Birth Part 3: The Green Mama Guide to Getting the Birth You Want
I work with a lot of women. In my conversations about their children, their lives, what their husband cooked for dinner last night, birth often comes up. This is also a subject on which I've done research and written. My conclusions from this research and these conversations are simple (even if the information itself is not): Women's birth experiences matter. This is because women who get informed and take informed action have better birth experiences and better birth outcomes.
The Green Mama's suggestions for getting the birth you want:
1. Interview care providers. Come on ladies: we try out a car before we buy it, we interview nannies, we even read on-line reviews of restaurants and salons before we visit, why would we not interview the care providers we expect to attend our births? Remember, obstetricians/gynecologists are NOT trained in "normal" birth, but are specialists in what can go wrong. In BC, most babies are delivered by family doctors or midwives. In the U.S., most women just go to the ob/gyn she has always gone to. If you want a vaginal birth, I highly encourage you include midwives in your interview process (and family doctors when midwives aren't feasible).
2. Ask REAL questions. Like many women, it is hard for me to ask questions of authority, especially if I think the person won't like my questions. Ask anyway. In the hospital on the day of your delivery, it is too late. (It is also probably too late at 36 weeks, start right away.) At the minimum ask:
- Rate of cesarean section? For their practice and at the hospital where they work if applicable. The U.S. average is almost 32% and a rate of over 15% is considered to due more harm than good.
- Rate of episiotomy? Routine episiotomy use is not supported by research and a doctor's rate should be below 15% . What does the doctor/midwive do during a birth to help prevent tearing?
- Rate of epidural? Epidurals have been linked with an increased chance of maternal fever, the need for vacuum extraction or forceps, serious tears in your perineum, and many other labor interventions. Some research links epidural use with increase risk of cesarean section as well.
- Who is most likely to attend your baby's delivery? Is it an individual or group practice? If it's a group practice, will you have any say in who attends your delivery? How many other laboring women will the doctor/midwife/nurse usually be responsible for at the same time?
- How do you define "high-risk"? Different practitioners will have different answers. For instance, some doctors will consider you high-risk if you have ever had previous cesarean section and will want to schedule your next cesarean delivery while other practitioners will allow you to try for a vaginal birth after cesarean (VBAC). Similarly, some practitioners consider it fine to go two weeks post your estimated due date while others will want to induce you if you are less than a week past. (Induction may double your risk of cesarean section.)
- How do you monitor the baby during labor? Continual electronic fetal monitoring (EFM) is often used in hospitals, but is not linked with improved outcomes. When a woman gets EFM it restricts her ability to be active and move in labor and makes it unlikely that she can use water for pain relief. Alternatively, monitoring with a doppler or fetoscope are safe and effective options that allow for freedom of movement.
- Will you be allowed and encouraged to move in labor, eat and drink, and try out different positions for the birth? Research supports mother's being free to move in labor, to drink when thirsty and eat lightly if interested. The research also suggests to avoid back-lying positions for pushing.
- What support does the midwife/doctor provide to help with pain relief other than drugs? (See below for the list of the six comfort practices that promote healthy birth.)
3. You are NOT likely to be the exception. Plan as if the statistics do apply to you: if a doctor has a 55% c-section rate that means you will most likely end up with a cesarean section. If this is your first baby, it is particularly important to consider what the impact of subtle (or not so subtle) pressure from your caregiver might be in influencing your birth experience. Save the positive thinking for birth and plan based on the facts.
4. Know the six comfort practices that promote healthy birth. Make sure you are realistically in a situation where you can get all six (or as many as you want). They are:
- let labor begin on its own;
- walk, move around, and change position throughout labor;
- bring a loved one, friend, or doula for continuous support;
- avoid any intervention that isn't medically necessary;
- avoid giving birth on your back and follow your body's urges;
- and keep mother and baby together.
5. Consider childbirth education classes. It is best to find a class or group that isn't affiliated with a hospital so that you will get information that is unbiased and does more than just prepare you for an epidural. Bradley, Lamaze, Birthing from Within, are all widely available options.
6. Watch and read about real (especially positive) birth experiences. Birth is NOTHING like what you see on TV (with the water breaking, a bunch of screamng and cursing, and a baby delivered before the next commercial). You can watch natural birth videos (on youtube, rent them, or borrow from your local library or midwife practice), read books, and talk to your friends.
7. If you want a Vaginal Birth after Cesarean (VBAC) start early asking questions and interviewing caregivers. Despite The American College of Obstetricians and Gynecologists (ACOG) easing their language on VBACs many hospitals and providers still won't allow them (or aren't prepared to really support a trial of labor after a previous cesarean). VBACs are a safe option for most women who have had a previous cesarean section and, when successful, are associated with better outcomes than a repeat planed cesarean.
Learn more about VBAC:
8. Do RESEARCH and get informed.
The Green Mama's list of BEST birth resources.
Ina May's Guide to Childbirth by Ina May Gaskin. If you are to only have one book this is it. It has numerous positive birth stories at the beginning that despite being hippy are wonderfully instructive and will actually get you excited about birth. The reason I recommend it, however, is that the second half of the book has some of the best information on the tests during pregnancy and procedures during birth and the science around them, why you may or may not want to do them, etc. This is the only one that my husband also read and then he referred to things he learned in it during my births.
Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block. Jennifer Block wrote this era's expose on maternity care in the U.S.A. and has coined the concept of "pushed" birth. A great read, this is a thorough examination of the state of the country and why the U.S. is one of the most dangerous places in the developed world to give birth. Her popular blog is a great source for daily information on the state of US maternity care.
Having Faith: An Ecologists Journey to Motherhood by Sandra Steingraber. Written as a non-fiction novel by a writer and a scientist, this will be one of your most enjoyable pregnancy reads. Through stories of her own pregnancy, this book explores the womb as a microcosm of the environment. What is precariously placed at the top of the food chain? A human baby. Yes, it will scare you, but it will also get you thinking like a green mama.
The Pregnancy Journal: A day to day guide to a healthy and happy pregnancy by Dr. Christine Harris. More book than journal, this is by far the best I have found in its genre of day-to-day pregnancy guides. It gives a daily description of what is happening with the fetus, the mama, and includes interesting tidbits about pregnancy and birth in other cultures.
The Thinking Woman's Guide to a Better Birth by Henci Goer. I haven't read this but I have come across parts of it in research I did. It is supposed to be quite good.
Your Best Birth by Ricki Lake and Abby Epstein. As above, I haven't read this, but loved the movie.
The Business of Being Born by Ricki Lake and Abby Epstein. Rent or livestream it. A great, easy introduction into why it matters that you prepare for birth. This movie is a fun watch while being inspirational and is a good source for images of inspiring births. (And kudos to Ricki Lake for showing her birth as part of it.)
What Women Aren't Told About Childbirth by Manda Aufochs Gillespie and Mariya Strauss