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Early Induction: What You Should Know

March 4, 2013 By Cara Terreri 3 Comments

In line with last week’s post about recommendations against elective induction before 39 weeks, let’s talk about what an early induction means. Below are some basic points with links to more in-depth information from evidence-based resources.

How early is an early induction?

An “early induction” is any induction that is performed before 39 weeks of pregnancy. Experts from several recognized organizations, including the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection and March of Dimes, state that a baby needs at least 39 completed weeks in order to fully develop their brain and other vital organs.

What are the risks of early induction?

Induction in and of itself carries risks to mom and baby. Because induction is an artificial process for starting labor, your body may not be ready to follow its cues. As a result, inductions can cause a cascade of additional medical processes (interventions) to keep labor going, which can ultimately lead to an increased risk for cesarean surgery. Unless there is clear medical indication (see below), letting labor begin on its own is the safest decision.

Induction before 39 weeks brings an additional risk of prematurity. Babies born even a little too early can experience complications like problems with breathing, feeding, maintaining body temperature and jaundice. In most cases, babies know best when it comes to being born.

What if I need to be induced?

There are solid medical reasons for induction before 39 weeks. Being done with being pregnant, isn’t one of them. ;)  There are also several reasons given for induction that are not true medical reasons. It’s important to know the difference. Click through and read up on the two links provided above on the new induction resource page on Childbirth Connection, a not-for-profit organization founded that works to improve the quality of maternity care.

If you’re pregnant and faced with the decision to induce — and even if you’re not — read up! Inform yourself. Learn all that you can, from sources in addition to your care provider and other than well-meaning family and friends. Start here:

Filed Under Birth, Featured Story, Healthy Birth Practice, Induction, Interventions Tagged With labor induction

“Choosing Wisely” & Reading the Fine Print with Maternity Care

March 1, 2013 By Cara Terreri 1 Comment

Did you know there are organizations out there that work to set checks and balances for our system of medical professionals? The ABIM Foundation, founded by the American Board of Internal Medicine, has made it their mission to enhance quality of care by encouraging regular assessment and improvement of our physicians, bringing diverse groups and leaders together, and promoting research. In line with their mission, ABIM Foundation developed the Choosing Wisely® initiative. Choosing Wisely aims to promote conversations between physicians and patients by helping patients choose care that is:

  • Supported by evidence
  • Not duplicative of other tests or procedures already received
  • Free from harm
  • Truly necessary

As a result, ABIM  developed a list, with input from national medical organizations, of  “Five Things Physicians and Patients Should Question.” The idea is that these lists (separated by medical specialty) will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. This is great news for us as consumers — what more do we want than transparency with our care? We want to know if the test or treatment that’s been prescribed is truly necessary and helpful. We also want to know the risks, weighed properly against the benefits. With regard to maternity care, Choosing Wisely developed the following recommendations:

Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.
Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher Cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

Considering the high rates of elective inductions, often prior to 39 weeks, these recommendations are a breath of fresh air. Of course, this is not the first stand that has been taken against unnecessary inductions (the American College of Obstetricians, ACOG, has included this directive for some time). But with these particular recommendations, there is added stress on the importance of not inducing unless there is a favorable cervix, and the added emphasis that “labor should start on its own initiative.”

While these recommendations represent a healthy step forward in improving our maternity care, there are some concerns about how they could be misunderstood. In a review of these guidelines on the Lamaze blog, Science & Sensibility, Amy Romano of Childbirth Connection questions, “will the new message lead women and care providers to think that delivery is indicated once a woman’s cervix is ripe?” In other words, Romano cautions:

The best indicator of readiness is still the spontaneous onset of labor at term, the culmination of an intricate interplay of hormonal signals between the fetus and the woman. Anytime we intervene with the timing of birth we have to weigh the potential benefits and harms of overriding that process in the context of the fully informed preferences and values of women.

 So, while the Choosing Wisely recommendations are important and helpful in our quest for the best maternity care, it’s vital to keep in mind that, unless medically indicated, a date or length of pregnancy (ie, 39 weeks) should not be the reason for induction. It’s still best to allow labor to begin on its own. For a better understanding on the importance of labor starting spontaneously, check out the Lamaze Healthy Birth Practice video:

 

Have you experienced pressure to induce? What did you do? How did you discuss it with your care provider?

 

Filed Under Birth, Featured Story, Induction

To Induce or Not Induce

February 4, 2013 By Cara Terreri Leave a Comment

Are you approaching your due date or sitting, waiting past your due date? If so, it’s possible that you may be considering an induction. Before you mark your calendar, be sure to do your homework. An induction can be a helpful procedure for moms & babies who need it for medical reasons, but when induction is used outside of necessity, you should know about the risks. The following is reprinted from the Lamaze “Push for Your Baby” campaign website. 

An increasing number of hospitals are working hard to reduce the number of inductions they are doing, and for good reason. Artificially starting labor may be good for a care provider juggling a busy calendar, or your mother-in-law who wants to book her plane tickets, but it can make labor harder and more painful for women, and stress babies and jeopardize their health. Studies have consistently shown that the risk of having a C-section for first time moms nearly doubles with induction. It also increases your baby’s chance of being born premature. That’s because due dates aren’t an exact science. Even if you and your care provider are positive about your dates, every baby matures at a different rate. Inducing labor can mean your baby is born before he or she is ready.

Aside from the risks of induction, there are specific benefits to letting labor start on its own. During the last part of your pregnancy, your baby’s lungs mature and get ready to breathe. He or she puts on a protective layer of fat, and develops critical brain function through 41 weeks of pregnancy. Cutting the pregnancy short can be tough on your baby.

Before going through with an induction, tell everyone to hold their horses, and take time to learn more about benefits of letting labor start on its own.

What’s Next?

So, how do you get a better idea of the care your doctor or midwife will provide? Ask good questions! Take a look at some suggestions.

Talk Back

How about you? Are you hoping to avoid certain interventions in your baby’s birth? Have you experienced interventions that made your birth harder? Did you successfully avoid an intervention that helped make your birth easier and safer? Tell us your story in the comments.

Filed Under Birth, Featured Story, Induction Tagged With labor induction

Are You Due on Christmas? Don’t Be Pressured into an Induction!

December 10, 2012 By admin 2 Comments

In the rush of the holiday season, most people worry about on-time delivery of important gifts and packages for friends and loved ones.  But if you’re a pregnant woman due around the holidays, there’s an added worry about when your baby will arrive.

Around the holidays, many pregnant women experience pressure from family or their healthcare providers to “schedule” their baby’s birthday around festivities and travel plans.  Be aware, however, that scheduling a baby’s delivery without a compelling medical reason can put your baby at risk.

“Few doctors want to be pacing the halls on Thanksgiving or Christmas, waiting for a mother to deliver,” said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “So it’s not uncommon to see a surge of women with normal pregnancies being told that there might be an issue and that they should consider scheduling the delivery, coincidentally, right before a holiday.”

It’s not just your healthcare professional who may try to rush your baby’s arrival.  Families often can feel stressed about the uncertainty of the baby’s arrival and feel it may compromise the celebration of holidays.  Some women also fear that their preferred healthcare provider won’t be available and will agree to a scheduled early delivery to guarantee that their provider will be available for the birth.

“I really understand that pressure.  You build a relationship with your care provider over the course of a pregnancy.  Plus, you build up expectations about your holiday celebration.  So it seems like ‘no big deal’ just to get the birth over with,” said Sue Galyen, RN, MSN, HCHI, LCCE, FACCE, a Lamaze childbirth educator from Brownsburg, IN.  “But it’s so hard to think that a scheduled delivery, whether through induction or cesarean, was worth it when either the mother or baby experiences a complication as a result.”

One complication of scheduling your baby’s birthday is that often, baby is delivered just a little too early.  A growing body of research shows that giving a baby those last few weeks or days inside the uterus can be crucial to the baby’s health.  Babies born even a “little” early face risks including breastfeeding difficulties, learning and behavioral problems, breathing problems, increased chance of time in the neonatal intensive care unit (NICU) and risk of death.

You can play a key part in driving down avoidable prematurity.  “Red flags” that might signal being pressured into an unnecessarily early delivery include:
• The care provider suggests that the baby is too big and will be easier to deliver “a little early”
• The suggestion is made that the care provider won’t be available for a holiday delivery or will be “booked up”
• The timing of the delivery is centered on travel and celebration schedules
• Holiday stress is driving feelings of wanting to get the pregnancy “over with”

Here are some things you can do if you feel you are being pressured into an early delivery:

  • Ask your provider if you need to make a decision right now.  If not, ask why not?  Few decisions need to be made on the spot unless the mother or baby are clearly doing poorly.
  • Research your options.  Use credible sources of information, like Lamaze, Childbirth Connection, Mothering Magazine’s online forum or your doula to see what the research says and talk to other moms about their experiences.
  • Make a pro/con list.  Label your pros and cons with “medical” vs. “personal” and weigh the “medical” pros and cons more heavily.  If you are talking about a major medical intervention like cesarean or induction and you don’t have a good list of cons, it’s a good sign that you need to do more research.
  • Trust your gut.  Your instincts are geared to protect you and your baby from risk.  Listen to what your gut is saying in the context of the research.
  • Find support.  It’s hard to disagree with your health care provider, so be sure that you go into your appointments with someone who can help you have an informed, evidence-based conversation about your best options.

Inducing labor without a compelling medical reason is one of many routine interventions that has not proven a medical benefit to mothers and babies and can impose harm.  Other common routine interventions include continuous fetal monitoring, coached pushing, being positioned on your back during labor, requiring repeat cesarean surgeries for women with a prior cesarean and separating mothers and babies after birth.

You can learn more about the Lamaze Six Healthy Birth Practices by enrolling in a Lamaze childbirth education class and visiting www.lamaze.org/healthybirthpractices.

Filed Under Birth, Due Date, Featured Story, Induction Tagged With early induction, labor induction

Finding Your Most Accurate Due Date

March 28, 2012 By Cara Terreri Leave a Comment

Calculating your due date can be tricky. Unfortunately, it’s not as simple as knowing the date of your last menstrual period (LMP), a tool used by most online due date calculators and care providers. Even the high-tech ultrasound, which can be helpful in detecting some things, is not the best at figuring out your due date.

Knowing your most accurate due date is important as you near the time of birth. Many care providers impose limits for how long a woman can go past 40 weeks before scheduling an induction (despite guidelines from the American Congress of Obstetricians and Gynecologists stating that a full-term pregnancy is 42 weeks). If your due date is calculated for July 1, but your actual due date is July 10, you may receive unwarranted pressure to induce when in reality, your baby has not even reached 40 weeks gestation. Inductions carry a host of risks and interventions and should be scheduled only if medically necessary for the health of you and your baby.

So how do you calculate your most accurate due date? Childbirth Connection has created a simple worksheet to answer questions and use in conjunction with your care provider to determine your due date. The form is below, and it can also be downloaded on the Childbirth Connection website.

 

 

 

Filed Under Birth, Due Date, Featured Story, Induction

Induction and the Holidays: Part 2

November 28, 2011 By Cara Terreri 1 Comment

In case you missed the first post in this special holiday series, we are talking about induction and the holidays. Women may feel the pressure to schedule an induction if their due date falls on or near a major holiday. Pressure can come from all sides — care givers, family, and even from within. If you’re feeling the pressure to schedule an induction that is not medically necessary, we urge you to do your homework and ask questions.

Today, we’re talking about where to find the best, evidence-based resources on induction.

Resources for Information on Labor Induction

Childbirth Connection – Childbirth Connection is a not-for-profit resource center dedicated to helping women and health care professionals make informed maternity care decisions. Among the many topics on their site, they have an in-depth section called “Induction of Labor.” Questions addressed include medically necessary reasons for induction, tips for avoiding induction, and the safest point in pregnancy for babies to be born.

 

March of Dimes – March of Dimes is a not-for-profit group that helps moms have full-term pregnancies and researches the problems that threaten the health of babies. March of Dimes has a resource on their site that explains why at least 39 weeks is best for your baby, including detailed information on the important development that babies undergo in the final weeks and days before they are born.

 

ACOG – The American Congress of Obstetricians and Gynecologists is the organization responsible for developing guidelines by which most OB/Gyn offices are expected to follow. Their site offers a basic FAQ section on labor induction that, most notably, states, “Unless a problem occurs, labor induction is not done before 39 weeks of pregnancy.”

 

If you’re looking for more information on induction and would like to talk to an expert, Lamaze International is hosting a live web seminar on December 12 called, “Is Labor Induction Right for You?“ During this one-hour interactive session, you will:

1. Receive unbiased, research-based information to help you in your decision-making process regarding labor and elective induction.
2. Interact with a professional Lamaze educator and other expectant parents.
3. Learn about indications for induction and what to expect during labor induction.
4. Discuss “talking points” to aid communication with your care provider on induction of labor.

Whether you’re facing induction or considering it, we urge you to learn more to make the best decision for you and your baby.

 

Filed Under Birth, Featured Story, Induction Tagged With early induction, labor induction

Induction and the Holidays: Part 1

November 18, 2011 By Cara Terreri 3 Comments

Throughout the rest of this month and December, Giving Birth with Confidence will be posting information on inductions. Why now? Well, if you are pregnant and due around one of the major holidays, you might be feeling the pressure to induce so that you’re not giving birth on Christmas day, for example. We want to give you some solid reasons to think twice about induction as well as information to use if your care provider or well-meaning family and friends start mentioning the “i” word.


Is Your Baby Due on a Holiday? Don’t Be Pressured into an Early Delivery!

In the rush of the holiday season, most people worry about on-time delivery of important gifts and packages for friends and loved ones.  But if you’re a pregnant woman due around the holidays, there’s an added worry about when your baby will arrive.

Around the holidays, many pregnant women experience pressure from family or their healthcare providers to “schedule” their baby’s birthday around festivities and travel plans.  Be aware, however, that scheduling a baby’s delivery without a compelling medical reason can put your baby at risk.

“Few doctors want to be pacing the halls on Thanksgiving or Christmas, waiting for a mother to deliver,” said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “So it’s not uncommon to see a surge of women with normal pregnancies being told that there might be an issue and that they should consider scheduling the delivery, coincidentally, right before a holiday.”

It’s not just your healthcare professional who may try to rush your baby’s arrival.  Families often can feel stressed about the uncertainty of the baby’s arrival and feel it may compromise the celebration of holidays.  Some women also fear that their preferred healthcare provider won’t be available and will agree to a scheduled early delivery to guarantee that their provider will be available for the birth.

“I really understand that pressure.  You build a relationship with your care provider over the course of a pregnancy.  Plus, you build up expectations about your holiday celebration.  So it seems like ‘no big deal’ just to get the birth over with,” said Sue Galyen, RN, MSN, HCHI, LCCE, FACCE, a Lamaze childbirth educator from Brownsburg, IN.  “But it’s so hard to think that a scheduled delivery, whether through induction or cesarean, was worth it when either the mother or baby experiences a complication as a result.”

One complication of scheduling your baby’s birthday is that often, baby is delivered just a little too early.  A growing body of research shows that giving a baby those last few weeks or days inside the uterus can be crucial to the baby’s health.  Babies born even a “little” early face risks including breastfeeding difficulties, learning and behavioral problems, breathing problems, increased chance of time in the neonatal intensive care unit (NICU) and risk of death.

You can play a key part in driving down avoidable prematurity.  “Red flags” that might signal being pressured into an unnecessarily early delivery include:
• The care provider suggests that the baby is too big and will be easier to deliver “a little early”
• The suggestion is made that the care provider won’t be available for a holiday delivery or will be “booked up”
• The timing of the delivery is centered on travel and celebration schedules
• Holiday stress is driving feelings of wanting to get the pregnancy “over with”

Here are some things you can do if you feel you are being pressured into an early delivery:

  • Ask your provider if you need to make a decision right now.  If not, ask why not?  Few decisions need to be made on the spot unless the mother or baby are clearly doing poorly.
  • Research your options.  Use credible sources of information, like Lamaze, Childbirth Connection, Mothering Magazine’s online forum or your doula to see what the research says and talk to other moms about their experiences.
  • Make a pro/con list.  Label your pros and cons with “medical” vs. “personal” and weigh the “medical” pros and cons more heavily.  If you are talking about a major medical intervention like cesarean or induction and you don’t have a good list of cons, it’s a good sign that you need to do more research.
  • Trust your gut.  Your instincts are geared to protect you and your baby from risk.  Listen to what your gut is saying in the context of the research.
  • Find support.  It’s hard to disagree with your health care provider, so be sure that you go into your appointments with someone who can help you have an informed, evidence-based conversation about your best options.

Inducing labor without a compelling medical reason is one of many routine interventions that has not proven a medical benefit to mothers and babies and can impose harm.  Other common routine interventions include continuous fetal monitoring, coached pushing, being positioned on your back during labor, requiring repeat cesarean surgeries for women with a prior cesarean and separating mothers and babies after birth.

You can learn more about the Lamaze Six Healthy Birth Practices by enrolling in a Lamaze childbirth education class and visiting www.lamaze.org/healthybirthpractices.

Filed Under Birth, Featured Story, Induction Tagged With early induction, labor induction

What You Need to Know About Premature Birth

November 16, 2011 By Cara Terreri 5 Comments

Tomorrow, November 17, is World Prematurity Day — an event created as part of the March of Dimes Prematurity Campaign to raise awareness of and remember babies who died from premature birth. Worldwide, 13 million babies are born prematurely. Prematurity is the leading cause of death among newborns, and causes complications at birth and lifelong illnesses. In the last 25 years, the prematurity rate in the United States has risen by 36% — one of the highest rates for preterm birth in the world.

Sometimes, in cases of true complications, preterm labor and birth is unavoidable. In many cases, however, preterm birth can be prevented. If you are pregnant, there are things you can do to lower your risk of preterm birth.

Lowering Your Risk of Preterm Birth

Prenatal Care – Seek ongoing prenatal care from a reputable care provider. Whether your preference is for midwife or obstetrician, be sure to research your care provider’s history and practices. Ask about their rate of induction. If they don’t know it or report a rate ranging from 20-30+%, consider finding another care provider.

Induction – Inducing birth or scheduling a cesarean surgery prior to 39 weeks of pregnancy can lead to premature babies. Even if friends and family tell you different, every week counts! Babies undergo vital development up to the very moment of their birth. And, because your due date is just an estimate, it can be off by up to two weeks in either direction. So, a baby that is induced at 38 weeks may only be at 36 weeks gestation. If your care provider is pushing for early induction, ask questions! Learn what counts as true medical indication for early induction or cesarean surgery. If being “so done with being pregnant” is getting to you, hold tight and think of the babies born at 28 weeks, with mommies who would have given anything to make it to 40 weeks.

Education – The Internet is overwhelming. When it comes to making informed decisions in pregnancy and birth, the Internet is a good place to start, but not a good place to stop. Sign up to take a childbirth education class from a childbirth educator certified by a reputable childbirth education organization (there are many, but we really think Lamaze is tops!). Childbirth education provides the foundation for educated, evidence-based decision making for you and your partner throughout pregnancy and birth.

Filed Under Birth, Childbirth education, Choosing a care provider, Featured Story, Induction, Pregnancy, Preterm Birth, Working with a midwife Tagged With Preterm Birth, Preterm Labor

What to Do When You’re Overdue

August 22, 2011 By Cara Terreri 8 Comments

40 weeks have come... and gone

As I write this, I am five days past my due date with my third baby. I’m no stranger to being “overdue.” With my last pregnancy, I gave birth five days after my estimated due date. I was lucky enough with my first to go into labor three days before being due. Despite the fact that a perfectly healthy pregnancy can last between 38 – 42 weeks,  we are so ingrained to hinge on the almighty 40 weeks “deadline.”

Here’s the reality: 40 weeks is an average time for pregnancy that is based on a date (last menstrual period or conception) that can be uncertain or inaccurate. The result is an estimate – not a deadline, expiration or delivery date. Your baby is not a FedEx package. And yet, women who go beyond the magical 40 weeks due date are made to feel like a pressure cooker. Well-meaning family and friends call, text and email to check in, asking questions like, “Are you still pregnant?!”; some care providers put women who are postdates on a time clock, often stripping membranes to jumpstart labor, performing a barrage of tests to check on baby and scheduling an induction date; and then there is the general discomfort and exhaustion that comes along with the end of a pregnancy that makes a woman feel like she is “so done” with pregnancy. With all of this pressure, even the most patient and informed woman becomes irritated, on edge and prone to doing whatever it takes to birth her baby.

Have you ever heard anyone say that children develop and hit milestones at different rates? The same is true for developing babies. Some may be ready for birth at 39 and-a-half weeks while others need an extra two weeks or more. Allowing baby to initiate birth helps ensure that he or she receives enough time to develop and mature. Contrary to what many believe, the last few weeks of pregnancy are not just for fattening baby up. Important organs, like the brain, lungs and liver, are still developing, as well as functions like sucking and swallowing. Interrupting these processes by scheduling an induction — unless there is true medical reason — can deprive baby of the time he or she needs to grow, and poses risks associated with induction.

So, what do you do when you’re overdue? Having been in this situation twice now, my best advice is to stop waiting around. Sitting around, jumping at every little twinge, ache or contraction, waiting for labor to begin will do nothing but drive you absolutely crazy! If you’re physically able, schedule something to do every day for three days straight. Make dinner plans, get a pedicure, see a movie, visit a friend, make freezer meals — you get the idea. If you come to the end of those three days and baby is still cooking, schedule the next three days. Having something to look forward to besides the birth of your baby will help pass the time and keep your mind occupied. And when you encounter the questions, comments and suggestions from others about your overdue-ness, smile and say something like, “Just like a cake, baking times may vary.”

Filed Under All Recent Articles, Birth, Healthy Birth Practice, Induction Tagged With early induction, labor induction, overdue, postdates

10 Tips for Avoiding a First-Time Cesarean

July 27, 2011 By admin 11 Comments

By Jessica English, CD(DONA), LCCE

More and more women in the United States (and around the world) are having cesarean births. A recent study from the Yale University of Medicine showed two main reasons for the rise: more c-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).

For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We’ve identified 10 areas where you can be proactive and stack the deck in your favor.

1) Hire your provider wisely. This point is number one for a reason – it’s critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It’s helpful to know your practice’s cesarean rates. The labels “obstetrician,” “family doctor” and “midwife” don’t necessarily tell you what you need to know about your provider’s philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tool to help you if your labor is complex? If you’re not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner.  If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.

2) Hire a doula. Simply put, doulas make birth better, and there’s research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits. Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review. What exactly is the doula magic? The research hasn’t pinpointed the magic, but I think the unique combination of physical, emotional and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn’t really promote natural birth.

3) Take an independent natural childbirth class. It’s not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process. An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.

4) Avoid induction unless there’s a serious medical problem. As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Doubles it. That’s huge! Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula (remember them?) to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you’ll need great support on the journey.

5) If having your baby in the hospital, stay home at least until strong, active labor. Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to “come in when contractions are five minutes apart, at least a minute long, for at least an hour,” most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean). In her book “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” Jennifer Block tells the story of a hospital in Florida that lost power after a major hurricane. A generator kept the essentials running, but there was not enough power for air conditioning. They wanted to save resources and keep laboring women cool, so for a full week they turned away any woman who was not in full-blown, active labor. Their emergency cesarean rates during that week dropped dramatically.

6) Avoid an epidural, at least in early labor. Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals. There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn’t have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won’t even need the drugs. Most women don’t.

7) Read only the best childbirth books. Get these books, and read them cover-to-cover. Seriously, throw away “What to Expect When You’re Expecting,” and dive into these wonderful books instead.

• “The Official Lamaze Guide: Giving Birth with Confidence,” by Judith Lothian and Charlotte Devries (the book that inspired this blog!)

• “Ina May’s Guide to Childbirth,” by Ina May Gaskin

• “The Thinking Woman’s Guide to a Better Birth,” by Henci Goer (Written in 1999, this book is due for a revision, but it’s still excellent information and routine procedures and hospital technology have not changed much since that time. Henci also runs a helpful Q&A forum on the Lamaze International web site, so you can ask the expert yourself.)

• “Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience,” by Ricki Lake and Abby Epstein (they also offer a great web site and community)

And while you’re at it, buy the DVDs “The Business of Being Born” and “Orgasmic Birth” – they’re even on Netflix. That’s right, I’m recommending “Orgasmic Birth.” Stretch yourself a little!

8) Get your partner on board. It’s hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin’s book “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions” is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.

9) Consider an out-of-hospital birth. It’s possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. As a doula I see them fairly often, and you should definitely choose the hospital if that’s where you feel safest and most comfortable. But the best research is pretty clear that your odds of a vaginal birth are better outside of the hospital: at home or in a birth center. In 2005 the British Medical Journal published a large study that looked at home births in the United States attended by Certified Professional Midwives. The women who gave birth at home had similar outcomes to low-risk women who had hospital births in terms of safety for moms and babies. But just 3.7 percent of the women who had their babies at home transferred to the hospital for a cesarean, while 19 percent of the low-risk women who had their babies in the hospital ended up with c-sections. The current cesarean rate in the United States is 32.9 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.

10) Believe in your body! The cesarean rate for women who birth at The Farm in Tennessee is less than 2 percent. Many industrialized countries around the world have cesarean rates of 15 percent or less. Women have been doing this for millions of years! Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly… trust your body. Trust birth.

 

Jessica English, CD(DONA), LCCE, is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, and in-home lactation consults. A DONA-certified birth doula and Lamaze-certified childbirth educator, she teaches an 8-week series of classes called “The Best of Natural Birth.” She is the editor of DONA International’s eDoula newsletter. A longtime writer and business woman, she also works as a consultant for organizations and birth professionals.

 

Filed Under All Recent Articles, Birth, Birth plans, Choosing a care provider, Healthy Birth Practice, Homebirth, Induction, Pregnancy, Working with a doula Tagged With cesarean, childbirth class, doula, home birth, hospital birth, labor induction, Lamaze Certified Childbirth Educator, natural birth
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