Birthing Options

Birthing Options Laura B. VanWaardhuizen

Providers Obstetrician/Ob-gyn Family Practioner Certified Nurse Midwife Direct-Entry Midwife Doula*

Obstetrician • Physicians who are trained in every conceivable medical aspect of pregnancy, labor, delivery, and the postpartum period • One who does all of the above plus cares for the reproductive systems of non-pregnant females is called an obstetrician-gynecologist, or Ob-gyn. • Some specialize even further into specific pregnancy issues • A definite must for a high-risk pregnancy or complicated birth

Family Practitioner • A “one stop” doctor who is trained in maternal care as well as primary care and pediatrics. • May have already seen for a check up and advice when first trying to conceive (couples without fertility issues) • Benefits are familiarity with mother and her health history, also the ability to provide continued care for the baby through it’s lifespan • In high risk pregnancies, will refer on to a specialist • Some may just provide the prenatal and postnatal care and leave the delivery to an obstetrician

Certified Nurse Midwife (CNM) • A registered nurse who has taken graduate level courses in prenatal, birth, and postnatal care who is licensed by the American College of Nurse Midwives • Typically more personally involved than a doctor • Can perform an epidural, though statistically do so less than doctors. Do have a higher VBAC rate • May not be able to deliver in a hospital • May not be covered by many insurance plans

Direct-Entry Midwife • Did not start as a registered nurse (though may have other health degrees). Those evaluated and certified by the North American Registry of Midwives may call themselves a “Certified Professional Midwife.” • Most likely to do a home birth (birthing centers are more likely to use CNMs) • Are not RNs, so cannot administer pain medications • Some states offer licensing and CPMs can be reimbursable through Medicaid or private healthcare plans. • In other states (including Iowa), it is illegal for CPMs to practice.

Doula • A doula does NOT medically assist with birth • A birthing assistant who supports the mother/family through pregnancy, labor, delivery, and early infant care. • Unlike friends or family members, a doula is a professional and will remain steadfast and stable through the birth • Research links them reduced incidence of C-sections, epidurals, and difficult labors • Are not covered by insurance; costs range from $300-$1000

Places Hospital Birthing Center Home

Hospital • 99% of North American women plan births in hospitals • Ready access to pain medications, specialists, and emergency care • Safest place to be for a high risk pregnancy • 1 in 4 incidence of C-section birth • Some now offer birthing rooms/suites which offers more comforts for the family • LDR room: Labor, delivery, and at least 1 hour recovery • LDRP room: + Postpartum; stay in room until go home

Birthing Center • Designed to be a more homey/comfortable atmosphere; private rooms, whirlpool tub/shower, kitchen • Not equipped to handle major birth complications • Can administer pain medications but not epidurals • Should be located close to a hospital in case of emergencies • Typically staffed by midwives, but some have on-call OBs • Will only accept low-risk pregnancies

Home • Idea: pregnancy isn’t a sickness or disease • You literally have “all the comforts of home” and you can begin to care for your infant immediately as you typically would but still have a support staff early on • Newborn is not exposed to many strangers (and potentially their germs!) • To consider a home birth, the ACNM recommends: • You have a “low-risk” pregnancy • You have a doctor or midwife in attendance • You live within 30 miles of a hospital (10 if heavy traffic)

Options Medicine Medicine Alternative Birthing Positions Waterbirth

Medicines- Epidural • A shot or spinal tap delivering a combination of drugs to the fluids surrounding the spinal cord; numbs your lower body. Does not enter the bloodstream (not transmitted to baby). A fetal monitor will be attached to your baby. • Restriction: don’t eat or drink. Restricted to bed • Drawbacks: slows down productive labor because the numbing keeps you from pushing. • Side effects: can decrease your blood pressure and slow the baby’s heartbeat (can be helped with IV fluids and lying on your side). Can have a headache if the covering of the spinal cord is pierced. Rare incidence of seizures.

Medicines: • Combined Spinal Epidural (Walking Epidural): Delivers the same amount of pain relief with less medication. Still have control over leg muscles. Can get as soon as 2 cm dilation; caregivers prefer to wait until 4 cm • Spinal Tap: Spinal block for C-section; Saddle block for vaginal delivery.

Birthing Options