Making Informed Childbirth Choices

By Barbara Behrmann, Ph.D.

(c) 2004

Giving 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.

Educate yourself on different ways of viewing birth. 

Obstetricians 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.

Studies confirm, for example, that many routine obstetrical interventions used during pregnancy and birthing do not improve birth outcomes and undermine a woman’s 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.” 

Obviously 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 you have.

Think about what kind of health care provider you want. 

Obstetricians 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 care. 

Midwives 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.

A 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.

Regardless of which type of provider you choose, it’s 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.

Explore different birth settings.   

The 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:

 http://motherfriendly.org/Ten_Questions/tenquestions.html.

Hospitals, 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. 

For more information on birth centers, visit the National Association of Childbearing Center’s 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/

Take a childbirth preparation course.  

“The 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. 

But 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. 

Gather support. 

The 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.”     

Doulas 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  women’s 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. 

Read and Learn. 

Although the number of pregnancy and childbirth books on the market seems to grow exponentially, here are five excellent choices: 

• The Thinking Woman’s Guide to a Better Birth by Henci Goer

• A Good Birth, A Safe Birth by Diana Korte and Roberta Scaer.

• Gentle Birth Choices by Barbara Harper.

• Your Baby, Your Way by Sheila Kitzinger.

• Ina May’s Guide to Childbirth by Ina May Gaskin.

Back to The Birthing Suite

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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.