photo credit: awonderedlife.com

Why You Need a Birth Team, Part 1: How Women Helping Women Impacts Birth Outcomes

Having a baby is incredibly exciting, and also more than a little terrifying. We’ve all heard our share of birth stories, and it’s difficult not to let your imagination get the best of you. You’ve probably spent a great deal of time thinking about labor, your ideal birth experience, whether you want a doula or midwife or both, and how the whole scenario will unfold.

The idea of labor can be really scary, and I know you want to do everything you can to make sure both you and your baby are safe—and I’m going to explain why the presence of other women during your labor will make all the difference.

Many of the women in my practice want to have home births, which I absolutely, fully support. However, I also want to make sure all women are educated about any possible risks, have a solid birth plan in place for a home birth, AND have a contingency birth plan if they have to go to the hospital. Although home births result in fewer maternal interventions, they can also result in higher risks to infants if complications occur.

But I’m not suggesting that hospital births are the answer—in fact, birth outcomes in the US, at home OR in the hospital are much worse than in other countries. A recent study published in Obstetrics and Gynecology found that the maternal mortality rate in the United States increased by more than 25% from 2000 to 2014. Hospital births also result in a much higher rate of cesarean births, which can be risky for both mama and baby, increasing the odds of infection, hemorrhage, other complications, and even death by as much as 30%.

So what’s the solution?

When Everyone Was Born at Home

Did you know that hospital births are actually a pretty new practice? It wasn’t until the 1930s that women in the US began routinely giving birth in a hospital setting instead of at home. And this was primarily a good thing—both infant and maternal mortality have been dramatically reduced since that time.

Home births were a lot more dangerous back in the day. In 1915 in the U.S, 70 women died per 10,000 births, compared to about 1 in 10,000 today, The major causes of death back then were hemorrhage, infection, and preeclampsia, a condition that often went undetected and untreated because of a lack of prenatal care.

But before antibiotics, hospitals were NOT a place you wanted to have a baby. Doctors often went from patient to patient without washing their hands, and diseases ran rampant. Even considering the high infant and maternal mortality rate for home births, history suggests that hospitals were just as dangerous, if not more so, than giving birth at home. Many women also felt uncomfortable going to a hospital to give birth. You can imagine how much more appealing it would have been to be at home, surrounded by all the women in your family, along with the trusted village midwife, rather than going to a hospital full of the sick, injured, and dying (many of the women in my practice feel this way now, too!).

So what brought more women into hospitals to have their babies? One word—painkillers. In 1914, many doctors started using “Twilight Sleep,” a combination of morphine and an amnesiac called scopolamine. Your grandmother or great-grandmother probably delivered her babies this way. Rather than eliminating their pain, Twilight Sleep made it so that women forgot their pain after the meds wore off. Sounds pretty creepy, but women wanted it, and you could only get it by having your baby in a hospital.

These days, with advancements in antiseptics, prenatal care, treatments for hemorrhage, preeclampsia, etc. the maternal mortality rates has plummeted: From 1900 through 1997, the maternal death rate dropped nearly 99 percent, to 7.7 deaths per 100,000 live births. While hospitals are certainly a safer place to have babies than they were almost a hundred years ago, they’re still worse in the U.S. than in our peer countries.

If you dig a little deeper into the data, it becomes clear that states with laws that make it easier for midwives to care for pregnant women and deliver babies show better birth outcomes than places where it’s harder for midwives to provide care. In addition, many of our peer countries, like the U.K., have more robust and consistent training for midwives, and the relationships between midwives and obstetric units are more clearly established, because unlike in the U.S., “midwifery units and home births are considered to be integral aspects of maternity care.”

Essentially, here in the U.S., we’ve cut out a critical component of caring for mamas and babies. In the process of moving from home births assisted by family and midwives to hospitals where babies are delivered by strangers, we’ve lost a precious and necessary component of labor and delivery.

The Science of Women Helping Women in Labor

The fact is that women in labor need other women. There is an emotional and spiritual ingredient to the experience of birth that is integral to the process, and too many women are missing this fundamental element.

There is science to back this up. Multiple studies in randomized trials have shown that support from midwives results in shorter labor and an easier birth with fewer interventions, and doulas have been shown to reduce the rate of cesareans by up to 56%. Not only that, but support for women in labor also means more successful breastfeeding and a lower incidence of postpartum depression.

Having other women present during birth, even if they’re not a midwife or doula, has also been found to help birthing moms feel safer during labor. This feeling of safety is critical. Fear results in a fight, flight or freeze stress response, which is NOT conducive to giving birth, to say the least. In this state, the body releases stress hormones, Adrenaline, Cortisol, and Norepinephrine. Some release of stress hormones is normal and to be expected during birth, but if the stress response is too high, if women aren’t able to come down from the effects of stress response, or if they get stuck (like a deer in headlights) in the “freeze” response, it can cause a much more difficult labor, and potentially cause postpartum issues like increased depression and anxiety.

Having other women present, especially women who are trained in supporting women in labor, and/or have given birth themselves, helps birthing mamas feel safe. Psychologically, cognitively, and hormonally, a woman who feels safe during labor is going have a safer birth.

So how do you get started building a team who will support YOU during labor?

Midwives, Doulas, Doctors and Labor/Delivery Nurses

The first step in assembling your birth team is understanding the differences in training and roles of the people who will help you give birth. Here’s a brief run-down of who you might have assist you in your birthing process.

First, let’s talk about Doulas. Many people get confused about the difference between midwives and doulas, since they’re both people (who aren’t OBs) who help women through labor. But the role of a doula in prenatal care, labor, delivery, and postpartum care is actually very different than the role of a midwife. A doula does not have medical training and doesn’t deliver your baby—she’s there to support YOU (the mama) emotionally and physically through the process of pregnancy, labor, and postpartum care. She’ll help you create a birth plan (and advocate for it when you’re too exhausted, dazed, or in pain to speak up for yourself), help you understand and choose the right pain management methods, and even do things like rub your back during labor, bring you tea or a snack, or do the same for your partner. Many doulas also help with small household tasks after the baby is born, like light cleaning or meal prep. Doulas are experts in the emotional labor of labor—they are an advocate for self-care that is in your corner through the entire process of having a baby, and they are an indispensable resource.

A midwife is a health care provider who specializes in prenatal care, labor and delivery. Depending on their certification and the state the practice in, they may have had to go through different training programs (you’ll want to check the requirements in your state for midwifery certification to learn more about your local area). Some midwives are more likely to assist in home births, some work primarily with an OB/GYN and work mostly in hospital births. Certified nurse-midwives (CNMs) are nurses who have graduate training in midwifery and are licensed to practice in all 50 states. CNMs will often work with an OB/GYN as part of their practice. If your birth is low risk, the CNM (or another CNM from the same practice) will likely handle the birth by themselves, but if there are complications, they may call in the OB/GYN to assist.

Labor and Delivery Nurses
provide care in hospitals to women who are in labor or who have recently delivered, or for those who may be having complications with labor. Many women are surprised to learn that if you deliver your baby in a hospital, you’ll probably spend a lot more time with the nurses than with your doctor, and you won’t be able to choose your nurse OR your doctor—it will all depend who’s on call. This is where having a doula with you can be handy—during labor you might not be capable of advocating for the choices in your birth plan. A doula will have had the experience of knowing you personally, knowing your birth plan, knowing your choices, and advocate for you when you’re not in a mental or emotional state to do so.

An OB/GYN is a physician who delivers babies. OB is short for obstetrics or for an obstetrician, GYN is short for gynecology or for a gynecologist. You’ll see your OB/GYN or members of their practice (possibly including your midwife) during your prenatal care, but you may or may not see your doctor or midwife during delivery. Again, it depends on who’s on call (and again, why having a doula is so important!) Obstetrics is also a surgical field, so in the case of a scheduled cesarean, your OB would most likely perform your surgery, or if you have an emergency cesarean, the OB on-duty would perform your surgery.

As you can see, whether you have a hospital birth or a home birth, there will be a lot of people involved in the process. The more comfortable you feel with your team, the higher your chances will be for a safe, healthy birth with minimal complications. I want to you to make absolutely sure you’re held in a place of safety and love as you go through the sometimes magical, sometimes terrifying process of having a child.

If you don’t already have a doula, midwife, or a team of experienced women at your disposal (most women don’t), make sure to check out Part II of this post (coming soon!), where I’ll discuss in-depth how to assemble the best possible birth team for YOU!

In a nutshell

  1. Even though birth outcomes in the US have improved in the last 100 years, we still aren’t doing enough to care for pregnant moms and their babies.
  2. Emotional support from other women during labor can dramatically impact birth outcomes.
  3. It’s important to understand the difference between a doula, midwife, nurse, and OB/GYN.

Let’s Talk!

I’d love to use this space as a forum of sorts, providing inspiration and community among my readers, so … I want to hear from you!

Are you pregnant now? Do you have a birth plan in place?

Have you started looking for a midwife or doula?

Have you already given birth and found that having a doula or midwife made a difference? Were you able to stick to your birth plan or did things go differently than you expected?

Spread some pregnant mama lovin’! Sharing is caring, and I bet you have some friends who would love to read this too :).

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Looking to have a more in-depth conversation about labor and birth? Schedule a consultation with me!

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