Today on facebook, I read this article by Sabrina of Jerusalem Health Coach. I am reposting because I think that it contains important information, however unpopular it might be. Parents need to understand that planning a "natural" birth in a hospital setting is something that takes a work: planning, education, hiring a doula and being your own advocate.
That’s right, I said it. Now, I hope everyone will forgive me as I let myself off the hook. These are not my words. My teacher and mentor, Shoshana Goldbaum (doula with 30 years experience) said it, first. She even goes on to say, “Natural birth is for the kitty cats having their babies behind the dumpsters. What I teach parents is prepared childbirth, or responsible, minimal intervention childbirth.”
When I first heard this, I must admit, I was shocked. “But wait,” I thought, “what about the fact that birth is a natural process? What about trusting our bodies?” Surely she couldn’t deny that birth is a womanly phenomenon, regardless of where it may occur. With time and a little experience, I began to see where she was coming from. The moment a woman leaves the comfort of her home and enters a hospital setting, the process takes a huge leap away from “natural.” Forms filled, heparin lock inserted, hospital gown on, cervix checked by a stranger’s gloved hand, belly strapped with two monitor belts, body reclined on a bed… There is nothing “natural” about any of it.
At a hospital, there is a slew of possible interventions that could take place… a variety of induction methods, sedatives, pain-blockers, metal instruments, antibiotics. A clock is ticking, from the time that the waters break, whether artificially or on their own. Various possible dangers loom overhead: infection, dystocias, nuchal cord, fetal distress, problematic presentation, placental issues, hemorrhage … the list continues. The medical staff is aware of all of them and is prepared to handle anything and everything. A woman’s body is not to be trusted because there is always a risk that something could go wrong.
I am learning that birthing with a licensed nurse-midwife has all the similar risks, but the difference is that the setting is warmer and invasive techniques are usually kept to a minimum. This lessens the possibility of causing many of the problems that lead to cesareans and instrument-assisted deliveries. However, while hospitals will take high-risk pregnancies, most licensed midwives in Israel will not. This can put a “high-risk” pregnant woman somewhere between a rock and a hard place when she is not comfortable birthing in a hospital where the chances of avoiding a traumatic birth or an unnecessary cesarean are next-to-nothing and no licensed midwife will take the risk of attending her birth. For many of these women, a natural birth can seem like more of a dream than a reality.
What my teacher is trying to alert women about is simple. Nobody just goes skipping down Pregnancy Lane all “la-dee-dah. I’m going to do everything natural” and somehow magically at the end of the road there is a peaceful baby in her arms and everyone is glowing and happy. There is a lot of work involved for mom: a great deal of learning, strategizing, planning, preparing, and understanding the uniqueness of her own body and circumstances.
When first-time birthing women tell me all about wanting a natural hospital birth, I smile and ask, “What’s your birth plan?” This initiates the conversation. Once I listen to her thoughts and feelings (sometimes for quite awhile) and help her sort out her own values, limiting beliefs, resources, and priorities, I remind her gently that any plan she may devise is almost always “plan B.” Plan A is G-d’s plan, which is ever-unfolding—and as choices in labor are made, a new set of choices appear (see my past article “When Your Birth Plan Flies Out the Window”).
As the minutes tick away, the possible outcomes in a hospital gradually become more and more limited. Therefore, if a woman is committed to a having a minimum intervention (natural) birth, certain aspects of her experience must be worked out well in advance:
1.Support. This is not a friend, a mother, sister, rebbetzin or any other kind of well-intentioned and loving hand-holder. I’m talking about a trained, professional doula or birthing assistant who is familiar with the various aspects of birth, including anatomy and physiology, emotional sign posts in labor, coping techniques, and educational resources. Ideally, she is someone who is calm and confident in the process of labor, compassionate, patient, and sensitive to the cues a woman’s body may give at any time. At the same time, she should be familiar with the warning signs indicating that emergency care is needed. Extensive time and energy should be invested in prenatal meetings because, as I say all the time, "90% of what I do happens before labor even starts." Indeed, my most successful birth stories were with women who valued my guidance enough to meet with me three and four times before their births.
2.Education. I strongly recommend taking a birth preparation course from a birth educator who is certified by an organization that is “mother and family-centered” in its philosophy. Otherwise, a woman runs the risk of sitting through a hospital-centered course which may teach her little else besides which drugs she has to choose from (all absolutely harmless, of course) and how to be a “good patient” and cooperate with the medical staff as they follow their necessary protocol. It’s also very important to involve a spouse or any person who will be entrusted with any decision-making power at the time of birth.
3.Preparation and Planning. This is best done with the doula and may include all parties who will be involved in some way with the birth. This is the time to understand all the various expectations, doubts, fears and thoughts that may come up in the process. This is also a good time to examine all the visible circumstances of the upcoming birth. Are there any special considerations? Is the mother GBS positive? What if her water breaks before the onset of labor? How will she deal with the increased risk of infection to her baby as time passes by? How is the baby positioned? Is there anything that can be done to encourage a fetal positioning that is more optimal? What are some coping strategies that sound appealing to the mother-to-be? What are the financial constraints on the situation, if any? Does it limit the possibilities? These are only a few considerations.
4.Labor Plan. Where does the mother intend to labor and how far is the location from the hospital? How can she use the resources around her at home to ease into labor and feel most safe and comfortable? When will it be time to get over to the hospital? What facilities does the hospital have for laboring, besides a bed? Creating a solid labor plan will ensure that a woman can feel the maximum confidence and support in her laboring process at the beginning and as she progresses onward to the second stage of labor (pushing). It’s especially helpful to discuss with the doula when is the appropriate time to leave for the hospital. Given a normal and healthy laboring process, it can be best to work though labor in a familiar space until labor is well-established and transfer to hospital is least likely to cause labor to stall. In the event that the woman must go to the hospital sooner, she and her doula should have a flexible game-plan for making use of the hospital's resources.
5.Perineal Support. Many first-time birthing women want to avoid an episiotomy or major tear. Advance preparation of the perineum to stretch as much as necessary during birth will help with healing and minimize discomfort later. There are also pelvic floor exercises which can help the mom to relax the muscles at crowning. Finally, there is a mental and emotional preparation that can be done in advance to reframe the anticipated uncomfortable experience.
6.Hospital Protocols. It is incredibly useful to know hospital protocols and the risks involved in deciding to go against them. I cannot stress this more. If a woman chooses to birth in a hospital, she must constantly remember (and accept) that she is on their turf. The doula is a privately-hired support person who is there with her but cannot and will not be expected to make any decisions for the birthing mom. This means that whatever their protocols may be (I listed several at the beginning of this article) they are expecting a woman to follow them without asking too many questions. In Israel, a woman has the right to refuse ANY and ALL hospital protocols that she sees fit and in doing so she assumes all responsibility for the outcome. She won’t be very well-liked by the hospital staff and she may need to sign a form, but this is her legal right. I will add that any woman who takes a hospital tour may be completely familiar with many of the major policies involved with birthing there and she may even feel okay with it at the time. However, many of these seemingly trivial details can add up to being a very big deal when she is in labor and hormonal and needing more than ever to be comfortable and feel safe.
These are some considerations to keep in mind in order to effectively plan and prepare for a natural birth in a hospital. I am aware that there are women who reportedly can create a “bubble of safety” around them and can just ignore hospital staff and pretend she’s laboring somewhere on a cloud far away. It is a special and enviable gift to be able to do this and as a doula I’d be hesitant to mess with perfection. However, in most cases women cannot achieve this level of unconditional safety and relaxation in a hospital setting. So, for all those ladies who choose a hospital birth and want to do it naturally, this article is for you.