Practices That Promote Safe, Healthy Birth

I recently re-read The Official Lamaze Guide and I was impressed with how much it resonates with me and my own philosophy of birth.  Similarly to Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, the authors of the Lamaze Guide are able to use a few simple principles to help women move towards the best possible outcomes for themselves and their babies.

They explain that up to 95% of women should have 'no-risk' pregnancies and be able to give birth safely, without the need for interventions.  If this is the case, why are so many women being labelled 'high-risk' and even those who are 'low-risk' ending up with all kinds of unnecessary interventions and births that are not what they had hoped for?  Simply, it is because we (parents, medical practitioners, support people and the general public) need to remember that birth is a natural part of life and that even the most subtle interference can have an a major impact.

The authors cite a lot of research, especially work that can be found on the Cochrane Library database, which proves that many routine interventions do not improve maternal and infant health and in many cases are potentially harmful.  They distill this research in a way that is easy to understand and, more impressively, in a way that supports their common sense birth practices. Most pregnant women will read this book and feel more confident in themselves and their ability to give birth in a safe and healthy way.

SIX PRACTICES THAT PROMOTE SAFE, HEALTHY BIRTH

Let Labour Begin on its Own:
Medically speaking a term baby is between 37-42 weeks gestation.  Many doctors encourage their patients to induce labour between 40-42 weeks or even earlier.  Usually there is no medical indication for this..  Many women at this point are understandably tired of being pregnant and misunderstand their doctor's encouragement as a medical necessity.  If your doctor suggests induction before 42 weeks, ask what the medical indications for induction are.

Sometimes women will be told that there is a risk of their baby being too big (macrosomia). It is important to know that this is not a true medical indication for induction (or for c-section) and that means used for establishing the size of a baby have a margin of error of more than 25% or more.  This means that your supposedly 10 pound baby could end up only being 7.5 pounds.

It is important to know that there are  risks to being induced and it can also negatively affect the birth experience, as most induction methods affect the body's natural ability to cope with pain.

See Lamaze International for more on letting labour begin on its own.

Walk, Move Around and Change Positions Throughout Labour
This one seems kind of obvious, but sometimes labouring women don't want to move.  They either find a position that is comfortable or they are uncomfortable and concerned that changing positions will make it worse.  The authors say the one of the purposes of pain in labour is to encourage us to move, find a new comfortable position and move the baby down.  The best thing to do is trust your body and ask for help from your support people if you want to try something different.

Obviously, the more interventions you have the move difficult movement can be.  In Lethbridge, you generally will not be allowed to move much if you have an epidural, but you should still be able to switch from side to side. If you are induced or labour is augmented with Pitocin, you will be required to wear the monitor most of time.  You can still get creative changing positions in and around the bed.


Bring a Loved One, Friend or Doula for Continuous Support
It is essential that your support people understand and agree with the type of birth experience you want.  Especially if you do not have a doula, the need to be well prepared and ideally have previous experience with birth.  Childbirth education classes can be really helpful and I hope to be offering them starting in the summer or fall of 2011.  Please contact me if you are interested.

You know best who can support you best during your birth.  In the Lethbridge Hospital there is a rule of 2 support people, which means you may have to choose between a family member and a doula.  If you choose a family member or friend along with your partner, try to envision how you would like them to help you during the birth.  Birth is very intimate and emotional and sometimes unresolved issues can come up and negatively affect labour.  Make sure personal issues are resolved before labour begins.


Avoid Interventions that Are Not Medically Necessary
Some interventions (such as IVs, epidurals, breaking your water, continuous monitoring) are done routinely, but have been shown by research to negatively affect labour (by slowing it down, increasing the need for even more interventions, increasing challenges with breastfeeding).  Make that there are good medical reasons for whatever interventions you agree to and try to come up with a compromise that will not affect your birth as much.  For example if you are Group B strep positive and need antibiotics, request a Hep(arin) lock to receive your antibiotics.  This way you can still move around freely without an IV pole and receive medication only when you need it.


Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push
The Lethbridge Hospital has squat bars that attach to the bed and these can be very effective for some people.  You might have an idea for a position to try, don't be afraid to ask, or even move into that position (with help from your support people).

Sometimes women are asked to wait before they start pushing and this is difficult to impossible for most.  In a non-medicated birth the urge to push for most people is overwhelming.  Once you are pushing, medical staff sometimes make suggestions for pushing.  Sometimes they can be very effective, but pushing harder than your body wants to or before you are ready will result in exhaustion.  Some women have a brief rest period after they are fully dilated, before they feel an urge to push.  If you have this break, take advantage of it, it is a gift to help you get ready for pushing.


Keep Mother and Baby Together, it's Best for Mother, Baby and Breastfeeding
Here in the Lethbridge, hospital staff will usually place your baby on your abdomen immediately after birth, if you request this beforehand, if you do not request it, they will usually take the baby away to be weighed, measured and checked.  Weighing and measuring does not need to happen immediately and the baby can usually be checked in your arms.

If the baby is skin to skin in your arms you body will regulate his temperature and he will be more likely to latch on and breastfeed successfully. Babies born without medication have a very awake period immediately after birth and this is the best time to start breastfeeding.  See my post on breastfeeding, for more on this.

If you are pregnant I would recommend signing up for the Lamaze International blog Giving Birth with Confidence.

Mother's Advocate has videos and handouts about the Six Lamaze Healthy Birth Practices.


As always, please feel free to contact me if you have any questions or if you are interested in a doula.