She’s having a baby, but how?
Choosing the best birth for you
Saturday, September 01, 2007
When the contractions get closer together and the baby is ready to arrive, it’s a little too late to consider how you want to give birth. Luckily, you can research your options and have a good idea of how you want to bring your new baby into the world before labor begins.
Place: In your home, but where is up to you. According to Dr. Mayer Eisenstein, medical director of Homefirst Health Services with four locations across Chicagoland, the best place to give birth in the home is "anyplace a woman wants."
In attendance: "We always bring two professionals to each home birth," says Eisenstein, who also has his own radio program on XM satellite radio and 1160 AM in Chicago. "The rest of the people in attendance are up to the mom-to-be, but she must remember that she’s giving birth, not entertaining."
Risks: The risks of giving birth at home with a qualified professional are few for a healthy mom and baby. Chances of an emergency situation are low with a home birth as long as mom doesn’t have any kidney, heart or bleeding complications and the baby isn’t in a bad position. While not necessarily a risk, it’s definitely worth considering that insurance may not cover a home birth.
Benefits: Giving birth to your baby at home with a professional can give you a great sense of accomplishment. It is usually easier to recover without pain medication and the ability to relax in your own home. Chances are that a home birth will also avoid any surgical or drug-related problems. According to Homefirst Health Services, around since 1973 and having delivered more than 14,000 babies at home, their births have resulted in less than 1 percent episiotomies, less than 10 percent cesarean sections and almost no pain medication.
Place: In the hospital of your choice. Many of the newer hospitals in the Chicago area have private rooms modeled off hotel rooms. Some are even equipped with DVD players, CD players and cable television.
In attendance: Check with your doctor first, but usually four to five people are acceptable in the labor and delivery rooms. "We usually discourage young children being present," says Dr. Martin Gallo, chair of the department of obstetrics and gynecology at Advocate Good Samaritan Hospital in Downers Grove. "If it’s important to the mom, we will evaluate a special request."
Risks: "There’s always a risk of something bad happening in any situation," admits Gallo, "but hospitals are a safe place to have a baby."
Benefits: From a safety standpoint, you are surrounded by qualified health care workers, including anesthesiologists, surgeons and neonatologists, if there is an emergency.
Alternative birthing center
Place: Some hospitals including West Suburban Medical Center in Oak Park and Advocate Illinois Masonic Medical Center in Chicago.
In attendance: Ask at your specific center.
Risks: There are virtually no risks associated with an alternative birthing center, especially since these two centers are located in hospitals.
Benefits: You are treated to a room with hotel-like amenities including a queen-size bed, refrigerator, microwave, CD player and food. You are also allowed to use a shower, labor ball, labor stool, birthing tub and hot packs for the back. Narcotics and analgesics aren’t offered, but are available if you ask. Insurance usually covers this since it takes place within a hospital.
Place: In a hospital or at home.
In attendance: It depends on your location, but you will definitely have choices.
Risks: A natural childbirth generally shuns pain relief and extensive medical intervention. "The biggest risk is that a mom may decide after the fact that it was simply too painful," says Therese Doyle, a certified nurse midwife and director of Midwest Midwifery in Addison.
Benefits: Natural birth provides great benefits to mom and baby. "Moms may feel empowerment," says Doyle, "and she’ll be more alert since she won’t be recovering from the effects of pain medication." Your baby will also be more alert and have a better suck reflex.
Place: In the hospital in a surgical room.
In attendance: Other than the medical staff, usually only the father or birth coach is allowed.
Risks: With a C-section, mom is exposed to a higher risk of infection, possible bleeding complications, blood clots and longer recovery times. The hospital stay is longer, mom is bedridden for a few days and pain can radiate from the scar for years.
Benefits: "If there is a specific indication that the baby is in distress, a C-section is performed to avoid further problems," says Gallo. A C-section can also be indicated when labor isn’t progressing or the baby is in breech position.
Place: In a few select hospitals or at home.
In attendance: Depends on your location and your medical team.
Risks: Certified Nurse-Midwife Gayle Reidmann of West Suburban Midwife Associates says the risks of water birth are few and she has only heard of two possible risks.
"Babies can get hypothermia if they are cold. After birth we place baby on mom’s chest, cover baby with blankets and a hat to keep her warm. I’ve also heard of excited moms who pull the baby out of the water too quickly and accidentally break the umbilical cord. But I’ve never seen either of these happen," says Reidmann.
Benefits: Water immersion reduces pain, lacerations, blood pressure, swelling, stretching and offers mom increased mobility. And contrary to what you might think, babies do not drown during a water birth.
"Babies don’t take a breath until they come out of the water," says Reidmann.
Place: In the hospital, most likely in your labor room.
In attendance: Anesthesiologist, nurses and anyone you’ve chosen to attend your birth.
Risks: Some moms complain of headaches and back pain in the spot of needle insertion after an epidural. If an epidural isn’t inserted just right, numbness can be felt more on one side of the body than the other. Epidurals sometimes result in a C-section because mom loses too much feeling and can’t push.
Benefits: An epidural allows some moms to experience birth without pain. It is also used for a C-section because it is safer than general anesthesia, says Gallo.
Place: In the hospital.
In attendance: Health care providers and mom’s attendants.
Risks: Close monitoring is essential for an induction, usually in the form of the drug Pitocin. Some people feel induction leads to a C-section, but that isn’t always the case.
Benefits: Induction allows mom to deliver when the baby doesn’t seem to want to come out on its own, usually around two weeks past the due date. "The process is so much safer today because doses weren’t controlled as well in the past," says Gallo.
Vaginal birth after cesarean
Place: In the hospital or at home.
In attendance: Your medical professionals and your chosen attendants.
Risks: There is a very small risk that the original C-section scar can open up, says Gallo. Uterine rupture is also a concern when attempting a VBAC.
Benefits: VBAC, if achieved successfully, can be a very healing process for a mom who was disappointed by a prior C-section. "Many women have an innate and deep longing to deliver vaginally," says Doyle. "It gives a mom a great sense of mastery."
A look at American childbirth history
How childbirth has changed over the years:
1600s and 1700s: Women give birth at home, with female relatives and neighbors nearby to offer support.
1700s: Skilled midwives become highly coveted, and communities offer salaries or room and board in exchange for midwifery service.
Late 1700s: Doctors begin to replace midwives at bedsides, especially for well-to-do women.
1847: Chloroform and ether are introduced to alleviate pain during labor.
1920s: The use of anesthesia becomes nearly universal during birth.
1935: The introduction of antibiotics and transfusions sharply decreases the maternal mortality rate during childbirth.
1940s: About half of women are giving birth in hospitals, thanks to the growing practice of putting women to sleep during labor.
1950: Hospital births increase to about 90 percent of all births.
1960s: Hospital procedures begin to change as more women choose to give birth without anesthesia.
Today: While the majority of women go through labor in hospitals, more women are bringing relatives or labor support into the delivery room or opting to give birth in more home-like birth centers.
Source: Digital History