Tips for Giving Birth from An Obstetrician, A MidWife, A Doula and More

Giving birth is something I’ve been thinking about a lot, as you might expect.  These final weeks of pregnancy have had me reminiscing on Parker’s birth and what this one will be like.  Gone is the naiveté of not knowing what to expect and instead my mind blows past all of the needles and machines and contractions to a place where all I can think about is this moment above, where we finally get to meet face-to-face, me and the babe I’ve been carrying with me since late last fall.  Will she look like Parker? Will she have hair?  What expression will she be making? I remember Parker’s first expression as vivid as if it was yesterday.  As I found myself filling out the birth plan questionnaire given to me by my doctor, I decided it might be a good time to consult the pros and get some different opinions on this most ancient of practices, the one responsible for the continuation of the human race– giving birth.

Photo by Stephanie Sunderland for Amber Fillerup

Photo via Emily K Morgan

1. What are some common misconceptions about the child birth process and giving birth?

Christy Capet, MD (Austin Area Obstetrics, Gynecology, and Fertility):  It’s a common misconception that labor is always fast, like in the movies. Lots of first time Mom’s (and Dad’s) think the first time a contraction happens or when their water breaks they should rush to the hospital by ambulance because they baby is coming any second! Labor is typically a long process the first time around average 14-24 hrs, occasionally longer in some circumstances. They stories you hear about women giving birth in the car or at home are typically after a woman has had a couple of children. They do tend to speed up but typically by then they know what to expect with how their body labors.  Another common misconception is that labor is predictable and/or controllable. Each patient, pregnancy, and labor can be different. Their may be certain complications that arise that necessitate modifications to birth plans.

Tif Greening, Amy Nevland & Cary Burtt – Co-owners of ATX Doulas: For some reason I don’t think people really get how intimate of a process it is. It can be hard for a mama to progress when having friends and family in the room or hovering. I’m always surprised when mama’s say “no one said it was gonna be this hard”.

Jennifer Duxbury, via KC Parent, SAHM and writer: It’s a myth that your second and third childbirth will always be easier.  The labor and delivery might not go as quickly or smoothly if you waited several years between pregnancies. Also, a c-section might be needed if your second or third child is not lined up in the birth canal properly or is larger than your other babies.

Photo via Huffington Post

2. What are your thoughts on a hospital birth vs. a birthing center?

Dr. Capet: As an OB/Gyn that trained at the busiest obstetrical hospital in the U.S., averaging 42 deliveries per day in its prime from 2006 -2010, I wholeheartedly believe it is safest for mother and baby to deliver in a hospital setting. That being said, a hospital birth and a birthing center are often misinterpreted to convey what ‘type’ of birth one desires to have. One shouldn’t equate a hospital birth with only a medicated delivery and thus a birthing center a natural or “unmedicated” delivery. I trained at Parkland Hospital and we had 3 labor and deliveries and 1 unit was dedicated to natural childbirth by midwives. One should associate a hospital with safety. You have all the capabilities of a birthing center (except a tub,- although some hospitals may do water births ours does not; we have showers for relaxations and pain management) with the added security that should something go awry we have the ability to make urgent interventions. In an emergency, time, training, and equipment can make the difference between life and death.

Beth Schwarting, Nurse Midwife in Oakland, California: The way we treat women in pregnancy and birth has come a long way from the dark ages of twilight sleep (think January Jones giving birth in Mad Men), forceps deliveries, and moms and babies being separated for days…but things still aren’t perfect.  The cesarean rate in most hospitals is much higher than necessary (reaching 34% across the country), and women are offered a variety of interventions that may offer little benefit and may be harmful in some cases. Some examples include not allowing women to eat or drink during labor, not allowing freedom of movement, and inducing labor for the sake of convenience.  Where you deliver your baby and who delivers your baby really can play a major role in whether you birth vaginally or by cesarean.  Consumer reports actually had a great article about this very topic.  But I’m not saying avoid a hospital at all costs! Many hospitals have obstetricians and midwives that support healthy birth practices What I strongly encourage, is you do research about your planned provider and hospital. The well-vetted website childbirthconnection.org has a list of resources where you can check things like hospital cesarean rates and other measures of quality care. Birth centers and birth at home are a wonderful choice for uncomplicated pregnancies. Women are usually cared for by a midwife and have the benefit of increased time for prenatal care visits and a relationship that builds over the course of the pregnancy. Wherever you plan to birth your baby, here’s a shameless plug for choosing a midwife. Midwives are committed to providing you with the information and resources you need so you and your baby can have the best outcomes possible.

Tif Greening: As doula I have to say that my thoughts are not really the ones that count. I am here to support my client: emotionally, physically and informationally. We love to support moms in all environments. Our goal is to educate and support. If we have mom’s that are on the fence then we can share with them our knowledge and some resources for them to make a more informed decision.

Photo via Lisa Quinn Photography

3. How important is it to have a birth plan before giving birth?

Dr. Capet: I think they are great! I pass out a ‘Birthing Preferences form’ and go over it with each one of my patients. The are helpful for a variety of reasons. First, it gets the patients involved and prepared for the labor, delivery, and postpartum care. Secondly, it helps guide the hospital staff to cater to your desires and needs. Our job is to help you achieve your goals so long as it is medically safe. Think healthy mom and baby = happy mom and baby! But keep in mind, a plan is just that, a plan. Always think of plan A,B, and C! They are not written in stone. Just because you said you wanted a natural delivery doesn’t mean you can’t change your mind and vice versa. The key to becoming and parent and of course parenting if flexibility!  Also, everyone tends to hyper focus on the labor process! Remember to keep in perspective that this 12-24 hrs is a very short window of time on the grand scheme of motherhood! I find that the real challenge for most moms is the “4th trimester” or 4th stage of L&D. Breastfeeding, sleep training, and maintaining healthy relationships with your spouse, partner, family and support system etc. Preparation for what happens immediately after birth is often overlooked.

Beth Schwarting: Researching and putting together a plan for the healthiest birth possible is a great idea. Sharing your ideas with your midwife or doctor should create dialogue and an open conversation. If your provider dismisses your birth plan or has a “no birth plan policy,” I’d say that’s a red flag.  That said, there is no way to plan all the details of your birth and a piece of paper will never be able to summarize the immensity of the experience.  A birth plan isn’t a guarantee that things are going to go a certain way (welcome to parenting!) but clarifying what is most important to you can guide you in choosing where you deliver and what kind of support you set up.  Here are two excellent websites with evidence-based research to help you make your plan:

http://www.lamaze.org/blog/birth-decision-guides 

http://www.childbirthconnection.org/maternity-care/ten-tips/

Tif Greening: Its a really nice exercise. It’s a moment for our clients to ask specific questions and have a better understanding of what to expect… especially with the hospital process.

Photo via Barefoot Blonde

4. When should I go to the hospital?

Dr. Capet: For term labor precautions I like to use the 5-1-1 rule. No, this is not the telephone number you call in labor!! It means contractions every 5 minutes each lasting 1 minute in duration and for 1 hour. In addition anytime your amniotic fluid membranes have broken commonly referred to as “water breaking” you should go to the hospital for confirmation and admission. Of course there are other factors that warrant clinical evaluation such bleeding, decreased fetal movement, and preeclampsia symptoms (such as severe headache, elevated blood pressures, sudden onset edema in hands, feet, and face). Should you have any concerns you should contact your medical professional immediately for further instruction and advice.

Beth Schwarting: Labor is unique for everyone, it can last anywhere from a few short hours to over a day. Ideally you get to the hospital you are in active labor (when your cervix is thinning and dilated to several centimeters) – this is when your contractions get longer, more intense and more frequent. It will be very difficult to talk or concentrate on anything else but the contractions during active labor. A general rule of thumb about timing: For 1st time moms, when your contractions are coming about every 4 minutes and last a full minute, and this pattern has gone on for at least an hour. If you’ve had a baby already, labor can be much quicker so consistent contractions every 5 minutes is probably safe.

Tiff Greening: It depends on what her goal is and if she is high risk at all. For a low risk, hospital birth where the goal is having a natural, vaginal birth, then we will try to support mama at home until she is showing signs of transition.

Photo via Babble

5. What should I bring to the hospital? What do some people bring that I should really leave at home?

Dr. Capet: Pack like your are spending a weekend trip at a hotel: Camera, baby book, breast pump (bring yours so you can get comfortable using it and get education with lactation consultant if needed), robe/comfortable nightgown, toiletries such as face wash, toothbrush, shampoo and conditioner, phones and tablets and chargers, ear plugs, car seat INSTALLED.  The hospital should provide everything the baby will need except for a cute outfit to go home in and for pictures.

Beth Schwarting: Chapstick! Labor is a lot of work and you breathe hard. This makes your mouth feel super dry. So bring your favorite water bottle too. Of course hospitals have cups, but if you have a water bottle you always drink out of, you’ll want it!  If you’re a music lover bring a small portable speaker to sync up to your phone… Your favorite music can help you get through the hard parts of labor.  And don’t forget your charger!  Leave your skinny jeans at home. The first several days after giving birth, your uterus is still about the size when you were 20 weeks pregnant (at about your belly button). So bring comfortable (and stretchy!) clothes.

Tif Greening: To me less is more… there are a lot of resources at the hospital and leaving with a baby and many bags of stuff seems intense. Some cozy clothes to chill in after baby, toiletries, snacks, car seat… if you forget something I’m sure your partner or a friend can get it for you.

Photo via Barefoot Blonde

6. Any tips for a successful, drug-free birth?

Dr. Capet: Preparation is key! Labor is a marathon! A complete physical and mental challenge. You can’t just wake up one day and decide your going to go out and run 26.2 miles! Likewise for labor. You need training and preparation. You need to be in optimal physical shape. Studies show that women who are physically fit have shorter labors and achieve spontaneous vaginal delivery more frequently then those who aren’t.  Maintaining an active life style by achieving 10,000 steps/day is recommended with cardio/aerobic exercise. Additionally you should invest in natural child birthing class. These classes should focus on coping and relaxation techniques. Hypno-birthing and Empowered-birth ATX are some of my favorites locally.

Beth Schwarting:  Yes! Hire a doula! There’s really good research that shows having continuous labor support reduces the use of epidurals and other pain medications.  Labor is intense!  A doula is a well-trained professional whose job it is to support you and your partner physically and emotionally.  Even if you have a midwife (like I did), their main job is to ensure you and your baby’s health and safety. Although a midwife certainly cares about your emotional and physical comfort, they may be busy taking care of other families, especially in a hospital setting.  My partner was totally on-board for my plans to have a un-medicated birth.  He’s exactly who I want around when I’m exhausted, beat-down, or frustrated.  He’s also listened to hundreds of birth stories and has probably overheard more than a few phone conversations like “So is that a clear watery discharge coming from your vagina or does it look more like brown snot?”  So in many ways he’d be the perfect person to support me during labor.  But when it time for me to give birth to our son, I was so glad I had a doula with me.  I was really loud and vocal while simultaneously completely sucked into my internal world.  I barely opened my eyes for hours and spent most of the time in a dark bathroom. I was a drunken grizzly bear lumbering around, trying to crawl up the walls. I remember briefly looking at my partner and he really wanted to help. And he would have done anything.  But all I wanted was for him to know I was in a lot of pain, but I was also in a groovy rhythm from the hormones and I didn’t want to come out of my internal world to think or talk. I was so happy to have the doula explain that the process was normal, we were safe, healthy and things were moving along fine.  He didn’t need to worry. I didn’t need to worry. Yes please, hire a doula.

Tif Greening: Have a supportive team and stay home as long as possible.

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  1. Christine

    07/28/2017

    This is great information – I think women don’t realize how many options there are for births – assuming no complications. I had drug free births in hospitals with two very different experiences. I think the best information I received is that you need to MOVE to get that baby moving downward. Are you familiar with the Squatty Potty and how it’s optimal for pooping? Well guess what, it is for birthing a baby too – hahaha! Sorry, TMI but it’s true – I delivered both ways!

    Anyway – thanks for informing women of just a few of their options!!

  2. Goodness this is wonderful and helpful. Thank you.

  3. This is so helpful! Thank you for sharing. My husband and I are considering starting a family soonish and I need to find an OB/GYN. Do you have any advice on how to get started or questions to ask to determine if they’re a good fit?

    • Jen Pinkston

      07/31/2017

      Oooh that’s a good question. Where do you live? Do you have other friends in your area that have already given birth? I feel like recommendations from friends that have been happy with their care and delivery is a good place to start. Also, perhaps posting to a mom’s facebook group in your area could be a way to get some good recommendations as well as some “steer clear of this person”s.

  4. I really like that what Beth Schwarting said about how birth is different for everyone. I didn’t realize that labor can last anywhere from a couple hours to as long as a day or more. It makes sense that you’d want to prepare for the worst so talking to my wife about this for when it comes near her due date just to make sure her first childbirth is bearable.