Approaches to Birth
Prepared childbirth refers to being not only physically in good condition to help provide a healthy environment for the baby to develop, but also helping a couple to prepare to accept their new roles as parents and to get information and training that will assist them for delivery and life with the baby as much as possible. The more a couple can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life. (Nothing can prepare a couple for this completely). Once a couple finds that they are to have a child, they begin to conjure up images of what they think the experience will involve. Once the child is born, they must reconcile those images with reality (Galinsky, 1987). Knowing more of what to expect does help them in forming more realistic images thus making the adjustment easier. Let’s explore some of the methods of prepared childbirth.
The Dick-Read Method of Natural Childbirth
Grantley Dick-Read was an English obstetrician and pioneer of prepared childbirth in the 1930s. In his book Childbirth Without Fear, he suggests that the fear of childbirth increases tension and makes the process of childbearing more painful. He believed that if mothers were educated, the fear and tension would be reduced and the need for medication could frequently be eliminated. The Dick-Read method emphasized the use of relaxation and proper breathing with contractions, as well as family support and education. This method influenced the most commonly taught method in the U.S. today, the Lamaze Method.
The Lamaze Method
This method originated in Russia and was brought to the United States in the 1950s by Fernand Lamaze. The emphasis of this method is on teaching the woman to be in control during the process of delivery. It includes learning muscle relaxation, breathing though contractions, having a focal point (usually a picture to look at) during contractions and having a support person who goes through the training process with the mother and serves as a coach during delivery.
Birthing Centers/Birthing Rooms
The trend now is to have birthing rooms that are hospital rooms that look more like a suite in a hotel equipped with a bed that can be converted for delivery. These rooms are also equipped with a bed and monitoring systems for the newborn. However, many hospitals have only one or two of these rooms and availability can be a problem.
The LeBoyer Method
Other birthing options include the use of birthing chairs, which make use of gravity in assisting the woman giving birth– the Leboyer Method of “Gentle Birthing”. This method involves giving birth in a quiet, dimly lit room and allowing the newborn to lie on the mother’s stomach with the umbilical cord intact for several minutes while being given a warm bath.
Home Birth and Nurse-Midwives
Historically in the United States, most babies were born under the care of lay midwives. In the 1920s, middle class women were increasingly using doctors to assist with childbirth, but rural women were still being assisted by lay midwives. The nursing profession began educating nurse-midwives to assist these women. Nurse-midwives continued to assist most rural women with delivery up until the 1970s and 1980s when their practice was believed to pose a threat to the medical profession (Weitz, 2007). Since that time, nurse-midwives have found it more difficult to sustain practices with the high costs of malpractice insurance. (Many physicians have changed areas of specialization in response to these costs as well.) Women who are at low risk for birth complications can successfully deliver under the care of nurse-midwives, but only 1 percent of births occur at home. Because 1 out of every 20 births involves a complication, most medical professionals recommend that delivery take place in a hospital. However, some couples choose to have their baby at home. About 1 percent of births occur outside of a hospital in the United States. Two-thirds of these are homebirths with midwives assisting with more than half of these. Midwives are trained and licensed to assist in delivery and are far less expensive than the cost of a hospital delivery. One-third of out-of-hospital births occur in freestanding clinics, birthing centers, or in physicians’ offices or other locations. In the United States, women who have had previous children, who are over 25, and who are white are more likely to have out-of-hospital births (MacDorman, et. als., 2010). (33)
The birth process is exciting, but sometimes a bit intimidating. Knowing what to expect can help expectant mothers to relax and enjoy the moment they have been waiting for the past nine months– meeting their newborn!
Just as prenatal development is broken down into three periods or stages, so to is the birth process (American Pregnancy Association, 2017). The first stage is the longest (up to 18 hours) and is broken down into three phases:
- Early labor
- Active Labor
The benchmark for the transition from one stage to the next is based upon how dilated the cervix is. Early labor ends when the cervix has dilated to three centimeters. The contractions are not terribly intense during this early phase. Active labor is more active. The contractions become more regular and intense. This phase ends when the cervix has dilated to seven centimeters.
The transition phase is the one typically shown in movies, where the woman is screaming. The contractions are incredibly intense and there is little break between each one. This phase ends when the cervix has dilated to ten centimeters. At this point, the woman is ready to begin pushing, which takes us to the next stage.
The second stage begins with full dilation and ends with the birth of the newborn (American Pregnancy Association, 2017). It can take from twenty minutes to a couple of hours. Usually, the first pregnancy takes the longest, because with subsequent pregnancies, the woman has experience pushing. Typically, the woman feels the urge to push. When the head finally appears, it is referred to as crowning .
Pregnancy Association, 2017). Contractions help the placenta to separate from the uterus. The doctor or nurse practitioner will typically apply pressure to the uterus while tugging on the umbilical cord. Once out, the birthing process is complete.(33)
Complications During Birth
Numerous things can go wrong during the labor and delivery. Trauma can be due to oxygen deprivation, preterm birth (prematurity), low-birth weight, and post-term birth. Unexpected c-sections can also occur. In this section we will learn about some of these complications.
Oxygen deprivation, or anoxia, prior to or during the birth process can be a result of premature separation of the placenta or the cord being wrapped around the babies’ neck causing inadequate oxygen supply. Deprivation of oxygen can result in a child having cerebral palsy — a term used for a variety of problems resulting from brain damage before, during, or just after birth. Newborns sometimes fail to start breathing immediately after being born. Risk of brain damage can result from delayed breathing of more than 3 minutes at birth. The effect of oxygen deprivation generally causes physical disabilities that tend to be permanent, as well as blindness, hearing impairments, intellectual and motor delays throughout early life. If oxygen deprivation were severe, problems will persist beyond early childhood.
Low Birth Weight
Birth weight is a good predictor of infant survival and healthy development. For a full term pregnancy (40 weeks), a healthy average weight is considered to be between 5 pounds 11 1 / 2 ounces and 8 pounds 5 3 / 4 ounces. Infants may have low birth weight because of prematurity and/or intrauterine growth retardation due to genetic makeup or an unfavorable uterine environment. Low birth weight infants face health complications: immature lungs and breathing, mild/severe cognition problems, cerebral palsy, delayed speech, and sensory impairments (visual and auditory). Infants weighing less than 2 1 / 2 pounds at birth experience more extreme long-term difficulties that are sometimes not overcome. Infants weighing less than 2 1 / 2 pounds need intensive neonatal care for survival and typically require lengthy stays in the hospital. (34)
Preterm birth is when a baby is born too early, before 37 weeks of pregnancy, regardless of birth weight. In 2016, preterm birth affected about 1 of every 10 infants born in the United States. Preterm birth rates decreased from 2007 to 2014, and CDC research shows that this decline is due, in part, to declines in the number of births to teens and young mothers. However, the preterm birth rate rose for the second straight year in 2016. Additionally, racial and ethnic differences in preterm birth rates remain. For example, in 2016, the rate of preterm birth among African-American women (14%) was about 50 percent higher than the rate of preterm birth among white women (9%).
A developing baby goes through important growth throughout pregnancy─ including in the final months and weeks. For example, the brain, lungs, and liver need the final weeks of pregnancy to fully develop. While the age of viability (when an infant can survive outside the womb) is 24 weeks, babies born too early (especially before 32 weeks) have higher rates of death and disability. In 2015, preterm birth and low birth weight accounted for about 17% of infant deaths. Babies who survive may have:
- Breathing problems
- Feeding difficulties
- Cerebral palsy
- Developmental delay
- Vision problems
- Hearing problems
Preterm infants commonly have respiratory problems due to underdeveloped lungs. Brain hemorrhaging is also a complication of preterm birth along with immature immune systems. Deficits in motor coordination, inattentiveness, overactiveness, and frequent illnesses are some of the difficulties that continue on into the primary years (McCormick, Gortmaker, & Sobol, 1990). Preterm babies are sometimes irritable, unresponsive, and suck poorly. Because of these problems, some parents become less sensitive and responsive in caring for them. Preterm babies are less often cuddled, touched, and talked to, especially those who are very ill at birth. According to Patteson and Barnard (1990), in an effort to receive a response from a baby who is passive, mothers will be overly intrusive via interfering pokes and verbal commands.
Post-term babies are infants that are born after 42 weeks. Approximately 5% of women deliver after 42 weeks. One concern of post-term babies is due to the placenta no longer functioning properly or the sharp drop in the amount of amniotic fluid. With the decrease of amniotic fluid, the infant’s movements in the uterus will squeeze the umbilical cord. In addition, the fetus has grown larger during the extra weeks in the uterus, which may cause the baby to experience difficulty moving through the birth canal. Increased risk for oxygen deprivation and head injuries occur in post-term births. (35)
Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother’s abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.
Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995. Public heath experts think that many c-sections are unnecessary. (36)
Reasons for C-sections
Doctors may recommend a c-section if she or he thinks it is safer for mother or baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:
- The mother is carrying more than one baby (twins, triplets, etc.)
- The mother has health problems, including HIV infection, herpes infection, and heart disease
- The mother has dangerously high blood pressure
- The mother has problems with the shape of her pelvis
- There are problems with the placenta
- There are problems with the umbilical cord
- There are problems with the position of the baby, such as breech
- The baby shows signs of distress, such as a slowed heart rate
- The mother has had a previous c-section (36)