Birth Method Choices

The options of childbirth involve selecting a practitioner, the type of medical practice the practitioner works in, the delivery facility an type of anesthetic. Expectant parents should explore their choices and select those that match their preferences and requirements. There are limitations in many cases due to complications of a pregnancy, lack of options in smaller communities, economic constraints, prepaid health plans or insurance restrictions, and laws in some states that control who can perform deliveries in hospital facilities.

PRACTITIONERS

  • Physician – medical doctor (MD) or osteopath (DO). The practitioner may be an obstetrician/gynecologist or family doctor. If your pregnancy appears to be routine, either practitioner may be selected. If the pregnancy is considered high-risk, you will likely need an obstetrician or a maternal fetal medicine specialist.
  • Midwife-certified nurse-midwife (CNM), or independent midwife who may be trained and certified without becoming a nurse first (CM). Midwives are trained to handle low risk pregnancies and to attend uncomplicated births.

TYPE OF PRACTICES

  • Solo medical practice-there is only one physician in the practice (or office). When that physician is away or unavailable, a covering physician will take care of the patients.
  • Partnership or group medical practice-two or more physicians work in the practice (or office). They may be of the same specialty (obstetrician/gynecologist or family practice) or combination of two or more specialties, such as often found in an HMO (health maintenance organization).
  • Other medical practice-may combine the services of a certified midwife and a physician, or a certified midwife as primary caregiver with a physician on call as needed.

BIRTHING LOCATIONS

  • Hospital – most often it is a full care facility (public or private) that is equipped to handle all aspects of childbirth and any possible emergencies.
  • Birthing center or maternity center – may be a stand alone facility or located in a hospital. The focus is on a home-like environment with family/friends sharing the birth. Often, one room is used for labor, delivery and recovery.
  • Home-delivery– is sometimes the first choice for a few women with a normal pregnancy and expecting a normal delivery. A qualified physician or certified midwife will attend the birth. Arrangements are made in advance for emergency transfer to a hospital if it becomes necessary.

PAIN RELIEF AND ANESTHETICS

  • General anesthesia – produces unconsciousness with an inhalant that is administered by an anesthesiologist in an operating delivery room. General anesthesia is most often used in surgical births and sometimes used when complications occur. It is not routinely used for normal deliveries.
  • Regional nerve block – an injected anesthesia that numbs a portion of the body. With surgical deliveries, the numbed area may be from the waist down, while with vaginal deliveries, the numbed area may be smaller. The mother is awake during delivery and alert afterwards.
  • Pain medication (analgesic) – is sometimes administered intravenously or intramuscularly once labor is well established. Most frequently used is meperidine (brand name, Demerol) and the amount of pain relief varies among women. The drugs does not normally interfere with contractions or progression of labor. Newer pain drugs, such as nalbuphine (Nubain) or butorphanol (Stadol) take less time to recover from and have less effects on the fetus.
  • Tranquilizer – can help enhance the effect of pain medicine and also relieve the anxiety some women experience with delivery (especially for first time mothers). If needed, a tranquilizer is administered once labor is well established. However, for someone who is extremely nervous, it may occasionally be given earlier in labor.
  • Hypnosis – is an acceptable method for helping to control pain. It varies in effectiveness from just making a woman more relaxed and comfortable to eliminating any feelings of pain. Hypnosis training needs to begin weeks to months prior to delivery time.
  • Hypnosis – is an acceptable method for helping to control pain. It varies in effectiveness from just making a woman more relaxed and comfortable to eliminating any feelings of pain. Hypnosis training needs to begin weeks to months prior to delivery time.
  • Other pain relief methods – for women who don not want to use drugs for various reasons, additional options include acupuncture, TENS (transcutaneous electrical nerve stimulation) and physical therapy (e.g. massage and heat).

BIRTHING POSITION

  • Lithotomy – use of a delivery table with a woman’s feet in stirrups.
    · Birthing bed-a special bed designed for comfort during the labor period and then converted into a bed suitable for delivery. The back can be raised so the mother is in a squatting position and the foot of the bed is removed. After delivery, it is converted back to a regular bed for recovery.
  • Birthing chair – a chair that supports a woman in a sitting position during delivery. The idea is to allow gravity to help with the birth.
  • Additional options – including LeBoyer births, underwater births or others are rarely used, but available in some areas.