How to Prepare for Childbirth


Women's bodies undergo changes before childbirth to prepare them for extreme pain. See more pregnancy pictures.
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Our attitudes toward pregnancy and childbirth form over a lifetime, shaped in part by the values and beliefs of our families and our culture. The way in which we assist a baby's entry into the world reflects not only personal and family beliefs but also the prevailing cultural attitudes.

Since the turn of the century, the birthing process has undergone continuous change. When you talk to your mother and grandmother about childbearing practices during the years they were having children, they probably won't tell you it was wonderful "in the good old days." Most people believe that childbirth today is managed much better than it was one or two generations ago.

In this article, you will learn about the options available to you for childbirth so that you can make informed decisions about what's best for you and your baby. The following sections will help you not only choose the childbirth setting that's right for you, but also prepare for the upcoming event. You will learn about:

  • History of Birthing Methods Childbirth has come a long way over the years, and some of the fears and misconceptions you have about delivering a baby may no longer be relevant. On this page, we will discuss the history of childbirth and some of the ways the procedure has changed for the better.
  • How to Choose a Childbirth Doctor Choosing a doctor to help you have a baby is not as easy as it sounds. For starters, there are many different doctors with different specialties to choose from. On this page, we will help you tell the difference between a perinatologist, an obstetrician, and an osteopathic physician. We will also show you how to find a good recommendation for a doctor and how to check their qualifications.
  • How to Choose a Midwife Some women choose not to use a traditional doctor, but instead use the services of a midwife. Midwives, however, can be every bit as experienced and trained as their medical counterparts. Midwives, just like doctors, must be certified and licensed. On this page, we will tell you the various types of midwives and help you decide which one would be best for you. We will also show you where you can find a midwife.
  • Questions to Ask Before Birth Regardless of which caregiver you choose, a doctor or a midwife, you will still have to find the right specialist for you and your family. Naturally, this will require you to do a certain amount of interviewing, which might make you uncomfortable. Many new parents might not even know what types of questions they should ask a prospective midwife or doctor. In this section, we will show you the areas you should concentrate on when questioning a potential caregiver.
  • Giving Birth in a Hospital The overwhelming majority of new parents choose to deliver their baby in a hospital, but not all hospitals will be right for all parents. In this section, we will show you what you should look for when choosing a hospital, what special considerations you might be interested in, and what sort of environment you might require while giving birth.
  • Out-of-Hospital Births A growing minority of women is electing to give birth outside of a hospital in their homes or a licensed birthing center. Naturally, there are some considerable risks to delivering a baby outside of a healthcare facility, but it will mean that the parents will have more control over what happens during the labor and delivery. On this page, we will show you all the pros and cons of an out-of-hospital delivery and what conditions will mandate a transfer to a hospital.
  • Childbirth Classes Childbirth classes can help prepare you for the eventual birth and offer you tips and techniques for coping with the pain and stress of a delivery. A well-known example of one of these techniques is the Lamaze method. On this page, we will describe the various childbirth classes and help you choose the one that's right for you.
  • How to Create a Birth Plan A birth plan is set of instructions prepared in advance for the medical professionals who will help you through the delivery process. This step is a critical factor in making sure that your wishes are carried out on your delivery day. Find out how to write the best birth plan possible.

Deciding where to give birth is one of the most important decisions you will make during your pregnancy. Go to the next page to start learning about the experiences of other women giving birth.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

History of Birthing Methods

The science of childbirth and various birthing methods has advanced rapidly in recent years.
The science of childbirth and various birthing methods has advanced rapidly in recent years.
Publications International, Ltd.

In looking back, we see that until the mid-1930s, childbirth was truly dangerous. High percentages of women and their infants died during or soon after childbirth. Determined to correct this grim statistic, organized medicine took many steps to lower mortality rates. A new medical specialty, obstetrics, was founded, and an aggressive effort was made to eliminate high-risk practices (for example, lack of cleanliness and infection control at delivery, and overuse of drugs to speed up labor and obliterate pain) and to improve the training of physicians. Prenatal care also gained recognition for its benefits in preventing death. Childbirth moved from home to hospital, with the promise of more efficient and controlled conditions for birth.

With these efforts, along with general improvements in public health (for example, improved working conditions, public sanitation, family nutrition, and better control of some chronic illnesses), came a reduction in the danger of death in childbirth. The 1940s brought such advances as antibiotics and blood banks, as well as improvements in surgical techniques and anesthesia, which further increased the safety of childbirth.

But by the 1950s, routine maternity care, originally designed to improve safety, had become almost too rigid. For example, the fear of infection, a major killer of mothers and babies, led to such practices as taking away all a woman's personal belongings when she entered the hospital; shaving all her pubic hair; administering large, uncomfortable enemas; prohibiting fathers and other loved ones from entering the maternity area; keeping babies in nurseries, away from their mothers; and handling babies as little as possible. At the time, bottle-feeding was believed to be more sanitary and superior in almost every way to breast-feeding.

In addition, heavy use of pain medications often took away mothers' ability to control their behavior and to understand and remember labor. They often remained drugged and sleepy for hours or days after birth.

In response to these hospital routines, women protested that such practices were not necessary or beneficial, and they began seeking other, more satisfying ways to give birth. Fortunately, concerned and enlightened professionals joined them in their quest.

Thus began the natural childbirth movement and the movement toward family-centered maternity care. The 1960s was a time when national and international organizations were founded to make these changes. Women and men wrote and read books describing more humane, satisfying ways to give birth to a baby. Mothers attended childbirth preparation classes, involved their loved ones in their support and care, breast-fed their babies, and spent more time during their hospital stay caring for their babies.

These improvements in care and in safety have continued. As the individuality of each woman was recognized, so was the uniqueness of each labor. It became clear that not all women need or want the same kind of care when they give birth.

The 1970s saw the reemergence of the midwife as a popular and trusted caregiver for healthy women wanting more participation in their own care, more emphasis on prevention of problems, and more recognition of their emotional needs. This was also the time when alternative settings for birth -- at home or in a birthing center -- surged in popularity.

Hospitals also joined the ranks, offering more flexible, family-centered care and more comfortable, homelike rooms for birth. The role of physicians changed, too: They became more sensitive and responsive to each woman's needs and wishes instead of assuming complete control of the birth.

Go to the next page to begin reading about your choices today and begin deciding what kind of care you think will be best for you during your pregnancy and the birth of your baby.

How to Choose a Childbirth Doctor

Its important to choose a childbirth doctor that both you and your partner are comfortable with.
Its important to choose a childbirth doctor that both you and your partner are comfortable with.
Publications International, Ltd.

Your pregnancy involves many people in addition to you and your baby. Your family, of course, is affected. You may have a childbirth educator and an exercise instructor. And you will certainly have a doctor or a midwife to care for you during your pregnancy and at the birth of your baby. This caregiver is a partner in your pregnancy. (As used here, the term caregiver refers to a person-doctor or midwife-who cares for a woman during pregnancy and labor.) He or she will have the responsibility for your health and your baby's health, so you want to be sure the individual is qualified and competent. And because your caregiver will intimately participate in a very special event in your life, you want someone with whom you can feel comfortable.

Choosing a caregiver is not always as easy as it sounds. Caregivers may differ vastly in their philosophies about pregnancy and birth and in their level of skill. Finding the right caregiver may take some work. In this section, we'll help you find the right doctor.

Physicians

Physicians -- those with a Doctor of Medicine (M.D.) degree or a Doctor of Osteopathy (D.O.) degree -- provide most of the maternity care in North America. All physicians have completed college and medical school; most have further residency training. Those who care for pregnant women generally specialize in obstetrics and gynecology, perinatology, or family medicine.

You can get recommendations for doctors from many different sources. Friends and relatives may suggest their doctors. Another doctor, such as your family practitioner, internist, or pediatrician, may provide a name. (In some cases, your family practitioner may provide your obstetric care.) Maternity nurses or obstetric residents (doctors in training) at your local hospital may also help you locate a doctor.

You can ask the Department of Obstetrics and Gynecology at the nearest university hospital for the names of graduates or faculty members who practice in your area. If these avenues fail, try contacting a childbirth education group, such as the International Childbirth Education Association, a local childbirth educator, or your La Leche League chapter.

When you have the name of a doctor who sounds promising, your next step is to find out more detailed information about him or her. One way to evaluate a doctor's competence is to find out about his or her training.

A board-certified obstetrician has completed an obstetrics residency and passed a board-certification examination administered in the United States by the American Board of Obstetrics and Gynecology and in Canada by the Royal College of Physicians and Surgeons.

The most highly specialized obstetrician is the perinatologist. Beyond medical school and obstetrics residency, the perinatologist takes further training in the care of women with high-risk pregnancies: those who have underlying illnesses, such as diabetes, heart disease, and high blood pressure, and those who have complications during their pregnancies or who experienced complications with previous pregnancies. Perinatologists tend to practice in large cities. Most of their patients are referred to them with complications requiring not only their special expertise but also the facilities of a large hospital equipped with the latest technology.

Family physicians care for women at all stages of life, including during pregnancy, as well as other family members from infancy through old age. They tend to refer difficult maternity cases to obstetricians or perinatologists. The family physician provides most of the maternity care in Canada and much of the care in rural settings in the United States. Women who choose family physicians for their maternity care appreciate the fact that the physician can take care of them throughout pregnancy and birth and then continue to care for the baby and family members.

Osteopathic physicians also provide maternity and family care. Osteopaths differ little from medical doctors in training and practice and have about the same legal scope of practice.

Certainly, board certification is one way to judge a physician's qualifications, but training and experience are also important. Hospitals monitor a doctor's performance. The doctor you select to deliver your baby should be a member in good standing of the medical staff of a reputable hospital.

Some women choose a midwife instead of a doctor. Go to the next age to learn more about midwives and how to choose one that's right for you.

How to Choose a Midwife

Besides a physician, the other large category of caregiver is the midwife. In many countries of the world, midwives are the primary caregivers for women during pregnancy and labor. In North America, their place is not as well established. All states have provisions for the legal practice of midwifery. In Canada, most provinces have active midwifery promotion groups who have made significant efforts in establishing midwifery as a legal form of maternity care.

The emphasis of midwife training is that birth is a normal physiologic event rather than a medical condition. They learn methods for supporting and promoting women's physical and emotional health to optimize the reproductive process. The care they give consists of thorough physical assessment and prevention of complications through education in self-care, emotional support, and nurturing of the woman throughout her pregnancy and labor.

Midwives do not care for women with complications of pregnancy, underlying illnesses, or other high-risk conditions. Should any of these problems arise, a midwife will refer the woman to an obstetrician.

Within the broad category of midwife, there are several subcategories. In the United States, certified nurse-midwives are the most numerous. They are registered nurses who have taken an additional one or two years of training in midwifery. Many receive master's degrees when they complete their nurse-midwifery training. They usually practice in close cooperation with physicians in hospitals, birthing centers, and the home setting. Nurse-midwives are certified after passing an examination administered by the American College of Nurse-Midwives.

In some states, other types of midwives are recognized and licensed to provide maternity care. Licensed midwives practice in several states. They receive training comparable with that in midwifery training programs in Europe. They are called direct-entry midwives. They do not necessarily possess a background in nursing, but they usually have received some college education followed by a two- to three-year training program in midwifery.

At present, most licensed midwives practice outside the hospital, providing care for home births and birthing-center births. Their orientation and pattern of care are similar to those of nurse-midwives.

Lay midwives, or empirical midwives, practice in a number of states. Most lay midwives have received informal training-apprenticeship to an experienced midwife, participation in short courses or study groups, or extensive independent study. Their qualifications, experience, and standards of care vary; some practice within the law, and others practice without legal sanction. Lay midwives emphasize the spiritual, as well as the physiologic and psychosocial, aspects of birth.

If the midwife option interests you, you may wish to research the role of midwives in your own state. What midwives do and are allowed to do by law vary from state to state. In some areas midwives work with doctors, providing much of the routine care for women during pregnancy and labor. In some areas they do home deliveries only, while in other areas they work in hospitals.

No matter what type of practitioner you choose to assist you and your baby during childbirth, you need to make sure that they are the right person for you and your baby. Go to the next page to find out about important questions you should ask any practitioner you consider hiring.

Finding the Best Childbirth Care for You

With all the choices that are available, how do you decide what kind of care and which person will be most appropriate for you? You can start by asking questions to help determine whether the caregiver you are considering provides the kind of care that you need or want.

Begin by shopping over the phone and talking with the office nurse or, in some cases, speaking directly to the caregiver.

  • Ask about the background and training of the caregiver and how long he or she has been in practice.
  • Ask about any limitations on the scope of practice of your caregiver. Midwives, for example, do not provide prenatal testing and some do not provide prenatal care.
  • Ask in which hospitals the caregiver has privileges.
  • Ask how much time is scheduled for each prenatal appointment. Your caregiver should allow at least 30 minutes for each appointment -- longer if you are undergoing a procedure such as an ultrasound. You should also expect to wait since the caregiver may be called away at any moment to deliver a baby.
  • Find out who sees you for your prenatal appointment if your caregiver is called away during office hours. Sometimes a colleague or the office nurse sees you. Some doctors employ nurse practitioners or midwives to do checkups or even perform uncomplicated deliveries. If this is the case, be sure you understand and are comfortable with the arrangement. In both instances, the substitute caregiver may not be willing or able to answer questions about policies, philosophies, and usual practices. Sometimes, in a busy practice, a woman comes in several times without seeing her own caregiver. This can be very frustrating, especially if she has questions that only the caregiver who will be present at the delivery can answer.
  • If the caregiver is involved in a group practice, find out how likely it is that your own caregiver will see you during your prenatal appointments. In some group practices, you meet all members of the group. In others, you may see only one, but one of the others may attend your birth.
  • If the caregiver is in a group practice, the members probably take turns being on call at night. If you go into labor on a night when your caregiver is not on call, ask whether your caregiver will come in or will the partner on call perform the delivery? If one of the partners may deliver your baby, you will need to make sure you are comfortable with the other members of the group and they have the same attitudes toward childbirth as your doctor. Otherwise, the delivery you've so carefully planned may change at the last minute. Some groups are so large that the chances of a woman having her own caregiver during the birth are really quite small. If you do not like that, and there are no other overriding reasons for choosing such a group, you might decide to look for a smaller group or an individual practitioner.
  • Ask if your partner is welcome to attend prenatal appointments with you.
  • Before you make an appointment, inquire about finances. Be sure your insurance will cover the caregiver's charges, and find out how and when payment is expected. Find out what happens to the charges if there are any complications.

If your phone conversation with the office nurse or caregiver gives you a positive impression, make an appointment with the caregiver. (You do pay for these appointments.) Plan to use this appointment as an interview rather than a first prenatal visit. (The latter includes an extensive physical examination and many costly laboratory tests.)

Make it clear when setting up the appointment that you are in the process of choosing a caregiver and would like the opportunity to meet with this person and ask questions. The charge for such an appointment is usually less than an initial prenatal appointment. It is a good idea for the baby's father to accompany you so that he can ask questions and form an opinion about the caregiver as well. 

See the next page to learn what questions you should ask during the interview with the caregiver.

Question to Ask the Caregiver

During an initial interview, come prepared with a list of questions for the caregiver regarding your pregnancy and the delivery. The caregiver should be willing to answer any questions and to discuss the type of care you will receive. He or she should be flexible about issues that are important to you, but if the caregiver believes that something you want will compromise your care, he or she should be willing to explain why. Some examples of topics you may want to discuss follow.

Important issues during pregnancy include nutrition, exercise, illness, and monitoring the baby's development.

  • Discuss with the caregiver what you should eat. How many more calories will you need? Will you need to increase your intake of certain nutrients? (Your caregiver may recommend vitamins and possibly calcium supplements.) How does the caregiver feel about your drinking coffee or other caffeinated beverages?
  • Discuss how much exercise you should get. Does the caregiver recommend an aerobics class?
  • Find out what you should do if you become ill. What medicines can you take and what should you avoid? A doctor monitors a pregnancy with blood and urine tests, ultrasound studies, and amniocentesis. Discuss which tests are appropriate for you.

You should make many of the decisions regarding delivery beforehand. For example, you need to decide where you want to give birth -- in a regular delivery room, in a birthing center, or at home. Your caregiver can explain the differences.

  • Ask the caregiver how he or she feels about a birth plan prepared by you.
  • If the person you are considering provides home birth or birthing-center care, ask about backup arrangements -- which hospital and physician are used if transfer or consultation becomes necessary.
  • Ask if the caregiver recommends childbirth preparation classes. If so, which ones?
  • Ask what interventions and diagnostic screening the caregiver normally uses during labor.

If you have strong opinions about the medical treatment during labor and delivery, discuss them with your caregiver. For example, some women do not want an intravenous line, anesthesia, or an episiotomy (a surgical incision to enlarge the external opening of the birth canal and make delivery easier). Questions involving delivery procedures include the following:

  • Does the caregiver recommend that all women receive intravenous fluids?
  • Do all women receive electronic fetal monitoring?
  • Are women free to walk, move, and take a shower throughout the early stages of labor?
  • What are the caregiver's usual recommendations regarding the use of medication and anesthesia?
  • Does the caregiver usually perform episiotomies?
  • When does the caregiver normally arrive during labor and how much time does he or she spend by the bedside during labor? If not the caregiver, who provides professional support and care during labor?
  • If you desire natural childbirth, does the caregiver encourage natural or prepared childbirth?
  • What are your caregiver's opinions about inducing labor? You might ask how often and for what reasons labor is induced, and what precautions are taken to avoid prematurity with induced labor.

Other questions might be related to the caregiver's level of skill and training and his or her ability to detect problems both before the baby is born and immediately after (during the neonatal period). You also will want to know any limitations on the scope of practice of your caregiver. For example, only some family physicians and no midwives perform cesarean sections. Few physicians attend out-of-hospital births. Midwives do not provide care in complicated labors, nor do they use forceps. Some midwives cannot give pain medication during labor. Some midwives cannot perform episiotomies or repair lacerations.

  • Ask who will provide any care you need beyond the scope of the caregiver's practice.
  • If you are planning a home birth, ask when your caregiver normally arrives during labor. You will want to know what equipment your caregiver carries for normal care and for emergencies and what his or her policies are on transfer to the hospital if problems arise. Can the caregiver continue to provide your care in the hospital or remain as a support person and advocate while an obstetrician takes over the management? Or does he or she not accompany you to the hospital?
  • If your caregiver is a physician, discuss cesarean sections. Does he or she perform them routinely for certain types of problems? Will you remain awake during the surgery and be given the baby immediately after the delivery? How long will you have to stay in the hospital if you need a cesarean section and everything goes well?

Other questions might center on the father's or support person's participation throughout labor and birth (even cesarean birth) and the events immediately following birth.

  • Are other support people also welcome? If you want the child's father or other children there, be sure your caregiver and the hospital agree.
  • Ask about the routine care of the newborn immediately after birth. Does the newborn usually stay with the parents, or is the baby taken to the nursery very soon after birth? For how long? For what reasons? Can some newborn procedures be delayed, especially those that interfere with the contact that allows bonding to take place between parents and baby? These include the use of eye ointments (which can blur the baby's vision), the use of nursery heaters to maintain body temperature, and the immediate admission of the baby into the nursery for routine procedures, such as weighing and measuring. Some of these can be delayed, which would give the parents time to admire and cuddle their new baby, if the baby's condition permits.
  • What about circumcision? Ask if your caregiver recommends it and, if so, why? Does he or she perform circumcisions?

By the time you finish discussing all of these topics, you should have a good idea how well you like the caregiver. Do you feel at ease with him or her? While you may not agree on every subject, you should feel confident you can develop a working relationship, and you can discuss a problem and reach a compromise that will be satisfactory to you and your partner and the caregiver.

Finding a caregiver may be easy, or it may require a search. Because the caregiver plays such an important role, it is worth the effort to find someone you like as well as trust. Only in this way can you be sure that your pregnancy and delivery will be as safe and joyful as possible.

Now that you have to tools to find a caregiver that's right for you, go to the next page to find out about the pros and cons of giving birth in a hospital.

Giving Birth in a Hospital

Giving birth in a hospital is not without its own share of complications. Learn about considerations like labor beds and birthing rooms.
Giving birth in a hospital is not without its own share of complications. Learn about considerations like labor beds and birthing rooms.
Publications International, Ltd.

Another basic decision involves where you will give birth. Most women choose the hospital. Some women choose to have their babies in freestanding birthing centers or at home. You can make the decision on where to have your baby in much the same way you choose your caregiver: Find out what options you have and ask questions about issues that are important to you.

If you prefer to have your baby in a hospital, the next question is, which hospital? Most caregivers have privileges in one hospital, but many use more than one. Tour each of the hospitals your caregiver uses. It also may be useful to tour other hospitals -- for comparison purposes, if nothing else.

It's important to choose a facility at about the same time you choose a caregiver, so you can match the caregiver with the facility. You might discover, for example, that you prefer a hospital where your caregiver does not have privileges. If so, and if you do not feel a strong tie to your caregiver, you might decide to change caregivers to use the facilities that appeal to you.

If your community has more than one hospital, you might be surprised at how different they are from one another in their facilities, policies, and philosophies of care. Most hospitals offer tours of their maternity ward. You should call the hospital to sign up for a tour.

What do you look for when touring a hospital? You can use the following questions to help evaluate a hospital's obstetrics area.

  • How do you feel about the overall atmosphere of the obstetrics unit? Does it seem comfortable? Will you have some privacy during your stay there? Many hospitals, for example, have attractive private labor rooms and bathrooms.
  • What provisions are there for the mother's comfort? Some have very comfortable labor beds, while others have very narrow, hard labor beds. Some provide nice touches like rocking chairs, couches where the partner can rest, showers and tubs to use for pain relief, and beanbag chairs for getting into comfortable positions. Others make no extra provisions for the comfort of either mother or father.
  • Does the hospital have birthing rooms (attractively decorated rooms where the mother can labor, give birth, and spend time with her newborn afterward)? In some hospitals, the birthing room is the only room the mother is in throughout her entire hospital stay. In others, labor and birth take place in the birthing room; she then goes to a postpartum room for one or more days before going home. In still other facilities, labor takes place in one room, the mother is moved to another room when she is about to deliver, she may go to another room to recover, and then she goes to still another room for the rest of her hospital stay. Many hospitals are beginning to convert their maternity facilities so that a woman can labor, deliver, and recover in the same room (a so-called LDR room).
  • What does the nursery look like? Are the mothers encouraged to keep their babies with them in their rooms, or do the babies spend most of their time in the nursery?
  • Do the nurses seem friendly and warm? What about the person leading the tour? Is she friendly and does she answer your questions, or is she simply herding you through brusquely? (Some hospitals are so busy they don't take potential clients on a tour of the actual facilities. In place of a tour there may be a slide show and discussion of policies and procedures with a member of the staff.)
  • Ask some specific questions about admitting procedures. Ask to see the general consent forms that require your signature when you arrive at the hospital. Be sure to read these in advance and clarify any questions you may have. It is certainly not easy to read consent forms carefully if you are already in labor.

Prepare your questions about hospital procedures in advance of your visit. How you phrase these questions may determine the thoroughness of the response. For example, if you ask, "What usually happens to the baby after he or she is born?" you will learn more than if you ask, "What is the hospital's procedure for routine newborn care?" There may be few hospital policies for such care, but there are certainly customs, and those are what you want to know about.

You might ask for a step-by-step description of what usually happens after a woman in labor arrives at the hospital. For example:

  • Do most women have a nurse assigned to them alone, or do the nurses take care of more than one woman in labor at a time? Are they understaffed sometimes, and what do they do if this happens?
  • Do women usually receive pain medications, or do many women use little or no pain medication? If a woman desires an unmedicated childbirth, is she actively encouraged and supported in this by the nurse?
  • Do most women receive intravenous fluids, continuous electronic fetal monitoring, rupture of the membranes, oxytocin (a hormone that causes contractions), and episiotomies?
  • Does the hospital have a high rate of cesarean births? Ask how cesareans are usually done; for example, what type of anesthetic is usually used, and is the father encouraged to be present? (Write down anything you don't understand to discuss with your caregiver later.) Can a woman who has previously had a cesarean attempt to deliver vaginally?
  • How long is the usual hospital stay? (The terms of your health insurance may also determine how long you can remain in the hospital after an uncomplicated delivery.) Is there a short-stay or early-discharge program that allows mothers and babies to go home within a few hours after the birth? Does the hospital provide any kind of follow-up?

Clarify the costs of labor and delivery rooms, nursery charges, postpartum care, and so forth. Of course, you will also need to check your insurance policy, if you have one, to see how much you will have to pay.

If you choose an alternative caregiver, you may want to give birth in a different setting, Go to the next page to find out more about out-of-hospital births.

Out-of-Hospital Births

Learn how to prepare for childbirth and how to write contingency plans in case of emergency for an out-of-hospital birth.
Learn how to prepare for childbirth and how to write contingency plans in case of emergency for an out-of-hospital birth.
Publications International, Ltd.

If you are considering giving birth in a setting other than the hospital, find out what services are available in your community. Are there competent people offering home-birth care? Is there a licensed birthing center in your area?

Out-of-hospital birth is a choice only for women who are in good health and who have had normal pregnancies. Interventions are often not necessary for healthy women having normal labors, but if the need arises, the woman is transferred to the hospital.

Those planning out-of-hospital births, therefore, expect to labor without pain medication and without medical intervention. It must be remembered that caregivers in out-of-hospital settings have fewer facilities (and possibly less skill) should emergency situations arise. Minutes count. How long will it take to receive adequate care?

Many women, of course, are not comfortable giving birth away from the emergency medical facilities available in hospitals. This disadvantage of out-of-hospital births should be carefully considered by all women contemplating birth outside the hospital.

Risks of Out-of-Hospital Births

Just what are the risks in giving birth outside the hospital? There are two classifications of risk: true obstetric emergencies, and other conditions that might require a less critical transfer to the hospital for assistance with the birth.

Even though true emergency conditions are uncommon, they are factors that must be considered by anyone who is contemplating an out-of-hospital birth.

You should also remember that even in a normal pregnancy and labor, unexpected situations could arise after delivery, making it necessary to transfer mother or baby to a hospital. For example, respiratory distress or cardiovascular problems of the newborn infant are true emergencies that can best be dealt with in a hospital setting.

Nonemergencies Requiring Transfer to the Hospital

Women are also transferred to the hospital for conditions that are not considered emergencies. Sometimes, if a complication (such as anemia, high blood pressure, diabetes, placenta previa, twin pregnancy, or breech presentation) is discovered during pregnancy, the woman is no longer a candidate for out-of-hospital birth.

If labor is prolonged or if it looks as though the mother will need pain medication, forceps or vacuum assistance, or other intervention, she is transferred to the hospital. Under these circumstances, the transfer is not an emergency, and there is usually time to try various solutions and, if necessary, decide whether and when to go to the hospital.

While it is never pleasant to have to give up plans for an out-of-hospital birth, and transfer is uncomfortable and worrisome for the parents, it does not usually present any danger to either mother or baby. A study of planned home births attended by certified professional midwives showed that approximately 15 percent of women were transferred to the hospital during labor or after delivery. First-time mothers were four times as likely to be transferred as mothers who had previously given birth. The possibility of transfer should be considered when parents are deciding on the merits of an out-of-hospital birth.

When inquiring about out-of-hospital birth services, find out what drugs and technology they use in their birth practices, such as pain medications, intravenous fluids, oxytocin, and fetal monitoring. Ask what emergency equipment they have available for all births. You will want to know about the backup hospital and the backup or consultant physicians. You should also know about transfer arrangements. For example, is an ambulance available at all times in case an emergency transfer becomes necessary? Or are the automobiles of the staff and clients the usual transportation in case of transfer? How far away is the backup hospital?

Advantages of Out-of-Hospital Birth

The advantages of out-of-hospital birth are that parents may have more control over the birthing experience. There are few routines that must be followed. In a home birth, for example, parents have the freedom to move around, visit with friends, go outside the home, and do household activities and other things during labor as much as they like. In addition, few interventions are used. Contact with the baby after the birth is unlimited and in accordance with the parents' wishes.

Women who choose birthing centers often find a sense of community and fellowship. Classes and social gatherings are often held at the birthing center, contributing to a sense of security and friendliness. Women who choose home births tend to find great appeal in the complete familiarity of their own surroundings.

The costs associated with home birth are by far the lowest of the three environments, and birthing centers usually cost less than hospitals. Those parents for whom finances are an important issue need to investigate thoroughly the actual costs involved in all three of these options.

Many uninsured people with low incomes find home birth to be the only affordable option. But if a planned home birth winds up as a transfer to the hospital, it may turn out to be more expensive than a planned hospital birth.

Some health insurance policies do not cover home-birth or birthing-center care, even though it is much less expensive. If you have insurance, make sure to investigate ahead of time the possibility of reimbursement for those expenses.

Disadvantages of Out-of-Hospital Birth

The major disadvantages of out-of-hospital birth are primarily related to the lack of available appropriate medical care should emergencies occur. Such situations can arise quickly (for example, hemorrhage, seizures, meconium aspiration, or any severe fetal or maternal complication that might place either baby or mother in jeopardy). The value of proximity to the full range of modern medical care should not be underestimated.

Once you've completed the important steps of choosing a caregiver and deciding where to give birth, you still need to prepare for the blessed event. Go to the next page to find out how to choose a childbirth class that's right for you.

Childbirth Classes

When you choose your caregiver and the place where you will give birth, you will have made the two choices that most affect your birth experience. Besides those, however, other choices also make a big difference. For example, your choice of childbirth classes will influence your feelings of confidence and readiness as you approach the birth and early parenthood.

The idea of formal classes to prepare women and their partners for childbirth came to North America in the early 1950s when the work of Grantly Dick-Read, an English obstetrician, became publicized. Dick-Read was the real pioneer of natural childbirth techniques in the Western world. As a young physician in the 1930s, he presented a new approach to childbirth management. He used education, relaxation, slow abdominal breathing, and caring labor support to combat the three-way cycle of fear, tension, and pain that fed on itself and escalated during labor to the point where a woman had to be heavily medicated. His belief that much of the pain women experience during childbirth is unnatural and unnecessary guided him in the development of the Dick-Read method.

In France in the 1940s and 1950s, Dr. Fernand Lamaze developed another, quite different, system of childbirth preparation, which was widely practiced in France and later in North America. Lamaze called his method psychoprophylaxis -- literally, mental prevention. He emphasized complex distraction methods and the dominant role of a professional coach to reduce a laboring woman's awareness of pain. Though these methods have differences, they share the belief that if a woman receives instruction on anatomy and the physiology of the birthing process, she will be less fearful and better able to participate in and facilitate the process.

Some competition and rivalry has always existed among proponents of the Dick-Read and Lamaze methods. Yet both methods thrived because they appeared at a time in our history when many women were heavily drugged and unconscious through labor and delivery. These methods of natural childbirth appealed to women who wished to be more in control during labor.

Childbirth education has evolved over the years, with major modifications contributed by prominent childbirth educators and obstetricians. Among them is Robert Bradley, the American obstetrician who brought the father into the birth situation as a labor coach. Fathers had traditionally been prohibited from attending births, but Dr. Bradley felt not only that the father's presence was his right, but also that his role as labor coach was an appropriate one for him to play, helping his partner through the labor process.

Sheila Kitzinger, a well-known British anthropologist and childbirth educator, brought a woman's perspective to childbirth preparation, emphasizing body awareness, innovative relaxation techniques, and breathing patterns that harmonize with the intensity of a woman's contractions. Rather than distracting the woman from her labor pain, Ms. Kitzinger said that labor pain is nothing to fear; it is "pain with a purpose." By accepting her pain and working with it, a woman can cope successfully and reap great psychological rewards from her active participation.

The popularity of natural childbirth led to the founding of several national and international organizations devoted to promoting family-centered maternity care, parent participation in childbirth, and childbirth education classes. The International Childbirth Education Association (ICEA), Lamaze International (formerly known as the American Society for Psychoprophylaxis in Obstetrics), and the American Academy of Husband-Coached Childbirth (AAHCC) were founded in the early 1960s to give parents a greater voice in maternity care. A closely related issue, the promotion of breast-feeding, became the cause of La Leche League International (LLLI), also founded in the early 1960s. These organizations and others contributed to effective change in maternity care in favor of more consumer involvement and choice.

In the 1970s, Dr. Frederic Leboyer drew our attention to the newborn baby and what he or she goes through during the birth process. He promoted "birth without violence," or gentle birth. He said that the baby should be helped to a gentle and calm transition from life in the uterus to life outside the mother's body. He advocated a warm, quiet room with dim lights for the birth and a warm bath for the baby shortly after birth.

Also during the 1970s, the term bonding was coined after it was discovered that when newborn babies stayed with their mothers for extended periods of time, the behavior of the mothers seemed to be more loving and maternal than that of mothers whose babies spent most of the time in the nursery. The work of Leboyer and others focused the attention of parents and caregivers on the early care of the newborn and early interaction between parents and newborns.

In the 1980s, investigators with training in psychotherapy focused on the healing potential (and, conversely, the potential for emotional trauma) of the profound experience of childbirth, and incorporated counseling and stress reduction measures into childbirth preparation. Some have urged more spontaneity in childbirth and less emphasis on intellectual preparation and prescribed responses to labor contractions. Childbirth education continues to evolve as we learn more, as people's tastes change, and as maternity care changes.

Finding the right childbirth class may require you to do some comparison shopping. Some classes teach only one method (Lamaze or Bradley, for example). Others provide a broader, more individualized kind of preparation, drawing from these methods and the other innovations to provide a framework of relaxation techniques, patterned breathing, massage, visualization, music, sound, and other pain-reduction methods, along with guidelines for adapting them to suit the individual.

The goal of these classes is to enable women and their partners to discover their own style for labor.

Many communities have independent, consumer-based childbirth education groups that provide classes. Most hospitals and some groups of physicians or midwives also sponsor childbirth classes for their patients or clients.

Where to Start

You can begin the search for classes by asking your caregiver, your friends with babies, or the hospital's maternity department for suggestions. Then call and ask the sponsors of childbirth education to describe their classes.

  • Find out who the teachers are. Ask if it is possible to interview the teacher before registering in a class. You can learn a lot in a brief phone conversation. Is the teacher an independent certified childbirth educator who subcontracts her services? Or is she an employee of a hospital or group? Does she belong to one or more of the local and national organizations of childbirth educators?
  • Ask about the teacher's qualifications. Some sponsors require a medical background, such as nursing or physical therapy. Others require a college degree, sometimes in a related field, such as psychology, social work, education, or biology. Some have no specific educational requirements. Many sponsors require that their teachers have a child. In addition to background requirements, most teachers have received training in childbirth education. Training may be minimal (for example, the teacher may be required only to observe a series of classes) or it may be rigorous. Certification by one of the national or international childbirth education organizations may be required. Some community childbirth education organizations provide their own training and require their own certification. The certification process may include classroom sessions or workshops, written work, examinations, observations of childbirth classes, attendance at births, and teaching under supervision.
  • Find out the number of classes in a series. They range from about 4 weekly classes to as many as 12. Classes may last 11/2 to 21/2 hours.
  • Ask what topics are covered. Possible topics include self-care in pregnancy, preparation for normal and complicated childbirth, cesarean birth, newborn care, breast-feeding and bottle-feeding, and the beginnings of parenthood. You should know how much time is spent on learning and practicing techniques for coping with labor, such as relaxation, breathing patterns, massage techniques, and methods of visualization and focus.
  • Ask about class size. Classes may range in size from private sessions for one or two couples to very large classes for 40 to 50 couples. A small, intimate class may be important to you, or you may prefer a more diverse, larger group. If the group is large, does the teacher have one or more assistants to provide more personal contact with the students? Is there room for everyone on the floor? Is personal contact by phone or private consultation available if you wish it?
  • Find out if there is a reunion of the group after the babies have been born. If so, it indicates that the teacher is aware of the importance of group support. It also shows that the teacher has an interest in following up on her students.

Specialized Classes

Many communities offer specialized classes, such as the following: early pregnancy classes; home-birth classes; refresher classes (a shortened series for those who had childbirth classes during a previous pregnancy); cesarean preparation classes; classes for single mothers, lesbians, parents with a language barrier, parents with impaired hearing or vision, and teen parents; classes for women planning to give up their babies for adoption; classes on vaginal birth after a previous cesarean; sibling preparation classes for other children in the family; grandparent classes; adoptive parent classes; and breast-feeding classes. Postpartum classes for parents with their infants are also offered in many communities.

The final step to prepare of childbirth is coming up with a birth plan. Go to the next page to find out about all the preparations you need to make for your child's arrival.

How to Create a Birth Plan

A birth plan is simply a written description of your priorities and preferred options during labor and birth and afterward. The plan may be placed in your chart, where those involved in your care can read and consult it. The portion that pertains to the care of your baby (the baby care plan) can be placed in the baby's chart, which is separate from your own.

A birth plan has many advantages. Simply preparing a birth plan helps you focus your preparation on the various options (for example, natural versus medicated childbirth, circumcision versus no circumcision, breast- versus bottle-feeding). It encourages you and your partner to discuss your worries and expectations, and to come to agreement on what is important. During labor, of course, the benefit of the birth plan is that you do not have to take the time and trouble to tell each staff member your wishes on every option as it comes up.

Birth plans also help your caregiver. If you prepare a rough draft and go over it with your caregiver, he or she will learn more about you as well as your preferences and will know how to help you in labor. He or she can also help you modify options that may seem unwise or inappropriate. Potential misunderstandings can be detected in advance, so that neither of you is caught by surprise when the stress of labor makes discussion difficult. Your caregiver may be willing to initial your plan, indicating to hospital staff that he or she agrees with it. It is not a legal agreement or a contract. It is simply a statement of your wishes.

For the nursing staff and other people who will be caring for you during labor, the birth plan makes you less of a stranger to them. It is a shortcut to communication and lets them know what is important to you and how they can help.

Your birth plan should be flexible, taking into account not only a normal, or textbook, labor but also the possibility of a difficult labor, complications, or other unexpected events.

Components of the Birth Plan

A birth plan helps you communicate your wishes to your caregivers help for the staff to know that. If you have a fear of hospitals or medications, or if you have had unpleasant experiences in hospitals in the past, tell them. If a natural birth is extremely important to you, let them know so they can offer you maximum support in that effort.

If avoidance of pain is a high priority, let them know. Inform the staff if you have religious preferences, impaired hearing or vision, or if this has been a difficult pregnancy. Knowledge of these conditions will help the staff meet your needs. You might simply state that you will appreciate their help, advice, and expertise.

The next section of the birth plan is a straightforward list of your preferences for a normal labor and birth. Include only items that you care about. You do not have to hold an opinion on everything. At the moment, you may feel you do not have enough background to decide your preferences on these procedures. Childbirth classes and discussions with your caregiver will give you the needed information.

If your labor is prolonged or more painful than expected, if the baby isn't tolerating labor, or if you develop complications that make intervention necessary, your ideal birth plan may have to change. It should reflect a recognition that these events can occur and you are flexible enough to accept changes in the plan if they are necessary for your sake or your baby's.

Sometimes a cesarean birth becomes necessary for any of a number of reasons. It helps if you acknowledge the possibility of a cesarean birth in your birth plan, and indicate your preferences if it becomes necessary. For example, you might state that you prefer to remain awake, to have your husband present, or to touch and nurse your baby as soon as possible after the surgery.

Unexpected Loss of a Baby

One of the greatest difficulties we face is the possibility that the baby may not live. Every prospective parent worries at times about losing a child. Although it is uncommon, some babies die. This very sad ending to the pregnancy leaves the parents stunned, grieving, depressed, and angry. After losing a child, parents are in no state to make important decisions. If you have thought through how you would want a newborn death handled, then, should a death occur, such decisions will have already been made by you at a time when you were calm.

Many counselors recommend that couples have private time together with their baby who died. Seeing or holding the child gives the parents a chance to say good-bye to the baby. In addition, pictures, footprints of the baby, and perhaps a lock of hair are mementos that mean a great deal later.

Having a memorial service or a funeral for the baby allows friends and relatives to also acknowledge the baby's life and death. Formal ceremonies can often give family and friends a way to express their grief and their support for the parents.

The question of an autopsy often comes up. If the cause of death is unclear, sometimes an autopsy is beneficial, both in answering questions and in possibly preventing the death of another baby in the future. It would be worthwhile to think through in advance whether you would consent to an autopsy in such a case.

The Value of a Birth Plan

A birth plan represents your thinking regarding normal labor, postpartum, and newborn care. It also includes your preferences if the process does not follow a normal course. Because you prepare it when you are calm and rational, it reflects what you really desire. It becomes a valuable guide for you and for your caregivers during a stressful period when you might not be thinking clearly.

Newborn Care Plan

Your birth plan should also include a newborn care plan. Many mothers wish to hold their baby skin-to-skin immediately after birth. Skin-to-skin contact provides warmth for the baby and satisfaction for the mother. Some parents want their baby to have a relaxing float in a Leboyer bath soon after birth. The baby might be placed in a heated unit in the nursery if the mother prefers or if the baby is chilled.

What about feeding your baby? Do you prefer to breast-feed or bottle-feed? Do you want to provide all the feedings for your baby (which would mean that the baby should receive no water or glucose water from a bottle)? Do you want to feed on demand (that is, whenever and for as long as the baby seems to want to nurse)? Many nurseries restrict demand feedings unless the mother states that demand feeding is her preference.

How much contact do you want with your baby? Some hospitals provide a private postpartum room, allowing the baby to stay with you and even allowing the father to rent a cot and stay all night. This enables you to begin caring for your baby immediately.

When you feel you need a brief respite from caring for the baby, staff will take the baby to the nursery for a few hours to allow you to rest. Other options are to have the baby with you during the day only or for feedings only. State in your birth plan if you want to feed the baby yourself and if you want to spend as much time as possible with your baby.

Remember, the amount of time you spend with your baby depends on several factors. The most important of these are your health and the health of your baby. For example, it may be medically necessary for a premature infant to be placed in the hospital nursery, where the baby's condition can be carefully and continually monitored.

What about circumcision of your baby boy? This surgical procedure involves removing the foreskin of the penis. Since the procedure is optional, it deserves your consideration.

When will you and your baby leave the hospital? Depending on your health and your insurance coverage, you may stay from a few hours to a few days after the birth. An early discharge, or short stay, means that you leave within 6 to 24 hours after the birth. One obvious advantage is the financial savings involved. Hospitalization costs are calculated by the day or fraction of a day; obviously, the longer you spend in the hospital, the more it costs. Find out how the billing is done so you won't inadvertently stay longer than you can afford.

Other considerations besides costs, however, are your need for rest, your need for medical care, and your desire for instruction in care for your baby and medical supervision for the first couple of days. Find out if your hospital sends a nurse to visit all women who have had a short stay, or if they at least make a phone call to check on them. Is instruction available for those wishing a short stay, so you know what observations to make to be sure everything is going well for both of you?

Another factor in your decision is whether you will have help at home. Sometimes the father can take time off from work, or a relative or friend can come in and help extensively; sometimes parents hire helpers to come in daily for a week or two after the birth. In the absence of any help, you might prefer to spend a couple of days in the hospital before going home to all that responsibility.

A baby who is premature or ill and needs extensive medical care either stays in the nursery or is transferred to a different hospital with more sophisticated facilities for newborns. Time with the baby and breast-feeding may be postponed until the baby recovers or becomes strong enough to suckle.

Choosing Freely

As prospective parents, you must make many choices regarding maternity care. These choices require thought and discussion and careful planning. They can make a great difference in your ultimate sense of satisfaction and fulfillment in giving birth. The emotional and physical quality of the experience will impact you and your family for a very long time to come.

Your choices regarding the birth of your baby are numerous. And to date, no studies indicate conclusively that one place of birth or one type of caregiver has a better safety record than another as long as women are well cared for throughout pregnancy and have access to hospital facilities and obstetric care when needed. That still leaves a lot of room for parents to freely choose the type of care that seems best for them. It is well worth the time and trouble to choose carefully.

ABOUT THE CONSULTANT:

Dr. Elizabeth Eden, M.D. is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

 

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