Pregnancy For Dummies
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More and more women are expressing interest in nontraditional or alternative birthing methods, and more and more possibilities are becoming available. Certainly, the following options aren’t for everyone, but knowing what’s possible can be helpful.

Delivering without anesthesia

Natural childbirth usually refers to giving birth without any medications or anesthesia. (It’s probably not the best terminology, because using pain medication doesn’t make the birthing process unnatural.) The theory behind natural birth is that childbirth is an inherently healthy and natural process, and that women’s bodies are made to handle childbirth without the need for medications.

Natural childbirth allows women to have a great deal of control over the childbirth process and their own bodies. It emphasizes having the woman choose which positions are comfortable, how mobile she wants to be, and which techniques she wants to use to be as comfortable as possible. Natural childbirth can be practiced in a hospital setting, birthing center, or even at home.

Some practitioners aren’t comfortable with every aspect of natural childbirth because they don’t want to be limited in doing what they feel is medically necessary and important. Discuss with your practitioner what he feels comfortable with, so your delivery can be as great an experience as possible.

Giving birth at home

Home births are still relatively uncommon in the United States, with fewer than 1 percent of women choosing to deliver at home. This rate is similar to other industrialized countries, except that England has a rate of about 2.4 percent, and the Netherlands about 23 percent!

Although the American College of Obstetricians and Gynecologists, in agreement with the American Academy of Pediatrics, believe that hospitals and birthing centers are the safest setting for births, they respect the right of women to make medically informed decisions about where they want to deliver. For some women, a home birth provides an ideal environment to deliver their baby.

Common reasons for choosing a home birth are the desire for a low-intervention birth; a desire for control over the birth process; a desire to give birth in a familiar and comfortable environment, surrounded by family and friends; living in a rural area with lack of access to a hospital; and economic, cultural, or religious issues. Typically, a midwife usually attends a home birth, and an obstetrician is on call in case problems arise.

Home births are certainly more appropriate for women who are at very low risk for complications. Although some studies demonstrate that home births are associated with greater risks for both the mother and baby, others show that home births are at least as safe as hospital births for healthy, low-risk women.

The American College of Obstetricians and Gynecologists recently published the minimum criteria for planning a home birth, which include informed consent, a singleton pregnancy with the fetus’s head down, no medical or obstetrical conditions, no contraindications to vaginal birth, and the prenatal care, labor, birth, and postpartum care administered by a licensed obstetrical caregiver.

The backup hospital should also be within 15 minutes of the home. In addition, and of prime importance, is that women completely understand that while the absolute risk of home births is low, it is still associated with a two- to threefold increase in neonatal death when compared with planned hospital births.

Using a doula

A doula may be a friend, relative, or trained companion who is there to provide nonmedical continuous support during labor and delivery. Doulas often meet with prospective moms before delivery so they get to know each other.

During labor, they provide both emotional support and physical support — helping to get moms into comfortable positions, massaging their back or legs, getting water or ice chips, and so forth. Some studies have shown that labors attended with doulas may actually be shorter in length, although there is no effect on cesarean delivery rates.

Women who used doulas also seemed to have a slightly better overall birth experience and were more likely to rate their labor and delivery as “very good.”

Some women choose doulas because they may not have someone there (like a partner or friend) who can be of emotional support. Others may be at a hospital without one-on-one nursing care and want the additional help. Others just like having a helping hand, and others believe it will enhance the birthing experience.

Immersing yourself in a water birth

Water births refer to spending much of labor immersed in water, with the option of even delivering the baby in the water. Water births usually take place in a birthing center with the help of a midwife, although some hospitals may provide birthing pools or baths.

The water temperature is kept about the same as the body temperature, and the woman’s temperature should be monitored throughout labor. A recent review of randomized trials found a somewhat lower rate of anesthesia when water immersion was used in the first stage of labor.

Interesting, prolonged immersion for more than two hours may actually slow down labor by decreasing the production of oxytocin. Although some professionals in the medical community feel that a water birth is a safe procedure, others have more serious concerns about its safety for both the patient and newborn.

Water immersion during the second stage is not well studied. There have been a few cases reported of water aspiration and snapped umbilical cords, difficulty regulating body temperature, and infections in the newborn.

About This Article

This article is from the book:

About the book authors:

Joanne Stone, MD, and Keith Eddleman, MD, are Board Certified in Obstetrics and Gynecology, and are Associate Professors at Mount Sinai School of Medicine.

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