• Alternative Birthing: Is It Safe?

    Using a Midwife

    PD Beauty and Health LS014190 Today, most women give birth in hospitals, under the care of obstetricians. But more and more women are considering alternative birthing methods, including midwifery, water birth, and birth at home or in birthing centers. Are these alternatives safe and, if so, who can safely consider using them?
    A midwife (meaning “with woman”) is a healthcare professional who has been trained and has expertise in managing low-risk pregnancies and deliveries. A midwife’s philosophy about childbirth is that it can occur naturally until proven otherwise.
    A midwife may carry one of several subtitles:
    • Certified nurse-midwives (CNMs) have at least a bachelor’s degree, have completed both nursing and midwifery training, and have taken licensing exams to become certified.
    • Certified midwives (CMs) have the same qualifications as CNMs, but are not registered nurses.
    • Direct-entry midwives may or may not have college degrees or certifications. They are trained through apprenticeship, workshops, and/or formal instruction.
    • Certified professional midwives (CPMs) are certified by the North American Registry of Midwives after passing written examinations and skill evaluations. CPMs are required to have out-of-hospital experience.
    While midwives are trained to recognize the signs of trouble in pregnancy and labor, they cannot perform surgical interventions in case of emergency. Therefore, midwives are not advised for higher-risk pregnancies, including multiple births, and women with pregnancy-related complications, diabetes , high blood pressure , or pre-existing health problems. Even if you have a low-risk pregnancy, talk to your midwife to find out what would be done in case of a complication.

    Water Birth

    In a water birth, the woman will go through labor and/or delivery in a warm tub of water. Since the baby lives in the fluid-filled amniotic sac for nine months, some people believe that being delivered into a similar environment is less stressful for the baby. There are also other potential benefits to a water birth:
    • A soothing, relaxing environment for the mother
    • Buoyancy, which lessens body weight and increases comfort
    • A sense of privacy, which can be calming
    • Less pain and use of pain medication during the first stage of labor
    Until recently, little research had been done to determine the risks associated with water births. A 2005 study compared 737 water births with 549 "land" deliveries. The researchers found that water births were associated with significantly shorter first stages of labor, lower episiotomy (cutting the skin between the vagina and anus) rates, and reduced need for pain medications.
    A water birth is not a safe option if you:
    • Have herpes , since it can be transmitted through the water
    • Are inflexible
    • Have a baby in the breech position
    • Have excessive bleeding, an infection, or high blood pressure
    • Are having multiples
    • Expect preterm labor
    Your doctor can help you determine whether water birth is a safe option for you. Many hospitals and birthing centers are equipped for water births, or you can rent a birthing tub for about $350.

    Home Births and Birthing Centers

    Home Births

    Before the 20th century, almost all births occurred at home. But today, most women give birth in hospitals. Recently, however, more women are considering giving birth at home.
    Since many of the complications that might occur during labor and delivery cannot be handled at home, your doctor may advise against home delivery. While this may be sound advice, a studies of over 500,000 low-risk women who gave birth at home or at the hospital found that there were no differences in infant illness or death. This suggests that being in a hospital does not necessarily provide an advantage for pregnancies at low risk for complications. If you choose the home birthing option, work with an experienced, licensed midwife and develop a plan to quickly reach a hospital at the first sign of trouble. You should also be aware that it is not always possible to reach the hospital in time to avert problems related to attempted home births.
    If you have diabetes, high blood pressure, preterm delivery, or any other complications, have your baby in the hospital.

    Birthing Centers

    If you are attracted to the idea of giving birth in a relaxed, warm setting, you may want to consider using a birthing center. Birthing centers can be free-standing, located on hospital grounds, or inside a hospital building. They provide women with access to a medical team, which may include midwives or nurses who work with physicians.
    In true birthing centers, there is no labor induction, no fetal monitoring other than ultrasound, no pain medications, few episiotomies, no operative deliveries (eg, cesarean sections), and limited equipment. For these reasons, women who are expecting multiples, have diabetes, or have high blood pressure should not consider birthing centers.

    Your Birthing Plan

    If you are considering an alternative birthing method, it is especially important that you and your partner devise a birthing plan a few months before you expect to deliver. This plan is a list of preferences that you will give your doctors so you will not have to make decisions while you are in labor.
    In this plan, you can specify your preferences in the case of a complication or abnormal situation during childbirth. For instance, if you are giving birth at home, you may plan to transfer to a hospital after being in labor for a specified amount of time. Your doctor can help you determine the situations that may arise and how you can safely handle them.

    RESOURCES

    American Pregnancy Association http://www.americanpregnancy.org/

    Womenshealth.gov http://www.4woman.gov/

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Birth plans. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/pregnancy%5Fnewborn/pregnancy/birth%5Fplans.html . Accessed September 10, 2005.

    Birthing center. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/birthingcenter.html . Accessed September 10, 2005.

    Home birth. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/homebirth.html . Accessed September 10, 2005.

    Midwives. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/pregnancy/birth/midwives.html . Accessed September 10, 2005.

    Thoeni A, Zech N, Moroder L, et al. Review of 1600 births: does water birth increase the risk of neonatal infection? J Matern Fetal Neonatal Med. 2005;17:357-361.

    Water birth. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/waterbirth.html . Accessed September 10, 2005.

    6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : de Johnge, van der Goes B, Ravelli A, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG. 2009 Apr 15 early online.

    7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009;(2):CD000111.

    9/18/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : de Jonge A, van der Goes B, Ravelli A, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG. 2009;116:1177-1184.

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