9.1: Preparing for Childbirth
- Page ID
- 225446
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- Compare and contrast hospital births, birthing centers, and home births.
- Describe the roles of certified nurse-midwives, licensed midwives, doulas, and birth coaches.
Approaches to Childbirth
| Method | Description |
|---|---|
| The Lamaze Method | The emphasis of this method is on teaching the woman to be in control during the delivery process. It includes learning muscle relaxation, breathing through contractions, having a focal point (usually a picture to look at) during contractions, and having a support person who accompanies the mother through the training process and serves as a coach during delivery. |
| The Leboyer Method | This method involves giving birth in a quiet, dimly lit room and allowing the newborn to lie on the mother’s stomach with the umbilical cord intact for several minutes while being given a warm bath. |
| Dick-Read Method / Mongan Method / Hypnobirthing | This method comes from the suggestion that the fear of childbirth increases tension and makes the process of childbearing more painful. It emphasizes the use of relaxation and proper breathing techniques, as well as the importance of family support and education. |
| Bradley Method | “The Bradley Method focuses on preparing the mother for a natural childbirth coached by her partner. They learn techniques to reduce the perception of pain and stay relaxed. The emphasis is on being prepared for an unassisted vaginal birth without medication.” 2 |
| Alexander Technique | This is a technique that can be used during childbirth that involves training to stop habitual reactions to pain, such as tensing muscles, and increase conscious awareness and control over posture and movement. This involves being able to move freely and stay upright during labor and using body positioning that is beneficial to the labor process.3 |
| Waterbirth | Involves immersion in warm water. Proponents believe this method is safe and provides many benefits for both mother and infant, including pain relief and a less traumatic birth experience for the baby. However, critics argue that the procedure introduces unnecessary risks to the infant, such as infection and water inhalation.4 |
| Lotus Birth | Or umbilical cord nonseverance – UCNS, is the practice of leaving the umbilical cord uncut after childbirth so that the baby is left attached to the placenta until the cord naturally separates at the umbilicus. This usually occurs within 3–10 days after birth. The practice is performed mainly for spiritual purposes of the parents, including for the perceived spiritual connection between placenta and newborn.5 |
| Silent Birth | Sometimes known as quiet birth, it is a birthing procedure advised by L. Ron Hubbard and advocated by Scientologists in which "everyone attending the birth should refrain from spoken words as much as possible." 6 |
| Medicated Childbirth | Health care providers can provide pain relief during labor with different types of medication, including epidurals, spinal blocks, combined spinal-epidurals, and systemic and local analgesia. There are benefits and side effects of each.7 |
Table \(\PageIndex{1}\) adapted from Lifespan Development: A Psychological Perspective (page 59) by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0; Lifespan Development - Module 3: Prenatal Development by Lumen Learning references Psyc 200 Lifespan Psychology by Laura Overstreet, licensed under CC BY 4.0
Choosing Location of Childbirth & Who Will Deliver
Hospitals
Figure \(\PageIndex{2}\): Hospitals are the preferred choice of expectant mothers, as they have access to advanced medical technology and a variety of healthcare professionals. Image by UM Health System is licensed CC BY-NC-SA 2.0.
Women often choose to deliver in hospitals due to the access to advanced medical technology and the presence of skilled healthcare professionals, which can provide reassurance and immediate care in case of complications (Declercq et al., 2020). Hospitals also offer pain management options, such as epidurals, and specialized neonatal care for high-risk pregnancies or premature infants (Martin et al., 2019). However, hospital deliveries may come with drawbacks, including higher costs and a more medicalized birthing experience, which some women feel limits their autonomy and ability to follow a birth plan (Vedam et al., 2018). Additionally, hospitals can have restrictive policies on movement, eating, or the number of support persons allowed during labor, which may detract from the comfort and personal experience some women desire (Declercq et al., 2020).
Birthing Centers
Birthing centers provide a middle ground between hospital and home births, offering a more homelike environment with fewer medical interventions while maintaining access to professional care. Attended by certified nurse-midwives, licensed midwives, or occasionally family physicians, these centers focus on low-risk pregnancies, making them ideal for women with uncomplicated health histories and minimal risk factors (Stapleton et al., 2013).
Figure \(\PageIndex{3}\): Birthing centers offer a more home-like feel while still maintaining access to professional care. Image by Bec Plumbe is licensed CC BY-NC-SA 2.0.
A Certified Nurse-Midwife (CNM) is a registered nurse with advanced training in midwifery, certified to provide care during pregnancy, childbirth, and beyond. They typically work in hospitals but may also attend births at birthing centers or homes. CNMs can prescribe medications and handle some complications, making them ideal for low- to moderate-risk pregnancies. Alternatively, a Licensed Midwife (LM) specializes in natural, low-risk births, often at homes or birthing centers. They are trained in midwifery but are not nurses and cannot prescribe medications. LMs focus on holistic care and transfer patients to doctors if complications arise.
A key advantage of birthing centers is the emphasis on personalized care, autonomy in birthing choices, and a natural birth experience without routine interventions (Walker et al., 2020). However, they are not equipped to handle emergencies requiring advanced medical intervention, which may necessitate transfer to a hospital (Stapleton et al., 2013). This limitation makes them less suitable for high-risk pregnancies involving conditions like preeclampsia, multiple births, or previous cesarean deliveries. Despite these drawbacks, birthing centers remain a preferred choice for women seeking a balance between safety and a less medicalized birth.
Doulas and Birth Coaches
In addition to physicians and midwives, doulas and birth coaches are non-medical professionals who provide physical, emotional, and informational support to women throughout the childbirth process, from before conception to after childbirth. Women often choose to use doulas for personalized, continuous care and advocacy during labor, particularly when seeking a more empowering and less stressful birth experience (Gruber et al., 2013).
Figure \(\PageIndex{4}\): Doulas assist expectant mothers through various non-medicated pain management techniques. Image by Agencia Senado is licensed CC BY 2.0.
Doulas assist by offering techniques for pain management, such as breathing exercises, massage, and positioning, and by facilitating communication between the birthing person and healthcare providers to ensure their preferences are respected (Bohren et al., 2017). Birth coaches, who may overlap with the role of doulas, focus on mental preparation, providing guidance and emotional support to help women and their partners feel confident and informed about the birthing process. Studies have shown that having a doula or birth coach can lead to improved outcomes, including shorter labor, reduced need for medical interventions, and higher satisfaction with the birth experience (Gruber et al., 2013).
References, Contributors and Attributions
Declercq, E. R., Sakala, C., Corry, M. P., & Applebaum, S. (2020). Listening to mothers in California: A population-based survey of women’s childbearing experiences. National Partnership for Women & Families.
Grünebaum, A., Bornstein, E., McLeod-Sordjan, R., Lewis, T., Wasden, S., Combs, A., Katz, A., Klein, R., Warman, A., Black, A., & Chervenak, F. A. (2023). The impact of birth settings on pregnancy outcomes in the United States. American Journal of Obstetrics and Gynecology, 228(5), S965–S976. https://doi.org/10.1016/j.ajog.2022.08.011
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2019). Births: Final data for 2018. National Vital Statistics Reports, 68(13), 1–47.
Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery & Women’s Health, 58(1), 3–14. https://doi.org/10.1111/jmwh.12003
Vedam, S., Stoll, K., MacDorman, M., et al. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLOS ONE, 13(2), e0192523. https://doi.org/10.1371/journal.pone.0192523
Walker, D. S., Lannen, B., & Rossie, D. (2020). Midwifery practice in the United States: Characteristics and recent trends. Journal of Midwifery & Women’s Health, 65(4), 451–459. https://doi.org/10.1111/jmwh.13110