Birthing YOUR Way: Labor and Delivery Trends
Many hospitals are also making an effort to let women go through labor the way that they want. Birth centers (including some situated on a hospital campuses) offer another option for women seeking a more natural childbirth, and more women are hiring doulas – trained professionals who provide support to a mother before, during and just after birth.
Monica Mendiola, M.D., an obstetrician and gynecologist at Beth Israel Deaconess Medical Center in Boston, says today’s doctors are less “paternalistic” toward laboring mothers than they were even 10 years ago. Birthing today, she says, is more “family- and patient-oriented.”
At Boston’s Brigham and Women’s Hospital, health care providers are trying to create a family atmosphere in the unlikeliest of places – the operating room. In a “family-centered” Caesarean section, the expectant mom will have one arm free from any constraints on the operating room table so that she can hold her baby skin-to-skin and breastfeed right after birth. Fathers and other support partners are encouraged to be in the operating room. And when it’s time for the baby to come out, the blue surgical drape is lifted, giving way to a clear drape.
“You can actually watch the baby being born,” says William Camann, M.D., director of obstetric anesthesia at the hospital. "What we’re trying to do is take a surgical procedure and make it more of a pleasant, family-centered experience.”
When asked about the biggest trends in birthing over the last couple of decades, the numbers roll off Camann’s tongue: The rate of women who receive an epidural is around 75 percent, up from around 20-30 percent in the early 1980s. And more than 30 percent of women are giving birth via C-section – a steep rise from decades past.
But while inductions may be up overall, hospitals have clamped down in the past couple of years on early inductions and C-sections, unless there’s a medical need for them. Studies have shown that babies born before full-term (39 weeks) are at increased risk for respiratory problems and other complications.
And while epidural and C-section rates remain high, Thomas Beatty, M.D., chairman of obstetrics and gynecology at Newton-Wellesley Hospital, says, “We may be starting to see a reversal in that trend. More women are coming in requesting natural childbirth."
Leslie Ludka, MSN, CNM, director of midwifery at Cambridge Health Alliance, has seen a small spike in the number of women choosing to deliver at the Cambridge Birth Center, which emphasizes natural births. The numbers are up from about 120 women a year three years ago to around 140 women now. That still pales next to the 8,000 to 9,000 women who give birth each year at Brigham andWomen’s Hospital.&pagebreaking&
One intervention that has fallen out of favor is the routine episiotomy. Until recently, many doctors believed that a surgical incision, allowing more room for the baby to emerge in a vaginal birth, would heal faster than if the mother’s tissue tore on its own during the birth. Research has not shown that to be the case, says Beatty.
Another change: Beatty says doctors today rarely resort to using forceps or vacuum devices to aid delivery, instead opting to simply wait for the baby. “We’ve learned to be more patient and therefore not to intervene at any fixed amount of time,” Beatty says.
Other changes include:
• Allowing laboring moms more mobility – Tara Poulin, who runs the Boston-based doula service Birthing Gently, says there’s now “more flexibility” – even in hospital settings – for moms who don’t want to labor on their backs. Tools like birthing bars and birthing balls that can help expand the pelvis and reposition the baby are more commonly used today. Birthing centers, of course, have always encouraged women in labor to move around more.
• Allowing laboring moms to take in nutrition through fluids during labor to keep up their strength – “It used to be in labor that people were absolutely starved. If you were really considered generous, you would give people chips of ice to suck on,” Camann says. “We still don’t advocate solid food but liquids are totally allowed. They can drink juice and tea and Gatorade. This is shown to be very safe.”
• Skin-to-skin contact – While birth centers have long touted early skin-to-skin contact between newborns and moms, most hospitals have only recently started advocating the practice. Now, rather than being moved to a scale to be weighed and measured, a newborn is placed directly on the mother’s chest.
• Extending family time with the newborn – At Newton-Wellesley, says Beatty, the emphasis on quality family time with a newborn extends through the entire hospital stay. Families are encouraged to keep their newborns with them in the hospital room rather than sending them to the nursery. And spouses or partners don’t have to head home after the birth if they don’t want to. Instead, the hospital is now providing beds and meals for that other parent, as well.
• VBACs – Vaginal birth after Caesarean fell out of favor in the mid-1990s due to concerns about maternal complications, but in the last few years a number of health officials have said that attempting a a VBAC is a safe option.
Calvin Hennick is a freelance writer in Roslindale.