Pregnancy & Birth

Planning a Better Birth

If you are healthy and have no medical complications that call for a “high-risk” approach to your care during labor and birth, you can increase your chances of having a safe and satisfying vaginal birth by trying the following strategies:*

• Find a doctor or midwife with low rates of intervention.

  
  Some caregivers have much lower rates of intervention than others. While rates of intervention will vary depending on the population served (for example, women carrying multiple babies and women with high blood pressure are more likely to need interventions), they also vary by the type of provider and the practice style. Although there are many exceptions, family physicians tend to have lower rates of intervention than obstetricians, and midwives generally have the lowest rates of all. These differences are partly due to varying degrees of risk among the women who choose an obstetrician, family physician, or midwife (for example, a woman with pregnancy complications will likely choose an obstetrician), and partly due to the differences in practice styles between types of providers. (For more information, see Chapter 2, “Choosing Your Health Care Provider and Birth Setting,” particularly the section “Models of Maternity Care,” page 15.)
  
  

• Choose a birth setting with low overall rates of intervention.

  
  Some birth settings have far lower rates of intervention than others. Use of interventions is much lower in out- of- hospital birth centers and home births, compared with hospitals. However, the rates of intervention among different hospitals can also vary widely, depending on the practices and policies of the hospital as well as the health problems of the women it serves. (For more information, see “Birth Settings,” page 22.)
  
  

• Create your own birth plan and discuss it with your caregivers.

  
  Writing down your values, preferences, and priorities can help you clarify your own thinking and feelings. Moreover, this type of birth plan helps prepare you to discuss these issues with your partner and your caregivers. Find out if your caregivers will work with you to meet your goals and preferences. If their response does not satisfy you and you have other options, seek a better match. (For more information, see “Birth Plans,” page 37, and “Some Questions to Ask Midwives and Physicians,” page 21.)
  
  

• Arrange for continuous labor support from someone with experience.

  
  Arrange for someone in addition to your partner to be with you throughout your labor and birth. You can work with a doula (a trained labor support companion) or ask a friend or family member who is experienced with birth and with whom you are comfortable. Women who receive continuous, one- on- one support have fewer complications, better health outcomes, and greater satisfaction with their birth experiences. (For more information, see “Your Birth Team,” page 32.)
  
  

• Explore your options for pain relief.

  
  There are a wide range of medications and nondrug approaches to managing pain in childbirth. Learn about the advantages and disadvantages of all the options. (For more information, see “Planning for Pain Management,” page 38, and Chapter 11, “Coping with Pain.”)
  
  

• Avoid continuous electronic fetal monitoring when possible.

  
  Continuous electronic fetal monitoring (EFM) increases the likelihood of both cesarean sections and operative vaginal births (births in which forceps or a device known as a vacuum extractor are used to help pull the baby out of the birth canal). Continuous EFM does not offer clear benefit for babies when compared to monitoring the fetal heart rate intermittently during labor. Talk with your caregiver and check hospital policies to find out whether they are willing to check your baby’s heart rhythm with a handheld device or occasional use of EFM instead of continuous EFM. With some types of intervention that involve increased risk (for example, epidurals for pain control), you will be required to use continuous EFM. (For more information, see “Fetal Monitoring,” page 174.)
  
  

• Avoid routine use of other medical interventions when possible.

  
  Using medical interventions when there is no clear medical need offers no benefit to mothers while increasing the likelihood of harm. For example, labor augmentation (use of drugs to increase the speed and strength of your contractions) can increase the discomfort of contractions and lead to fetal heart patterns that cause concern. Some research links labor induction (use of drugs or techniques to try to start labor) with increased likelihood of cesarean section, especially in first- time mothers, or before full term, or when the cervix is not soft and ready to open. Avoid having a provider break your bag of waters (artificial rupture of membranes) before labor starts or in early labor, unless there is a clear medical reason to do so; early breaking of the bag of waters may increase the likelihood of a cesarean. It is also good to avoid arbitrary time limits for your labor. There is no need to turn to a cesarean if you and your baby are doing well. Talk with your caregivers about these practices and how to avoid them. (For more information about induction, see page 146. For information on rupture of membranes, see page 180.)

Being informed can help you negotiate the choices you face during pregnancy and childbirth. While you won’t be able to control everything that happens in the months to come, you can clarify what is important to you. Excellent support can also help, so surround yourself with caregivers and others who understand your priorities and will advocate for you.

At first I was really scared of labor. I knew I wanted a birth as free of interventions as possible, but I thought this meant I had to be some kind of Amazon who squatted in the field, grunted out her baby, then stood up to pick the crops. Or else a superfit marathon runner who had endless endurance and tolerance for pain. But the more I learned, the more I talked to other women, and the more support I got from my midwife, the more confident I felt. I took great comfort in the fact that women have been giving birth forever—every one of us had a mother who managed to birth us!

 

* Adapted from content produced by Childbirth Connection. The organization’s website (www.childbirthconnection.org) has information about the best available research on the safety and effectiveness of maternity care practices as well as extensive materials to help women and families make informed decisions during pregnancy, labor, and birth.