Birthing and relaxation: not mutually exclusive

by Lain Chroust Ehmann

Birthing Gone is the stark delivery room and administration of heavy-duty anesthetics. Parents now have more choices than ever as to the environment into which their babies will be born.

With the growing openness of medical staff to complementary and alternative therapies, moms-to-be are investigating and choosing new options for delivering their babies. In fact, so many parents elect "nontraditional" paths that "what used to be alternative is now the norm," says Loma Ellis, nursing manager for Californias Alameda Hospital Birthing Center. As a result, parents now have more birthing choices than ever before.

A doula, or birth assistant, is a professional woman hired privately by parents to attend their childs birth and provide support to the laboring mom. Usually highly trained in childbirth, doulas can serve as a stand-in when Dads not available. But doulas can be an asset for any mother; many parents hire doulas even if Dad is present.

"The doulas a safety net," says Sandi Miller, RN, CD, owner of Before Birth and Beyond in San Jose, CA. "Whatever happens, whether its a cesarean or whatever, the parents know whats going on and the doula is watching out for them."

Because shes met with the mother several times prior to the birth, the doula also serves as insulation against a hospitals impersonality and can run interference with medical staff, who may be dealing with several other births simultaneously. Miller, a certified member of Doulas of North America (DONA), says that a doulas main purpose "is the continuity of someone who is not only trained and experienced, but is there for you and has no other agenda."

Although doctors may not have worked with a birth assistant before, most doulas accompany moms to a prenatal visit in order to meet the doctor before the big day. Once the doctor knows the doula is there for support and not to replace or interfere with the medical staff, he or she is likely to welcome this additional member of the team.

Studies also show that doulas—whose services start at $100 on average for a doula-in-training and can go as high as $1000 or more—have positive medical effects on both mother and baby. A 1986 study published in the British Medical Journal suggested that doulas result in fewer cesareans and shorter labors for mothers, and a lower admission rate to neonatal intensive care for infants.

Water can smooth away aches, drain off tension, and float us to a state of bliss. Its no surprise, then, that moms who labor and/or deliver their babies in a birthing pool experience less pain and greater relaxation. According to the Israeli medical journal Harefuah, waterbirthing moms are more relaxed and comfortable; water immersion also speeds the dilation of the cervix, leading to a shorter labor.

These benefits are passed on to the infant as well.

Less discomfort

• "If mom is having a positive, easy birth, it makes it positive and easy for the baby," says Barbara Harper, RN, director of Oregon-based Waterbirth International and the author of Gentle Birth Choices. When the mother is relaxed, says Harper, the child spends less time in the birth canal and undergoes minimal discomfort.

Less trauma

• Proponents of waterbirths also believe the method is less traumatic for babies. "Babies seem to be very relaxed. They open their eyes and focus on people," says Beah Haber, CNM, of The Birth Home in Pleasanton, California, who has attended approximately 200 waterbirths.

Smoother transition

• The easier transition is partly a response to the relaxed state of the mother, and partly due to waters insulating effects, according to Harper. "The baby has hearing even in utero, but its muffled and muted...the same way it is underwater," she says. Underwater, the baby is protected from harsh lights, sounds, and even touch, and thus is more relaxed and comfortable.

Harper says that approximately 9,000 mothers have birthed underwater over the last decade in the United States, and the number is rising rapidly. Many hospitals and birthing centers now offer the alternative of laboring in a tub. Some offer water delivery as well.

Despite the rising interest in water birthing, the American College of Obstetricians and Gynecologists (ACOG) has not been so quick to endorse this practice. ACOG does not feel there is enough information, specifically concerning rates of infection, to recommend warm water immersion as a safe and appropriate birthing alternative. A baby can develop an infection if he or she begins breathing while underwater and inhales the soiled birthing water.

"However," explains Marion McCartney, certified nurse midwife and director of professional services for the American College of Nurse Midwives, "most research has found that healthy babies do not gasp upon delivery, rather they do not take a breath until they are removed from the water and reach the air." These studies have been quite small, though, and until larger, more definitive research has been done, ACOG maintains that water birthing should only be performed under the strictest measures of infection control. And all experts agree that water birthing is only a consideration for healthy moms and babies.

The bad news is, labor will probably hurt. The good news is, there are many non-pharmaceutical options when it comes to managing the discomfort.

Relaxation techniques
The first step to pain management is relaxation. The tenser you are, the higher the sensation of pain. "Get the woman to relax, and her perception of pain goes way down," says doula Miller.

Relaxation starts with the environment. Even in the hospital, you can dim the lights, play soft music, light candles or use aromatherapy to create a safe feeling. The Birth Homes Haber says that lavender and sage are especially soothing scents. Other relaxation techniques include massage, showers and baths.

The mind is one of the most effective pain-fighting tools available. Hypnotism, visualization and imagery are all methods moms have used for pain relief. "The psychology involved in birth is pivotal," says Miller, who says relaxation tapes are especially effective.

Herbal remedies
Also consider using pain-alleviating herbs and homeopathic remedies. Gloria Attar, an herbalist from Canton, Ohio, recommends a skullcap tincture during labor. "You still feel the contractions, but they dont hit you like a ton of bricks," she says. She also suggests motherwort and tinctures of dandelion and red clover.

If you decide to use herbs, check with a qualified herbalist, homeopathic physician, or pharmacist first, and inform your doctor or midwife of anything you take. Herbs and drugs can interact, causing dangerous side effects.

When planning your baby's birth, investigate the options and be realistic about your personality and desires. Work with your doctor or midwife early on, and check policies of the hospital or birthing center you've selected (for instance, some may allow only family members in the delivery room; others might have policies against candles or other open flames). And be flexible; even the best laid plans can go awry. After all, babies have their own ideas about the way things should turn out!