By Dr. Charles H. Bowers, Jr., M.D., FACOG, FACS
It is a life changing decision when a couple plans to expand their family and start trying for a baby. Many couples want to wait until they are settled into a home, financially stable and feel like the time is right. While this may seem like one of the biggest decisions that a couple will ever make together, it is only the beginning of what they will need to think about before their child actually enters into the world.
Giving birth is not something that should be taken lightly, and it rarely goes as smoothly as it looks in the movies. There are many different scenarios that can be encountered and a plethora of things that could potentially go wrong during the labor and delivery process, so it is imperative that pregnant women know what they want prior to giving birth.
One of the first things that should be decided on is whether a midwife or doctor will be providing the prenatal care and delivering the baby. In many instances, midwives are capable of providing quality care just as much as a physician provider. However, there are also times when a midwife is not the best decision. If a woman has a high-risk pregnancy and/or there is a greater possibility that she will be having a cesarean section, then a doctor should be seen instead. Regardless of the type of practitioner chosen, the most important factors to consider beyond safety are the experience and training of your chosen provider and whether this individual makes the patient feel comfortable and takes the time to fully answer all of her questions.
With the practitioner selected, it is time to start considering the actual delivery. First, a plan should be established on who will actually be in the delivery room. Will it just be the woman and her partner, or will any other friends or family members be invited into the room as well? Does she want to have a doula present? There is plenty of evidence to demonstrate that women who are supported during labor have a much better outcome with respect to their babies. Without proper support during the labor and delivery process, there is a greater chance of cesarean section and fetal distress, so this is not a decision to take lightly.
While a mother is able to tolerate labor much better when she has good emotional support surrounding her, pain management is still a factor that needs to be considered. According to the American Pregnancy Association, over 50% of women delivering at a hospital will receive an epidural. This regional anesthetic is able to reduce the discomfort of childbirth, and many women report having a more positive birthing experience once getting the epidural.
However, it does not come without its downsides. An epidural may cause labor to slow down and weaken the expulsive efforts needed to deliver. If this occurs, medication like Pitocin may be necessary to help move things along. Additionally, it may become difficult to push because the mother cannot feel when she is having contractions. This may result in other techniques being necessary to assist the baby in coming through the birth canal, like the use of forceps or a vacuum.
Speaking of other techniques to deliver the baby, a pregnant woman should at least give some thought to a cesarean section. While most mothers do not go into their pregnancy wanting to have a cesarean section performed, the reality is that the rate of C-sections performed in the United States is more than double what the World Health Organization recommends. According to the CDC, the rate of cesarean sections was at 32.7% in 2013.
There are times when this procedure is imperative for the safety of the baby and/or mother. Regardless of the reason, there are increased risks that a woman faces after a C-section. This can include increased chances of complications in future pregnancies, bowel injuries, bladder injuries, hemorrhage, blood clots and the possibility of needing a hysterectomy. For all of these reasons, it is important for pregnant women to at least be educated about the procedure.
Giving birth is exciting, emotional and a serious matter to be understood. By taking the time to make important decisions before labor begins, a mother can help herself to better understand what is going on and avoid facing major surprises during the process.
Dr. Charles H. Bowers, Jr. was the Chief of the Obstetrics and Gynecology Department at Kings County Hospital Center in Brooklyn, NY where he delivered hundreds of babies. He now works with Ross Feller Casey consulting on birth injuries and other medical issues.