Different Birthing Methods and Philosophies Plus Finding the One that’s Right for You
You’re pregnant. Congratulations!
Once you’ve moved past the first stage of pregnancy, in which you are so preoccupied with your body’s absolutely wonderful and amazing ability to build and sustain another human, you hit the next stage: contemplating the dizzying prospect of this human baby coming out of your body. For many of us, this thought of actually giving birth is a bit terrifying. Fortunately, education is a way of dispelling fear. And thus, the childbirth education class was born. (See what I did there?!?)
Selecting a Childbirth Class
Actually selecting a class proves to be another daunting prospect. There are so many possibilities to choose from! As a doula, I’ve helped many clients try to figure out which class to take. Here’s a handy little graphic I put together, which will hopefully help you sort through your options:
In any class you sign up for, you will learn some of the same basic information: what are the stages of labor, what is a contraction, common interventions, when to call your care provider, etc. The differences are in the basic philosophy of the class.
Hospital-taught or Independent Classes?
Your first choice is between taking a class offered by a your hospital or care provider, or choosing an independent childbirth education class. Hospital/care provider classes tend to be focused on helping you be a good patient of that hospital or practice, which can be great if you feel very confident that your hospital or care provider has your best interests in mind. For example, women who plan to deliver at a particular birth center may find that the class they offer in-house helps them to know what to expect in that environment and with those caregivers. Another advantage of this type of class is that the cost tends to be much more affordable than an independent class, since the cost of the class is often heavily subsidized by the hospital or practice.
However, many birthing couples choose to pay a higher price to take an independent class, since the instructors of these classes can freely discuss options in birth without pressure from their employers. For example, a group of OBs or hospital administrators may not want mothers to deliver their babies in any position other than flat on their backs, and so they would not allow an educator in their employ to include information on upright pushing positions. If you want to be sure that you are educated on all of the options available to you, you may want to look into taking an independent class.
But once you choose to go outside the system, so to speak, that’s when things get really confusing. There are so.many.choices. How to decide which class is right for you?
Which Birth Philosophy or Class is Right for You?
Independent classes can be subdivided into two groups: classes adhering to a specific philosophy of birth and employing methods that correlate to that philosophy, and classes that are more of a mash-up of methods.
In the specific philosophy camp are: Hypnobirthing®, Hypnobabies®, The Bradley Method®, Birthing From Within, Birth Boot Camp®, and many others, though the ones I’ve listed seem to be the most popular options going. Again, all of these will include some information on common interventions in birth, but they all share the goal of helping mothers avoid intervention in general, and pain medication in particular. An exception to this may be Birthing From Within, as it emphasizes acceptance of what comes, more than focusing on a specific (unmedicated) outcome as best.
Let’s go through them one by one, with a brief overview of each philosophy:
Hypnobirthing and Hypnobabies
Hypnobirthing® and Hypnobabies® share a lot in common. They both use guided relaxation scripts and self-hypnosis techniques as a means of coping in labor. Hypnobirthing® has been around longer, and there are more instructors out there teaching in-person classes. Hypnobabies® is newer, so it may be more difficult to find an instructor in your area. Hypnobabies® does offer a home-study course, while Hypnobirthing® does not, though it is possible to buy a book on Hypnobirthing® to read on your own.
The Bradley Method
The Bradley Method® has the subtitle “of Husband-Coached Natural Childbirth,” which gives you a good idea of what this method emphasizes. Bradley Method classes focus on keeping mothers low risk, and on the partner taking a very active role in helping her stay relaxed, and thus able to cope with the intensity of labor and achieve a low intervention, unmedicated birth. Important to note: Bradley classes are required to be 12 weeks long, so if you are interested in this philosophy, sign up early.
Birthing from Within
Birthing From Within takes a different view of the role of partners—rather than helping them to become birth coaches, they view partners as “birth guardians or loving partners.” The role of the instructor in Birthing From Within classes is that of mentor, guiding the parents in their own self-discovery. Above all, Birthing From Within sees birth as a rite of passage, which, regardless of birth outcome, can be an occasion to practice awareness. I once had a birth client asking me for help in choosing a class tell me, “You should know that creating birth art is more terrifying to my husband and me than the prospect of the birth itself.” I steered her very firmly away from Birthing From Within.
Birth Boot Camp
Birth Boot Camp® uses a unique frame for their classes. They use a militaristic theme throughout their materials, and their tagline is “Training Couples in Natural Birth.” The military theme is clever packaging for some really serious preparation for giving birth naturally and for breastfeeding. This course is 10 weeks long, so be sure to sign up early if this philosophy speaks to you. They also have an online version of the course, for those who don’t have an instructor in their area.
Again, these are the main options for classes promoting a specific philosophy in birth, though there are others out there (probably someone wrote a new one while I was typing this). The other class options are those that use a mixture of methods and philosophies. These vary widely, because the instructor of the class often writes her own curriculum, or at least she adapts a model to suit her own experience and preferences. The class may include a guided relaxation script and/or an exercise in releasing fears, or it may not—it all depends on the instructor. Often these classes will not focus so determinedly on achieving a low intervention birth, but will guide the parents in evaluating the risks/benefits of each intervention and encourage the parents to advocate for themselves in making the choices that are right for them. There are loads of training and certification programs out there—Lamaze*, ICEA, Childbirth International, CAPPA, and many others.
Knowing your Options and Feeling Empowered
I hope this post has helped you to cut the confusion and choose a class that will suit your preferences and help you prepare to meet your baby, whether it is through self-hypnosis or boot camp, the hospital class or mindfulness practice. Good luck! You can do it.
*A note on Lamaze, since a lot of people think it is something it isn’t (or at least isn’t anymore): Lamaze has been around for a long time, and used to be known primarily for their breathing and relaxation techniques. But over the past 50 years, Lamaze has adapted its curriculum, dropped the emphasis on learning specific breathing techniques, and now focuses on helping parents have a safe and healthy birth through knowledge of their “Six Healthy Birth Practices.” Lamaze instructors can be found teaching both in hospitals and independently.
This guest post was written by Stephanie Spitzer-Hanks. Stephanie gave birth to her first child in the Netherlands, where the nurturing and encouragement she received from so many women there inspired her to become a doula. Now she strives to give unconditional support and evidence-based education to families so that they can be confident in making the choices that are right for them. She is an ICEA certified childbirth educator, an Evidence Based Birth® Instructor, a DONA certified birth and postpartum doula, a StillBirthday certified bereavement doula, and a certified lactation counselor through Healthy Children’s Center for Breastfeeding. On the side of all of that, Stephanie is an ordained minister in the United Church of Christ, and she serves as a chaplain at a hospital and writes and speaks about birtheology when she gets the chance. You can find out what she is up to at www.revdoula.com.
Questions for Interviewing a Midwife
A midwife you can trust and feel comfortable with is worth her weight in gold. Birthing a baby is an incredibly personal and intense experience in it’s own right. Having a professional there to assist you should only offer comfort and help. It’s vital that you find someone that you not only click with, but who you can trust wholeheartedly. Here’s a list of interview questions to start you on your journey to finding your midwife!
A good midwife will be able to speak frankly and to balance your needs/desires with the safety of you and your baby. The midwifery philosophy is generally hands off and more about trusting your body with guidance offered when desired by the mother and medical intervention implemented when required. At the same time they are extremely engaged with you throughout your care with appointments that usually last one hour and covering not only any physical concerns and questions, but also your emotional state as well. A good book to get you started if you’re new to the idea of hiring a midwife is Ina May’s Guide to Childbirth or watch The Business of Being Born.
Basics in Determining if a Midwife is Right for You
- How long have you been practicing? How many births have you attended? What are your credentials?
- Are you available via phone/text? Specific days/hours you aren’t available?
- What is your practice like—are you in practice solo or with other midwives? Are there additional staff like doulas?
- Is your practice involved in the natural birthing community at all? Are there resources for me to connect with other women?
- Do you work with specific OBs? Do you have a good rapport with OBs at the hospital? How does the hospital view you and your practice?
- How many planned births do you accept per month? If you are not available when I go into labor, who is your back-up?
- What is your overall philosophy on pregnancy, delivery, and birth?
- What do you feel your role is as a midwife?
- Where do you attend deliveries? Birth center? Home? Hospital?
- How do you feel about water births?
- Have you ever lost a baby or mother? What happened?
- What is your hospital transfer rate?
- What are your fees? Do you offer payment plans? Accept insurance?
Pregnancy Topics to Cover in Midwife Interviews
- What screenings and tests do you recommend? Which ones do you offer in house vs send me somewhere else to get?
- Have you ever worked with gestational diabetes? What is the process?
- What are your views on nutrition and exercise during pregnancy? Do you offer resources?
- Voice specific pregnancy concerns — does she offer good solutions and recommendations?
- Do you require a Group B Strep test? What if I test positive for Group B Strep?
- If I become “high risk” what is the process? When would I have to transfer to an OB?
- What “high risk” situations do you have experience with? Twins? Breech? Advanced maternal age? Pre-eclampsia?
Labor and Delivery Questions When Choosing a Midwife
- At what point in labor do you prefer to get involved? When would I call you?
- What is your view on VBACs? What is your success rate?
- Potential birth emergencies—what are they and how would you handle each one? Tell me some situations you have dealt with (Hemorrhaging, partial placenta delivery, shoulder dystocia, nuchal cord or limb).
- Are you equipped in neonatal resuscitation? How often do you refresh your training in this area? Tell me some experiences.
- What equipment do you bring with you to a delivery?
- If my baby is breech before delivery, what would you recommend we try? If it does not turn, would you still deliver? Have you had experience with this—both successful turning and breech delivery?
- In labor do you routinely perform vaginal checks?
- In what situation would an episiotomy be performed?
- If a labor stalls, what is the process?
- If my water breaks, is there a time limit to when I need to deliver by?
- In the event that I go past my due date, what is your philosophy and what would be the process?
- In the event I had to be transferred to a hospital, what would be the process? Who would drive me? Is there a specific hospital we’d go to? Would you come with me, or stay with me through delivery?
- Can you offer me some references from mothers who have had to transfer?
- How do you feel about delayed cord clamping?
- Can my husband catch the baby? Can I catch my own baby?
Postpartum Questions for your Midwife
- What postpartum care do you offer (herbal baths, sleep in the bed, meals served, massage)?
- What newborn care do you provide?
- Do you offer newborn testing? Do you require it?
- If I deliver at a birth center, how long would I stay there afterward?
- Do you make postpartum home visits? When?
- Will you offer breastfeeding support?
- Do you offer placenta encapsulation?
- When will I switch over to pediatrician care for my baby?
- Can I continue to see you for annual well-woman visits?
Question to Ask Yourself After the Visit
Overall, what general feeling do you have after talking with the midwife? How does your partner feel? A good sign would be connection, feelings of excitement, trust, and calm. Uneasiness, trepidation, or uncertainty are good clues that you should continue looking.
When you are thorough with research and questions, your gut feeling can really carry a lot of weight. Trust your judgement.
When I took up meditation during my pregnancy I had no idea the effect it would have on my baby, my birth and my new motherhood experience.
Although proper nutrition, adequate exercise and prenatal vitamins are staples for a healthy pregnancy and often the ones doctors prescribe, research shows that meditation should be right up there on that list as well.
How does meditation in pregnancy help exactly?
Overall, meditation makes you more aware. An increased awareness during pregnancy can help you tune into you which in turn helps you tune into your baby. When you become more mindful of how you are feeling emotionally, you start to be able to listen to your body more. This can be extremely beneficial in pregnancy and labor. An increased body awareness can decrease pain during labor and help you manage stress and anxiety with more ease. A daily meditation practice can also help you sleep better, have more focus and give your baby a better start in life.
Benefits of how meditation during pregnancy, birth and new motherhood can transform your experience.
Better pain management
Meditation helps you step out and observe pain instead of being consumed by it, which can make the birth experience less painful. A study done on a group of people who attended a four-day mindfulness meditation training found that they were able to decrease the intensity of painful stimulus by 40 percent (1). Decreased pain is also beneficial during pregnancy when your body is preparing for birth and recovery after birth when your new baby needs you more than ever.
Decreased stress and anxiety
Meditation can significantly reduce stress, anxiety and your fears about your pregnancy and giving birth. Through meditation you can learn to maintain an inner calm regardless of your external circumstances (2). This means that the more relaxed and positive you are about your birth experience, the more pleasant the outcome will be. A good thing to keep in mind is that although some stress during pregnancy is normal, continuous stress has been linked to preterm birth and long term negative effects on you and your baby down the road.
Increased chance of going full-term
Before 39 weeks pregnant your baby’s brain, lungs and liver are still maturing. Infact, your baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks. Also, within those last few weeks of pregnancy the part of your baby’s brain that he / she will use for thinking doubles in size. A study that explored preterm birth found that women that participated in a mindfulness training program were 50% less likely to give birth early than women with no mindfulness education (3). Going full term allows your baby to fully develop and have a better start in life.
According to Dr. Marilyn Glenville, author of Getting Pregnant Faster, “Pregnancy suppresses the body’s immune system (to ensure the fetus isn’t rejected as something foreign) which means your body is less able to fight off infection and illnesses, making it more susceptible to colds and flu.” Meditation enhances the body’s immune function. (4) A healthy immunity can help keep your body healthy during pregnancy and protect you and your baby from immune-related issues after delivery.
Practicing meditation is what allowed me to truly enjoy my pregnancy, release expectations from my birth experience and be a more patient mother. If you are looking for something that will support you emotionally through your journey and help you to have a healthy pregnancy and baby, meditation might just be the answer.
This guest post was written by Anna Gannon who is the Community & Editorial Lead at Expectful, a company with a groundbreaking meditation program for pregnancy and parenthood. She is also a seasoned NYC yoga guide and a new mom who is passionate about helping other new moms find the tools they need to create a wellness routine that fits their lifestyle. Follow Anna and Expectful for stories on how to have a mindful pregnancy, birth and motherhood experience.
- Brain mechanisms supporting the modulation of pain by mindfulness meditation. Zeidan, F., Martucci, K., Kraft, R., Gordon, N., McHaffie, J. & Coghill, R. (2011). The Journal of Neuroscience 31(14). 5540–5548.
- Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Vieten C, Astin J. Archive of Women’s Mental Health. 2008; 11910:67-74.
- Meditation for preterm birth prevention: A randomized controlled trail in Udonthani, Thailand. Sriboonpimsuay W, Promthet S, Thinkhamrop J, Krisanaprakornkit T. International Journal of Public Health. Vol 1, No 1 pp 31-39.
- Alterations in brain and immune function produced by mindfulness meditation. Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S., Urbanowski, F., Harrington, A., Bonus, K. & Sheridan, J. (2003). Psychosomatic Medicine 65. 564–570.
You’ve decided to go with an OB/GYN. There are several advantages to using an OB for your care and delivery. Physicians tend to have experience with and knowledge about high-risk pregnancies and complications. If you know you are high risk due to advanced maternal age, diabetes, or any medical condition, you can have peace of mind knowing your OB is equipped to handle it and to manage medications if needed. If your intuition is telling you that you feel more comfortable knowing you have access to all the medical procedures and personnel a hospital offers, this is the route to go. OBs have access to advanced medical testing and screenings, and are connected in a network of specialists and colleagues. If you’re still considering a midwife, there are many midwives that work in collaboration with OBs so you don’t necessarily have the rule that out either. Talk to your care providers and come up with a plan catered to all of your needs.
Where to start in finding the OB that’s just right for you? You’ll definitely want someone you feel completely comfortable with, and that you trust to take care of you and your baby. This is your life (and emotional well-being) and your baby’s health in someone else’s hands, so it’s a big deal. Here’s some ideas to help you get started.
Where to look first
Ask around. Your best bet is going to be word-of-mouth. Talk to everyone you know and trust about their OB/GYNs. What things did they like/dislike about him? What was their prenatal care like? How was their delivery experience? Would they go back to this same person? The more details the better, just start asking. Of course it’s important to keep in mind that not everyone wants the same type of birth experience so the doctor that was a good fit for your sister may not be right for you.
Join Facebook groups in your area. There are many Evidenced Based Birth local groups that you can join where the admins and members are knowledgeable about the OBs in your area and which ones follow evidence based practices. What is Evidence Based Birth?
If you don’t know many recent moms personally, get in touch with your hospital’s Childbirth Educator. She or He should be familiar with doctors and nurses at the hospital, and know the ins and outs of the kind of care they give (and their bedside manners). She’d be able to give a few recommendations that you can then do more research about. Of course keep in mind that they work for the hospital so may not be able to be completely forthcoming.
Ask for statistics. Hospitals keeps track of things like induction rates, episiotomy rates and cesarean rates so asking for these facts will give you a good idea of hospital practices. Unfortunately, even if you love your OB sometimes the hospital policies limit their ability to provide the care that you may be imagining.
Do you currently have a gynecologist that you like? Do they practice obstetrics as well? Asking a few additional questions can help you get a feel for if it would be a good fit or not. If they don’t deliver babies, they could recommend some colleagues to you, that you could then check out. Keep in mind that prenatal and birth care is MUCH more involved than an annual exam so don’t just go with your current doctor because it’s convenient. You want to make sure it’s a good fit and that their maternity care is in line with what you want for your birth.
Once you have a few names of potential doctors, there’s a lot of things to mull over before the interview process. Here’s a few considerations:
Your health history
Do you have specific concerns about your pregnancy that not every doctor would have experience with? Plus-size pregnancy, previous recurrent miscarriages, diabetes, or trying for a VBAC (Read more in our post What you need to know about VBAC?) can be uncharted territory for some practitioners. Look at the websites and reviews of doctors to find out if they have specific experience in the areas you are concerned about.
What does the provider value? What is his/her overall outlook on pregnancy, birth, and labor? Are they super medicalized or do they lean toward the more natural route—and which do you prefer? What are his opinions on certain medical procedures like continuous electronic fetal monitoring, scheduling inductions, episiotomies, and epidurals? Do they tend to take control of how a labor is progressing, or allow the mother to take the lead? How pushy will they be?
Do you click? Do you feel comfortable? I had a friend who went in for a breast exam and the doctor chatted for a few minutes and then said, “Okay, flash me.” That exchange made her feel so uncomfortable she never went back. Bedside manner and professionalism matter! Do you trust their experience and judgement? Do they listen to your concerns and questions or just plow through the appointment as fast as possible? Are their credentials up to date? What does your gut say?
Are they supportive of you having a doula with you during labor/delivery? How comfortable are they with extra people in the room in general, and does your partner get a good vibe from them as well?
This is public information that you can request from your hospital. However, doctors don’t usually post their own personal stats. You can get an idea of how things go by calling the front office and asking some questions. Many offices don’t give out specific numbers, or may not even keep track, but you can get an idea by saying something like, “Out of the last 10 deliveries this provider performed, how many ended up being c-sections?” Or “Out of the last 10 attempted VBACs, how many were successful?” Get an idea of how willing they are to work with you. Keep in mind that specific hospital rates are higher than others for cesarean. Which brings us to our next item…
What are the c-section stats? You can search online to find this info. In general, what is the hospital like? Do they have natural birthing accommodations and tools if you’d like to go that route? Birthing tubs to labor in? Is the hospital friendly to natural delivery? Do they require IVs, continuous electronic fetal monitoring? Do they have VBAC policies? What are their standard procedures right after the baby is born? Do you get to have skin-to-skin bonding for a while? Does the baby get to stay in your room? Calling the Labor and Delivery floor is your best bet to getting answers to these questions. A nurse can help you out, or refer you to someone else who knows the specifics. Nurses generally want you to be informed about the hospital policies so that there aren’t any surprises when you come in.
Office Protocol—Questions to Consider
- What is the OB clinic experience like?
- How easy was it to get an appointment?
- How many doctors are in the practice?
- Are you a number who is shuttled through the routine, or are you treated like an individual?
- How long do you typically wait in the office?
- What are the after hour policies?
- Will your OB be the one to deliver you, or do they rotate who is on-call, and will that bother you?
- Is there an on-call nurse that is available to answer questions?
- What is the staff like?
Think about how you feel about all of these things.
Once you’ve thought about all of these issues, and researched a few doctors, narrow it down to a couple. You can either take the plunge and make your first appointment with the one you want, or you can be even more thorough and schedule a consultation, where you can bring your list of questions.
Above all else, keep in mind that you are not stuck once you make your choice. If at any time you start to feel uneasy about your care giver, or feel like you don’t align with his philosophies, shop around. It’s completely acceptable, and it happens all the time. If you feel uncomfortable firing your OB, simply call the front desk and ask them to transfer your files to your new doctor. You don’t even have to speak to the doctor you are leaving. This experience will be one of the most important of your life, and you deserve to feel as safe and as comfortable as possible. Follow your gut!
Interview Questions for Potential Obstetricians
- What is your general philosophy on pregnancy, labor, birth, and postpartum care?
- What is your role as physician? What is your role during labor and delivery?
- How long have you been practicing? How many births have you performed?
- How many births do you anticipate attending month? Is there a limit to the number of patients you take on?
- What is the chance of you delivering my baby? Who delivers when you are not available?
- What is your c-section rate?
- If there is a complication beyond your expertise, who would you refer me to?
- What is your after-hours policy? Are you reachable during an emergency?
- How often am I required to meet with other doctors?
- How much time do you spend with each patient during an appointment?
- Are you available in between visits if I have a question or concern?
- What is your view on nutrition and weight gain?
- What prenatal tests do you require and/or recommend?
- What childbirth education resources do you recommend?
- How do you feel about birth plans? Do you help with writing them?
- What experience do you have with high risk pregnancies?
- What would the procedure be if I become high risk?
Labor and Delivery
- When will you arrive on scene? Who will support me in the meantime? How often will you be with me during labor?
- If you have two simultaneous labors/deliveries, what do you do?
- How do you feel about a support team? A doula? Other friends and family?
- What if I approach my due date without going into labor? How long will you let me go past? What is your induction policy?
- Do you ever recommend induction for an estimated large baby?
- How long will I be able to labor after my water breaks if no signs of infection?
- What routine policies during labor do you recommend/require? What does the hospital require? (Continuous fetal monitoring, IVs, etc.)
- Am I allowed to move around during labor? Eat and drink?
- What are your views on pain management during birth, both medicated and unmedicated? Will you recommend different positions and coping techniques?
- What percentage of your patients deliver without an epidural? What resources are available to me, should I want to labor without drugs?
- What percentage of your patients get epidurals? What is your view on epidurals?
- How do you handle a “stalled labor”? What do you consider a stalled labor?
- What birthing positions do you allow for labor and delivery? What is most common for you?
- Do you perform episiotomies? How often? How often do you use forceps or vacuum extraction?
- Do you encourage and support VBACs? How many VBAC attempts have been successful? (60-80% is norm). What is the hospital policy for VBAC?
- At what point in labor do you recommend c-sections?
- Have you ever performed a vaginal breech birth? Twins?
- What procedures do you perform on the baby? What can wait?
- Is delayed cord clamping okay?
- What happens if there is postpartum hemorrhaging?
- Will I have uninterrupted skin-to-skin bonding time immediately following birth? For how long?
- Will the baby stay with me in my room?
- Do you assist in breastfeeding? Is there someone else available to help me?
- What if I hemorrhage?
- Can my partner stay in my room?
Questions to ask yourself after the appointment
- Do I feel comfortable with this person? Is he/she flexible?
- Do our philosophies line up? Or are they willing to work with me? (You want them to enthusiastically support your wishes not just be “willing to let you try that”)
- Do we have a mutual respect?
- Do I trust his expertise and judgement?
- Is the office staff friendly and helpful?
- What was the wait time? Did I feel rushed in and out?
Why evidence based maternity and birth care are important
Simply put, evidenced-based maternity care and birth are policies and procedures based on proven scientific evidence from medical research and peer-reviewed journals. It is the practice of effective care with the least amount of harm. Unfortunately in many parts of the world, standard hospital care is not practiced in this way. In fact, many hospital procedures go in direct contrast to recent medical evidence, and increase the risks for healthy mothers and babies.
Standard care in hospitals can be intervention-intensive. IVs, continuous electronic fetal monitoring, epidurals, restricting food and drink, restricting movement, and having mothers push in the supine position all increase stress to the mother and baby, disrupt the natural flow of hormones, and may lead to complications.
There are a few reasons for this dichotomy between research and practice
Many birth practices in America, were put in place in the 1950s and 60s, using research based on the past rather than looking forward. Although more information and education is now available, it is a challenge to turn research into practice. Traditional methods are simply easier to continue.
It benefits hospitals financially to use interventions like induction, pitocin, epidurals, c-sections, and lengthened recovery stays.
OB/Gyns can be nervous about being sued, and for good reason. They are the second highest sued doctors after neurosurgeons. If worry creeps in to a doctor’s mind about the “traditional potential dangers” of labor (say, if water has been broken for a while, baby’s heart rate is decelerating, labor has stalled at a certain point, or the pushing phase is getting long), he can choose to order a c-section. If he is potentially sued, he can make the case that he took action by doing all he could, rather than waiting it out. The same can happen with other worries before labor—if a woman measures big, or has some minor concerns, a doctor may order induction to prevent possible negative outcomes and being sued.
Unfortunately, these situations happen more commonly than they should. An OB might have a vacation coming up and therefore will push an induction to have the birth before he leaves. He might be at the end of a very long shift and ready to go home, so may order some pitocin to be administered to speed up the labor. It’s a sad reality, but it does occur.
Reliance on Specialists
Although doctors are traditionally trained to handle higher risk pregnancies and use many interventions, healthy women with low-risk pregnancies often choose to be under their care. This is certainly a woman’s prerogative and she should go wherever she feels the most comfortable. However, this can contribute to the slow progress of change being implemented in birth. A woman with a low risk pregnancy might be in better care with a midwife.
Lack of education
More support is needed in terms of evidence based maternity research, not only in the healthcare field, but for patients as well. Many women are simply not informed of the data and their options when they meet with their healthcare providers. In addition, there needs to be more awareness and implementation requiring performance measurement, improvement, and reporting in hospitals.
There is great need to close the gap between the evidence and the standard practices in hospitals, especially in the United States. Consider this table.
There is, however, progress being made in certain parts of the country. Some hospitals are starting to encourage natural pain relief methods and utilize tools like birthing tubs, birthing balls, squat bars, showers, and supportive nurses on hand. A local hospital in Portland, OR has midwives deliver the majority of babies, and the doctors handle only the high risk cases and emergencies. These things are certainly encouraging, and a sign that change is possible, no matter how slow.
How to know if your care provider is using evidence based birth methods of care
Get familiar with the science. Here is a great article about evidence based birth and 6 key practices to a safer delivery for mother and baby. Essentially, induction, epidurals, and c-sections are overused, whereas labor tubs, labor support, changing of positions, eating and drinking during labor, and delayed cord clamping are all underutilized. Know your options for these procedures. Learn about other standard procedures like vitamin K shots, failure to progress, the science about mothers over the age of 35, the truth about waterbirth, etc, Evidence Based Birth is a great resource with many scientific articles.
Discuss your findings with your current care provider. How do they feel about each of the practices? What are the local policies if you will be delivering in a hospital? Is your doctor flexible and willing to allow modifications to certain “standard” procedures? The better informed mothers become, the easier these implementations will be for communities.
Resources for learning more about Evidence Based Maternity Care and Birth
Evidence Based Maternity Care: What it is and What it Can Achieve
The American Congress of Obstetrics and Gynecology
Evidence Based Birth
When it comes to evidence based maternity care and birth practices, education is key.
High Risk vs Low Risk Pregnancy
It goes without saying that all women want a healthy pregnancy and ultimately safe arrival of their babies. A woman is considered to have a low-risk pregnancy when it is free from complications or worry, and she is otherwise healthy. However, sometimes unforeseen circumstances can arise that warrant the label “high-risk pregnancy,” meaning there is an increased risk of complications. Being labeled “high risk” definitely doesn’t mean that there will be health problems with mother or baby. It simply means doctors will want to monitor her closely for specific concerns during the course of her pregnancy. Here we discuss what conditions indicate a high-risk pregnancy, what course of action to take afterward, and how to decrease the odds of a high-risk pregnancy from occurring.
What conditions constitute a high risk pregnancy?
Some pre-existing conditions that occur prior to pregnancy can automatically put someone on the track for high-risk pregnancy. These include:
Being underweight or overweight
Being underweight prior to conceiving can be dangerous to both a developing fetus and the mother. There is an increased risk for preterm birth, fetal distress during labor, and a low birth weight baby. Adequate nutrition is vital for both mother and baby. Achieve a healthy weight by eating large meals, adding good oils and fats to dishes, and drinking juices. Nutrient-dense foods are always preferable to junk food.
Being overweight prior to pregnancy also poses some risks for mother and baby. Mothers with a higher BMI have a greater chance for developing high blood pressure or preeclampsia and gestational diabetes. Likewise there is an increased risk for preterm birth, birth injury, c-section, and birth defects (specifically neural tube defects). Being overweight does not mean a woman will automatically experience these distressing complications. It is certainly possible to go on to have a healthy pregnancy. There are many ways for plus size women to take care of themselves prior to and during pregnancy. Find good support and education at Plus-Size Birth.
Infertility/History of miscarriage or preterm labor
Women who have used fertility drugs to achieve pregnancy have a higher chance of complications arising during pregnancy, specifically with the placenta and vaginal bleeding.
Repeated miscarriage or preterm labor puts a woman at high risk as the odds of recurrence are higher. A doctor will want to investigate the cause of recurring loss or premature birth to prevent complications in current and future pregnancies. At any rate, difficulty conceiving or previous loss can cause great anxiety for mother. Close monitoring for both mother and baby can put your mind at ease.
High blood pressure
If left unchecked or uncontrolled, high blood pressure during pregnancy can lead to kidney damage in the mother or pre-eclampsia, which is a very serious condition. High blood pressure, managed carefully can lead to a healthy delivery and baby.
Autoimmune diseases like Lupus and Multiple Sclerosis can cause complications during pregnancy. Lupus in particular puts a mother at higher risk for preterm labor and stillbirth. Some women’s conditions tend to improve during pregnancy while others worsen. It can be helpful to consult a doctor prior to conception to ensure conditions and factors are under control. Medication may need to be adjusted to a safe dosage or weaned off of completely, or doctors might recommend waiting until remission to conceive.
Advanced maternal age (over age 35)
First time mothers over the age of 35 have an increased risk for cesarean delivery plus a number of other potential complications. These include excessive bleeding during delivery, prolonged or stalled labor, high blood pressure, premature delivery, and increased risk of genetic disorders in the baby. Certainly women of advanced maternal age go on to have otherwise completely healthy pregnancies and deliveries—increase odds by practicing healthy lifestyle choices and seek out a care provider that doesn’t automatically classify you as high risk simply based on your age.
Family history of genetic disorders
A family history of certain conditions puts a woman at higher risk during pregnancy, specifically: pregnancy loss or death, chronic diseases like diabetes, high blood pressure, and mental illness. Pre-conception appointments can offer genetic counseling so you know the likelihood for potential complications
Smoking, drinking, or using harmful substances are very dangerous for a fetus as well as the mother. The Center for Disease Control (CDC) recommends women do not consume alcohol while pregnant or even while trying to conceive. Drinking during pregnancy increases the chance for miscarriage, stillbirth, and the baby developing Fetal Alcohol Spectrum Disorder (more about FASD here). There are varying viewpoints on this in terms of whether the occasional glass of wine is okay or not— consulting with your care provider will be your best course of action.
Smoking can lead to birth defects as well, and there is a strong link to SIDS (sudden infant death syndrome). Even second hand smoke while pregnant can increase risk for health problems.
Your own medical history
Previous c-sections, low birth weight babies or preterm delivery can all put a woman at greater risk for repeat occurrences. Doctors will want to monitor closely to prevent any further complications.
Conditions that may arise during pregnancy that constitute high-risk
Some complications can develop during pregnancy that could project a woman into the high risk category. These include:
Problems with uterus, cervix or placenta might arise. These could include a heart shaped uterus, or bicornuate uterus (divided in two halves); placenta previa (when the placenta is covering the cervix); or cervical insufficiency. Likewise, structural complications in the fetus discovered during anatomy scans might warrant further testing and very close monitoring.
Abnormal amniotic fluid levels
During pregnancy, too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid can develop. Doctors will usually notice these anomalies during routine exams. A uterus might measure too big or two small, there might be excessive swelling in hands and feet, or fluid might be leaking from the vagina.
Restricted fetal growth
A baby can begin to exhibit signs of restricted growth during the course of pregnancy. Doctors will schedule continuous monitoring and possibly even an early induction (if the baby is post 34 weeks).
Rh factor issues
The Rh factor is a protein that can be present on the surface of red blood cells. Just as a person has a blood type (A, B, O, AB) they also either have the Rh protein (positive Rh factor) or they do not (negative Rh factor). A mother is only at risk if the she is negative and the father is positive, potentially resulting in an Rh positive baby. When the mother’s blood comes in contact with the baby’s, it will cause the mother to produce Rh antibodies to attack the fetus’s blood as if it were a foreign substance, which can cause severe anemia in the baby. Mother and baby would need close monitoring—a blood transfusion may be given through the umbilical cord if need be, or the baby may need a transfusion after delivery. Rh factor issues can be prevented through early screenings. If a mother is Rh negative, and the baby is positive, she can receive a shot to prevent her from developing Rh antibodies. Read more about Rh factor here.
A mother is at greater risk of complications if she is carrying twins or more. You will come up with a care plan to address multiples early on in your pregnancy.
Ways to promote a healthy pregnancy
Although many conditions cannot be helped, there are many ways to decrease your chances of becoming labeled “high risk.” Here’s some things you can control.
It is wise to meet with a healthcare provider prior to becoming pregnant. Your doctor can do a complete physical, review your personal and family medical histories, and provide council on any potential problems. They can help you adjust any current medications to a safe level, or help wean you off of them. They can discuss the things to do to ensure a healthy lifestyle and help you provide the best physical environment in which the baby can grow.
Keep all pregnancy appointments
It’s wise to have regular appointments with your practitioner while pregnant, not only to make sure things are going well with the baby, but with you as well. A good doctor or midwife will spend adequate time listening to any concerns you may have, answering questions, offering counsel, and making sure you are doing okay mentally and emotionally as well.
Practice good nutrition habits
It’s more important than ever to be conscious of what you are eating. The developing baby gets all his nutrients from you, and it’s important to make sure what he is receiving is high quality. Focus on eating large amounts of fruits and vegetables in a variety of colors, and good fats like nuts and avocados. Eat food close to its natural form and cook things from scratch rather than reaching for processed packaged items. Get enough protein from high quality sources, and eat a variety of leafy greens for iron. Remember water as your beverage of choice. Staying hydrated is essential for you and baby.
Keep weight in check: Eating right and good nutrition will help to ensure a proper amount of weight gain during pregnancy. A good rule of thumb to follow is to listen to your body. Eat when you are hungry, and stop just before you are full, when you are satisfied. This can be more effective than following “rules” of eating three square meals a day at certain times. Ensure you have healthy food on hand for when hunger strikes, and let your body communicate with you. You might find you are starving only an hour after breakfast, or that you are satisfied well beyond. You can’t go wrong when you listen to physical cues. Keep in mind that all women gain weight differently during pregnancy and as long as you are eating healthy food and visiting your care provider regularly you shouldn’t worry too much about the number on the scale.
Physical activity also helps keep your weight in balance before, during, and after pregnancy. This is another opportunity to listen to your body. You do not have to be intensely pumping iron til exhaustion for 2 hours each day. In fact, quite the opposite. Ask yourself, “How would my body like to move today? What would feel good?” Use a variety of activities to keep your program well rounded. Some good exercises for pregnancy are: walking, swimming, elliptical machines, gentle strength training, yoga, stretching, hiking, low-impact aerobics, and pilates. Do what is enjoyable and what will help you stay motivated to move.
Avoid harmful substances: smoking, drinking, and illegal drugs are all very harmful while pregnant and have potentially damaging effects on a fetus. Stay away from them, and tell your doctor if you need help weaning off. There are good resources, so speak up.
One of the most empowering tools you can have as a new mother is the gift of education. Arm yourself with knowledge about pregnancy, birth, breastfeeding, mental/emotional health, and more. There are endless resources available. Start with what you are interested in, or the phase of pregnancy you are in. The more you know, the more options you will have available to you, and the better equipped you will be to handle the demands of a changing body, and the challenges up ahead.
What happens if I become high risk?
If you are seeing a midwife, depending on the nature of your conditions, you will potentially be passed to an OB’s care. There are certain circumstances where a midwife will continue seeing a patient, but it really rests on the midwife’s comfort level and the specific case of the patient. Homebirths are generally not recommended or in some cases aren’t legal for midwives to attend once you become high risk, but again, it depends on the individual case. No matter who your current care provider is, you may also be referred to an MFM (maternal fetal medicine) doctor.
Depending on what has developed during the pregnancy, your OB may suggest the following tests/screenings: specialized ultrasound, amniocentesis, chorionic villus sample, umbilical cord sample, lab tests, routine ultrasounds or stress tests. You may be asked to go on bed rest or pelvic rest, or to otherwise take it easy physically.
Continued monitoring will be important to doctors treating a pregnant woman at high risk. Even if nothing alarming is happening, he will want to continue regular appointments, stress tests, ultrasounds, and extra appointments to ensure optimal health up until delivery.
Ask your doctor about specific risks with your condition. What warning signs do you need to be aware of? Things like bleeding, sharp pains, early contractions, decreased fetal movement, headaches and vision changes can all be warning signs. When should you call? What constitutes an emergency? Educate yourself about situation.
A low-risk pregnancy is certainly preferable, but be aware of the possibility of high-risk conditions and complications. Pregnancy, and delivery, and motherhood for that matter, can all be unpredictable. Do your best to take care of yourself and stay informed, and try to be flexible with what comes your way. Never be afraid to speak up and follow your intuition!
- The American College of Gynecologists. September 27, 2013. The Rh Factor:How it can affect your pregnancy. American College of Gynecologists, Frequently Asked Questions (027). [September 27, 2013; January 17, 2017]. http://www.acog.org/Patients/FAQs/The-Rh-Factor-How-It-Can-Affect-Your-Pregnancy
- 2008. Understanding Pregnancy and Birth Issues. NIH Medline Plus (winter 2008). [winter 2008; January 17, 2017]. Volume 3 (issue 1): https://medlineplus.gov/magazine/issues/winter08/articles/winter08pg22-23.html
- The American College of Gynecologists. March 2015. Good Health Before Pregancny: Preconception Care, Frequently Asked Questions (056). [March 2015; January 17, 2017].http://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Preconception-Care#being
- Goldmuntz, Ellen and Penn, Audrey S. July 16, 2012. Autoimmune Diseases Fact Sheet. Office on Women’s Health (e-publications). [July 16, 2012; January 17, 2017]. https://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html
- Centers for Disease Control and Prevention. July 21, 2016. Atlanta, Georgia. [July 21, 2016; January 17, 2017]. https://www.cdc.gov/ncbddd/fasd/alcohol-use.html