to her and she was treated
as an object instead of a person, she may even feel disappointed
or depressed after her labor, which is not an ideal way to
enter motherhood.
Most women find labor difficult (which is why
it’s called labor!) A natural birth in today’s
environment is even more difficult because of the medical
system and the fear that exists in our society. But labor
is also something that every woman can do, it’s something
women’s bodies were made for, and it is something that
women for generations have been doing since the beginning
of mankind.
Many women reach a point in their labor where
they feel like they can’t go on. We call this “self-doubt”
and the woman is likely to say or think, “I can’t
do this anymore.” But then, with determination and/or
encouragement, SHE DOES IT! As Elan McAllister, president
of Choices in Childbirth, states in the movie The Business
of Being Born, “it’s amazing to be with a woman
after she gives birth when she says, ‘I knew I couldn’t
do it, I knew I couldn’t do it and then I DID IT. I
hit a wall that was higher than anything I had ever seen and
I scaled it!’”19 This sense of accomplishment
combined with the natural flow of hormones from birthing naturally
gives the mother the feeling that she can do anything and
that she is AWESOME (and she is!!!) Feeling awesome and able
to do anything is a GREAT way to enter motherhood. A mother
is more in control of her experience and empowered by choosing
a midwife and an out-of-hospital birth environment.
Notes:
1. Johnson, K.C. & Daviss, B.A. ‘Outcomes of planned
home births with certified professional midwives: large prospective
study in North America’. June 18 2005 British Medical
Journal 330 (7505):1416.
2. Tracy, S., Dahlen, H., Tracy, M., Laws,
P., & Sullivan, E. ‘Birth Centres in Australia.
A national population-based study of perinatal mortality associated
with giving birth in a birth centre’. 2008. Birth 35(1),
86.
3. ‘Appropriate Technology for Birth.’
1985. Lancet 2(8452): 436-37.
4. Center for Disease Control, National Vital
Statistics Report: 57:12, March 2009, <http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf>.
5. See Note 1.
6. FloridaHealthFinder.gov: <http://www.floridahealthfinder.gov/Researchers/QuickStat/documents/Cesarean%20Rates%202000_2008%20for%20FHF.xls>.
7. Wagner, Marsden. Creating Your Birth Plan:
The Definitive Guide to a Safe and Empowering Birth. New York:
Penguin Group; 2006: 51.
8. Hodnett ED, Gates S, Hofmeyr GJ, Sakala
C. ‘Continuous support for women during childbirth.’
Cochrane Database of Systematic Reviews 2007, Issue 2. Art.
No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2
9. Goer, Henci. The Thinking Woman’s
Guide to a Better Birth. New York: Penguin Group;1999: 65.
10. Mittendorf, Robert, et al. ‘The Length
of Uncomplicated Human Gestation’. June 1990. Obstetrics
& Gynecology, 75:6.
11. Wagner, Marsden. Creating Your Birth Plan:
The Definitive Guide to a Safe and Empowering Birth. New York:
Penguin Group; 2006: 91.
12. Alfirevic Z, Devane D, Gyte GML. ‘Continuous
cardiotocography (CTG) as a form of electronic fetal monitoring
(EFM) for fetal assessment during labour. Cochrane Database
of Systematic Reviews’. 2006. Issue 3. Art. No.: CD006066.
DOI: 10.1002/14651858.CD006066
13. Buckley, Sarah J. Gentle Birth, Gentle
Mothering: A Doctor’s Guide to Natural Childbirth and
Gentle Early Parenting Choices. Berkley, CA: Celestial Arts;
2009: 205.
14. Christensson, K., et al. ‘Temperature,
metabolic adaptation and crying in healthy full-term newborns
cared for skin-to-skin or in a cot’. June/July 1992.
Acta Paediatrica 81(6-7): 488-493.
15. Edwards, D.R., et al. ‘A pilot study
of postnatal depression following caesarean section using
two retrospective self-rating instruments’. 1994. Journal
of Psychosomatic Research 38(2): 111-17.
16. Bland, Michelle. ‘The Effect of Birth
Experience on Postpartum Depression.’ 1 December 2008.
National Science Foundation and Missouri Western State University
National Undergraduate Research Clearinghouse. <http://clearinghouse.missouriwestern.edu/manuscripts/59.php>
17. Eidelman, AI. ‘Hypoglycemia and the
breastfed neonate’. April 2001. Pediatric Clinics of
North America 48(2):377-87. < http://www.ncbi.nlm.nih.gov/pubmed/11339158>
18. Righard, L., Alade M. ‘Effect of
delivery room routines on success of first breast-feed’.
1990. Lancet 336: 1105-07
19. The Business of Being Born. Dir Abby Epstein.
Prod. Ricki Lake. DVD, 2007.
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