• Birthing and Relaxation: Not Mutually Exclusive

    IMAGE Gone is the stark delivery room and administration of heavy duty anesthetics. Parents now have more choices than ever as to the environment into which their babies will be born.
    With the growing openness of medical staff to complementary and alternative therapies, now often called integrative medicine, moms-to-be are investigating and choosing new options for delivering their babies. As a result, parents now have more birthing choices than ever before.

    Giving Moms a Helping Hand

    A doula, or birth assistant, is a professional woman, or at times a man, hired privately by parents to attend their child's birth. A doula serves the role as support and coach for the laboring woman. The doula does not replace the role of partner, and, very importantly, is not a member of the health care team. A doula is present solely to attend the laboring mom. Usually trained and experienced in childbirth, doulas can serve as a stand-in when dad is not available. But doulas can be an asset for any mother; many parents hire doulas even if dad is present.
    Since doctors may not have worked with a birth assistant before, most doulas accompany moms to a prenatal visit in order to meet the doctor before the big day. Once the medical staff knows the doula is there for support and not to replace or interfere with them, they are likely to welcome this additional member of the team.
    Doulas can be available weeks in advance to help an anxious mother before delivery by answering questions. They can also be helpful after the mother and infant come home. They help new mothers with feeding, recovery, and newborn care. A postpartum doula helps with the transition a family faces with a new baby in the home.

    Studies Support Doulas' Role

    Studies show that doulas have positive medical effects on both mother and baby. A study published in the British Medical Journal suggested that doulas result in fewer cesareans and shorter labors for mothers, and a lower admission rate to neonatal intensive care for infants.
    A review found that continuous support by a doula reduces anxiety, shortens labor, decreases the need for cesarean deliveries and other forms of assisted birth, and reduces rates of postpartum depression.

    The Wetter, the Better

    Water can smooth away aches, drain off tension, and float us to a state of bliss. It's no surprise, then, that moms who labor and/or deliver their babies in a birthing pool experience less pain and greater relaxation.
    These benefits may be passed on to the infant as well. It is considered safe, but there is no evidence supporting that it is better than a conventional birth. Water-immersion birth benefits may include:
    • Less discomfort—In water, the mother can move into any position that makes her comfortable. This may encourage an easier birth.
    • Less trauma—Proponents of waterbirths also believe the method is less traumatic for babies.
    • Smoother transition—The easier transition is partly a response to the relaxed state of the mother, and partly due to water's insulating effects. The water environment is similar to the uterus. The helps muffles sound and keeps out harsh light, keeping the baby comfortable.

    Caution Regarding Waterbirthing

    Despite its increasing popularity, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics do not support water-immersion birth. The concern among the groups is that if the baby starts breathing under water, the soiled water may cause an infection. Because there haven't been enough studies to find any benefit with water-immersion births, both groups feel that more research needs to be done before they can endorse it.

    Pain, Pain, Go Away

    The bad news is that labor will probably hurt. The good news is that there are many nonpharmaceutical options when it comes to managing the discomfort.

    Relaxation Techniques

    The first step to pain management is relaxation. The tenser you are, the higher the sensation of pain.
    Relaxation starts with the environment. Even in the hospital, you can dim the lights, play soft music, light candles, or use aromatherapy to create a safe feeling. Aromatherapy may reduce the perception of labor pain. Other relaxation techniques include massage, showers, and baths.
    The mind is one of the most effective pain-fighting tools available. Hypnotism, visualization, and imagery are all methods moms have used for pain relief, and there is some scientific support for their use.

    Alternative Remedies

    Acupressure and acupuncture have been studied as natural treatments for reducing labor pain. Each of these methods may offer some benefits, but more research is needed.
    Although red raspberry is an herb traditionally used during pregnancy and labor, a double-blind, placebo-controlled trial evaluating the effects of red raspberry in 192 pregnant women failed to find benefit.
    The herb blue cohosh is sometimes recommended by midwives, but it is a toxic herb and should not be used.

    Have It Your Way

    When planning your baby's birth, investigate the options and be realistic about your personality and desires. Work with your doctor or midwife early on, and check policies of the hospital or birthing center you've selected. For example, some may allow only family members in the delivery room, or may have policies against candles or other open flames. Be flexible; even the best laid plans can go awry. After all, babies have their own ideas about the way things should turn out!

    RESOURCES

    DONA International http://www.dona.org

    Waterbirth International http://www.waterbirth.org

    CANADIAN RESOURCES

    The Canadian Women's Health Network http://www.cwhn.ca

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

    References

    Bodner K, Bodner-Adler B, Wierrani F, et al. Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr. 2003;114:391-395.

    Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database of Syst Rev. 2009 Nov 19;2: CD000111.

    Comfort measures (nonpharmacologic) during labor. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 28, 2013. Accessed October 3, 2013.

    Fehervary P, Lauinger-Lorsch E, Hof H, et al. Water birth: microbiological colonisation of the newborn, neonatal, and maternal infection rate in comparison to conventional bed deliveries. Arch Gynecol Obstet. 2004;270:6-9.

    Gilbert RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ. 1999 Aug 21;319(7208):483-487.

    Having a doula: Is a doula for me? American Pregnancy Association website. Available at: http://americanpregnancy.org/labornbirth/havingadoula.html. Updated January 2013. Accessed October 3, 2013.

    Klaus MH, Kennell JH, Robertson SS, Sosa R. Effects of social support during parturition on maternal and infant morbidity. Br Med J (Clin Res Ed). 1986 Sep 6;293(6547):585-587.

    Nesheim BI, Kinge R, Berg B, et al. Acupuncture during labor can reduce the use of meperidine: a controlled clinical study. Clin J Pain. 2003;19:187-191.

    Overview of labor and delivery. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 26, 2013. Accessed October 3, 2013.

    Postpartum doula. American Pregnancy Association website. Available at: http://americanpregnancy.org/planningandpreparing/postpartumdoula.html. Updated January 2013. Accessed October 3, 2013.

    Ramnero A, Hanson U, Kihlgren M, et al. Acupuncture treatment during labour—a randomised controlled trial. BJOG. 2002;109:637-644.

    Scott KD, Klaus PH, Klaus MH, et al. The obstetrical and postpartum benefits of continuous support during childbirth. J Womens Health Gend Based Med. 1999;8:1257-1264.

    Simpson KR. Underwater birth. J Obstet Gynecol Neonatal Nurs. 2013;42(5):588-594.

    Simpson M, Parsons M, Greenwood J, et al. Raspberry leaf in pregnancy: its safety and efficacy in labor. J Midwifery Womens Health. 2001;46:51-59.

    Skilnand E, Fossen D, Heiberg E, et al. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002;81:943-948.

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

    Waterbirth International website. Available at: http://www.waterbirth.org/ .

    4/29/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, Waldenström U. Acupressure to reduce labor pain: a randomized controlled trial. Acta Obstet Gynecol Scand. 2010;89(11):1453-1459.

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