Part 1/ Chapter 2 Ten Tips for Having a Safe and Satisfying Birth

Hi, my name is Jen and I’m reading the parenting books and articles so you don’t have to. 

To get us started, I read:

The Sears Baby Book, Revised Edition: Everything You Need to Know About Your Baby from Birth to Age Two (from the Sears Parenting Library)

TLDR – These 10 tips are helpful but be sure to put them into context for your life and if they aren’t realistic to you, give yourself grace and use them as a guide, not a mandate. The tips are: Find Dr. Right, Choose the right birthing environment, Use a professional labor coach, Get moving, Get off your back, Experiment with labor positions, Use technology wisely, Use medical pain relief wisely, Avoid an episiotomy, and Formulate your birth plan.

Here’s chapter 2 –

1. Find “Dr. Right”

The chapter begins by telling parents to take responsibility for their baby’s birth. I immediately have issues with this as I think to my own experience in having ONE option in the city we live in. How can you take responsibility if you have one option? But by all means, if you have more options, perhaps you’ll get something from this…

The book states that you should choose a “birth attendant” who is medically competent and experienced enough to deal with medical emergencies during birth, then goes on to state that this is only of concern for 10% of births. 

According to a report from Blue Cross Blue Shield – between 2014 and 2018, about 7 out of every 1,000 pregnant women experience a complication during childbirth. (Our book was printed in 2013, so roughly the same statistics).

“Every year in the U.S., nearly 4 million women give birth, the vast majority without anything going amiss for themselves or their babies. But more than 135 expectant and new mothers a day — or roughly 50,000 a year, according to the Centers for Disease Control and Prevention — endure dangerous and even life-threatening complications that often leave them wounded, weakened, traumatized, financially devastated, unable to bear more children, or searching in vain for answers about what went wrong… Each year in the U.S., 700 to 900 women die related to pregnancy and childbirth…” –  NPR article Dec., 2017 (https://www.npr.org/2017/12/22/572298802/nearly-dying-in-childbirth-why-preventable-complications-are-growing-in-u-s)

Dr. Sears says to select a “birth attendant” that will assist you in creating a natural progression of birth. A birthing attendant is a doctor, midwife, or any person you choose to be with you in your birthing environment. He notes that doctors should be kept free to care for mothers during complications while midwives tend to labor in support of the mother. 

2. Choose the right birthing environment

Dr. Sears recommends choosing a facility that will allow the mother to labor, deliver, and recover in the same room. The birthing room should be relaxing and inviting. The medical equipment should be secondary and unobtrusive to the ambiance of the room. (Again, I interject here that, when you have few options…) Lastly, he highlights that the staff is the key to having a positive birthing experience.

“Delivering in the traditional surgical style promotes fear and tension, contributes to that dreaded malady of the laboring mother – failure to progress – and often results in agonizing labors and surgical births. As an added attraction, baby stays right where he or she belongs – nesting in the room.” – Dr. Sears

According to the National Library of Medicine; Birth Settings in America: Outcomes, Quality, Access, and Choice; “Hospitals are the most common place of birth in the United States, with 98.4 percent of births taking place in a hospital in 2017 (MacDorman and Declercq, 2019).” 

Further, “Birth centers are intended for low-risk women who desire less medical intervention during birth, a home-like atmosphere, and an emphasis on individually tailored care. Birth center numbers are increasing in the United States, with 375 such centers in operation as of November 2019. (Personal communication, Kate Bauer, executive director AABC.) (Keep in mind that these are pre-Covid numbers). 

3. Hire a labor coach

“Older studies by Dr. Kennell and Dr. Klaus… showed that mothers whose births were attended by a labor coach… had an 8 percent cesarean-section rate versus 18 percent for the matched controls whose births were not attended by one,” Dr. Sears. (Sure, but what about those who cannot afford one?) 

A labor coach is also called a doula. Per Dr. Sears, a doula’s role is to help the mother move through labor in harmony, recognizing her body’s signals so that labor can progress efficiently, functioning as a personal labor assistant and liaison. 

Doula’s in my area charge around $700 to attend two prenatal visits, the birth, and one postnatal visit. This is quite low for what is charged in larger, metropolitan areas. 

“A birth doula costs on average between $800 and $2,500, depending on location, the local market and cost of living, the experience of the doula, and what services the doula provides.” -The Cost of Hiring a Doula for Your Pregnancy; verywellfamily 

4. Get moving

“Move with the urges of your body,” Dr. Sears. This is the principle that seems universal. Moving will help labor to progress and ease discomfort. Essentially, a body in motion will stay in motion, and a body at rest stays at rest. But also, a distracted laboring mother is less focused on her pain and discomfort if she isn’t dwelling on it (I add as a woman who on the pain scale considered herself at a 9 for all 29 hours of her pregnancy). 

5. Get off your back

“Back birthing makes no medical sense. It is not good for the baby…and it is not good for you,” Dr. Sears. Well, shit. I spent at least of my 18 hours in labor on my back… oof. 

To reinforce this idea, we look back to the National Library of Medicine, this time the Journal of Perinatal Education, Advancing Normal Birth – Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push by Joyce T. DiFranco, RN, BSN, LCCE, FACCE and Marilyn Curl, RNC, CNM, LCCE, FACCE (2014)

“Despite irrefutable evidence that prolonged, directed pushing is of limited value and may, in fact, have negative consequences for both mothers and babies, it remains the standard of care in many hospitals. Midwives have generally been more open to the recommended changes than physicians and nurses, who often choose to continue doing what they have always done.

Childbirth educators should continue to teach families about the benefits of approaching birth physiologically and should help them understand how the process is enhanced by an evidence-based approach that includes the following:

•  Self-determined positioning throughout the second stage of labor
• Recognition that the length of the second stage is variable and may be prolonged without adverse effects
• Willingness to delay active pushing efforts until the body’s natural urge is recognized
• Continuous labor support provided by family members and professional caregivers

Nearly a decade ago, Lamaze International recommended that women opt for upright positioning and spontaneous, rather than directed, pushing efforts. In the intervening years, not a single study has refuted this approach to second-stage management. Changing the culture of birth will not be easy but appears inevitable as evidence-based care becomes the expectation throughout health care. The care practices will continue to provide a framework for safe, healthy birth.”

In many birthing books, I read during my prenatal education phase, as well as in class, it was discussed to use different laboring positions. However, the importance of choosing alternatives to back birthing, if it was discussed, was lost on me. 

Okay, moving on…

 6. Experiment with labor positions

Optional positions as per pregnancybirth&baby

• kneeling, using a chair or birthing ball (yoga, or ‘fit’ ball) for support
• swaying or walking and holding a support person during contractions
• standing and moving in the shower to help reduce pain
• sitting or kneeling in a bath, to reduce pain and make you buoyant, making it easier to change positions
• squatting, using a birthing stool, ball or squatting bar; this can help the flow of oxygen to your baby, reduce back pain and move the baby correctly into position
• sitting and rocking on a chair or edge of the bed
• sitting backwards on a chair, with arms resting on the chair-back
• leaning forward over the bed
• sitting on a chair leaning forward
• lunging with one foot up on a chair or footstool
• kneeling on hands and knees to help reduce back pain

7. Use technology wisely

“Enter a traditional labor room and you will likely see a mother lying on her back with the electric fetal monitoring (EFM) belt girding her abdomen and attached to a video display terminal. All too often these mothers ‘fail to progress’ in their labor and ‘need’ a cesarean section. Most mothers should not be lying on their backs during labor.” Double oof. Ugh, why didn’t I KNOW this? Raise your hand if you also labored on your back and ended up with a C-section. 

Dr. Sears encourages laboring mothers to continue to move positions for the best possible outcomes. He is also talking of C-Sections like they are to be avoided at all costs. So let’s see what someone else has to say?

Let’s take a moment to look toward one of my favorite authors on the subject of pregnancy and parenthood – economics professor at Brown University, Emily Oster.

8. Use medical pain relief wisely 

“The more informed you are about your options for pain relief, the safer and more satisfying your birth is likely to be.” Okay, allow me to interject again. I went into labor wanting a completely natural, pain medication-free, birth. My pain was more than anything I had ever dreamed it would be. I asked for the Motrin and received it. It did nothing. I then received the next level of intervention (the name of which I do not recall though I do know it was an opioid). It did nothing. I ultimately received an epidural. Which finally did allay my pain. However, when I was finally coming down from those medications, my entire body itched for at least 24 hours afterward, which I can only explain as similar to having been attacked by a million mosquitos and suffering the itch of their bites afterward. (Also, I looked like a certain skit from the Dave Chapelle Show IYKYK). So I agree, use pain relief wisely, but if you’re in pain and suffering, be flexible enough to adjust your birth plan and take the relief you need. 

“…Overuse of anesthetics, to the extent that you lose all birthing sensations as well as movement, is a setup for a longer labor and possible surgical birth,” this seems to be a universal truth. While it is risky and you may expect a longer recovery after birth, weigh the risk for your personal needs. 

9. Avoid an episiotomy & 10. Be flexible in formulating your birth plan

As for avoiding an episiotomy, Emily Oster also discusses this in her book. She says that the procedure of cutting an incision to allow for more room for the baby to birth was a common practice in nearly 60% of births in 1979, where it was about 25% by 2004 (Copyrights of Dr. Sears’ book were 1992, 2003, 2013 so these 2004 data points are relevant). Ultimately, there is good reason for the reduction in the procedure as recovery is difficult, as there is a risk for infection and trauma, as well as blood loss.

“We stress the importance of a good birthing experience so parents and baby can get the best start,” Sears says. So this point I do fully agree with. Being flexible is key so that your expectations (and guilt) don’t get the better of you if things don’t go as planned. 

Next read – Part 1/ Chapter 3 Preparing for baby – COMING SOON

• BEDSHARING & SLEEP TRAINING
• FAIR PLAY (Part Three)
• FAIR PLAY (Part Two)
• FAIR PLAY (Part One)
• SEARS BABY BOOK (Part Two)