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Labor and Birth

Natural-Birth Providers and Options

Certified midwife: Certified by the American College of Nurse Midwives, this health-care

Professional is trained to handle low-risk deliveries, with obstetrical backup should complication arise.

· Plus: Offers a birth experience with fewer medical interventions and more humanistic care.

· Minus: If the delivery suddenly becomes high risk, an obstetrician may be needed on the scene.

Doula: Mirroring the “old style” female experience, this person provides loving emotional and physical support during labor, offering massage and help in breathing and relaxation, but not performing actual health-care tasks, such as vaginal exams. (Doulas have no medical training.)

· Plus: Provides caring support from an advocate.

· Minus: Drives up birth expense.

Lamaze method: Developed by French physician Ferdinand Lamaze, this popular method prepares women for childbirth by teaching pain management through relaxation and breathing exercises.

· Plus: Offers a shared experience with a partner (who acts as the coach) and the sense of approaching the birth experience with greater control.

· Minus: Doesn’t necessarily work for pain control “as advertised”!

Bradley Method: Developed by Robert Bradley in the 1940’s, this technique is designed for women interested in having a completely natural, nonmedicated birth. It stresses good diet and exercise, partner coaching, and deep relaxation.

· Plus: Tailored for women firmly committed to forgoing any medical interventions.

· Minus: May set women up for disappointment if things don’t go as planned and they need those interventions.

Medical Interventions

Episiotomy: The cutting of the perineum or vagina to widen that opening and allow the fetus to emerge (not recommended unless there is a problem delivery).*

· Plus: May prevent a fistula, a vaginal tear into the rectal opening, which produces chronic incontinence and pain.

· Minus: May increase the risk of infection after delivery and hinder healing.

Epidural: This most popular type of anesthesia used during labor involves injecting a painkilling medication into a small space outside the spinal cord to numb the woman’s body below the waist. Epidurals are now used during the active stage of labor-effectively dulling much of the pain-and during c-sections, so that the woman is awake to see her child during the first moments after birth.

· Plus: Combines optimum pain control with awareness; because the dose can be varied, the woman can see everything, and she has enough feeling to push during vaginal deliveries.

· Minus: Can slow the progress of labor in vaginal deliveries, can result in headaches, and is subject to errors if the needle is improperly inserted. Concerns also center on the fact that the newborn may emerge “groggy”.

Electronic fetal monitor: This device is used to monitor the fetus’s heart rate and alert the doctor to distress. With an external monitor, the woman wears two belts around her abdomen. With an internal monitor, an electrode is inserted through the cervix to record the heart rate through the fetal scalp.

· Plus: Shown to be useful in high-risk pregnancies.

· Minus: Can give false readings, leading to a premature c-section. Also, its superiority over the lower-tech method of listening to the baby’s heartbeat with a stethoscope has not been demonstrated.

C-section: The doctor makes an incision in the abdominal wall and the uterus and removes the fetus manually.

· Plus: Is life-saving to the mother and the baby when a vaginal delivery cannot occur (as when the baby is too big to emerge or the placenta is obstructing the cervix). Also is needed when the mother has certain health problems or when the fetus is in serious distress.

· Minus: As a surgical procedure, it is more expensive than vaginal delivery and can lead to more discomfort after birth.

* Late twentieth-century research has suggested that the once-common U.S. practice of routinely performing episiotomies had no advantages and actually hindered recovery from birth. Therefore, in recent decades, the episiotomy rate in the United States has declined.