Approaches to Childbirth

Prepared childbirth refers to being not only physically in good condition to help provide a healthy environment for the baby to develop, but also helping soon-to-be parents prepare to accept their new roles as parents and to get information and training that will assist them for delivery and life with the baby as much as possible. The more parents can learn about childbirth and the newborn, the better prepared they will be for the adjustment they must make to a new life. Nothing can prepare parents for this completely. Once parents find that they are to have a child, they begin to conjure up images of what they think the experience will involve. Once the child is born, they must reconcile those images with reality (Galinsky, 1987). Knowing more about what to expect does help them in forming more realistic images thus making the adjustment easier. Let’s explore some of the methods of prepared childbirth.

HypnoBirthing

Grantley Dick-Read was an English obstetrician and pioneer of prepared childbirth in the 1930s. In his book Childbirth Without Fear, he suggests that the fear of childbirth increases tension and makes the process of childbearing more painful. He believed that if mothers were educated, the fear and tension would be reduced and the need for medication could frequently be eliminated. The Dick-Read method emphasized the use of relaxation and proper breathing with contractions as well as family support and education. Today this method is known as the Mongan Method or HypnoBirthing. Parents using this method report having less fear and pain, and faster labor compared to parents in a control group (Atis & Ratfisch, 2018).

The Lamaze Method

This method originated in Russia and was brought to the United States in the 1950s by Fernand Lamaze. The emphasis of this method is on teaching the pregnant parent to be in control in the process of delivery. It includes learning muscle relaxation, breathing through contractions, having a focal point (usually a picture to look at) during contractions, and having a support person who goes through the training process with the mother and serves as a coach during delivery. Evidence shows that pregnant persons who use the Lamaze Method have shorter labors, less pain, and are less likely to deliver via C-section compared to women not using the method (Wu et al., 2021). The Lamaze Method is still the most commonly taught method in the U.S. today.

Nurse-Midwives

Historically in the United States, most babies were born under the care of lay midwives. In the 1920s, middle-class women were increasingly using doctors to assist with childbirth but rural women were still being assisted by lay midwives. The nursing profession began educating nurse-midwives to assist. Nurse-midwives continued to assist most rural women with delivery until the 1970s and 1980s when their growth is thought to have posed a threat to the medical profession (Weitz, 2007). Pregnant individuals who are at low risk for birth complications can successfully deliver under the care of nurse-midwives and report having positive birth experiences (Hildingsson et al., 2021). Some hospitals give privileges to nurse-midwives to deliver there. They may also deliver babies at home or in birthing centers.

Home Birth

Because one out of every 20 births involves a complication, most medical professionals recommend that delivery take place in a hospital. However, some parents choose to have their baby at home. About 1 percent of births occur outside of a hospital in the United States. Two-thirds of these are home births and more than half of these are assisted by midwives. In the United States, parents who have had previous children, who are over 25, and who are white are most likely to not give birth in a hospital (MacDorman et al., 2010). For low-risk pregnancies, home birth may be a good option. Studies show positive outcomes including fewer interventions (e.g., fetal monitoring) and higher parental satisfaction, but the outcomes for newborns are more variable (Wax et al., 2010; Zielinski et al., 2015).

Birthing Centers

A birthing center presents a more home-like environment than a hospital labor ward, typically with more options during labor: food/drink, music, and the attendance of family and friends if desired. Other characteristics can also include non-institutional furniture such as queen-sized beds, large enough for both parents, and perhaps birthing tubs or showers for water births. The decor is meant to emphasize the normality of birth. In a birth center, parents are free to act more spontaneously during their birth, such as squatting, walking, or performing other postures that assist in labor. Active birth is encouraged. The length of stay after birth is shorter at a birth center, with some families being able to leave just 6 hours after birth. One-third of out-of-hospital births occur in freestanding clinics, birthing centers, or in physicians’ offices or other locations.

Water Birth

Laboring and/or giving birth in a warm tub of water can help an individual relax. The buoyancy of the water can help alleviate discomfort and pressure for the pregnant parent. Many hospitals have birthing tubs that allow individuals to labor in them. However, only some hospitals allow for birth to take place in the water. Some believe that water birth gives a more calm and tranquil transition for the baby from the womb. Water births are more common to occur at home or in birthing centers.

Hospital Birth

Most births in the U.S. occur in hospitals. Parents have the choice to have a medicated or unmedicated delivery. Some do fine with “natural methods” of pain relief alone but many blend “natural methods” with medications and medical interventions that relieve pain. Building a positive outlook on childbirth and managing fear may also help cope with the pain. Labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing the baby down and out of the birth canal. In other words, labor pain has a purpose.

The most common pain relief method used during labor and delivery is an epidural. An epidural is a procedure that involves placing a tube into the lower back, into a small space outside the spinal cord. Small doses of medicine can be given through the tube as needed throughout labor. With an epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness felt can be adjusted. An epidural can prolong the first and second stages of labor. If given late in labor or if too much medicine is used, it might be hard to push when the time comes.

Another form of pharmacologic pain relief available for laboring parents is inhaled nitrous oxide. This is typically a 50/50 mixture of nitrous oxide with air that is an inhaled analgesic and anesthetic. Nitrous oxide has been used for pain management in childbirth since the late 1800s. The use of inhaled analgesia is commonly used in the UK, Finland, Australia, Singapore, and New Zealand, and is gaining in popularity in the United States.^[1]