With all the talk about the Duchess of Cambridge planning for a "natural" birth of England's future monarch, it's a great opportunity to talk about the pros and cons of delivering with a midwife.
In England, many more women chose to have their births attended by a certified nurse midwife than we do here in the US. After having the privilege of delivering more than 1,000 babies as a Board-certified Ob-Gyn, I have some tips for women who are considering this option.
This is by no means a scientific or exhaustive discussion on the option of natural delivery or delivering with a midwife; it is simply a birds-eye view into the discussion that I would have with you if you were in my office or clinic. I chose not to include statistics not because they aren't important, but because 60 percent means nothing to you when it will be either 100 percent or zero percent for you personally. We aren't gambling or playing the odds here; we are considering what you as one pregnant woman may want to know before your labor and delivery train leaves the station!
My words here are meant to start the dialogue you may have with your health care provider, and also to give you some insight into my thoughts as an obstetrician and mother. I hope it is helpful!
Delivering With a Midwife Does Not Necessarily Equal 'Natural' Childbirth
This is a myth that many people believe to be true. I had the opportunity and great experience of working hand-in-hand with the best midwives in NYC for four years at Roosevelt Hospital, an affiliate of Columbia University College of Physicians & Surgeons. In fact, you can say that I was partially trained in the medical specialty of Obstetrics by midwives. I learned a tremendous amount from some of the best and most experienced certified nurse midwives in NYC. (Thank you Barbara, Sandy, Jeannie and others!)
The fact is that many midwives can, will and do use the medication Pitocin, they use epidurals for pain relief, they use antibiotics when indicated and they recommend c-sections when necessary. The only procedure that midwives really cannot perform is a c-section.
There are good midwives just as there are good obstetricians. They key is finding one with a good reputation whom you trust. Delivering in an environment that has the ability to rapidly respond to emergencies in minutes is also essential, in my opinion. Using a midwife can mean having interventions just as delivering with an obstetrician can be done entirely naturally. Neither is an "all-or-none" situation. So, in many ways, in terms of the actual process of labor and delivery, midwives and obstetricians can do many of the same things.
Low-Risk Pregnancies Can Deliver With the Help of a Doctor or a Midwife
But delivering with a midwife is not recommended for high-risk pregnancies. The definition of high-risk can vary slightly so if you are not sure if you are considered high-risk, talk to your health care provider. Some examples include breech presentations, placenta previa, serious maternal medical conditions, or a history of obstetric complications in prior pregnancies.
Discuss Your Wishes and Concerns With Your Provider, but Be Flexible
The vast majority of the time, labor and delivery proceed well and according to its own schedule, with little or no need for intervention. Women were made for this! However, childbirth, like parenthood, is a dynamic physiologic process and sometimes unanticipated issues arise. Just because childbirth is a natural process doesn't mean that medical issues don't occur. Being flexible and rolling with the punches is important physically as much as emotionally. Remember the goal: healthy baby and healthy mommy.
There Are No Extra 'Mommy Points' for Delivering a Certain Way
There is so much pressure on women today: Pressure to look a certain way, pressure to act a certain way, and pressure to deliver their baby a certain way. We all need a reality check sometimes on the pressure that is put on us, and on the pressure we put on ourselves. Being a parent is hard enough, we don't need to start the scrutiny at the moment we have our first contraction. Whether the baby comes out through the birth canal, through the abdomen, or through the ear (just kidding about the ear) does not matter. It doesn't make a woman any more or less of a woman or a mother by delivering a certain way.
Explore the Mind-Body Connection of Labor and Delivery
The feat of pregnancy and delivery continues to amaze and impress me. The human body and female spirit is capable of incredible acts of strength and stoicism, and few things reflect that more than the process of having a baby. Whether you are a royal mum or a regular mom, you can trust in your spirit, and in the natural strength of your body and its power. A good way to start preparing for this fantastic experience is to explore the options of meditation, hypnosis or mind-body modeling. These methods are safe and can be incredibly effective as a method of dealing with pain during labor. The only real risk is that they won't be completely effective for you. These methods include Lamaze, the Bradley Method, and various other forms of self-hypnosis. If you are considering this for your baby's birth, I say, "Go for it!"
Minimal Intervention Does Not Mean No Supervision
Monitoring maternal and fetal vital signs during labor and delivery is important for both mommy and baby. Monitoring you and your baby intermittently versus continuously is an option. Laboring and delivering in various positions is another option. Being in different physical environments (a birthing center, a birthing tub or chair or a delivery bed) is yet another choice. One of the most exciting deliveries I ever performed occurred in a birthing center with the mom on all-fours! There was no fancy equipment - just me, my patient and our nurse. We had to rely on our knowledge, our judgment, our assessment and our communication with each other.
Everything turned out well, and my patient's labor progressed smoothly. However, it's important to remember that if there are signs that the baby or mom are not doing well, intervention is indicated to reduce the chances of serious complications to mother and baby. This may include anything from supplemental oxygen, to IV antibiotics, to various medications. In addition, there is time to the course of labor for both first babies and subsequent deliveries. When women deviate significantly from this 'labor curve' it can be a sign that the strength of the uterine contractions are insufficient and/or that the baby is not in the right position (or is too large) to navigate the maternal pelvis. Again, having trust in the medical professional who is attending your birth is key for understanding and dealing with these issues if they arise.
Get Ready for an Unbelievable Experience
Ideally, you will remember the events of your labor and delivery and actually enjoy the memories in the process. It is your unique experience and no two deliveries are identical. I try to liken the entire process to getting on a roller coaster: there may be ups and downs, some parts may inch along slowly, other parts may pass in seconds. You may scream, you may laugh, you may be afraid, you may be excited. At the end, you may be eager to do it again, or you may say, "once is enough!" Whatever your opinions, they are yours to share with your baby.
Welcome to one of life's greatest adventures. Enjoy it, baby!