The New Rules of Giving Birth
Listen up, expecting moms. Childbirth isn't what it used to be -- and that's good news! We asked top ob-gyns to explain the most important improvements that you'll benefit from on delivery day.
Then: C-sections or inductions were scheduled at 37 or 38 weeks.
Now: You should be at least 39 weeks before your doctor schedules any intervention.
Sure, those last few weeks aren't the most comfortable, but it's best to give labor a chance to start on its own. Babies born before 39 weeks are more likely to have developmental and health problems -- both at birth and later in life -- and end up spending time in the neonatal intensive care unit, according to the latest research. In fact, the American College of Obstetricians and Gynecologists (ACOG) says doctors should wait until 41 weeks before scheduling an induction without a medical reason. "We'll examine you at 40 weeks and give your cervix a score: Is it dilated? Has it thinned out? How far back is it?" says Vicki Reed, M.D., an ob-gyn at the Cleveland Clinic. "If your cervix isn't ready -- which is common with first-time moms -- we wait."
Still, there are some exceptions. If you have a complication such as preeclampsia, gestational diabetes, or another risk factor, your doctor may recommend speeding things up. It may be safer to welcome your baby earlier than later in such a situation.
Then: Only ice chips were allowed during labor to quench thirst.
Now: You can drink clear liquids and even have a light snack.
The ice-chip recommendation dates back 50 years, when women received general anesthesia if they had a C-section, and there was a higher risk of aspiration (breathing stomach contents into your lungs). Today, most moms-to-be who need a C-section have an epidural or a spinal block instead. Modern methods of administering general anesthesia have also greatly reduced the risk of aspiration, says Cynthia Wong, M.D., a Chicago anesthesiologist with the Northwestern University Feinberg School of Medicine. As a result, clear beverages like water, juice, sports drinks, soda, chicken broth, and black coffee are often permitted.
Some doctors even allow a light snack, since other research finds no harm from eating. Perhaps try a nondairy protein shake? One study found that it significantly increases a woman's satisfaction during labor. Just make sure you avoid fatty or hard-to-digest foods that will sit in your stomach -- remember, plenty of women vomit during labor.
Then: No epidural until a woman was 4 to 5 centimeters dilated.
Now: You don't have to wait!
Doctors once thought if you had an epidural too early, you'd prolong your labor, thus increasing your odds of needing a C-section. But a slew of new studies has found that women who have early epidurals are no more likely to have C-sections than those who get one later, notes Dr. Wong, who conducted one of the studies. Some research even shows that women who get their epidural early have slightly shorter labors.
Then: Doctors called for a C-section if labor took too long.
Now: You're allowed more time so nature can take its course.
Many women have been given C-sections for the simple reason of "failure to progress," meaning their labor was taking too long. No more. "It turns out that we were using outdated numbers about how long labor actually takes," explains Aaron B. Caughey, M.D., Ph.D., an ob-gyn at Oregon Health & Science University, in Portland; he coauthored ACOG's new guidelines, which, in a nutshell, say both doctors and moms need to be more patient. "Evidence now shows that labor progresses slower than we thought, so we're giving women a lot more time to labor and deliver vaginally instead of moving to a cesarean delivery." The changes call for extra time during different stages of the labor process.
Then: Most doctors used staples after a C-section.
Now: Sutures are recommended.
For years, doctors used staples to close a C-section incision for a simple reason: They're quick. In fact, a doc can close you up nine minutes faster with staples than stitches. But that speed may come at a cost. A large-scale and influential study last year found that women who were stapled instead of sewn had a 43 percent higher risk of wound complications, notes Vincenzo Berghella, M.D., a professor of obstetrics and gynecology at Thomas Jefferson University, in Philadelphia. Using stitches means your incision is less likely to reopen and get infected. Confirm with your ob-gyn that this is how the doctors in your practice operate.
Then: Women who had a previous C-section were discouraged from attempting labor.
Now: Doctors are more willing to allow appropriate patients to attempt a vaginal birth.
It used to be that if you had one cesarean, you were destined to have more. But doctors now say vaginal births after cesarean (VBACs) are a reasonable choice for many women, as long as your incision is low and horizontal (as most are). "If you think you may have more babies after your second one, having a VBAC is really beneficial," explains Dr. Caughey. "Each C-section increases your risk of complications, such as heavy bleeding, infection, and placenta abnormalities, which can be life-threatening." The risk of maternal death, while minuscule, is also greater with a repeat cesarean than with a VBAC.
Of course, VBACs carry risks as well, namely the threat of uterine rupture, a rare but sometimes fatal complication. That risk, along with the threat of malpractice suits, has prompted some hospitals to stop offering VBACs altogether. So if you have your heart set on one, make sure your physician is comfortable with performing VBACs and delivers at a hospital that supports them.
Then: Doctors clamped the baby's cord right away.
Now: Your health-care provider may wait a minute or two.
It's been standard practice for decades for physicians to clamp a baby's umbilical cord immediately after delivery. But doctors have started to rethink this after recent research found that delaying cord clamping for at least one minute after birth was better for Baby and posed no risk for Mom. "It's a simple intervention with major benefits," says Kathleen Berchelmann, M.D., a pediatrician at St. Louis Children's Hospital. "Your placenta pulsates like a heartbeat, and it pushes blood into your baby that will significantly reduce her risk of anemia for at least six months." That's important because anemia in infancy is a known cause of cognitive, social-emotional, and motor deficits. The only downside: Delayed cord cutting may slightly increase your baby's risk of jaundice, but that's usually easily treated.
Neither ACOG nor the American Academy of Pediatrics has issued an official policy on delayed cord clamping for full-term infants, but both groups do recommend a 30- to 60-second delay for preemies. And the World Health Organization recommends waiting one to three minutes before cutting the cord on full- and pre-term babies who are breathing on their own.
Then: Episiotomies were routine.
Now: Episiotomies are discouraged.
The old thinking was that if you were going to tear during childbirth, a clean cut would be easier to stitch and would heal more quickly than a jagged tear. Now we know that's not true. More than a dozen studies have shown that surgical incisions take longer to heal than natural tears, and can cause pain, infection, and increased risk of incontinence for months or years after delivery.
Episiotomies are still sometimes necessary, such as when your doctor needs to deliver in a hurry because your baby's heart rate has dropped, notes Steve Rotholz, M.D., medical director of obstetrics at the University of Colorado School of Medicine, in Boulder. And unfortunately, some docs still do episiotomies routinely. "Episiotomy rates vary widely by practitioner, so ask your ob-gyn how often she performs them," advises Dr. Rotholz. The episiotomy rate is below 5 percent in his practice.
Originally published in the August 2015 issue of American Baby magazine.
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