How to Have a Natural Birth in a Hospital

You've decided you want a natural birth, but feel more comfortable delivering in a hospital than anywhere else. How can you ensure that your wishes for a natural birth experience will be respected? (Note: this article is not a substitute for professional medical advice.)

Difficulty: Moderate

Instructions

Things You'll Need:

• The Thinking Woman's Guide To A Better Birth
• The Birth Book
• Natural Childbirth The Bradley Way
• Doula
• Birth Plan

1. 
    

   Choose your care provider carefully. You want an OB or midwife who believes in and supports a healthy pregnant woman's ability to birth; who will not interfere or hurry the natural process unless medically necessary, or force unwanted interventions merely based on insurance requirements or blanket hospital policies.
   
   In the US it is almost a matter of course to choose an obstetrician. But keep in mind that obstetrics is a surgical specialty which typically views birth in light of all the possible abnormalities and potential emergencies. Only high-risk pregnancies truly require that specialty. Midwives are trained to facilitate normal birth, though they are well qualified to handle emergencies. Hospital midwives work under the supervision of an OB, who would be able to perform a C-section if necessary.

2. 
    

   Before settling on a midwife or OB, ask them about their philosophy of birth. Do they see it as a natural process which only occasionally requires intervention, or as an emergency waiting to happen? Are they willing to support you in a completely intervention-free birth (unless medically necessary)? Do they insist you comply with certain hospital protocols? (For instance: IV or continuous fetal monitoring, two factors which may restrict movement, increase discomfort, and make it more difficult to use natural comfort measures like a shower, tub or birth ball.)
   
   Are they familiar with whatever childbirth method you are using (Lamaze, Bradley, Hypnobirthing), and will they accommodate it? (I had one OB tell me she didn't recommend the class I'd chosen because it made patients "question their doctors too much", as if patient compliance was more important than the actual effectiveness of the method).
   
   Keep in mind that some obstetricians are very supportive of intervention-free birth, and some hospital midwives are more eager to use routine (though often unnecessary) medical interventions than you might expect. Labor is not the time to find out that you and your doctor see things differently. If you feel that you and your current provider are not on the same page (or you feel pressured to do things their way), take the time to shop around for someone who is a better fit.

3. 
    

   Use the time throughout your pregnancy to educate yourself regarding your body's natural process during labor and birth, and your options in labor and delivery. There are several fantastic resources for this (links provided below). I highly recommend "The Birth Book" by Dr. Sears, "The Thinking Woman's Guide To A Better Birth" by Henci Goer", "Ina May's Guide To Childbirth" by Ina May Gaskin, and "Natural Childbirth The Bradley Way".

4. 
    

   Attend an independent childbirth class. Why independent? Classes offered at the hospital largely focus on helping "patients" understand what to expect at the hospital, and cannot encourage natural childbirth over medically managed birth. (A woman in labor is not sick, but merely going through a natural process, which is why I prefer to consider them "guests" at the hospital, rather than "patients". The staff are there to be lifeguards on watch, not to "treat" an "illness".)
   
   Independent childbirth instructors answer to their clients, not the hospital bureaucracy, and will typically spend much more time focusing on your alternative options. Since nearly all encourage natural birth, they will equip and prepare you to manage your entire labor and delivery, not just try to "keep you comfortable until your epidural".
   
   I am personally partial to Bradley classes, because they typically spend a large portion of the class educating you regarding the risks, benefits, and alternatives to routine hospital interventions. This way you can be an educated consumer regarding which, if any, of these interventions you are willing to allow. In case any of them become medically necessary, you will already be familiar with them and be able make an educated decision, rather than a fearful one.

5. 
    

   Take a tour of the maternity ward around 6 months gestation (so you have time to switch venues if necessary). Keep in mind that many preventative actions taken in hospitals are designed to avoid lawsuits, and may not be medically necessary. Write down your questions in advance. Ask them to give you their statistics: what percentage of patients receive pitocin? C-section? What is hospital protocol regarding IV, fetal monitoring, and other interventions? Do they offer facilities such as showers and tubs? Any restrictions on their use? Do they have time restrictions on how long you are allowed to labor? How soon you must deliver after your water breaks? Are they familiar with whatever childbirth method you are using (Lamaze, Bradley, Hypnobirthing), and will they accommodate it?

6. 
    

   Create a birth plan. After you've done all your research and attended your class, you should have a general idea of what your wishes are. Give a copy to your midwife or OB and ask her to sign it and put it in your file (if they don't feel comfortable with it, it might be time to switch to someone who is). Remember, these are your preferences for a normal, natural birth. Make it clear that if a complication arises that requires medical intervention, you are willing to be flexible.
   
   Although birth can be unpredictable, keep in mind that some things ARE avoidable. One intervention often leads to another, and another, in domino effect. If you can manage to avoid the first intervention, you're much less likely to require the others. (For instance: use of pitocin can lead to increased pain, requiring epidural or narcotics, and their related side effects. It can also lead to unusually intense contractions, fetal distress and possible C-section. So decide in advance: under which circumstances do you consider the benefits of pitocin and other interventions to outweigh the risks?)

7. 
    

   Hire a doula. Sort of like a professional labor coach, doulas are trained to "mother the mother", support the father, create the atmosphere you desire, be an advocate, and help you achieve the goals of your birth plan. Doulas do not replace your husband, family or friends, but rather are there to support the whole family during the labor and delivery process.

8. 
    

   Wait until you are well established in active labor to arrive at the hospital. While you are at home, you are in your own safe comfort zone. You can wear what you like, eat and drink as you wish, use whatever positions or comfort measures you want, and have no time restrictions. The further along you are when you get to the hospital, the fewer interventions you'll be encouraged to use.

Tips & Warnings

• Eat before you go! It's likely the last meal you'll get for awhile. Laboring is like running a marathon, and your body needs nourishment to do its hard work. Many hospital restrict food to laboring mothers, in the very rare event that you may require general anesthesia and accidentally aspirate your stomach contents.
• Bring a few bottles of Gatorade or other sports drinks to the hospital with you. They help you stay hydrated so that you have the option of declining an IV, and they also provide a steady source of energy when you can't eat.
• Many hospitals want to administer an IV not only because it guards against dehydration, but it also gives them an easy way to administer pitocin. At some hospitals, pitocin is automatically given to all women immediately after birth, to safeguard against hemorrhage. However, if your baby has no drugs in his system and is able to nurse immediately after birth, your body will usually produce the natural oxytocin it needs to expel the placenta and clamp down on bleeding. Take this into consideration when deciding on an IV.

Resources

• The Birth Book: Everything You Need to Know to Have a Safe and Satisfying Birth
• The Thinking Woman's Guide to a Better Birth
• Ina May's Guide to Childbirth
• Natural Childbirth The Bradley Way
• The Business of Being Born
• Giving Birth Naturally: Empowering Women
• How to Write A Birth Plan
• How to Avoid an Unnecessary Induction
• How to Natually Induce Labor
• How to Decide If An Epidural Is The Right Choice For You
• How to Choose A Childbirth Class
• How to Help Dad Get Involved With A New Baby
• How to Decide If A Home Birth Is For You

[LilacGirl]

on 7/18/2008 Very good article, as always. You really know your stuff.

[Hapworth]

on 7/18/2008 Wonderful information.