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Have a Choice: Alternative Birthing Methods
Atlanta Parent Magazine
by Sharon Morioka
http://www.atlantaparent.com/may2004-art4.html
Before her son Alex was even conceived, Dawn Cone knew she wanted a “waterbirth.” Water seemed to be the most natural and supportive environment for her baby to enter the world.
“As soon as I heard about it, I said that makes sense because when the baby's in utero, the baby's in water. And the transition from the womb to the world, from water into water, resonated with me.”
But after several calls to metro area hospitals, she was disappointed to learn that waterbirth has yet to become mainstream. She started to get discouraged until she learned that North Fulton Regional Hospital had a birthing tub as well as midwife who would support the birth. “I was just elated,” she says.
In a traditional birth, still the most common in this country, a mother is attended by a doctor and other hospital support staff. The father and even other family members can be present. During this type of birth, the mother starts in a labor room, then proceeds to a delivery room. To help her deal with pain, she can receive pain killers such as an epidural, and labor may be induced or a cesarean performed.
While alternative birthing methods such as waterbirth are not as common as traditional birth, they are the preferred method of mothers who want a more natural experience. Techniques such as waterbirth, hypnobirthing and acupuncture provide these mothers with options.
Rob Tackitt, a doctor with OB/GYN Associates at Kennestone Hospital, acknowledges the benefits of alternative birthing methods for those mothers who want them. “Labor is at least 50 percent psychological, and if you go in positive, that makes a huge impact on the way the whole process goes. These different methods are ways of dealing with physical and emotional stress.” He adds that it is very important that mothers have a baby in a standard delivery room or birthing center in case an unexpected emergency occurs.
Waterbirth
Midwife Margaret Strickhouser, who assisted Dawn and husband Bobby in Alex's birth last May, was skeptical when she first heard about waterbirth several years ago. “My initial response was, ‘Oh, that's some hippie thing they do in California.' ” But five years ago, a mother whose labor she assisted was in a bathtub for comfort and relaxation when the baby unexpectedly popped out. The mother, who had given birth three times before, experienced none of the burning she had with previous deliveries. “She just sank down in the tub and relaxed and they brought the baby to her and she nursed,” says Strickhouser, who has been practicing waterbirth ever since.
Waterbirth takes place in a special tub that is about three feet tall and large enough for both the mother and the father. It has seats and supports for the parents, who might be in the tub for several hours. The warm water is soothing and provides buoyancy to help the mother shift to more comfortable positions. “When they have a contraction, it's still uncomfortable but it's more bearable,” says Strickhouser.
The tub is in one of the hospital's regular labor rooms with all of the regular equipment. “It's just a standard delivery room you'd see anywhere in Atlanta,” she says. However, the practice of waterbirth has not become standard in this community. “I think that the majority of labor and delivery units are not geared toward waterbirths.”
She says that the biggest concern of people who don't know about waterbirth is whether the baby will breath upon delivery and possibly drown. “When the baby comes out, it's the air on the baby's face that makes them cry,” says Strickhouser. She says drowning is not a danger before the baby is initially exposed to the air.
While she has had good experiences with waterbirth, she doesn't actively advocate it to her patients. “And I tell them I have the last word whether they deliver with waterbirth,” she says, in case complications arise. But she adds that she's never had to get anyone out of the tub in the few hundred waterbirths she's assisted.
Hypnobirth
For most of us, our impressions of hypnosis have been formed by comedy skits – watching mild mannered people cluck like chickens on command or perform other zany stunts. But hypnosis can be serious business for mothers looking for a tool to help them through labor and delivery in a relatively painless way.
“They're trained how to hypnotize themselves,” says Cheryl Ann Burney, a certified hypnotherapist and hypnobirther with Hypnosis Works in Roswell. “We're teaching them how to hypnotize themselves to achieve a naturally induced state of relaxed concentration.”
Mothers communicate suggestions to their subconscious, which influences how they think during the birthing process. The body's endorphins, which are natural anesthesia, replace the stress hormones that create pain, says Burney. When it's time for the baby to be born, mothers are fully awake and involved but without the need for medication.
Before their child is born, parents attend 12½ hours of class, learning about labor pain; the father's role during the birth process; relaxation and other tools to use during labor; and related topics. Parents learn from practitioners such as nurses, midwives, doulas and certified hypnotherapists who have been trained in the Mongan Method, named after founder Marie Mongan.
Burney says there are no risks to mothers who use hypnosis during birth, which is increasingly accepted by health care providers. “It is becoming more well known and is well-received by some in the medical community, tolerated by others, and rejected in some instances by some.”
She adds that even if mothers do not give birth naturally, the preparation they receive with hypnobirthing can be valuable. “Even if they end up having intervention because of special circumstances, they go through the experience more confidently and peacefully,” she says. “They learn to step out of the model of fear.”
Acupuncture
For centuries, Chinese practitioners have used acupuncture to treat problems related to pregnancy, such as morning sickness and high blood pressure, as well as problems related to labor and delivery, such as inducing labor, repositioning a breech baby, and relieving labor pain. And while conventional health care workers in this country increasingly use acupuncture for a variety of ailments, its use in the Atlanta area for childbirth is rare. However, a tenacious mother in search of an acupuncturist has some choices.
“Women who want an unmedicated labor can use acupuncture,” says Li Liu, a practitioner of traditional Oriental medicine and a licensed acupuncturist in Atlanta. While Liu performs acupuncture in her office for pregnancy-related ailments, she is not present in the labor and delivery room. Instead, she teaches the mother and her partner beforehand so they can perform acupuncture or acupressure while in the hospital. Usually the husband, wife's mother or other family member or friend performs the procedure.
The fact that so few mothers have the option to use acupuncture during childbirth is due to liability issues. However, Liu says that there are no risks associated with the process. “It's very natural and noninvasive.”
Still Not Mainstream
Medical liability is a serious problem for doctors and, increasingly, midwives. Therefore, it might be difficult to find a provider who will allow an alternative method such as waterbirth or acupuncture despite a practitioner's assurance of its safety and a mother's wish to have that alternative available.
In this climate, “many doctors might not want to discuss these alternatives,” says Tackitt. He suggests that mothers interested in alternative birthing methods do the initial research to determine the method that most appeals to them and then discuss it with the Ob-Gyn. Some might be open, depending on the method.
Others, he says, might not. “Be prepared to find another provider if necessary.”
Tackitt says everyone has the same goal in the birthing process: a healthy baby. “Nurses and doctors are used to allowing patients make all the safe choices they can. We just have to make our methods coincide.”
The Role of Midwives
On a woman's journey through pregnancy, labor and delivery, the role of a midwife is to guide the mother so she can make the best choices for herself and her child. “A lot of times we get on a journey and sometimes we run into a fork in the road,” says Catherine Salazar, a certified nurse midwife with Kaiser Permanente of Georgia. “My job is to guide them along. The support and involvement is really unique.”
Midwives – both certified nurse midwives and certified midwives – make it their job to focus on the mother and her needs from their initial meeting through delivery several months later. Salazar sees her patients every four weeks until their 28th week, every two weeks until their 36th week and then weekly until delivery. “We see them for their first visit and give them intensive information about nutrition and issues that arise early in pregnancy [such as nausea],” she says.
“For labor and delivery, our focus is on the individual and family for physical care and emotional and social support,” says Salazar, who adds that she provides her service according to the values and personal preferences of the mother and her partner. She says one of the first things she asks a mother in labor is whether she has a birth plan or anything specific she wants to do.
The midwife also relies on her intuition to know where a patient is and wants to be in the birth process. “For example, sometimes you go into a room and the patient's working with her husband so well, I may not be as physically present because I feel like I'm intruding. There are other times when I feel I have to be right there at the bedside.” When she is bedside, she provides alternatives to the mother, such as getting into a tub of water or finding the best physical positions.
The inclusion of a midwife in the process doesn't necessarily result in the exclusion of a physician. As a certified nurse midwife, Salazar works in collaboration with physicians so, if a problem arises that's beyond her area of expertise, they can find the best solution. But while a physician cannot remain with the mother throughout her labor and delivery, a midwife can.
Another advocate for the mother during labor is a doula. While a midwife oversees the entire labor and delivery, the doula is a professional who is focused solely on providing labor support to the mother. She might help her with her breathing, massage her back, and provide words of encouragement.
If you're interested in finding a midwife in your area or in learning more about midwives, visit the website of the American College of Nurse-Midwives at www.midwife.org. For more information about doulas, visit Doulas of North America at www.dona.org.
Nurturing Mom Doula Services information available for birthing couples and post-partum Moms in the Albuquerque, NM area.
Positive Human Dynamics, Ltd
1453 Rio Rancho Blvd., Ste E Rio Rancho, NM 87124
(505) 892-1313 www.posihd.com