Choices in Childbirth

Nothing is more exciting than the anticipation of a new baby in the family! A pregnancy announcement is usually followed by mother and father planning for the upcoming months and finally, the birth.

In today’s world, a choice of where and how to have a baby can be as important as choosing a name. There are few limitations on where a woman might give birth. Hospitals, Birth Centre, at home with a midwife and at home unassisted are the main choices available today.

In our western world, most women opt to give birth in the Hospital. Statistics Canada reports that 333,291 babies were born in the hospital in 2003. Babies born out of the hospital numbered at 2038. In Canada, most doctors will not attend an out-of-hospital birth for legal reasons. Hospital births are generally attended by family practitioners, Obstetricians, Obstetrician-Gynaecologists and midwives. In Ontario, British Columbia, Alberta and Manitoba, some midwives are granted hospital privileges. Quebec. Saskatchewan, Newfoundland, and Nova Scotia are working on integrating midwives into the hospital system currently. Of the provinces that allow midwives to attend hospital births, Alberta is the only one that has yet to approve funding.

For those choosing a family doctor to attend their birth, sometimes the doctor will not be at the actual birth, but whoever is on call will be sent to attend. It is important to be aware of the local hospital and physician’s policies before deciding on this route. Women who are considered high risk are often sent to an OB or an OB-GYN. Often this will entail more monitoring. High risk means that the physician feels that some condition might put her or her baby at risk for complications during pregnancy or the birth. This might include previous caesarean section, history of complications, pregnancy-induced hypertension or pre-term labour.

Hospitals also have policies which staff are expected to follow when a labouring mother is admitted. This might include intermittent foetal monitoring (this would require the mother to stay supine for an extended period of time), limitations on length of labour, frequent internal checks, rupture of the membranes at a certain point in labour or in some cases, “prep” (where the mother is shaved in her pubic area and given an enema). This last is very uncommon in most hospitals, but is still present in some smaller towns. Remember though, that these policies are not set in stone. One can request that any or all routine procedures be skipped or delayed. It is important to have a birth plan that the physician, birth support and the hospital staff are familiar with. It is very useful to have birth support, for example a doula, someone who not only offers help and comfort, but who can act as an advocate in a hospital setting.

In the hospital, one has the range of completely drug-free, non-interventive birth to caesarean section where the mother might be under general or local anaesthetic. The fewer interventions a mother has, the less likely she is to end up with a caesarean section.

Another growing choice in childbirth is use of a birthing centre. A birthing centre has all the amenities of the hospital with a more homelike atmosphere. Rooms are mostly private, the mother and her support are generally left to labour without much interference and the birth is more often attended by a midwife. Women who are not prepared to do without the choices offered in the hospital, but who desire a more comfortable and homey environment often choose this option. Predominantly births are more natural in a birth centre, but there is more likelihood of some interventions. It is still important to have a birth plan and good birth support.

More women are choosing homebirth with a midwife attendant today. These women commonly desire more control of their birth and believe birth to be a non-medical event. They choose midwives to attend them in their own homes for various reasons. Midwives carry their own equipment, everything necessary for a birth, which may include herbs, some approved drugs, a baby scale, oxygen equipment and Doppler for heart monitoring. Prenatal visits are generally more frequent as are post-natal visits. Most midwives approach birth from the health-generated perspective while the medical profession have a tendency to approach it from a pathological model. This more laid back, health oriented attitude is appealing to many women.

Another less known choice is unassisted homebirth. More women and families are choosing to have their babies at home without a doctor or a midwife present. These births can range anywhere from a solo birth to a family birth, to a birth with family and friends present. Often these women choose UC after having given birth in the hospital, one or more times. Generally a traumatic birth has created a desire to learn how to heal from that experience and research and education has brought them to this experience. Other women decide to have an unassisted birth before giving birth in any other fashion. An unassisted birth can be preceded by usual prenatal visits to a doctor or a midwife or self-prenatal care only. During the birth there is a lack of usual hospital procedures such as frequent monitoring with a foetal monitor, frequent internal checks, options for drugs such as epidurals, demerol etc. An unassisted birther has more choices in positions to give birth in and what to do during labour, including actual birth location and movement in active labour. A desirable trait in unassisted birth is the autonomy such a choice brings.

There are many misconceptions concerning the safety of homebirth (whether is be unassisted or with a midwife present) versus hospital birth. Studies have shown that both options are equally safe and that the true measurement of safety is dependant on only two factors: Nutrition and birth support. Other criteria that can be added are individual education and personal preparation.

Whichever choice a mother makes for her birth the most important thing to remember is that she is always in charge of what happens. Leaving the decision making of any aspect of the pregnancy, labour or birth to an outside attendant is counterproductive. When anything is presented during pregnancy or during birth, an opinion or a diagnosis, it is not only valuable, but crucial to research all the options, gain individual understanding of what is being proposed and make decisions based on the findings. This research needs to be done before labour begins so decision making will be made easier. It is almost impossible to make educated choices during active labour without prior exploration. The onus is on the mother and sometimes the father to do this work. This shouldn’t be left in the hands of a doctor, midwife, doula or other labour support. Their role is to support the choices the birthing couple or woman has made. In any event, the important factor is to create the experience and atmosphere that is most conducive to the peaceful and gentle arrival for the baby.

Happy birthing!
Written by Mary Seiver, CBE, NFP.
This Article originally appeared in Mother's Milk Magazine.