By Alexa Joy Sherman
If you think being pregnant is a memorable experience, just wait until a certain tiny someone decides it’s time to emerge. That incredible day will likely be etched in your mind for many years to come. “You can talk to 80- or 90-year- old women who probably can’t remember what they had for breakfast, but they can remember their labor and [giving] birth,” says Susan Martensen, CD-PCD, president of Doulas of North America (DONA International), headquartered in Jasper, Ind. “That’s how significant it is.”
What can you do to make your delivery-room memories as positive as they can be? First, learn about all your options by reading as much as possible and/or taking childbirth classes (find book recommendations and certified educators at icea.org). Then, simply control what you can—as our experts discuss here—and let the experience take you where it will.
It may sound extreme, but it’s wise to be as discriminating about choosing a person to deliver your baby as you were about selecting your partner. “A lot of women don’t interview prospective caregivers enough,” says Jane Hanrahan, ICCECD, president of the International Childbirth Education Association (ICEA), headquartered in Minneapolis. “They don’t ask about their philosophy, what’s typical in their practice, what they advocate for patients.
As a result, a woman who wants a natural childbirth, for instance, may end up with a doctor who believes in a medical model—or vice-versa.” Katie Cartwright, CD (DONA), of Bacon Hill, N.Y., says many of her clients say they just went with the first doctor they found or the one they’d always seen. “This is a business decision as much as a personal one,” she notes, “yet people often put more thought into buying a car. Look for a provider who treats you well and offers the services you want.”
A good place to start: Ask new moms for referrals. “Most women are passionate about their ob-gyns; they either love them or hate them,” says Robert James Gallo, M.D., FACOG, a board-certified obstetrician-gynecologist at Hackensack University Medical Center in New Jersey. If you have a lowrisk pregnancy, your preferences may even prompt you to opt for a midwife. For instance, Cartwright had a midwifeassisted home birth because the local hospital didn’t allow mothers to deliver in water—which she’d decided she wanted to do, barring any complications. Many midwives have nursing degrees, extensive training and decades of experience. They can often deliver your baby at your home, a birthing center or the hospital. (Learn more at the North American Registry of Midwives’ Web site, narm.org.)
Seek Extra Support A laboring woman screaming at her partner may be the ubiquitous image you see on television. But the reality, according to a 2003 study published in The Cochrane Library, is that women who receive supportive care from their partners (among others) are more likely than women without such care to be satisfied with their birth experience, as well as to avoid medical interventions like a Cesarean section, an epidural, vacuum extraction and forceps. Whom should you invite to the birth? Doulas, trained companions and other friends or family members top the list. Ideally, make sure your partner or another loved one attends childbirth classes with you, and consider meeting with doulas in your area (find one via icea.org or dona.org). “I had the greatest support team,” says Julie Jacobs, mom of 6- month-old Lucinda in Santa Monica, Calif. “My doula did and asked things I never would have, my husband was amazing and my friend Carol helped everyone. At one point, I even heard my doctor ask, ‘Carol, can you do me a favor?’”
Manage the Fear Factor The closer you get to your due date, the more nervous you may become. “I think the hardest thing about labor is the fear that what you’re experiencing isn’t normal or that you’re not strong enough to do it,” says Hanrahan. That’s when communication with your support team and your caregiver is crucial, particularly if you’re experiencing signs of labor. “If you have any indication that your water has broken or you have any vaginal bleeding, you should inform your caregiver,” says Gallo. “We offer patients a guideline we’ve learned from childbirth educators called ‘5-1-1,’” he adds which refers a time when you’ve been having contractions five minutes apart, which last for a full minute, for one hour. That’s a good time to get in touch with your caregiver as well.
Explore Pain-Management Options
If agonizing contractions are a source of anxiety for you, try to keep things in perspective. “This isn’t pain from an injury; it’s pain with a purpose,” notes Martensen. “It’s working toward something and it is going to stop.” Realizing this may put your mind at ease.
Learning about the variety of options to ease labor pain may also provide some comfort. Natural pain-management methods, which tend to divert your mind away from pain, include breathing techniques, taking a shower, walking around, sitting on a “birth ball” or listening to music. Baths, which Cartwright notes are often called “aquadural,” are becoming popular as well.
And while women who have opted for anesthesia may remain skeptical, those who have used natural methods exclusively often claim profoundly positive, even pain-free experiences. “Educate yourself on what a magnificent organ your uterus is,” suggests Cecilia Hyoun, who gave birth to her daughter Carolina at home in Venice, Calif., with a midwife and hypno-doula (Hyoun recommends visiting hypnobabies.com). “Understand that it’s designed to make birth easy and pain-free,” she says. Hyoun’s equation for the most positive birthing experience: relaxation training (she says hypnosis is great for this), along with a setting, positions and pushing that are all directed by the mother.
Keep in mind that natural techniques and drugs need not be mutually exclusive. If you opt to give birth in a hospital,you can arrange with your caregiver to try a natural method first, but have anesthetic at the ready in case you feel you need it. “Non-drug approaches can help all women, regardless of their pain medication choices,” says Maureen Corry, M.P.H., executive director of the Childbirth Connection in New York City. “They are safe and provide welcome relief.”
The most popular medication option is an epidural, in which anesthesia is given through a needle inserted in the back. “The majority of American women are delivering with epidural anesthesia, and in many cases it makes the birth process more enjoyable,” says Gallo. Other drug options are narcotics like Demerol or Stadol. “If you’re near delivery, a narcotic will work quickly, offer some pain relief and let you push in whatever position you like,” says Hanrahan. “With a long haul ahead of you, the epidural may be a better option.”
Be aware, however, that drugs have some drawbacks.
Getting an epidural can increase the risk of operative delivery, says Gallo, because when you can’t feel your contractions, it may be difficult to push. This could result in a need for forceps or vacuum extraction, or in extreme cases, an emergency C-section.
Plus, with an epidural, you’ll be hooked up to equipment and lose sensation in your legs, so you won’t be free to squat or get into positions that may both reduce pushing time and help stretch your perineum. This may increase the chance of your perineum either tearing or requiring an incision to prevent tearing, called an episiotomy.
Take a Ready-for-Anything Approach
While gathering as much knowledge as you can will help to ease your mind and smooth the process for you, every delivery comes with its own surprises, so expect the unexpected. You may be ready for a typical first-time 14-hour labor, for example, but find yourself weathering contractions for much longer than that or be pleasantly surprised with an unusually fast delivery. “I thought that all first-time labors were long,” says Los Angeles-based Julie Goldin, mother of Ari, 15 months. “I was planning on a drawn-out process, but mine took four hours total, from the time of my first contraction— when my water broke—to delivery.”
Similarly, you may arrive at the hospital expecting to have a vaginal delivery and discover, hours later, that your doctor needs to perform a Cesarean section. “When contemplating your delivery, you don’t typically plan to have a C-section,” says Hanrahan. “So, when faced with one, you may need to adjust to the loss of what you thought was going to happen.”
Cesarean births are on the rise in the U.S.—up 41 percent in the past decade. Labor induction rates are up, too, perhaps because caregivers are increasingly trying to avoid complications that can crop up past the due date. Inducing labor usually involves administering the hormone Pitocin (oxytocin). “When you’re induced, labor “When you’re induced, labor comes on faster and contractions are longer, stronger and closer together,” says Hanrahan.
“Typically, women say it’s harder than having labor naturally.” It could also cause distress to the baby, but the fetal monitor can detect this so your doctor can take the steps that are safest for your baby. The best course could be an emergency C-section. If either of these interventions is pursued, it’s important to focus on the fact that your obstetrician has decided that it’s medically necessary for the health and safety of you and your baby. “Many times a patient can’t deliver or a baby is in distress,” says Gallo. “These measures are never our first choices.”
This is why it’s so important to find a caregiver you trust. Whatever route your labor and delivery ultimately take, if you start out well-prepared, you’ll be more likely to remember your “labor day” as being one of the best of your life.
ORIGINALLY PUBLISHED IN NEW PARENT MAGAZINE, FALL/WINTER ‘07