Approaches to childbirth

H aving babies is no longer the hazardous business it used to be a century ago. Many women weren’t then afforded the luxury of a choice between a home or hospital delivery. The baby would be delivered in a bedroom by the midwife. Without electricity or running water and without modern drugs and instruments the birth would probably have been painful for the mother and almost certainly hazardous to both mother and child.

There have been dramatic changes since then. Labour can be painless and the baby can be delivered on a chosen date. If he is born sick, he will no longer have to fight alone for his life, there are now machines to help him. All this, and more, is now available. But, as technology marches on, some parents and doctors have started to question whether a return to more ‘natural’ methods of childbirth would be better both for the mother’s physical health and her emotional well being.

In an ideal world, happy healthy babies would be born every time and giving birth would always be an uncomplicated business requiring only mid-wife, mother and a baby who’s ready to be born. In most cases this all that’s needed and the baby who’s born in hospital is lucky in that he doesn’t need the incubator, the intensive care unit or any of the specialized medical attention which is to hand. But, until a baby has actually been born, there’s no way of knowing whether or not such facilities will be needed.

In the early stages of a woman’s pregnancy a number of tests may be used to try and establish her baby’s shape, position and whether he appears to be healthy. All the indicators may show mother and baby to be in good shape. Indeed, the first stages of labour may go without a hitch but then something unpredictable and unexpected may happen. The baby may show signs ofhis heart-beat may be irregular or show signs of slowing down. The mother may start to haemorrhage after she’s given birth. Such things don’t often happen, but when they do specialized medical attention and equipment will be needed and this is something which only a hospital can adequately provide.

Ir a similar situation were to occur during a home birth, the chances of both mother or baby surviving are going to be reduced. This is not to doubt the expertise of your doctor and the midwife who’s attending you. It’s just that it’s not possible for transfusion or resuscitation equipment to be installed for a home birth. And, although most areas are serviced by an obstetric flying squad which can be called up if complications do occur, the time before its arrival may mean vital seconds are lost.

Most babies who are born at home are delivered safely; out of every 1,000 births in England and Wales, for example, only five die. The perinatal mortality rate – the number of babies who die during birth or within the first week of life— is low because only the healthiest mothers, having the best antenatal care, are advised to have their babies at home. Some 5 per cent of expectant mothers in England and Wales feel the advantages of a home birth outweigh the slight risks and opt to have their babies at home. Just over 1 per cent of women in America do so, and the figure is even lower in Sweden and Australia.

However, if you do decide you’d like to have a home delivery, it won’t only be your feelings that count. The baby’s physical well-being will also have to be assessed, something which your doctor will be able to establish.

Some women come under a high risk category which makes hospital delivery vital there are complications. Into this category come women who are over 35, those suffering from diabetes, high blood pressure or other illnesses and the woman who’s expecting her first child. In the animal world the perinatal mortality rate among first-born sheep, cows and dogs is so high that farmers tend to regard the first pregnancy merely as a warm up to the second, usually successful one. Of course perinatal mortality isn’t anything like as high amongst first-born humans, though the contrast between first and subsequent births is still present There are 23 deaths per 1,000 births for first babies compared to 16 per 1,000 for second babies. Birth simply gets easier the second or third time round. For a start you know what’s going on and are familiar with the routine so breathing and relaxing properly should be easier. More importantly, the birth canal will also be slightly different from the one your first baby encountered. With the first it’ll be muscular and rigid and will consequently hinder the baby’s descent With subsequent babies it will be slightly more flexible, making labour easier.

Do most women feel a home birth is a happier experience? Most women feel that birth is a happy experience wherever it takes place, providing the end result is a healthy baby. You may feel happier at home because you’re in your own bed – perhaps the same one in which the child was conceived— and the familiar surroundings can greatly add to feelings of security. There’s a privacy at home which no large hospital could ever hope to match. If you have other children you won’t have to be separated from them. There are practical advantages, too, such as not having to travel.

Generally, women who opt for a home birth do so because they feel it’ll be a more emotionally satisfying experience. But, although it can be argued that medical staff are obviously going to be more concerned with the physical well-being of mother and child rather than with providing emotional support, more and more hospitals are making their maternity wings brighter and more attractive places to be in.

Approaches to childbirth are changing, too. No longer is it routine for babies to be whisked away as soon as they are born, to be returned to their mothers only when feeding time arrives.

Increasingly, a cot is kept by the mother’s bed so she can feed and touch her baby when they both want this. Fathers are encouraged to be present during the birth – one hospital even makes it routine to position an armchair behind the father just in case he’s overcome by the proceedings! In another hospital, immediately after the delivery, the medical staff leave the room, leaving mother, father and baby together so they can enjoy the first hour or so of a new life quietly together as a family.

Of course, hospitals are going to differ in their approach — one may welcome anything innova-tive, another may regard all variations on the usual routine as a nuisance. Before you’re due to go into hospital, find out how far the staff are willing to go in accommodating your wishes. Talk things over with the obstetrician who’ll be attending you.

What is natural childbirth? Does it mean a pain-free birth? Natural childbirth simply means a labour which doesn’t require any medical intervention – no anaesthetics, induction, episiotomy, no forceps and no Caesarean – just you and the baby working together to push the baby out. It’s based on the idea that if a woman knows exactly what’s happening to her body during the different stages of labour, she is likely to experience less anxiety and pain, and can control- even enjoy the birth.

Natural childbirth relies considerably on how you breathe and when you push, techniques which you will need to be taught in antenatal classes. But other factors, too, which no amount of preparation will be able to influence, are also important — how the baby’s head is positioned, for example. Ideally it should be head first and facing your back. The size of the baby is significant- if he’s too big, he may be impossible to push out without medical assistance. Ideally, also, labour should start between the 37th and 42 nd week from the first day of the last menstrual period. If the baby is born much later or earlier there may be complications making medical assistance vital.

Women who give birth without medical inter-vention regard it as a more emotionally satisfying experience. Quite naturally, they feel a stronger sense of achievement when it’s their uterus which has done all the work.

The advocates of natural childbirth say that labour doesn’t need to be painful, or certainly not painful in the way you’d recognize the sensation of a smashed rib, say, or a badly crushed finger. They believe that the right attitude, correct breathing, knowing when to relax and when to push, and being aware of what’s going on can all help to create pain relief without the need for drugs or injections.

However, natural childbirth can’t guarantee a pain-free labour. Some women are more sensitive to the pain of birth than others- everyone has a different pain threshold and, even if you’ve completely mastered all your breathing and relaxing techniques, this is no guarantee that the birth will be painless. In fact, the only way to such a thing would be to have an an injection which numbs the body from the waist down but leaves you fully conscious. Lots of women do, in fact, opt for some pain relief.

The idea that natural childbirth must be painless stems, in part, from the notion that women in primitive societies are capable of having babies without fuss, bother and pain. It’s argued that because these women haven’t been culturally conditioned into expecting childbirth to be painful, it isn’t. Because, too, they have children with more frequency and from an earlier age, the experience becomes a familiar one which is gone through without fear. Anxiety and tension do tend to make pain feel worse than it actually is.

But it’s difficult to generalize. Just because women in a primitive society don’t have access to epidurals, it doesn’t mean to say they wouldn’t ask for them if they could. They do, in fact, use herbs and plants as pain relieving agents during labour which suggests that it’s not the entirely painless procedure it’s made out to be. It’s perhaps also significant that the number of babies who die during, or immediately after, birth in such places is extremely high, as is the number of women who die in childbirth through lack of proper medical facilities.

No, not necessarily. You may start your labour to use natural childbirth methods but it may become clear to you and the medical staff who are looking after you that you’re going to need assistance in delivering the child. Alternatively, you may yourself decide that you’d like pain relief after all, it’s not always possible to predict such things in advance.

There are several ways in which an obstetrician may help a. woman to deliver her baby more quickly. While every woman has a right to say whether or noi she wants this type of assistance it’s important to bear in mind thai a labour lasting longer than 12 hours can be bad for mother am 11 abv. 11Nderstandi ilg the advantages and disadvantages of the medical procedures and in which way each is designed to help in the delivery, as well as will help you to decide just how much medical assistance you want.

There are several reasons why doctors may need to interfere to speed up or bring on a labour, and generally they are in the interests of both mother and baby. The monitoring which goes on during labour means that any abnormal patterns can be detected early and corrected. For example, very few women are able to put up with 12 hours of contractions and backache with a baby facing the ‘wrong way’ without wanting some form of pain relief. In the same way, three days of weak, ineffective or irregular contractions can be dangerous to both mother and baby. She will be exhausted, and probably unable to put in a final effort to push the baby out. The baby itself may also become distressed, suffering through a depletion of oxygen. Many obstetricians feel that any labour which continues for longer than 12 hours is going to be bad for both mother and child; others consider even 12 hours as being too long.

In cases like this an obstetrician may decide to speed up the labour by giving the mother an This, like the hormone produced by your own brain, has the effect of increasing the strength and frequency of the contractions and thereby causes the (the neck of the womb) to dilate, allowing the baby’s head to pass through.

If your baby is overdue it is probably in your best interests to start the delivery with some medical assistance. With late babies there’s a danger that which supplies the baby with its nutrients, may be ageing and unable to perform its function so well. Many obstetricians believe that any pregnancy that continues for longer than two weeks after the estimated delivery date ought to be helped on its way. If the membranes- the sack of fluid which surrounds the baby- haven’t ruptured, this can be done by making a small incision with an instrument. This may be the only assistance that a mother needs and. She may then be able to complete the delivery herself.

An is a surgical incision made in the vaginal muscle so that the baby can pass out of the vaginal opening more easily. Without an episiotomy the baby’s head pushes on the mother’s vagina, until the pelvic floor muscles relax sufficiently to allow it to pass through. With a baby showing signs of foetal distress when speed of delivery is crucial, this simple cut will generally be made. Some obstetricians believe this should be routine for all women having their first baby because, by cutting the birth opening, the stress is removed from the vaginal muscles and this will make prolapse in later life less likely.

There’s a considerable controversy going on at the moment over whether these, and other methods of speeding delivery, should be carried out or whether ifs best just to leave the whole process to ‘nature’. Some people argue that since technology has entered into the deliver)’ room many mothers have been robbed of the chance to experience the full emotional and physical impact of giving birth. They argue that the baby doesn’t arrive when it’wants’ to arrive, but comes when the doctor decrees. Episiotomies are given, they say, when instead it would be better to either wait for the vaginal muscles to fully relax, or to allow the baby to push its way out naturally. This way the baby determines the size of the tear and whether there’s to be one.

There are equally valid arguments from the other side. While it may be untrue to say that doctors know best, nature is likely to be even more fallible. For this reason, many parents feel more confident when they know that the very best technological equipment is going to be used to bring their new baby safely into the world. Lots of women want some pain relief during labour. Analgesics, such as numb the muscles but leave the mother awake and able to continue to contribute to the deliver)’ of her child. Epidurals are also popular, although, because the mother feels nothing below her waist, there is a slightly increased risk that she will be unable to push the baby out herself and a forceps deliver)’ may be necessary.

As for the controversial use of episiotomies, before they were as common as they are today, the birth opening was left to stretch for hours to avoid a tear or allowed to tear randomly. Con-sequently muscle was devitalized, nerves destroyed and prolapse was more common. Technological developments such as machines which monitor the progress of mother and baby now allow a baby’s journey down the birth canal to be charted continuously. The size of the cervix, the frequency of contractions, the mother’s blood pressure and the foetal heart rate are all recorded so that the pattern of labour can be observed and compared to the’average’ labour. By using such monitors, doctors can see problems early and correct them.

If the obstetrician decides that your baby needs to be induced then there will probably be a good reason for it and it’s unlikely to be something that’s done for the convenience of the medical staff However, it’s important to remember, too, that you always have a right to know what’s going on and, generally, your obstetrician should be willing to tell you.

Yes, this may occasionally happen, but generally with good reason. Sometimes the birth process can proceed very quickly. Occasionally there may not be time to ask a woman if she wants an anaesthetic nor even time to explain what’s happening. If the mother has suddenly become unconscious due to a haemorrhage, say, the medical staff who are attending her will have to act very rapidly to deal with the emergency and, in some circumstances, to save her life.

The important thing to remember about giving birth is that ifs often full of surprises -generally nice ones; finding out whether the baby’s a boy or a girl; whether it has dark or fair hair and seeing whether it bears any resemblance to other members of the family. You may even be surprised lo find that, although you may have expected your labour to be a long, drawn out and painful one, it’s quite the opposite. Keep an open mind about things. Don’t resolve in advance to refuse pain killers; rather wait and see how things turn out. After all, labour shouldn’t be an endurance test No woman should ever be made to feel guilty about the fact that she wants pain relief during childbirth.