There are no guarantees in labor and childbirth, but making decisions that support your body’s ability to birth your baby will help you have the safest, healthiest labor and birth possible. This week’s guest blogger, Carol Ward, MD, addresses the importance of expectant mothers creating a well-thought-out birth plan, and finding healthcare practitioners and birth facilities that support that very plan – from start to (no cesarean) finish.
“She had a cesarean section.” How often have we heard that phrase? In the last 50 years, the cesarean rate has gone from 5 percent to 30 percent (and higher). There are many reasons why cesareans are performed, but far and away the most common reason for cesarean is “failure to progress” or “cephalopelvic disproportion” or “obstructed labor.” These overlapping terms basically all suggest that the baby is too large for the pelvis, or the power that the uterus is generating is not enough to mould the head through the pelvis. Clearly, women’s pelvises have not grown smaller, lost the natural hormonal ability to conjure up labor, and become totally dependent on the knife. In many cases, a longer trial of labor, stronger contractions, better maternal positioning during pushing or just patience might have produced a different outcome. So what on earth is going on? The answer lies in a complicated list of medical, social and attitudinal factors, for which we all share responsibility. How can you shift the odds in your favor for having a vaginal birth?
First, it’s important to identify everything that you wish to strive for during your labor and delivery:
- Is a vaginal delivery important to me? Am I prepared to go through 18 hours of labor, with or without pain relief, to achieve that end? If your answer is “Yes,” careful shopping for a caregiver with a proven track record of vaginal delivery is essential.
- Do I, as a woman, shop for caregivers with technical skill and cesarean section rate in mind, or am I inclined to choose based on charm, pretty labor suites and convenient office parking? (Sometimes the experienced, cranky, grey-haired male doctor is the one who understands labor really, really well.)
- Am I prepared to expect hard work in labor, or when the going gets tough, am I going to be tempted to ask for an epidural or cesarean? The cesarean rate goes up in proportion to the epidural rate in most hospitals.
- Am I too rigid about my expectations? Do I want to be in complete control? Sadly, you’re not. Good labor, like good sex, involves letting go! Mother Nature is in control, and she’s a wise old lady.
- Am I willing to hire a Doula? Sadly, your poor, inexperienced mate may not make a good doula. There is clear evidence that patients with doulas at the bedside have a much lower rate of regional anesthesia and cesarean section than do their unsupported sisters.
- Am I taking care of myself through the pregnancy – eating right, resting enough, staying active?
- Am I working too hard? Am I getting enough rest? If you go into labor tired, you will run out of gas and bail out prematurely. And if you don’t get some horizontal time during the day as term approaches, you may develop decreased amniotic fluid, an open invitation for intervention.
- Am I set up to expect my labor on the “due date,” after which I also lose patience? The normal first pregnancy is usually closer to 41 weeks, if we don’t intervene. Induced labors are associated with far more cesareans. If the cervix is not nice and soft and ready, pitocin just won’t work well. Try like mad to avoid inductions, and certainly don’t ask for one!!
- Have I been “set up” to fail in labor by being told I have a small pelvis? Babies are designed with nice soft heads to fit through tight spaces just for this reason, you know! Or the “everyone in my family has cesareans” excuse. Or the “I have a low pain threshold” fear. Family mythology is so, so powerful!!
Now that I’ve made you dig deep, it’s your turn to do the grilling! There are certain questions that all expectant mothers should ask their healthcare providers and the facility where they’re planning to give birth. To have your best birth, you should be completely satisfied with each and every answer given (don’t settle)!
- What is your cesarean rate? This is a loaded question, but the answer is important in your decision to choose a provider and birth facility.
- What is your induction rate? If natural labor is more functional labor, can we follow my overdue pregnancy or slightly low amniotic fluid with testing, and not jump right into induction? Can I buy three or four extra days?
- Do you encourage your patients to move and change positions during labor?
- Do you use intermittent fetal monitoring, or keep patients on the monitor continuously? (As long as your labor is normal and the baby shows no signs of distress, there is no reason you need to be nailed down to the bed.)
- Do you try to turn breech babies? The answer should always be “Yes.”
Parenthood teaches us flexibility — we might as well start during labor! Ultimately, it is a healthy baby that you want, no matter what crooked path you may have to take to get there. At the end of the day (or two), knowing that you gave it your best, you’ll be holding a beautiful baby in your arms — a baby your body created, nurtured and birthed — and nothing compares. Nothing.
Mother, wife, mentor, teacher, writer, gardener, seamstress, advocate and obstetrician – Carol Ward has a private practice in Portland, Maine, is an assistant professor at the Vermont School of Medicine, and adjunct assistant professor at Dartmouth Medical School. Carol attended Case Western Reserve University School of Medicine and completed her residency at Maine Medical Center. She served as chairman for the Division of OB/GYN at Mercy Hospital, Maine from 1997-2004, and is currently a board member of Planned Parenthood Northern New England.