Au Natural: Nine Ways to Manage Labor Without Drugs
Know Your Birthing Options
To watch most baby-bearing American movies and television shows, you'd think that giving birth means being in a hospital, strapped to a monitor, drugged and flat on your back. But that's not the only way. With the national rate for Cesarean surgery at 31.8 percent, more and more women are turning to natural birth in hopes of avoiding the regimentation and unnecessary medical interventions that can accompany a hospital birth. Whether it's HypnoBirthing, acupuncture, The Bradley Method, or a water birth, there are many alternatives to the flat-on-your-back hospital scene.
What it is: Certified nurse-midwives are certified by the American College of Nurse-Midwives (ACNM) and trained formally in both nursing and midwifery. They work with the mother during the pregnancy to provide counseling, education, and prenatal care, but can also work with women year-round to provide well-woman care.
Midwives emphasize pregnancy and birth as a natural process and aim to decrease unnecessary medical interventions in births. Their philosophy is that they are there to facilitate but not control. CNMs are present throughout labor and allow labor to progress on its own.
A Real Mom's Take: "My prenatal experience with the Nurse-Midwifery Group at Swedish Covenant Hospital in Chicago mirrored that of my friends who saw OBs. I had ultrasounds, did prenatal testing, and all of the typical lab work that pregnant women typically have.
"The difference, I think, is that each appointment included a conversation with one of the midwives that lasted 30-45 minutes and discussion about the birth experience that my husband and I wanted. My goal was to avoid medical interventions and methods of 'augmentation' (Pitocin, pain medication, breaking the water) and the things associated with them (IVs, restricted movement, restricted food, etc.). I wanted a natural, unmedicated birth.
"My husband, Bob, and I have now had two babies with the midwives, both without pain medication (we used yoga breathing and acupressure for pain management). The midwives who attended both of our births were present throughout, allowed labor to progress on its own, and provided us with ideas about positions to manage contractions and positions for pushing. They were our partners in the labor process and viewed themselves as facilitators and guides rather than directors. I found this approach so reassuring and empowering, especially in the last hours of labor, when you have the potential to doubt your ability to do the 'work.'" -- Kimberley Farster
Relaxing Water Birth
What it is: A water birth is often referred to as one of the gentlest ways to give birth, because a woman labors and gives birth within a soothing water-filled tub. The warm water helps with comfort, relaxation, and pain management. Some women labor in the water and leave the tub for delivery while others actually give birth in the water.
A number of hospitals across the United States offer water birth, and those interested in home births can purchase or rent a tub. Water birthing isn't recommended in the case of breech births, multiple births, premature labor, or for those at risk for any serious pregnancy complication.
A Real Mom's Take: "In the week before the birth, we prepared the house to welcome my labor and this new person. We cleaned like crazy, set out Mexican votive candles everywhere, put plastic under the bedsheets, gathered flowers and a big stack of dry firewood, and set up a big inflatable birthing tub in the baby's room. The tub was connected by hose to the bathroom sink and was enormous -- large enough that two people could move around comfortably inside. All that week I caught myself looking longingly at the empty tub, dreaming about filling it and splashing around in it. I wonder now why I didn't, just for practice!
"I started feeling contractions late Friday morning. They were not painful, just a mild cramping feeling. I was excited. I told Sebastien I wanted to go to the forest immediately. So we dragged the old Subaru up a misty ridgetop, parked it among wet conifers and ferns, and slunk through the trees doing the slowest of slow walks, punctuated by frequent stops. It was the perfect impulse. In the forest, things felt right and momentous. It seemed to me as if everything was technicolor: The autumn leaves were on fire, the understory was sparkling, the moist bark filled the forest with an incenselike fragrance. I remember the birdsongs were so lovely, they made me weepy.
"At some point during our slow, slow amble, the contractions were regular enough that Sebastien thought to call our midwife. She suggested we head back home, promptly! The midwife examined me and announced that I was 2 centimeters dilated. I asked the blur of people milling around to start filling the tub with warm water. Unnervingly, the hot water source dropped to little more than a trickle after a few minutes. So they began what was going to be a nightlong routine of heating water on the stovetop and dumping it into the tub.
"When the birth tub was finally full enough to get into, the pain-relieving quality of the warm water was near miraculous. I kept saying, 'It feels so much better. So much better.' Apparently I was in the tub for four hours. But I had no concept of time. I just remember that I wouldn't have gotten out if my life depended on it. A contraction would come, I'd lean forward in the tub, focus on three flickering candles across the room, breathe deeply, and try to keep my moans low and not panicky-sounding (according to midwives, low sounds help open up the pelvic muscles, while high sounds actually tighten them). At some point I shouted, 'I just can't do this anymore!' This is usually a clear sign to midwives that a laboring woman has reached 'transition' -- that is, when the cervix is fully dilated and the pushing stage commences.
"My pushing stage lasted two hours. The midwives tell me now that it was a relatively difficult and painful pushing stage. I was in the tub the whole time. Moments before Oliver was born, however, I stood up out of the water -- perhaps I needed the aid of gravity? My legs were still in the water up to midthigh, but his head emerged into air. This resulted in a mad scramble as the midwives tried to catch him before his face touched the water (since he'd taken his first breath in the air).
"Successfully caught, Oliver was delivered to my chest, grunting. The room was silent, warm, and dim. The moon was full. Sebastien and I were stunned, and blown away, and tired. When we dried off, we all collapsed in bed. I remember the midwives were talking to us while we were in bed but I have no idea what they said. All I remember was how beautiful Oliver was, how he looked like the moon." -- Amanda Kolker
Take Comfort in a Home Birth
What it is: he home birth is, in the most literal sense, the traditional birth. This is how women gave birth for centuries, before doctors began handling the process in America in the early 1900s. Home births are usually attended by a lay midwife, which means a midwife who has received her education through experience rather than through nursing and midwifery school.
A home birth allows a woman to labor in her own home on her own schedule and choose what positions are comfortable for her to use during birth. Home births are a natural, drug-free option. Moms-to-be who are more likely to experience complications with their birth should choose to give birth in a hospital, not their home.
A Real Mom's Take: "I chose home birth because I believe that during the time of a child's birth, the mother must be alert and in control of her body's functions so she is able to work with her body during the process. I didn't want to be in a relationship where I felt the doctor was in charge of my labor instead of what felt best for me.
"I was mobile, alert, and able to move around freely. I ate and drank when I wanted. I labored through my contractions, sat in my bathtub when it felt intense, and was able to push him out in any position that felt comfortable instead of being confined to a hospital bed. My partner was supportive and involved, even helping to give me physical support by hugging me from behind as I pushed out our baby. It was beautiful.
"By having my baby at home I was able to hold the baby I had been dreaming about for months in my arms right away. I was completely aware and up walking around soon after, even though my labor had been a long one. I was surprised to see how much my baby's features changed over the first hour or so. It was incredible to witness that, along with hearing his first sounds. He was wide-eyed and extremely responsive, with a strong neck and fine features. His two older sisters were able to be there to welcome their baby brother into the world soon after.
"My birth was peaceful, loving, and -- best of all -- I feel empowered because I gave my baby what I thought was the most natural and gentle entrance into his new world, even though it was emotionally, physically, and mentally challenging at times.
"Most women, after hearing that I gave birth to three of my adorable children at home, look at me as if I must have super powers to have been able to do that successfully. I'm just an everyday gal who often indulges in a glass of wine and a box of chocolates. I also happen to be lucky enough to have access to the finest modern health care offered in the United States, and yet I chose to have my baby at home with no intervention besides the guidance of a skilled and loving midwife. Since birth is usually viewed as a scary, dangerous thing, most people don't realize that you can have a safe, empowering, beautiful birth experience in the comfort of your own home like I did." -- Rochelle Costigan
Better Breathing and More
What it is: Lamaze International is a nonprofit organization that promotes a mother-empowering philosophy. It provides education and resources to women about how to have a safe, natural childbirth experience and aims to reduce the number of medically unnecessary interventions that often accompany the birth process.
Founded in France in 1951 by Dr. Fernand Lamaze, the method emphasized relaxation, breathing techniques, childbirth education classes, and the support of the father. It has evolved over the years and today focuses less on breathing methods and more on the philosophy that women have the right to give birth the way they choose and receive support from both family and health care professionals.
A Real Dad's Take: "When my wife, Sarah, and I had our first child, we felt we were in many ways better prepared than most. I was working on a master's degree in public health and she is a registered nurse. However, we had a lot of questions about pregnancy and the birth process. We decided we wanted to learn as much as we could so we could be as prepared as possible. We wanted to be able to make informed choices. Thus, we signed up for and attended an eight-week childbirth preparation class with a Lamaze certified instructor.
"There are many things our instructor told us that were important to us. For example, she told the class, 'Your baby won't be born too early or too late, your baby will be born on his or her birthday.' This message was important to hear since it reminded us that our baby and my wife's body were in sync, and labor would start on its own without us interfering.
"At the end of the class we received a paper certificate of completion. This certificate reminded us that we were knowledgeable and prepared for childbirth. These thoughts gave us more confidence in my wife's body and ourselves. As a way to maintain confidence in ourselves we taped the certificate to the wall of the room that we would bring our new daughter home to. Every time we went into this room the certificate reminded us of what we had learned during our classes. In fact, we did not take down the certificate until several months after our baby was born.
"During labor many other things our Lamaze instructor taught us were useful, such as when my wife wanted to labor on her hands and knees (the position she was able to give birth in). In the Lamaze class we were taught that she should move around and be in positions that were the most comfortable for her. My wife refused to have continuous fetal monitoring because she found labor so much more painful on her back. The midwife and nurses supported this request, but without the class we would have been less direct. We also stayed home longer because I felt more confident supporting my wife through early labor and thus, she was never confined to a bed. And we knew the benefit of keeping our baby in our hospital room and how much easier it is to breastfeed when the baby stays with you -- my wife did not have any of the issues some other women have with breastfeeding.
"Giving birth was hard work, but our classes helped us feel prepared and have a safe and healthy birth experience. I felt like a full participant during labor. That feeling also made me feel more competent in the first few weeks with our newborn." -- David K. Jones, husband of Sarah Sacuto
Coaching Through Labor
What it is: The Bradley Method educates women on tuning into and trusting their own body during natural childbirth, and emphasizes natural breathing, relaxation, nutrition, exercise, and education. Known as "husband-coached childbirth," the husband or significant other also attends classes and learns how to be helpful during labor. Classes last 12 weeks and are recommended for the last trimester of pregnancy.
Dr. Robert A. Bradley created The Bradley Method because he believed giving women the tools for natural childbirth would help save them from countless unnecessary medical interventions.
A Real Mom's Take: "The Bradley method gave me the information I needed to make my own decisions for my birth. It taught my husband to be my support and to help me give birth to our children. It helped me have a healthy pregnancy and prepared us to be parents after the actual birth. I know other people who take several hospital classes and still don't learn everything I learned in the Bradley classes.
"To this day I still keep in touch with my Bradley teacher. She taught us in her home, one-on-one, because of difficulties with our work schedules. In many ways I think The Bradley Method not only offered me a wonderful birth experience, but also gave me a positive outlook on birth itself.
"I know many first-time moms who are scared to give birth, and they hear so many horror stories about the pain. I wanted something different, so I chose The Bradley Method because the information I found appealed to me. The classes helped me feel prepared and confident in my ability to give birth to my son.
"By the time I had my second child I was teaching classes on The Bradley Method. I was planning a home birth, but because I went into labor early I ended up in the hospital. The doctors were amazed at how much control I had. I was able to move freely, and in the second stage I pushed in classic, squatting, and hands-and-knees position. It would have been agonizing trying to labor with an epidural numbing me and keeping me stuck on my back. Luckily my daughter was fine, and I was just off on my dates. I've said before that I should have just stayed home." -- Nicole Blomberg
Connect with Your Spiritual Side During Labor
What it is: Birthing from Within is a natural and spiritual approach to childbirth that considers childbirth a rite of passage, not a medical event. It helps women connect with themselves, their mothers, and their sisters, and to prepare for the birth process. Birth art (belly casts, sculptures, etc.) play a role in this school of thought, as do techniques to cope with pain.
In 1998 Pam England published the book Birthing from Within, with the mission of teaching women to embrace the birth process, pain and all. Birthing from Within classes were born soon after.
A Real Mom's Take: "When I had my first child, I used a blend of all that I had learned from watching and supporting women in labor as a longtime doula, and from studying various childbirth education techniques and philosophies, including Lamaze, Bradley, and HypnoBirthing. But when I actually gave birth, though enormously informed, I found out I was much less prepared to deal with the pain than I thought. And after attending a seminar about Birthing from Within after having my child, I know I will use this method to prepare for the next time. (I have begun to incorporate it into the blended-method childbirth classes that I teach -- Birth Day Presence in New York City-- with great results.)
"Birthing from Within acknowledges that birth may be incredibly painful and helps women develop a pain-coping mind-set. It offers that pain is a sensation, but suffering occurs when the mind tries to escape the sensation. So there are several concrete techniques that can help women deal with pain and ease suffering during labor, which increase a mother's pain-coping confidence as she moves toward labor. Birthing from Within also acknowledges that a laboring woman should be free to do whatever she needs to do to birth her baby and acknowledges there is no one right way to labor -- a sort of permission to moan, scream, writhe, and curse if that's what she needs to do, without feeling like she's not laboring 'right' or relaxing enough.
"Birthing from Within prepares women to get out of an outcome-focused mind-set and into a solution-focused mind-set. It helps women release the self-judgment that often comes when women go into labor focused on avoiding something (such as a Cesarean or pain medication or whatever your particular thing is), so should that thing happen or become necessary during labor, she has developed the inner resources to deal with it. The purpose of childbirth preparation, according to Birthing from Within, is to prepare mothers to give birth-in-awareness, not to achieve a specific birth outcome." -- Jada Shapiro
Hypnotize Yourself During Labor
What it is: HypnoBirthing teaches women self-hypnosis, which puts them in a state of deep relaxation and acts as a natural anesthesia during birth. This birth practice was developed in 1989 by Marie Mongan and is often referred to as the Mongan Method. Through deep relaxation and self-hypnosis, HypnoBirthing teaches moms-to-be how to reach a peaceful state that helps keep pain to a minimum.
A Real Mom's Take: "When I learned I was pregnant, I immediately sought an OB who supported this method. The moment of truth came six weeks early with the birth of our first child, Maya. I went into labor in the evening and used self-hypnosis throughout the night and into the next morning. All of this occurred without any of my husband's help, I might add, since he did not think I was really in labor and was asleep beside me the entire time.
"I woke him around 7 a.m. and let him know it was time to go to the hospital. He proceeded to get ready and then came back to the bedroom for me. By then, Maya had dropped and I had a hard time standing and felt like I needed to hold her in. My husband was still in denial at this point!
"By the time I got to the hospital I pushed twice and Maya was born. I never had any drugs. I was totally rested and refreshed and ready to go home a couple hours after delivery -- every minute of self-hypnosis is like getting a half hour of sleep! My husband, who was at first skeptical, was truly amazed at the process and afterwards bought every pregnant woman he knew a HypnoBirthing manual and gave them our nurse's business card so that they, too, could have the same amazing experience." -- Deb Yoder
Connect with a Doula
What it is: "Doula" comes from the ancient Greek word meaning "a woman who serves." It refers to a trained professional who supports mothers and mothers-to-be physically, emotionally, and through education. Doulas attend the birth and help ensure that any involved parties adhere to the birth plan, whenever possible, and allow the mother's partner to be involved in the birth according to his or her comfort level.
A study published in the American Journal of Obstetrics & Gynecology found that women who used doulas were not only significantly less likely to have an epidural, but also much more inclined to rate their birth experience as good.
A Real Mom's Take: "Most people think your husband should be your sole support person in the delivery room. But my husband had never been to a birth before, so asking him to be the only person to support me would have been like me caddying for him -- kind of an unfair setup for both of us.
"Our doula, Tanya McHale, had been to more than 1,000 births. If I was looking for someone to explain to me what was happening and guide me through it, I wanted it to be someone who knew what she was talking about. We had a midwife that we were comfortable with, but her job is to deliver the baby. The doula was there for me.
"When I was only a couple of hours into labor with my first child, we were waiting for the doula to meet us at our home so we could all go to the hospital together. Even though I was just experiencing early contractions, I was panicky and scared. All our HypnoBirthing practice went out the window. I forgot it all and was freaking out, crying and screaming at my husband until the doula arrived and immediately calmed me down. She mostly just talked in my ear for hours, saying, 'Each contraction brings you closer to your baby,' and 'With each contraction your cervix is opening.' Since she also taught our HypnoBirthing class, it was her voice on all our practice CDs doing guided imagery, so her voice kept me calm and relaxed. She offered me water and told my husband to mop my face and where to put his hand on my back. She held my hand. I think she waved off the nurses who wanted to ask about pain relief, but she wasn't obnoxious to them.
"I know it's because of her that I was able to have short labors and unmedicated water births for both kids. Not to take anything away from my husband -- he was great, too. He supported my back with his arm and rubbed down my face with a cold, wet washcloth; told me I was amazing; and made jokes and all the stuff I knew he'd be wonderful for. Knowing the doula was there helped him to just be there as himself instead of trying to be some kind of birthing coach or patient advocate. -- Nancy Yeomans
Use Ancient Healing Technique with Acupuncture
What it is: Many women use acupuncture leading up to their birth to help prepare their body for labor, and they also use it during birth to manage pain, sustain energy, lower blood pressure, and decrease anxiety.
Acupuncture has been used in China for nearly 2,000 years to prevent pain and promote health. By inserting small needles throughout the body, acupuncture is said to balance a person's "qi," or energy.
A Real Mom's Take: "Jennifer Paschen, from The Nest in Chicago, was my acupuncturist during my entire pregnancy and up through the birth. Throughout the pregnancy several medical situations came up for me, and Jennifer was always able to provide a balanced, thoughtful, and honest assessment of complementary ways to approach the situation.
"The biggest issue came up when my baby was discovered to be breach at 36 weeks. When I decided to do a hospital 'version' -- a medical procedure where the doctor manually externally turns the baby -- Jennifer came with me and offered a natural way for me to relax, thus eliminating the need for an epidural during the procedure.
"Two days later I went into labor. Immediately, Jennifer dropped the other commitments she had and arrived at my door. She joined my husband and me as we went to the hospital, and never left my side from that moment on. My contractions were pretty frequent, every three minutes, and lasted with this frequency for several hours. For every contraction, Jennifer applied acupressure on my lower back to counteract the intensity.
"When we reached a stuck point, in which it seemed the baby might be facing backwards, Jennifer knew just what to do to move things along. She got me in the proper position and brought out the needles. At this point her balanced perspective was also deeply welcomed, as she advised the medical team to consider a saline shot to alleviate the back labor pains. Within minutes of the acupuncture, my labor progressed from a three, where it had been stuck for several hours, to a nine, and we were ready to go.
"Jennifer served as an acupuncturist, a doula, a sister, a friend -- all of the elements that make for a powerful and beautiful birth. When people hear that I gave birth naturally, with no pain medication, they usually think of me as either crazy or a hero. I know that I could not have done it without the strength of my birthing team and, at the helm, the support, presence, and magical hands of Jennifer Paschen." -- Vered Hankin, Ph.D.