When it comes to labor and delivery, experts stress doing what feels right for you.
Kelly Latka wanted to have as natural a birth as possible. While the Williamstown resident was prepared for an epidural to be an option, the idea of it scared her and she wanted to go as long as she could without it. But when Latka found out she had placenta previa (a condition where the placenta covers the cervix, essentially blocking the “baby’s exit”) at 20 weeks, everything changed. She was scheduled for a C-section—which scared her even more than the idea of the epidural. While she knew she had to do what was best for her and the baby, she also felt brushed off by her OB/GYN, who was too busy to sit down and answer her questions. She ultimately switched doctors, and delivered a healthy baby via C-section at Virtua Voorhees.
When it comes to maternity care, pregnant women meet fairly often with their OB/GYN, so it’s important to be happy with the practice they select. “What is most important is that the couple feels comfortable with their health care provider,” says Joanne Richichi, DO, a certified OB/GYN with Obstetrics and Gynecology Associates in Sewell and author of 9 Months to Go: What you Need to Know. “They must be able to communicate their concerns and issues openly and honestly. They should consider three questions when choosing their provider: Do they want a physician or a midwife? Do they want a single practitioner or a larger group? Do they mind if the group cross-covers?”
Exploring the options
While a lot of women do have a specific birth plan in mind—and many practices urge women to create those plans—it’s still important to be flexible. As with Latka’s case, there are factors that can come into play during pregnancy, labor and delivery that can change the plan. “We hope that parents will be open-minded to the process of labor and delivery,” says Michelle A. Iavicoli, MD, FACOG, co-head in the division of General Obstetrics & Gynecology at Cooper University Hospital. “The process of labor and delivery does not follow a cookbook. We cannot predict how a patient’s labor will proceed nor can we predict ultimately the mode of delivery. The goal is a healthy mom and a healthy baby. Too many first-time moms set their expectations too high and are disappointed when it doesn’t go as planned.”
When it comes to the decision to have an epidural, many women do feel pressure one way or another, whether it’s feedback from her mother, sister or friends. Everyone has a birth story they want to share, but everyone is different and there’s no right way to do it.
Iavicoli says this is another area where it’s helpful to be open-minded. “Every individual perceives pain in a different way,” she says. “Some tolerate pain very well and others not so well. A new mom won’t know how well she will be able to tolerate the pain of labor until she experiences it for herself, so be open-minded. It’s a great experience to give birth without an epidural. Yet for those who cannot tolerate the pain of labor, an epidural is a very safe method of pain control in labor that protects the baby from exposure to medication. It is not a failure to receive an epidural—just another option for mothers who need it.”
It’s also important for women to know there are a variety of options out there when it comes to giving birth beyond an epidural. Latka says she even considered hiring a doula, who is a trained professional focused on providing continuous physical, emotional and informational support to the mother before, during and just after birth. Women also have the option of delivering with a physician or a certified nurse-midwife (CNM), the latter of which has been trained in two key disciplines: midwifery and nursing. CNMs are able to administer drugs, perform medical procedures, and provide clients with other technological interventions, though their basic philosophy is to keep the birth as natural as possible.
Another option increasing in popularity women might consider is water birth, in which a warm tub is used for easing pain and deepening relaxation during labor. In the early 2000s, Karen McEvoy Shields, CNM, MSN, was practicing midwifery and getting a lot of requests for water birth. She found that the warm tub allowed women to have success with a drug-free labor, but the tub being used was not large enough for actual birth (nor would the hospital where she worked allow for water birth). “I found many women pleading with me to let them stay in the tub,” Shields recalls.
Shields became motivated to bring the option of water birth to local women, and she found the administration at South Jersey Healthcare was very receptive to the idea. In the fall of 2003, a water birth room was opened at SJH’s Elmer Hospital, offering a tub designed especially for birth along with the development of specific water birth protocols.
“It’s a much more gentle birth and really helps calm the mother, making it a more peaceful, relaxed atmosphere,” Shields says of water birth. “And it has the same benefits for the baby. It’s calming as the baby is coming from water into water.”
The biggest concern women have about water birth is whether the baby will take a breath underwater, but Shields says there are a few mechanisms that will prevent that from happening. One is a natural reflex called the “dive reflex,” which means that being underwater triggers several biological responses to help prolong breath-holding. The baby is only underwater for a matter of seconds and Shields says the trigger for the baby to breathe is “atmosphere on the cheek,” so they wouldn’t take their first breath until they come up. Still, there are strict regulations on who can have a water birth and there can’t be any medical complications. When complications are present, the tub can be used for relaxation during the labor, but the delivery will be done in a traditional bed.
Feeling at ease
There’s no question that labor and delivery—and even the progression of pregnancy—can leave a woman feeling overwhelmed. There are not only a lot of options, but also a lot of changes taking place at once. Feeling at ease comes back to being comfortable with your care providers.
Latka is currently pregnant with her second child and is hoping for a VBAC this time around (a vaginal birth after caesarean). Still, she knows her previous C-section and her placenta previa condition put her at a higher risk and stack the cards against that idea. But through the process of her first labor and delivery, she’s learned the importance of being your own advocate and is armed with questions this time around. “Women need to do their own research and weigh that against the advice of their doctors,” she says. “And you have to find a doctor you are comfortable with. Don’t be afraid to ask questions.”
Cooper University Hospital
One Cooper Plaza
1 (800) 8-COOPER
Obstetrics and Gynecology Associates
239 Hurffville-Cross Keys Road, Suite 250
South Jersey Healthcare Elmer Hospital
501 W. Front St.
Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 4, Issue 2 (April, 2013).
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