Showing posts with label birth plan. Show all posts
Showing posts with label birth plan. Show all posts

Friday, March 19, 2010

Birthing Classes

If you are having a child for the first time, it is easy to feel overwhelmed by questions, fears, and just not knowing what to expect. Many new parents find that birthing classes can really help calm their worries and answer many questions.

These classes cover all kinds of issues surrounding childbirth including breathing techniques, pain management, vaginal birth, and cesarean birth. They can help prepare you for many aspects of childbirth: for the changes that pregnancy brings, for labor and delivery, and for parenting once your baby is born.

Typically, new parents take birthing classes during the third trimester of the pregnancy, when the mother is about 7 months pregnant. But there are a variety of different classes which begin both sooner and later than that. It's a good idea to talk with your doctor about the different kinds of classes that are offered in your community.

Benefits of Taking a Childbirth Class

A childbirth class can provide you with a great forum to ask lots of questions and can help you make informed decisions about key issues surrounding your baby's birth. Some of the information you can find out from a birthing class includes:

* how your baby is developing
* healthy developments in your pregnancy
* warning signs that something is wrong
* how to make your pregnancy, labor, and delivery more comfortable
* breathing and relaxation techniques
* how to write a birth plan
* how to tell when you are in labor
* pain relief options during labor
* what to expect during labor and delivery
* the role of the coach or labor partner

Many classes also address what to expect after the baby is born, including breastfeeding, baby care, and dealing with the emotional changes of new parenthood.

You might also find support from other expectant couples at a childbirth class. Who would better understand the ups and downs of pregnancy than couples who are going through them, too? Many people find friends in their childbirth class who last long past the birth of their child.

If your birth coach is also the baby's father, taking a class together can mean his increased involvement in the pregnancy, and can act as a good bonding experience. Like the mother, the father can also benefit from knowing what to expect when the mother goes into labor - and how to assist in that process. Some classes have one session just for fathers, where men can discuss their own concerns about pregnancy and birth. There are also classes geared just for new fathers. Some classes even offer a special session for new grandparents, which is a great way to get them involved in the process and to make sure they're up on the latest in baby care techniques and safety.

Of course, some people get more out of childbirth classes than others do. But even if you find the techniques you're taught don't work for you when you finally go into labor, you may get other benefits from the class. The common goal of all birthing classes is to provide you with the knowledge and confidence you need to give birth and make informed decisions. This includes reducing your anxiety about the birth experience, as well as providing you with a variety of coping techniques to aid in pain management. Remember that the ultimate goal is to have a healthy mom and healthy baby.

What Types of Classes Are Available?

Many childbirth classes embrace a particular philosophy about pregnancy and birth. The two most common methods of childbirth breathing, relaxation, and exercise in the United States are the Lamaze technique and the Bradley method.

The Lamaze technique is the most widely used method in the United States. The Lamaze philosophy holds that birth is a normal, natural, and healthy process and that women should be empowered through education and support to approach it with confidence. The goal of Lamaze is to explore all the ways women can find strength and comfort during labor and birth. Classes focus on relaxation techniques, but they also encourage the mother to condition her response to pain through training and preparation (this is called psychoprophylaxis). This conditioning is meant to teach expectant mothers constructive responses to the pain and stress of labor (for example, controlled breathing patterns) as opposed to counterproductive responses (such as holding the breath or tensing up). Other techniques, such as distraction (a woman might be encouraged to focus on a special object from home or a photo, for example) or massage by a supportive coach, are also used to decrease a woman's perception of pain.

Lamaze courses don't advocate for or against the use of drugs and routine medical interventions during labor and delivery, but instead educate mothers about their options so they can make informed decisions when the time comes.

The Bradley method (also called "Husband-Coached Birth") places an emphasis on a natural approach to birth and on the active participation of the baby's father as the birth coach. A major goal of this method is the avoidance of medications unless absolutely necessary.

Other topics stressed include the importance of good nutrition and exercise during pregnancy, relaxation techniques (such as deep breathing and concentration on body signals) as a method of coping with labor, and the empowerment of parents to trust their instincts and become active, informed participants in the birth process. The course is traditionally offered in 12 sessions.

Although Bradley emphasizes a birth experience without pain medication, the classes do prepare parents for unexpected complications or situations, like emergency cesarean sections. After the birth, immediate breast-feeding and constant contact between parents and baby is stressed. Bradley is the method of choice for many women who give birth at home or in other nonhospital settings.

There are several other types of birthing classes available. Some include information from the two previously mentioned techniques, and some are offshoots that explore one particular area. Two options that might be available in your area are active birth classes that teach yoga techniques to prepare for labor and "hypnobirthing" courses, which use deep relaxation and self-hypnosis as relaxation techniques.

When Should I Start Taking a Class?

In addition to offering many techniques and curricula, birthing classes also vary greatly in terms of duration. You'll find classes that begin during the first trimester and focus on all the changes that pregnancy brings; 5- to 8-week courses offered late in pregnancy aimed at educating parents mostly about labor, delivery, and postpartum issues; and one-time-only refresher courses for repeat parents. Most parents opt for a course that meets about six or seven times in the last trimester for 1 1/2 to 2 hours per session, or for full-day versions that take place over one or two weekends. What's important to remember is that a variety of options are often offered, so be sure and find one that fits your needs.

Choosing a Class

The type of class that's right for you depends on your personality and beliefs, as well as those of your labor partner. There is no one correct method. If you're the kind of person who likes to share and is eager to meet people, you might like a smaller, more intimate class designed for couples to swap stories and support each other. If you don't like the idea of sharing in a small group, you might want a larger class, where the teacher does most of the talking.

Of course, the community you live in may limit your choices - expectant parents in rural areas often have fewer choices than those in large cities. You may find childbirth classes offered by:

* hospitals
* private teachers
* health care providers (through their practices)
* community health organizations
* midwives
* national childbirth education organizations
* videos and DVDs

Before you sign up for a class, it's a good idea to ask what the curriculum includes and what philosophy it is based upon. You can also request to see the course outline. A good class will cover a range of topics and prepare you for the many possible scenarios of labor and delivery. Classes should include information about vaginal births and cesarean sections; natural childbirth techniques as well as the use of pain medication during labor; tips on pre- and postnatal care; and postpartum adjustment.

If something you wanted or expected to see isn't included in the outline, ask about it - if your teacher doesn't seem flexible or his or her philosophy doesn't match yours, you may want to look elsewhere.

You should also feel free to contact the teacher or childbirth class coordinator with questions, such as:

* What's your background and how were you trained?
* Do you have certification from a nationally recognized organization?
* What is your philosophy? Do you teach a particular method?
* How does the class time break down between lecture, discussion, and practicing techniques?
* How many people are in the class?

Whatever course or method you choose, you'll want to begin exploring your options early - some classes fill up well in advance of the start date.

Wednesday, March 17, 2010

Birthing Centers and Hospital Maternity Services

You'll make plenty of decisions during pregnancy, and choosing where to give birth — whether in a hospital or in a birth center setting — is one of the most important.

Hospitals

Many women fear that a hospital setting will be cold and clinical, but that's not necessarily true. A hospital setting can accommodate a variety of birth experiences.

Traditional hospital births (in which the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room) are still the most common option. Doctors "manage" the delivery with their patients. In many cases, women in labor are not allowed to eat or drink (possibly due to anesthesia or for other medical reasons), and they may be required to deliver in a certain position.

Pain medications are available during labor and delivery (if the woman chooses); labor may be induced, if necessary; and the fetus is usually electronically monitored throughout the labor. A birth plan can help a woman communicate her preferences about these issues, and doctors will abide by these as much possible.

In response to a push for more "natural" birth events, many hospitals now offer more modern options for low-risk births, often known as family-centered care. These may include private rooms with baths (birthing suites) where women can labor, deliver, and recover in one place without having to be moved.

Although a doctor and medical staff are still present, the rooms are usually set up to create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also may be available.

In addition, many hospitals offer a variety of childbirth and prenatal education classes to prepare parents for the birth experience and parenting classes after birth.

The number of people allowed to attend the birth varies from hospital to hospital. In more traditional settings, as many as three support people are permitted to be with the mother during a vaginal birth. In a family-centered approach, more family members, friends, and sometimes even kids may be allowed. During a routine or nonemergency C-section, usually just one support person allowed.

If you decide to give birth in a hospital, you will encounter a variety of health professionals:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 additional years of training after medical school in women's health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and also perform C-sections.

Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.

If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they're trained to handle normal, low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

In addition to obstetricians and CNMs, registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might be present during the birth. Some family doctors also offer prenatal care and deliver babies.

While you're in the hospital, if you choose or if it's necessary for you to receive anesthesia, it will be administered by a trained anesthesiologist. A variety of pain-control measures, including pain medication and local, epidural, and general anesthesia, are available in the hospital setting.

Birth Centers

Women who experience delivery in a birth center are usually those who have already given birth without any problems and whose current pregnancies are considered low risk (meaning they are in good health and are the least likely to develop complications).

Women giving birth to multiples, have certain medical conditions (such as gestational diabetes or high blood pressure), or whose baby is in the breech position are considered higher risk and should not deliver in a birth center. Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.

Natural childbirth is the focus in a birth center. Since epidural anesthesia usually isn't offered, women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. The baby is monitored frequently in labor typically with a handheld Doppler. Comfort measures such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques are often used. The woman is free to eat and drink as she chooses.

A variety of health care professionals operate in the birth center setting. A birth center may employ registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). Although a doctor is seldom present and medical interventions are rarely done, birth centers may work with a variety of obstetric and pediatric consultants. The professionals affiliated with a birth center work closely together as a team, with the nurse-midwives present and the OB/GYN consultants available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.

Birth centers do have medical equipment available, including intravenous (IV) lines and fluids, oxygen for the mother and the infant, infant resuscitators, infant warmers, local anesthesia to repair tears and episiotomies (although these are seldom performed), and oxytocin to control postpartum bleeding.

A birth center can provide natural pain control and pain control with mild narcotic medications, but if a woman decides she wants an epidural, or if complications develop, she must be taken to a hospital.

Birth centers often provide a homey birth experience for the mother, baby, and extended family. In most cases, birth centers are freestanding buildings, although they may be attached to a hospital. Birth centers may be located in residential areas and generally include amenities such as private rooms with soft lighting, showers, and whirlpool tubs. A kitchen may be available for the family to use.

Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so find out if the birth center you choose has all the proper credentials.

Monday, March 8, 2010

What Are Midwives and Doulas?

Whether you’re a first-time mom or mom of many, having a baby brings with it many different emotions, perhaps the most common of which is worry. Mom’s worry. If you are expecting, you’re probably pondering the type of delivery you would like to have. Many women are opting for more natural births that can be performed in the home with as little medical intervention as possible.

This trend is becoming increasingly more common for second-time moms, having tried a traditional birth once, are more open to trying something more natural the second time around.

If you are considering a natural birth, you will undoubtedly want to know more about midwifery and doula practices. As a midwife or doula will tell you, there are many differences between a traditional or medically-managed birth versus a natural childbirth either at home or in the hospital.

Midwives

A midwife may deliver your baby in your home or in a hospital. This depends in part upon her credentials. Midwives can be accredited or non-accredited. Accredited midwives generally have the option of performing hospital or home births, whereas non-accredited midwifes traditionally practice only within the home. Keep in mind that a midwife’s title will reveal some information related to her educational background, certification and practice.


Most certified midwives have accreditation that includes schooling and apprentiship. A certified nurse midwife usually also requires an RN and BSN degree, though there are exceptions to the rule. Depending on a midwife’s credentials, they may deliver your baby in a hospital or in your home.

Non-accredited midwives are also schooled and apprenticed in natural birthing processes, but traditionally have less schooling or are not credentialed in the same manner as accredited midwives. They are not, for example, required to uphold regulations, and therefore there is less documentation related to their skills and abilities. If you are expecting your first baby, it might bring you more peace of mind to work with a certified midwife.

Doulas

A wonderful addition to the birthing process is working with a doula. A doula is also often referred to as a labor coach or assistant. Doulas have been credited with relaxing many soon-to-be moms during the labor process. Doulas work to reduce your stress level while in labor so as to produce a delivery with fewer complications and problems. A doula will attend to you continually throughout the birthing process. Like midwives, a majority of doulas are certified as childbirth assistants. To find a doula near you, contact the Doulas of North America or DONA association. A midwife might be able to recommend a doula for you.

Doulas are credited with aiding laboring women in many ways. Services traditionally offered include:

* physical comfort techniques
* aromatherapy
* massage
* meditation
* breathing assistance
* labor positions education
* assistance with birth plan development
* pre-natal and post-natal physical and mental support
* childcare during labor


Generally, services vary according to practice.
Many moms-to-be worry that having a doula present means there is no place for their husbands. Ask any doula however, and she’ll tell you this is not the case. She will attend to the mom to be as much or as little as necessary, while at the same time allowing dad to partner in the labor process as much or as little as he likes.

Wednesday, March 3, 2010

Birth Plans

In the happy haze of early pregnancy, you're probably already thinking of baby names and planning to shop for baby clothes. The reality of labor and birth may seem extremely far off — which makes this the perfect time to start planning for the arrival of your baby by creating a birth plan that details your wishes.

What's a Birth Plan?

The term birth plan can actually be misleading — it's less an exact plan than a list of preferences. In fact, the goal of a birth plan isn't for you and your partner to determine exactly how the birth of your child will occur — because labor involves so many variables, you can't predict exactly what will happen. A birth plan does, however, help you to realize what's most important to you in the birth of your baby.

While completing a birth plan, you'll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who'll be helping during your delivery, it also means you won't have to explain your preferences right at the moment when you're least in the mood for conversation — during labor itself.

A birth plan isn't a binding agreement — it's just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don't want. Also, if you go into labor when there's an on-call doctor who you don't know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.

What Questions Does a Birth Plan Answer?

A birth plan typically covers three major areas:

1. What are your wishes during a normal labor and delivery?


These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.

2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?

Do you want the baby's cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep — next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you'll want to know what these are and how they match what you're looking for.

3. What do you want to happen in the case of unexpected events?

No one wants to think about something going wrong, but if it does, it's better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.

Factors to Consider

Before you make decisions about each of your birthing options, you'll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.

You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses are not what you're hoping for, you might want to look for a health provider or facility that better matches your goals.

And it's important to be flexible — if you know one aspect of your birthing plan won't be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn't agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind. There may be important reasons why a doctor believes some birth options are better than others.

Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You'll want to discuss, and consider, this information when thinking about your options.