As I wrote in my last article about the safety of midwife-attended childbirth, there was more information I wanted to share. This article will cover in a bit more depth the specific ways a midwife promotes safer childbirth, while contrasting the common obstetrical practices and their risks.

A recent study showed that pregnant women show a huge lack of knowledge about childbirth options, with fewer women attending childbirth classes and appearing to simply follow the advice of their caregiver. A large number of them were not able to answer basic questions regarding the pros, cons, or safety issues associated with epidurals, episiotomies, Cesareans, and other childbirth options. The study did say that women who received prenatal care from from midwives tended to be more informed about their options compared with women receiving care from a medical doctor.

I am hoping this article will share some basic information about the risks of common obstetrical practices during labor and childbirth, and also open your eyes to the safe, natural birthing methods used by midwives.

As you’ve read in my previous article on safety, there are are fewer interventions, safer birth practices, and better outcomes for moms and babies with midwife-assisted birth. Complications in birth often arise because of all the interventions used. Midwives use fewer interventions and have better outcomes; complications are avoided because of the method in which babies are born. But what specifically do they do (and not do) during childbirth that leads to these great outcomes?

8 Ways Midwives Promote Safe Childbirth

Midwives follow evidence-based birth practices. I’ve put together a list of 8 ways that midwives approach birth that lead to healthy outcomes of mother and baby.

1. Labor Starts on Its Own and Proceeds at Its Own Pace

In home births, labor starts on its own and proceeds at its own pace; and this is a good thing. Nature knows when a baby is ready to be born and midwives know to follow nature’s lead. When babies are truly ready to be born, the natural birth process works better.

Even though the World Health Organization’s (WHO) recommendations for labor induction are 10% or less, 34% of labors are medically induced in hospitals (compared to just 2.1% in home births). And despite a common nonchalance about inducing labor, especially elective induction, there are risks associated with induction.

Induction with drugs and rupture of the amniotic sac increases the risk of:

  • having the cord prolapse (a life-threatening complication for the baby)
  • having the baby in a less than optimal position in the birth canal (often leading to a cesarean section)
  • having a premature baby with respiratory problems because the lungs are not mature

The common use of drugs (pitocin, for example) to speed up labor is associated with greater likelihood of the baby being distressed, and increases the chance of uterine rupture (which can be life-threatening to mother and baby).

2. Freedom of Movement and Position During Labor and Birth

Midwives find that women instinctively move in ways that help the baby move through the birth canal. Therefore, a laboring mother is free to be in any position during labor. This can include sitting on a birth ball, taking a warm shower, taking a bath, walking, squatting, being on hands and knees, etc. For birth, women are also allowed to birth in a position of their choosing. It’s not uncommon for a midwife to catch a baby while the mother is on hands and knees, or squatting, or in a birthing tub, or on a bed.

In hospital births most women are told to lie on their backs during labor and birth and 70% give birth this way. The mother is then more likely to have:

  • slow labor
  • a baby showing signs of distress
  • difficulty pushing the baby out
  • perineal lacerations from tearing

3. Intermittent Fetal Monitoring

Midwives use intermittent monitoring, or Intermittent Auscultation (IA), to monitor the baby during labor. For this, a hand-held Doppler device or a fetoscope is held against the mother’s belly at certain time intervals to listen to the baby’s heartbeat, just as she did during prenatal visits. Since a laboring mother could be in any position during labor, a midwife might find herself doing some bends and twists to work around the mother to get the reading!

In hospital births over 90% of women are attached to electronic fetal monitors, even though WHO’s recommendation for Electronic Fetal Monitoring (EFM) is ‘not routine‘. While this might not seem like an intervention to be concerned about, since Electronic Fetal heart rate Monitoring (EFM) became the standard of care in hospital obstetrics in the mid 1970’s this technology has contributed to the dramatic increase in cesarean section birth, while the perinatal morbidity and mortality rate have not declined with routine electronic monitoring.

In fact, it has been reported that between 71 – 95 % of operative deliveries for fetal distress result in a baby that is not “clinically” distressed at birth, based on Apgar scores and umbilical artery pH. One study has shown that routine EFM increases the cesarean rate by 21% and the use of forceps and vacuums by 11%, with a total increased risk of 23%, as compared to IA.

4. Mother May Eat and Drink During Labor

Midwives allow the mother to eat and drink as she wishes during labor, understanding that labor is vigorous exercise and quenching a mother’s hunger and thirst is not only tolerable but actually preferred in order to maintain chemical balances in both mother and child.

Eating and drinking during labor are safe. Despite the fear about aspirating stomach contents during surgery, other countries that allow oral intake during labor do not have a problem with aspiration. Restricting food and drink in labor is not justified.

In the United States, 60% of women are denied fluids and 85% of women are denied food during labor. There are some risks with the strict “nothing by mouth” standard during hospital births; dehydration and starvation are associated with:

  • longer labors
  • increased use of Pitocin
  • instrumental delivery
  • chance of producing ketones, which can make the fetal blood more acidic and lead to fetal distress

Even though they have been linked to difficult labor and cesarean sections, routine IVs have thus become an acceptable solution to doctors. But they also have risks:

  • fluid overload, which can lead to fluid in the mother’s lungs and baby’s lungs
  • dilutes the blood, which decreases concentration of red blood cells leaving fewer oxygen-carrying cells/volume for the baby and the uterine muscle cells

5. Natural Pain Relief Methods Used

Midwives are skilled at helping women to labor naturally utilizing techniques such as position change, hydrotherapy (labor in water), massage, breathing patterns, and other holistic modalities. By using natural pain relief methods, the very real and common complications of epidurals are avoided.

In hospital births 86% of women are given drugs for pain relief, even though WHO’s recommendation for pain relief drugs in labor is ‘not routine‘. Epidural analgesia is the most common form of pain relief used and most laboring women welcome the pain relief it provides, but they do not appear to be well-informed about the side effects.

Epidurals alter the physiology of labor, leading to:

  • Prolonged first stage of labor
  • Increased risk of malpresentation of baby’s head
  • Increases need for Pitocin augmentation (which has its own risks)
  • Prolonged second stage of labor
  • Decrease in ability to push effectively
  • Fivefold increase of the likelihood of a forceps or vacuum extraction delivery
  • Increased likelihood of needing an episiotomy
  • Increased risk in cesarean section (which carry far more risks to both mom and baby than vaginal births)

Maternal side effects include:

  • Drop in blood pressure (which can lead to respiratory distress for mother and baby)
  • Urinary retention and postpartum urinary dysfunction
  • Nausea and vomiting
  • Fever
  • Spinal headache
  • Immobility
  • Increased risk of hemorrhage
  • Itching
  • Serious perineal tear

Fetal/newborn risks include:

  • Drop in baby’s heart rate/abnormal heart rate/fetal distress
  • Drowsiness at birth and a poor sucking reflex
  • Hyperbilirubinemia (Neonatal jaundice)
  • A baby born with poor muscle strength and tone
  • Direct drug toxicity
  • Poorer performance on newborn assessment scales

6. Perineal Support

Midwives seldom do episiotomies, preferring to protect a woman’s tissues from the scalpel or serious tears by skillful hands-on care and positions that aid smooth delivery. Some may even apply a type of counter pressure to the stretching from the baby’s head, to help prevent a tear.

Episiotomies (cutting the vaginal opening to make it larger) and serious tears (usually the result of an episiotomy) can cause long term pain for many women. They can also increase:

  • perineal injury
  • need for stitches
  • experience of pain and tenderness
  • risk of infection
  • delayed healing
  • wound breakdown
  • likelihood of leaking stool or gas
  • pain with intercourse

7. Exhale Pushing/Mother-Led Pushing

Midwives encourage breathing and pushing according to the mother’s natural tendency. During mother-led pushing, the mother may want to push as she feels the urge from her body. During exhale pushing, the mother will slowly let the air out of her mouth while she pushes instead of holding the air in. This may be accompanied by natural noises she may make such as grunts and groans. This is how I birthed my son and to me it was like a full, purposeful, heavier exhale with focused attention on squeezing, if that makes sense.

Mother-led pushing is generally easier on the mother and reduces the risk of tearing. Exhale pushing promotes a gentler, slower pushing phase which may be easier on the mother and baby. Making noises like grunting and groaning during pushing also relieves strain on the mother’s heart and circulations.

Prolonged breath holding during direct pushing, as is commonly used in hospital births, has some consequences including:

  • increases the chance of a tear
  • increases the mother’s fatigue
  • decrease oxygen levels for both mother and baby

8. Delayed Cord Clamping and Cutting

Midwives do not cut the umbilical cord as soon as the baby is born in order to ensure the baby receives as much oxygen as possible. Instead, they wait until the cord stops pulsating which can take 2-5 minutes. The benefits of delaying cord clamping/cutting are:

  • Increased levels of iron
  • Lower risk of anemia
  • Better oxygen levels
  • Fewer transfusions
  • Fewer incidences of intraventricular hemorrhage

In one study, a two-minute delay in cord clamping increased the child’s iron reserve by 27-47 mg of iron, which is equivalent to 1-2 months of an infant’s iron requirements. This could help to prevent iron deficiency from developing before 6 months of age.

At birth the umbilical cord sends oxygen-rich blood to the baby’s lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth.

In hospital births it is common practice to clamp and cut the cord immediately, which has some consequences:

  • Deprivation of the placental blood (which belongs to the baby) results in a large loss of iron to the baby.
  • Prolongs the average duration of the third stage (delivery of the placenta) and greatly increases maternal blood loss.

Bonus: Nutrition

While one may not think excellent nutrition during pregnancy contributes to labor and birth, good nutrition is important to prevent a variety of pregnancy-related complications. It thus plays a crucial role in having a healthy baby and mother. Midwives promote the importance of good nutrition throughout pregnancy and often recommend certain dietary changes in order to help with certain issues.

Excellent prenatal nutrition can help with:

The Thinking Woman’s Guide to a Better Birth

The Thinking Woman’s Guide to a Better Birth, by Henci Goer, provides scientific research about many birth choices so the reader can make informed decisions about their maternity care and birth. I *highly* recommend it to anyone pregnant, or thinking of becoming pregnant. The information is easy to read and presented well. It covers the topics mentioned in this article as well as many more.

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Wendy – ParentingTips365.com

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