Optimum Birth – The Options Involved

Table 1.1 presents a list of options in which many women have shown an interest. Not all of these options will be appropriate for you. If any of them are important to you, but your caregiver doesn’t seem welling to accommodate your desires, encourage him to discuss his reasoning. If, following the discussion, you are still not comfortable with his response, you have the option of seeking care elsewhere. Be sure to let your original caregiver know your reasons if you make this decision.

The options in Table 1.1 are divided into four categories—pregnancy, labor, delivery, and postpartum. They are geared to the low-risk woman having a normal, uncomplicated labor and birth. Read the list and check those options that are important to you. Add any other options that you may desire. This list will be your birth plan. Take it with you when choosing or consulting with your doctor or midwife. A list of cesarean options is also provided, in Table 1.2.

After you and your caregiver have agreed on your birth plan, make several copies of it. Keep one copy with your record, give one to your labor partner, and give one to the nursing staff when you check into the hospital. You might want to have your doctor or midwife sign or initial all the copies of your birth plan to indicate his or her agreement with your desires.

Table 1.1. Options for an Optimum Birth Experience
Option Reasoning
Optimum nutrition • The No-Risk Pregnancy Diet can reduce the danger of complications for you and your baby to the lowest possible level.
• See Section [3].
Supportive caregiver willing to be flexible in your labor and delivery choices, including birth place (hospital or birth center) • Careful selection of your caregiver can eliminate the stress of trying to change the attitude of a doctor or midwife who will not consider your individual wishes.
• Some low-risk women feel more at home in an out-of-hospital birth center. Others feel safer within a hospital environment.
• See Section [1].
Consumer-oriented childbirth classes • Consumer-oriented classes inform you about all the available options rather than just the routine of a particular hospital or doctor. They enable you to make educated decisions about what options you want for your childbirth experience, plus provide you with thorough training for labor and delivery.
No smoking, taking drugs, or consuming alcohol • These have been shown by experts to have adverse effects on the baby.
• See Section [3].
No routine use of ultrasound during pregnancy • Routine screening of all women is not recommended by the National Institutes of Health or the American College of Obstetricians and Gynecologists.
• See Section [2].
Presence of a support person during the admission procedures, examinations, labor, and birth. • This eliminates the stress of separation.
Your partner can provide emotional support during labor and birth, as well as during any necessary procedures. His presence can enhance family bonding.
• See Section [6].
Presence of other family members or friends during labor and/or delivery. • Other family members and friends can provide additional support for you and your partner.
• The incidence of infection does not increase as long as those present have no signs of illness (for example, runny nose or diarrhea).
• See Section [6].
Enema only if needed • An enema is unnecessary if you had a good bowel movement within 24 hours. A soapsuds enema can be very uncomfortable. However, if you have been constipated, you may desire an enema; a small disposable enema will suffice.
• See Section [6].
Freedom to move about and to assume a position of comfort. • Walking simulates the uterus to work more efficiently. Labors that include waling are documented to be shorter and to require less pain medication.
• Sitting up, laying on your side, or kneeling on your hands and knees may be most comfortable for you.
See Section [6].
Laboring in water • Laboring in a tub or shower enhances relaxation and decreases the need for pain medication.
• See Section [7].
Liquid nourishment and high-carbohydrate, low-fat snacks as desired. • Foods that are high in carbohydrates and low in fat are digested quickly and supply energy that will be needed during labor. Liquids prevent dehydration.
• See Section [6].
Ice chips, sips of water or clear juice, or Popsicles. • Your mouth can become very dry when you do the breathing patterns.
• See Section [6].
Personal items (for example, nightgown, music or flowers) • Familiar articles can enhance your birth experience by encouraging relaxation and comfort.
• See Section [6].
Prep (shaving of the pubic hair) only if desired • Shaving of the pubic hair does not decrease the incidence of infection, and the regrowth of the hair is uncomfortable.
See Section [6].
Intravenous (IV) fluids only if medically indicated • IVs restrict mobility and interfere with relaxation.
• Clear liquids during labor reduce the chance of dehydration.
• Hemorrhage is rare when the birth is unmedicated and spontaneous, and when breastfeeding is begun immediately.
• See Section [8].
Electronic fetal monitor only if medically indicated • In a low-risk woman, a trained nurse frequently listening to the fetal heart rate has been shown to be as effective in detecting fetal well-being or distress as an electronic fetal monitor.
• Fetal monitors restrict movement and can be uncomfortable. Sometimes, women are instructed to lie on their backs, a position that can be uncomfortable and can also negatively affect labor. Intermittent use of a fetal monitor throughout labor is an alternative.
• See Section [8].
Spontaneous rupture of the membranes • The amniotic fluid contained in the membranes has a cushioning effect, equalizing the pressure on the baby, which results in less molding of his head.
• Artificial rupture of the membranes provides a passageway for infection and creates a time limit for delivery.
• See Section [8].
Medication administered only wen requested by you and with full information regarding the possible effects on you, the baby, and the labor. • All medication has the potential to affect you, your baby, and your labor. Knowledge of the benefits and risks of the medications your caregiver uses most often will enable you to make informed decisions.
• See Section [7].
Presence of a professional labor support (childbirth instructor, registered nurse, trained doula, licensed massage therapist, or midwife not associated with the hospital or birth center) • A knowledgeable professional who has a strong commitment to the type of birth you desire can provide you with additional information.
• The presence of a doula can reduce your chances of having a cesarean by 50 percent. Also, your labor may be shorter, you may require less Pitocin and pain medication, and you may reduce your needs for an epidural and a forceps delivery.
• A massage therapist can perform techniques to relieve labor discomfort.
• See Section [6].
Pitocin to induce or augment labor only if medically indicated • The contractions induced by Pitocin are more difficult to handle than natural contractions for both the woman and baby.
• The risks of induced labor include reduction of the baby’s oxygen supply and premature birth, which are not warranted just for the woman’s or doctor’s convenience (elective induction).
• The complications that may develop in a labor involving Pitocin can increase the chances of cesarean delivery.
• See Section [8].
Comfortable and efficient pushing and delivery position • Semireclining at a 70-degree angel, side-lying, or kneeling may be more comfortable than being flat on your back.
• Lying flat on your back reduces the pelvic outlet to its smallest diameter, may be uncomfortable, and causes the weight of the uterus to impede blood flow. Squatting shortens the birth canal, opens the pelvic outlet to its widest diameter, and makes the contractions more efficient because the uterus is assisted by gravity.
• See Section [5].
No use of stirrups • The lithotomy position, in which you lie on your back with your feet in stirrups, works against gravity and forces you to push the baby uphill.
Wide stirrups, while giving the caregiver a good field of vision, cause the perineum to be stretched taut and increase the need for an episiotomy (a small incision in the vaginal outlet to enlarge the opening).
• See Section [5]
Episiotomy only if needed • Allowing the baby’s head to emerge slowly under uterine force alone gives the perineal tissue a better chance to stretch, which minimizes tearing.
• An episiotomy shortens the pushing stage. It may be necessary if fetal distress is detected and a faster delivery or the use of forceps is required. Many doctors do an episiotomy routinely, whether or not it is needed.
• Healing of an episiotomy may be very uncomfortable. Muscle scarring, which can negatively affect later sexual pleasure, can result.
• See Section [8].
Use of a birthing room or the same bed for labor and delivery • This avoids the stress and discomfort of being rushed to a delivery room during the expulsion stage and of then being awkwardly moved onto a delivery table. Most hospitals do provide birthing rooms for labor and delivery.
• See Section [6].
Regional anesthesia only if medical or surgical intervention becomes necessary • Anesthesia is unnecessary in an uncomplicated delivery. If an episiotomy is done, a local anesthetic may be given for the repair work after the baby is delivered.
• Regional anesthesia is compatible with an awake delivery; general anesthesia (gas or sodium pentothal) is not.
• See Section [7].
Leboyer delivery (gentle birth) • Gentle birth is an attitude as well as a procedure. It decreases the sensory and physical trauma to the infant as he is delivered.
• See Section [8].
Cutting the cord delayed until the pulsating stops • The delay allows the baby to continue receiving oxygen through the cord while his respiratory system begins to function.
• See Section [6].
Father cutting the umbilical cord • This increases his participation in the birth.
• See Section [6].
Collection of cord blood for banking • Collection of cord blood for donation or for storage for your own personal use may provide lifesaving benefits.
• See Section [6].
Baby placed immediately on your bare abdomen or in your arms • Immediate skin-to-skin contact is beneficial. When both mother and baby are covered with a blanket, the infant’s temperature can be maintained.
See Section [6].
Baby allowed to breastfeed as soon as possible • The baby’s sucking stimulates the mother’s production of the hormone oxytocin, which aids in the release of the placenta and decreases postpartum bleeding.
• A baby’s sucking reflex is strongest during the first hours after birth.
• Colostrum (the first milk produced in the breasts) acts as a laxative, cleansing the baby’s intestinal tracts of mucus and meconium (fetal fecal matter).
• See Section [11].
Antibiotic ointment or sliver nitrate drops delayed until after bonding • These can interfere with the baby’s vision, which is so important during the bonding period.
• See Section [6].
Placenta allowed to detach spontaneously from the wall of the uterus • Strong traction or massaging may cause placental tissue to be retained, which can cause postpartum bleeding.
• See Section [6].
Bonding • The first hours after birth are very important in the development of maternal and paternal attachment to the newborn.
• See Section [6].
Taking snapshots or making a tape • These are wonderful ways to remember these unforgettable moments.
Breastfeeding • Nutritionally, your breastmilk is the perfect food for your baby.
• Breastfeeding is an emotionally satisfying experience for both mother and baby.
• It is economical.
• It helps the uterus return to its prepregnant state faster.
• See Section [11].
No separation of mother and baby unless medically indicated • Continuous mother-baby contact enhances bonding. It also increases the opportunity for the nurse to provide baby-care instruction. The initial bath can be given in the mother’s room.
• See Section [6].
No supplements (water or formula) or pacifiers if breastfeeding • Sucking on a rubber nipple may confuse your baby, since he must use a different tongue action to suck from your breast.
• If your baby is fed supplements between nursings, he may not breastfeed as often as necessary to stimulate milk production.
• See Section [11].
Full 24-hour rooming-in • This allows close contact between parents and baby to enhance the bonding process, depending on the mother’s postpartum condition.
• You are able to breastfeed on demand.
• You can learn how to care for your baby while supervised by hospital staff.
• See Section [6].
Father staying in the room with the mother until discharge • This enhances family bonding.
• It enables the father to assist with the baby care.
• Many hospitals provide cots for fathers to spend the night.
Sibling visitation with mother and baby • This helps reassure your other children that your are fine.
• It encourages acceptance of the new baby by his siblings.
• See Section [6].
Circumcision Is strongly recommended • Circumcision is normally done for religious or cosmetic reasons, and it has proven its medical benefits, particularly to male babies.
• It should be delayed for at least 12 to 24 hours after birth to give the baby time to adjust to extrauterine life.
• It may cause bleeding or infection if not done carefully with sterilized tools.
• See Section [10].
Discharge from the hospital within 24 hours after birth • This decreases the chances of a hospital-induced infection.
• Early discharge is safe as long as there is adequate follow-up care for the mother and baby. The decision should be made on an individual basis.
• It decreases the time you are separated from your other children.
• See Section [6].

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