PREGNANCY AND BIRTHING Q&A

By Jess Stone

Pregnancy and birth are perhaps the most profound and important events in a woman’s life. The process is not just about making babies, it is about making mothers as well. The paths you tread during this time shape your future as much as your child’s. Every choice you make is a brick laid in the foundation of your parenting style. You are in the process of becoming the mother you want to be.

For this reason, it is of vital importance to both you and your child that you do what you can to have a positive, balance and healthy pregnancy and birth experience. This can seem like an overwhelming task at times, especially for the single expectant mother, who can easily feel that she shoulders more burdens than the married or partnered mother. The truth is that the proactive and well informed single mother is much more likely to experience a positive and healthy birth experience than any woman who is ill prepared and uninformed, even if she’s in the happiest marriage in the world.

My job, as a doula, is to help you prepare and inform yourself before birth, and to help you achieve the positive, empowering birth experience that will transform you into a confident, strong mother.

Here are some frequently asked questions about preparing for birth.

What important decisions should I make regarding my birth?

  • What kind of care provider you want/need to care for you during pregnancy and birth
  • Where you want to give birth
  • Who you want to be there
  • What child birth education classes to take
  • How you want to manage pain.
  • Learn about interventions.
  • How you want to feed your baby.
  • How you want your baby cared for after birth?
What’s the difference between a doctor, a midwife and a doula?
In short, doctors and midwives provide medical care to expectant mothers and deliver babies. Doulas do not provide any medical care, but instead provide emotional, informational, and physical support to mothers and their birth partners before, during, and immediately after birth.

The difference between a doctor (OB or OBGYN, most of them) and a midwife is generally the style of care. Doctors tend to be much more medicalized and are usually the only choice for women experiencing a high risk pregnancy. Obstetricians are surgeons.

Midwives are experts in normal birth and low risk pregnancies. They tend to be more holistic in their care and give more personalized service. Midwives spend more time with their patients during pregnancy and birth than doctors do, in general, and tend to have lower intervention and complication rates. Though midwives can perform most any procedure that doctors can, there are a few complications, such as c-sections, that midwives must refer their patients to doctors for.

There are many types of midwives. A Certified Nurse Midwife (CNM) is a midwife who was first a nurse, and then received a masters degree in Nurse Midwifery. Certified Midwives (CM) and Certified Professional Midwives (CPM) are also known as Direct Entry Midwives and have been trained only in pregnancy and birth. It is interesting to note that in most every other country in the world, the majority of births are attended by midwives.

It is easy to argue over which care provider is better, but what it comes down to are your needs. If you are high risk, an OB is very likely the best choice for you. If you are experiencing a low risk, normal pregnancy, then a midwife is likely a better choice. Midwives have been shown in the vast majority of studies to have much lower rates of complications and much higher rates of birth satisfaction in low risk births than doctors do in low risk births.

You can learn more about the midwifery model of care at The Citizens for Midwifery website, http://cfmidwifery.org/mmoc/index.aspx, or at the Our Bodies, Our Selves website,http://www.ourbodiesourselves.org/book/companion.asp?id=21&compID=121.
Which ever care provider you choose, doctor or midwife, it is important to pick a provider whom you trust, who treats you with respect, and who has faith in you and your body to birth your baby. Interview several care providers before you settle on one.

Really, you can have your baby just about anywhere, but generally, people choose to have babies either in hospitals, birth centers or at home.
Births in hospitals are generally attended by doctors or nurse midwives. The hospital is the ideal place to have your baby if you are experiencing a high risk pregnancy. Some women choose hospitals because they wish to have medicinal pain relief during labor, because they like the service and experience of the hospital, or because they feel safer there. It is important to note, however, that the vast majority of studies have found tat for low risk pregnancy, hospitals are no safer than birth centers or a planned home birth with an experienced midwife.

If you are lucky enough to live near a birth center, you may find their services and care more intimate and luxurious than a hospital. Birth center births are generally attended by midwives who provide constant care during labor and birth, unlike the intermittent care provided by nurses and doctors/midwives in hospitals. You will also likely have more options for where and how you birth; standing, squatting, in a birth tub, etc. Medicinal pain relief such as epidurals are not generally available in birth centers.

Home births are generally attended by midwives, although some doctors still attend home births. Midwives come to your home with everything needed for a normal birth and to handle common complications. There is nothing an EMT can do that a home birth midwife cannot also do. Some women are much more comfortable in their own homes than they are traveling for birth, and the risk of infection in a home birth is much lower, because the mother already has immunity to all the germs in the house. A home birth midwife can also bring a birth tub, if you are hoping for a water birth.

You can pick anyone you want to be your birth partner. Personally, I picked my mother. Make sure you pick someone who is up for the commitment, preferably someone who can attend childbirth education classes with you, and maybe a few prenatal appointments. Most people consider it to be an honor to be chosen as a birth partner.

It is also worth noting that you can have more than one person in your room when you have your baby. Many hospitals will allow you to have as many people as you want. I also had my little sister there, to take pictures, and my doula. If you are planning a home birth or a birth center birth, they are much more likely to have an open mind about how many people you let in the room with you.

Don’t feel pressured to have more people in the room than you want, though. Unless you are on really, really, really good terms with him, I recommend against having the father of your baby there. You want your birth environment to be filled with love, don’t muck it up with the presence of someone who doesn’t love you and has probably caused you pain. He can wait in the delivery room, or, better yet, don’t let him know you are in labor, and only call him after the baby is born and you have rested. Stress, which an ex boyfriend or husband’s presence usually causes, is your worst enemy during labor.

A doula is a wonderful person to have at your birth in addition to your birth partner, or alone if you can’t find a good birth partner. A doula is a birth and labor support professional well trained in the birth process, and will provide continuous support and advocacy to you while you are in labor. You will never be left alone when you have a doula.

Doulas cannot replace the role of your birth partner if you have one, they cannot provide the personal, loving support that you get from a loved one. What they do provide is experience in birth, the process, and how to make it go smoothly.

Numerous clinical studies have found that the presence of a doula during labor and birth significantly reduces the risk of complications, interventions, need for medicinal pain relief and health complications in mothers and infants after birth. Furthermore, women who have had doulas attend their births report feeling more positively about their birth experience, have easier times nursing, and have quicker, easier recovery periods. To learn more about doulas, visit the Doulas of North America website at www.dona.org.

Average cost for a doula varies greatly depending on your location and her services offered (a doula who is also a massage therapist will charge more, for example), but often doulas offer special rates or volunteer their services to those in financial need. Doulas in the process of certifying also offer services for cheap or free. You can find them by looking on Craigslist, checking local pregnancy and parenting forums, checking local doula or midwife associations, or contacting DONA or CAPPA. The website DoulaMatch.net can also help you to find and compare doulas in your local area.

There are many kinds of childbirth education classes, but for the general single pregnant woman, I recommend Lamaze or CAPPA. These classes are well rounded and focus on the mother and the baby. They are also the classes most likely to be offered by local hospitals.

If you are pretty sure you want an unmedicated birth you might look into Hypnobirthing or Hypnobabies. Bradley and ALACE are two other well known and highly praised childbirth education methods. While I love the Bradley method, I don not generally recommend it to single mothers because if focuses quite a bit on husbands, which can make the single mother feel singled out. Still, if you think that will not bother you and your birth partner, I would highly recommend Bradley classes to anyone going for an unmedicated birth.

Childbirth education class is essential. It is the number one thing you can do to reduce your risk of complications during birth. Watching programs like Baby Story and reading pregnancy magazines are not a substitute for childbirth education. If you are worried about the cost, many hospitals provide lower cost classes for those in financial need. Your local March of Dimes office may also be able to point you in the direction of low cost or free community childbirth education classes. At the very least, your doctor or midwife should be able to give you a few ideas.

You literally have hundreds of options to manage pain during labor. Your unmedicated options are virtually endless, from breathing techniques and position changes to warm baths and hypnosis.

There are a vast variety of medicinal pain relief techniques that are also available, and your doctor or midwife can walk you through what is available under their care. The most commonly chosen method of medicinal pain relief is the epidural, and it is probably the safest of all of them available. However, like all interventions, an epidural does pose some risk, and you may find upon researching it that i might not be the best pain relief method for you. You have so many options, research them all and choose a few you’d like to try.

It is impossible to go through a birth without any pain at all, so it is important you choose some methods of unmedicated pain relief even if you intend to use medication. Sometimes you have to wait to get medication, or the medication doesn’t work. Even epidurals sometimes fail. Also, doctors tend to let medication wear off towards the end of labor, so you can feel how to push more effectively.

Pregnancy and birth are normal. They are phases of your life that you are designed to go through, much like getting your period every month. Because your body has been perfectly designed to bring babies into this world, chances are you will not ever need any interventions over the course of your pregnancy and birth. So why should you bother learning about them?

In short, you should learn about interventions so that if the unexpected happens during your pregnancy and birth you will know what’s going on and what your options are. Sadly, doctors and midwives don’t always give you all your options, either because they don’t know them, or they aren’t familiar with how to work them.

Also, it is very likely that many women are offered interventions that they do not actually need. The United States has one of the highest intervention rates in the world, and some of the lousiest birth outcomes. This suggests that some of these interventions are actually making our birth outcomes worse, rather than better. The only way an intervention makes outcomes worse is when the risks of doing the intervention is higher than the risks of not doing the intervention. In short, if the intervention is not actually needed.

All interventions (a procedure your doctor or midwife performs which alters the course your pregnancy or labor is taking on it’s own) carry some risk. You will want to make sure you are only taking on that risk if you or your baby are in more danger if you don’t get it. The best way to make sure this happens is to stay informed, because if you are not informed, it is easy for you to be lied to about what is going on with your body.

I highly recommend you learn more about the risks, benefits and needs for the following interventions, at least:

Induction of labor, to include induction with

  1. Pitocin
  2. Cytotec
  3. Foley Bulb
  • Cesarean Section
  • Augmentation of labor with drugs
  • Continuous fetal monitoring / internal fetal monitoring
  • Vacuum and forceps delivery
  • Episiotomy
  • Artificial Rupture of Membranes

These are the most commonly performed interventions in this country, and the ones most likely to be performed without need.
For more information, visit www.kellymom.com or www.yourbestbirth.com

Of course, its not always that simple, especially for the single mom. Life gets busy, stress, special diets, lack of sleep, all of this can interfere with the nursing relationship and make breast feeding a challenge.

What I recommend for the single mom is to breast feed as much as you can for as long as you can, but don’t feel bad about having to supplement with formula when you really have to.

It is true that breast milk is nutritionally far superior to any formula on the market (its so good for you, in fact, that I considered making a habit of drinking my own), and that the attachment formed during nursing is hard to achieve when bottle feeding. Nursing reduces your chances of developing post partum depression, and of women who do suffer from PPD, those who nurse have shorter and much less sever bouts of it. Nursing can help some women lose the baby weight, and even reduces your chances of developing breast cancer later in life.

I very much loved nursing my son, it was my favorite part of being a mom the first year. I loved our special cuddle time, and so did he. But I did have to supplement with formula while I was at work. I just couldn’t pump enough during the day to feed him. The pump doesn’t remove as much milk from the breast as a baby does and for me, my body adjusted its self to produce less milk while I was away from my baby (as some women’s bodies will do, since breast milk is produced on a supply and demand basis). I made up for it by nursing all night (we bed shared, so this was fairly easy) and all day on the weekends. My son grew up healthy and happy, and we were able to continue nursing until he was two, when he gradually self weaned.

I recommend trying to keep nursing, at least a little, for at least a year. But some women can’t make it that long, and that’s okay. Some breast milk is better than none, what’s important is that you give it a try for as long as you can. If you can manage to breast feed exclusively for the first six months, and continue to nurse while supplementing with solid foods for the rest of the first year and as far beyond that as you desire, good for you! That’s the gold standard of nursing your baby.

After the birth is where the real down pour of parenting decisions take place. Here are a few choices you will want to carefully research before you have your baby so that you can instruct the hospital staff of your wishes.

  • When do you want the umbilical cord clamped?
  • Do you want to store the cord blood? Donate the cord blood?
  • Do you want to room in with your baby?
  • Do you want your baby circumcised if it is a boy?
  • Do you want your baby vaccinated?
  • Do you want your baby to take a pacifier or bottle?
These choices are intensely personal, but I can tell you what choices I made, and what choices I will make the next time I have a baby.
I wanted to delay cord clamping, so my baby could receive all the benefits of the cord blood, which they say is very good for them. Really, I had wanted to donate the cord blood, but I couldn’t because I had too recently had a tattoo (it works under the same rules as regular blood donation). Next time, I will donate the cord blood.I chose to room in with my baby. Next time I hope to have a home birth, so rooming in is pretty much my only option there.I am strongly opposed to circumcision, so much so that I would have a hard time finding anything unbiased to say about it. I realize that it is a very personal decision, but I want to say this. Only 15% of the worlds male population is circumcised. Most of the circumcised men in the world are Muslims. Obviously, 85% of the world’s men do not have any kind of problems with their intact penises, or more people would be circumcised. I understand that there are religious reasons to circumcise, but I would have you know that most of the world’s Christians are intact (not circumcised), as are most of the world’s Athiests, Buddhists, Pagans, Agnostics, Hindus, etc. I know there is a movement in the Jewish faith against routine circumcision, you can learn more at JewsAgainstCircumcision.org. Other websites I recommend to learn more about circumcision and the functioning body part the procedure removes are Nocirc.org and Sexasnatureintendedit.com.

I did get the first few rounds of vaccinations with my son, then decided to delay vaccination until he was a year old upon learning more about vaccination. In the future, I will delay vaccination of my children, and get the vaccinations we wish to get on a drawn out schedule. I will avoid vaccinations for generally harmless childhood diseases, like chicken pox.
I offered my son a pacifier, but he never really took one. I’m not sure if this was a good thing or not. Many experts believe that it is better for babies to use the breast as a pacifier. Admittedly, this is probably the only way I was able to keep my milk in, I believe I would have dried up entirely if it weren’t for the fact that my son was almost always nursing. But, it would have been nice to have a break every now and then, or to have been able to give him something to suck on when we were somewhere where we couldn’t stop to nurse right away. Many experts believe introducing a pacifier or bottle too early can cause nipple confusion. Next time, I may offer a pacifier once nursing is strongly established, but I won’t push it.

Ultimately, all these choices are up to you, but the only real choice is an informed choice. If you make a choice based not on what you know to be the pros and cons, but instead based on what other people are telling you to do, you are actually being coerced. Do your research on all of these issues, and pick the option that will work best for you and your child. This is YOUR pregnancy, YOUR birth, and YOUR child. Don’t let someone else step in and take over for you.

Ultimately, all these choices are up to you, but the only real choice is an informed choice. If you make a choice based not on what you know to be the pros and cons, but instead based on what other people are telling you to do, you are actually being coerced. Do your research on all of these issues, and pick the option that will work best for you and your child. This is YOUR pregnancy, YOUR birth, and YOUR child. Don’t let someone else step in and take over for you.