Natural Birth (Vaginal Birth – VBAC)

There are those who wonder why with the advent of epidural anesthesia a woman would “martyr” herself by not having pain relieving medications in labor. There are others who aren’t sure what they want and go in and try to have an unmedicated birth. And then there are women who know exactly what they don’t want – pain relief in labor. Here are just a handful of the reasons a woman might choose to avoid pain medications in labor:

• VBAC is usually safer for mom and baby.
• VBAC reduces the risks of infection to the mother.
• Labor is good for babies in most cases.
• Not having surgery makes mom’s recovery easier.
• VBAC reduces the risks of respiratory problems in babies.
• VBAC involves a shorter hospital stay.
• More than 80% of women will be able to have a vaginal birth after a previous cesarean.
• Breastfeeding is easier after a vaginal birth. Usually for a variety of reasons, including faster and more direct access to your baby and less postpartum pain for mom.
• VBAC can help prevent injury to your internal organs, like your bladder, intestines, or even the need for an emergency hysterectomy.
• VBAC is less expensive.

C-section: Medical reasons

Cesarean birth is the birth of a baby by surgery. The doctor makes an incision (cut) in the belly and uterus (womb) and then removes the baby. The surgery is called a cesarean section or c-section. If you or your baby have certain problems before or during labor, c-section may be safer than vaginal birth.

You and your health care provider may plan your cesarean in advance. Or you may need an emergency (unplanned) c-section because of a complication that arises for you or your baby during pregnancy or labor. Your health care provider may suggest that you have a c-section for one or more of these reasons:

• You’ve already had a c-section in another pregnancy or other surgeries on your uterus.
• Your baby is too big to pass safely through the vagina.
• The baby’s buttocks or feet enter the birth canal first, instead of the head. This is called a breech position.
• The baby’s shoulder enters the birth canal first, instead of the head. This is called a transverse position.
• There are problems with the placenta. This is the organ that nourishes your baby in the womb. Placental problems can cause dangerous bleeding during vaginal birth.
• Labor is too slow or stops.
• The baby’s umbilical cord slips into the vagina, where it could be squeezed or flattened during vaginal delivery. This is called umbilical cord prolapse.
• You have an infection like HIV or genital herpes.
• You’re having twins, triplets or more.
• The baby has problems during labour that show it is under stress, such as a slow heart rate. This is sometimes called “fetal distress.”
• You have a serious medical condition that requires intensive or emergency treatment (such as diabetes or high blood pressure).
• The baby has a certain type of birth defect.

Choosing a birthing method is a personal decision. And selecting from the variety of methods can be a bit overwhelming.

Natural childbirth

A natural birth is when a woman wants as little medical intervention with labor and delivery as possible. She chooses not to use epidural analgesia or other painkillers. And she will try to avoid delivery by cesarean (c-section) unless it’s necessary.

The decision to try a natural birth is between you, your partner and your doctor. Some women opt for a natural birth because they fear the rare but possible side effects of epidurals and other medications.

No matter which type of childbirth you choose, make sure your requests are outlined in your birth plan. Go over your birth plan with your partner and doctor before labor starts so everyone is aware of your wishes. Also discuss with your doctor when and why medical intervention would be needed for your safety or the safety of the baby.

Birthing methods

Childbirth education classes usually focus on one birthing method. Your doctor can answer your questions and help you choose the one that’s best for you. Some common methods include:

• Lamaze emphasizes distraction techniques, such as controlled breathing, to lessen pain during labor. In Lamaze classes, women and their partners will learn how to make informed decisions during the childbirth process. Other topics covered include:
  • Positioning for more comfortable labor and birth
  • Massage for pain relief
  • How the labor coach can help
  • Tips for communicating with your partner
  • Healthy lifestyle advice
  • Information about medical procedures you may need during labor and delivery

• Bradley method teaches couples how to do everything possible to achieve a natural childbirth. In this method, you choose to forgo any anesthesia or pain medications and prefer not to use forceps, fetal monitors or other tools. The Bradley method stresses good nutrition and exercise throughout pregnancy. This standard course also includes information on:

- Specific nutrition guidelines

- Labor rehearsals

- Postpartum care

- How the coach can advocate for the mother

• Hypnobirthing stresses deep relaxation during the labor process. This method says that pain does not have to be a part of childbirth if mom is very calm. The classes teach moms how to achieve a daydreaming-like feeling that will lead to a happy, peaceful experience.

• Water birthing is when the baby is born into a warm tub of water. Some women choose to spend labor in the tub and get out for delivery. Being in the water is soothing and may reduce stress. Water may also ease the pain of labor because it creates buoyancy, which results in less pain for the mother. Check with your doctor to be sure that you are a candidate for this type of birthing experience.

Getting through labor and delivery

It is advisable for pregnant women and their partners to take childbirth education classes. A study found that women who took classes and prepared for birth had a more satisfying experience. Classes prepare couples for labor, delivery and the postpartum period. The topics covered may include:

• What to expect during childbirth, including when you may need to have medical intervention
• Relaxation techniques
• Coaching tips for the partner
• Breast-feeding advice
• Newborn care basics

The goal of most childbirth education classes is to help mothers cope with the pain of labor. Even if you’re not doing a natural birth, you can still benefit from some of these classes. The relaxation techniques can be used to ease labor pain before you’re ready for painkillers.

You can find out when and where the next Pre-Natal Classes with your doctor, midwife, local hospital or check BaiBoo’s Event Calendar.

Waiting to find out can be beneficial even if you really, really want a baby girl. Because, when the time comes and they hand your newborn son to you, you may think he’s perfect! Even if you later start thinking ‘what if..’ this might be less of a problem. Because you already have the happiness of your healthy baby boy being with you. The hormones of labor and birth could help you forget about your previous wishes.

By 18 to 20 weeks, you can find out the gender of your baby through and ultrasound. This is the easiest and best way to find out. But, your baby has to cooperate. He or she has to be in a position that allows the doctor to see the baby’s genitals. You should always be prepared for a baby of the opposite sex. Even the best doctors can’t usually guarantee whether it’s a girl or a boy.

Remember that even if you feel disappointment during pregnancy, it may turn out you’ll get the joy and happiness at birth of something you never knew you were waiting for!

Admitting your feelings to someone you trust, like your partner, a friend, a relative, or your doctor can really help avoid future complications with your baby. It’s okay to feel disappointed. Don’t feel ashamed about these feelings, many women experience this. Talking is always a relief and it will definitely help in this situation. If you don’t feel like you can talk about it, try writing down what you feel.

Being disappointed doesn’t mean you don’t love your baby or that you’re a bad mother. It means that you had a dream of something specific and the end result is great, but different than how you had imagined it to be.

Some doctors say it is better to find out the gender of your baby during pregnancy with an ultrasound. Doing so can clear the way for a healthier postpartum period for both parents and baby. But whether you choose to find out the sex of your baby before or after birth, don’t be surprised if the news fills you with something other than pure joy.

Most women find that within a few weeks they’re so happy and they can’t imagine that they ever wanted something other than what they got. It just takes a bit of time to realize the gift they have.

If this is not the case, read the article on this website about postpartum depression and baby blues, to be sure you know what you’re dealing with.

• They feel they’ll be unable to connect to a particular gender
• They have several children of the same gender already
• Pressure from family to fulfil the need for a specific gender
• They were abused as a child

Women find this difficult to talk about because:

• They are worried they will upset those who are having trouble conceiving
• They don’t want to be looked at as being selfish or insensitive because their child is healthy
• They are worried people will think that means that they will not love their child or be a bad mother

No matter what your situation might be, it is okay to experience gender disappointment and it’s important to acknowlege this.

Gender Disappointment and Sexual Abuse
Some mothers who were abused as a child, experience gender disappointment and anxiety as a result of feeling unable to cope with having a boy. Especially if their abuser was a man. On the other hand, they may feel anxious that they wont be able to protect a daughter from a potential abuser.

In the case of disappointment for having a boy, these feelings only last for the duration of the pregnancy, they are usually gone once baby is born and in mum’s arms.

In the case of having a girl, during pregnancy mum-to-be may feel okay, as baby is safely protected inside her. But once baby is born, this is when she may feel anxious that she can no longer protect her child.

But for some women that sadness intensifies into an overwhelming feeling of depression and loss. Most women feel guilty to admit this to anyone. If you in any way have a preference to either sex, it may be interpreted as you’re not being a good person, that you are not a good mother.

Actually it’s a very natural thing to be disappointed when you’ve been dreaming of having a girl and then you suddenly have a boy! Or the other way around, of course. It’s a way of your dreams not coming true, no matter how healthy and wonderful your baby is.

Even if a woman has no personal preference for a boy or girl, external pressure to produce one or the other can cause feelings of loss, disappointment, and depression. These ideas can also come from stereotypical depictions of men and women in the media or in certain cultures.

There are some women and their partners who actually experience more than a passing depression over the sex of their baby, they sometimes choose to use techniques, habits or ‘home remedies’ to influence the sex of their next baby.

Common symptoms of gender disappointment are:

• Sadness
• Disappointment
• Concerned about their own reaction upon birth of the baby
• Depressed or in fear of depression
• Anger towards themselves for feeling this way
• Robbed from having the gender they wanted
• Feeling terrible having to ‘pretend’ to be happy all the time

It works in the same way as a local anesthetic works when the dentist numbs your mouth before extracting a tooth. The anesthetic deadens the nerves which are carrying pain signals from your womb and cervix.

You could have an epidural at any point in labor, even in the second stage when you are pushing your baby out, although a spinal anesthetic would probably be offered in that phase. Most women choose to have an epidural when the cervix is about 5 to 6 centimeters dilated and the contractions are getting pretty strong. If you are 8 or 9 centimeters dilated, your doctor might say that it’s too late for an epidural and advise you to manage without because your baby should be born soon.

Pro’s

• More than 90% of all women get complete pain relief
• Your mind remains totally clear
• Can help to control high blood pressure
• Can put you back in control of your labor, and restore your confidence
• Epidurals are more sophisticated than they used to be and you might find that your legs and feet are not completely numb

Con’s

• May make you feel shivery
• You may be numb down only one side of your body
• You have to stay in bed
• You need to have a drip in your arm. This is because epidurals make some women’s blood pressure drop which seriously affects the flow of oxygen to the baby. The drip is a safety precaution so that the volume of your blood can be quickly boosted to bring your blood pressure back to normal again.
• You will probably have a catheter into your bladder. An epidural means you can’t tell when you need to empty your bladder, so this has to be done automatically for you.
• You might feel very out of control. You have three tubes going into your body and you have to be told when to push if the anesthetic hasn’t worn off by the second stage of labor. Your doctor manages your labor for you.
• Epidurals can increase the length of labor, especially the pushing stage. Your baby’s heartbeat will be monitored continuously, using a transducer strapped to your abdomen.
• If the epidural needle goes beyond the epidural space, there will be a leakage of cerebro-spinal fluid after the tube is taken out. Even a very small leak will give you a terrible headache. This is usually treated by taking a small amount of blood from your arm, perhaps the day after your baby is born, and injecting it into your back to seal the hole made by the epidural needle.
• Some women have problems passing urine after having an epidural.
• It’s not available for a home birth.

Tips

• Keep very still while the anesthetist is setting up the epidural. You will be on your side or sitting on the edge of the bed, leaning forward. Concentrate on your breathing. Breathe in deeply through your nose and sigh out slowly through your mouth. Hold your partners hand and keep eye contact with him.
• Discuss the possibility of letting the epidural wear off for the second stage of labor when you are going to deliver your baby. Being able to feel the contractions will help you push more effectively.

You can have “gas and air” whenever you want in labor. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly. Continue to breathe deeply until you start to feel a little light-headed. Your hand will then drop away from your face and you will stop breathing in the Entonox. Within a few seconds, you will feel perfectly normal again.

Pro’s

• Easy to use
• Under your control
• Doesn’t stay in your body
• Takes the sharp edge off contractions
• Contains oxygen that is good for your baby
• Can be used for a home birth

Con’s

• Only a mild pain killer
• May make you feel sick
• Dries your mouth out

Tips

• Start breathing the Entonox the second you feel a contraction beginning. It takes over 20 seconds for the gas to give you some pain relief, and 45-50 seconds before it’s most effective. If you wait until the contraction really hurts, and then start breathing the Entonox, it will be taking effect in between contractions.
• If you take “gas and air” through a rubber facemask, and the rubber makes you feel sick, ask for a mouthpiece. It’s easy to change the mask for a mouthpiece.
• Have sips of water in between contractions to keep your mouth moist.
• When you’re pushing your baby out in the second stage of labor, women usually find it easier to concentrate without using the “gas and air”.
• Don’t feel bad if Entonox isn’t enough to help you cope with contractions. Using “gas and air” doesn’t prevent you from having any other drugs for pain relief.

Massages
Tell your partner or other birth companion where you’d like to be massaged. You might like your shoulders massaged in between contractions to help you relax. Tell him to massage you slowly. He should use firm pressure in order to stimulate your body to release endorphins, the ‘feel-good’ hormones which make massage such a positive experience. Having someone rub your back also provides warmth. And, it does not only keep your back warm, it’s also relaxing and stimulates your body to release natural pain-killing substances.

Positions
Avoid getting on the bed once your contractions are regular and painful, unless you are really tired. Your labor will be slower if you lie down. Remain upright, but choose whatever position feels most comfortable. Stand up and lean on the bed or your partner. Kneel down and lean on the seat of a chair. Get down on your hands and feet to help ease backache. Sit in a chair, then get up and walk around. Move your hips as much as you can, it gets your baby moving.

Love
Research has shown that when a woman has someone she loves with her during labor to comfort her, she gives birth more quickly and easily than if she doesn’t have that continuous loving support. So choose your birth companion carefully. Someone who won’t panic; who believes you can do it, and who is confident to talk to health professionals on your behalf. This may be your partner, your sister, your mom, your best friend or someone else. Or, you might like to choose two birth companions. It’s up to you.

Breathing

Focusing on your breathing is a great way of getting through each contraction. Here are some things to practice and keep in mind: take a deep breath at the beginning of the contraction and, as you breathe out, relax. Then breathe in through your nose and breathe out through your mouth, keeping your mouth and cheeks very soft. Don’t worry too much about how deeply you’re breathing, just keep a good rhythm. Concentrate as hard as you can on your breathing as the contraction builds up, and as it fades away. Take your time to relax when the contraction is over.

The best thing you can do to prepare yourself to cope with pain in early labor, is to conserve your energy by resting. Make yourself as comfortable as possible on the bed or on a chair. Take pillows and put them all around yourself. Have a hot, sweet drink and play some music or put the TV on, and, rest. Later on, you’ll find it much easier to cope with painful contractions if you’re not exhausted because you were rushing around in early labor.

Tips

• Ask for information: the more you know, the more relaxed you’ll feel
• Drink sips of water in between contractions
• Eat carbohydrate-rich foods when you feel hungry
• Use a small electric fan to stay cool
• Talk to your partner and hold his hand
• Listen to music to help you relax
• Move around to make yourself as comfortable as possible
• Walk around to ease aches and pains and bring on contractions
• Go to the toilet; a full bladder will slow your labor
• Trust your body: you do know how to give birth!