Informed Childbirth Choices
By Barbara Behrmann, Ph.D.
birth is a common occurrence, but if you are anticipating it for
the first time, it feels anything but ordinary. Little in life affects
you profoundly as becoming a mother. Although the choices you confront
may seem overwhelming, a little education, introspection and planning,
can make the road much easier to navigate. Take charge of the trip
by considering the following few issues.
yourself on different ways of viewing birth.
are trained to view pregnancy and childbirth as medical conditions
requiring treatment and intervention, while midwives tend to see
them as natural, healthy and normal occurrences. This philosophical
distinction is significant and affects how your pregnancy, labor,
and birth are managed, as well as what kind of outcomes you have.
confirm, for example, that many routine obstetrical interventions
used during pregnancy and birthing do not improve birth outcomes
and undermine a womans ability to give birth naturally. And
a single intervention such as inducing labor may set into place
an entire cascade of interventions, often culminating in a C-sections,
half of which are medically unncessarily. C-sections have been skyrocketing
in recent years 29.1% in 2004. That means your odds are close
to one in three! Sociologist Barbara Katz Rothman refers to this
as an epidemic.
there are situations when technology and interventions save lives.
But how a health care provider views pregnancy and childbirth
not to mention women - can dramatically impact the kind of experience
about what kind of health care provider you want.
are surgical specialists and their expertise is clearly needed in
high risk situations. While the majority of women in the U.S. today
receive obstetrical care, such expertise is typically not required
to manage healthy, normal pregnancies. In fact, outside of the United
States and Canada, explains, Marsden Wagner, neonatologist, perinatal
epidemiologist, and former director of Maternal and Child Health
in the European Regional Office of the World Health Organization,
the majority of women receive not obstetrical care, but midwifery
are qualified health care professionals, trained to assist healthy
women with normal pregnancies and births. Some are CNMs, (certified
nurse-midwives who are registered nurses with additional education
in midwifery), and others are independent midwives with differing
credentials. Some are CPMs (certified professional midwives) and
some are CMs, (certified midwives), but both follow programs leading
to national certification. And all are trained to act in emergency
situations and recognize problems requiring the consultation or
care of a physician.
third alternative is a family physician. Although fewer family doctors
do deliveries than in years past, approximately 25 percent offer
obstetrical care for healthy women with low-risk pregnancies. Their
approaches vary considerably, as does their reliance on medical
and technological intervention.
of which type of provider you choose, its important to find
the setting and practitioner with whom you trust and feel comfortable.
Explore all your options, sit with the information, and then listen
to what your heart tells you.
different birth settings.
vast majority of U.S. births take place in hospitals. If this is
your choice, find out ahead of time what options are available and
who can be with you during labor and birth. The Coalition for Maternity
Services, a coalition of individuals and national organizations
working to promote a wellness model of maternity care, recommends
asking what happens during a normal labor and birth and finding
out how often various procedures are performed, such as labor inductions,
episiotomies and C-sections. A list of ten helpful questions to
ask is available at:
however, are not the answer for everyone. Birth centers and home
births offer women with normal pregnancies the option of more individualized,
personal and intimate birth experiences. Many people shy away from
home births fearing they are not as safe as birthing in a hospital.
Numerous studies in scientific and medical journals, however, conclude
that for low-risk women, planned home births are associated with
fewer interventions, lower costs and equally safe, if not safer,
outcomes than those of physician-attended, hospital births.
more information on birth centers, visit the National Association
of Childbearing Centers web page at: http://www.birthcenters.org/.
For more information on home births, as well as midwives, go to
Citizens for Midwifery at http://www.cfmidwifery.org/
a childbirth preparation course.
difference between taking a class and not taking one can mean the
difference between a vaginal birth and a cesarean for something
as simple as the positions you choose for your labor, explains
Barbara Hotelling, Past President of Lamaze International, the oldest
childbirth education association in the U.S.
look around. Some classes are designed simply to prepare you for
what to expect in the hospital setting, while others aim to empower
you to be active participants throughout pregnancy and birthing.
Likewise, instructors training may differ. Those trained with
organizations such as Lamaze, Bradley, Birthing From Within, and
Birthworks, understand the distinction between normal birth and
medicalized birth. Hotelling recommends speaking with several instructors
before making a decision.
focus in our culture is on the birth of a baby. Little attention
is given to the birth of a mother. If at all possible, surround
yourself with supportive people and think about who you would like
to have with you at the birth. "Birthing women need loving,
reverent support, asserts psychologist and doula, Lauren Korfine.
as they do the hard work of surrendering the life they have
known and crossing over into motherhood.
offer emotional and physical support during labor and childbirth,
as well as postpartum support. Studies show that the presence of
a birth doula can result in shorter labors, less need for pain medication
and intervention, and lower C-section rates. It also increases womens
birth satisfaction. In other words, birthing women without someone
whose only job is to support them, are likely to have longer and
more difficult births. Doulas of North American (DONA) is a good
starting place and has the website has a link on how to find a doula
near you. Visit: http://www.dona.org/ or call 1-888-788-DONA.
the number of pregnancy and childbirth books on the market seems
to grow exponentially, here are five excellent choices:
Thinking Womans Guide to a Better Birth by Henci Goer
Good Birth, A Safe Birth by Diana Korte and Roberta Scaer.
Birth Choices by Barbara Harper.
Baby, Your Way by Sheila Kitzinger.
Mays Guide to Childbirth by Ina May Gaskin.
Barbara L. Behrmann, Ph.D. is a writer, researcher, and author of
The Breastfeeding Café: Mothers Share the Joys, Secrets &
Challenges of Nursing, University of Michigan Press, 2005. She is
a frequent speaker around the country and is available for talks,
readings, and conducting birthing and breastfeeding writing circles.
The mother of two formerly breastfed children, Barbara lives in
upstate New York. For more information, visit: www.BreastfeedingCafe.com
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.