It may be the most natural thing in the world, but as every mom learns, giving birth is only partly instinctive. The rest is a matter of going with the flow -- adapting to the unique circumstances of your own pregnancy and labor -- and making the most informed choices you can. But are women as aware of the options they have along the path to parenthood as they could -- or should -- be?
A landmark survey conducted by Harris Interactive for the Maternity Center Association with support from Johnson & Johnson Pediatric Institute, uncovered some surprising answers. Polling nearly 1,600 first-time and veteran mothers across the country, the wide-ranging questionnaire touched on everything from caregiver choices to pain relief options. And while the numbers show that women are more involved than ever in mapping out their own birth plans, the poll also uncovered some basic gaps in our knowledge about labor and delivery. Of course, we can only fill in the blanks if we know what we're missing. For that, read on.
1. Planning a healthy pregnancy begins before conception.
The majority of women (60 percent) carefully planned their pregnancies -- yet less than one in three (30 percent) of the women consulted a health care provider before sperm met egg. Why let your doctor in on your plan to get pregnant? Plenty of reasons, says David Plourd, M.D., assistant professor of obstetrics and gynecology at the Naval Medical Center in San Diego. "Counseling lets your caregiver see things in a larger context," explains Dr. Plourd. Points that a health care provider covers:
Medical History
It's important to go over your immunization record -- specifically, to see if you're protected against rubella, chicken pox, and hepatitis B, diseases that pose grave risk in a fetus. In addition, your caregiver will want to know whether you've had a sexually transmitted disease or are at risk for acquiring one (chlamydia, for example, can damage fallopian tubes or leave scar tissue), or if you smoke or use drugs.
Weight. Getting your weight within a normal range before you start lessens the risk of hypertension, gestational diabetes, or preeclampsia (if you're overweight) or delivering a low birth weight baby (if you're underweight).
Diet and exercise. Increasing your intake of folic acid to help prevent neural tube defects is just one of the important ways nutrition plays a part in pre-conception planning. In addition, starting a modest exercise program eventually will pay off when you go through the ultimate workout of labor.
2. Some labor coaches could use more coaching.
Almost all of the women (99 percent to be exact) received support during labor, with most moms choosing their husbands or partners to coach them through delivery. Nurses assisted 83 percent; doctors, 53 percent; family members or friends, 50 percent; and midwives, 11 percent. Doulas accounted for only 5 percent. Some lucky women received support from several sources (for example, from a husband, a friend, and a caring nurse).
When it came time for women to rate the quality of support they had received, doulas came out on top and husbands fell to the middle of the pack. Why the flip-flop? Most dads simply have never witnessed something this intense, nor have they undergone much training to help them know what to do or say. Even second-time dads may not be prepared, since each labor and delivery is unique. Doulas, on the other hand, are trained labor coaches with delivery-room experience.
While it would be fantastic if we could all have doulas, the truth is not all of us can afford them. So how can we help our nonprofessional labor coaches to be even better? Attending childbirth education classes (for both new and experienced dads and partners) is a great start. In addition, sitting in on more than a few checkups will keep him in the loop as will reading all of those baby books that are on your nightstand. That said, we're thrilled to point out that most husbands did a wonderful job, with an amazing 59 percent of moms rating them as "excellent" coaches.
3. Inductions are fairly common, but may bring on more medical procedures.
Tallying the final numbers, it would seem that Mother Nature gets a lot of nudging. Over half (54 percent) of first-time moms had their labors induced, while 46 percent of moms who had already had at least one child also got their party kick-started. Pitocin, a synthetic hormone that triggers strong uterine contractions, was the jumper cable of choice, sparking 86 percent of the women into labor. Fifty-nine percent had membranes broken by their caregiver, 31 percent had them stripped, and 26 percent had prostaglandin (a gel, pouch, or tablet applied that loosen the cervix).
Why the rush? Forty percent cited health concerns (which might include toxemia -- a sudden surge in blood pressure -- and gestational diabetes). But disturbingly, nearly 20 percent of the women elected to be induced: "I wanted to go into labor with the doctor or midwife I preferred." "I wanted to be done with my pregnancy and have my baby." "I wanted to control the timing of birth to make work or personal plans." From these responses, it's clear that many women viewed induction as a way to gain control over when, where, and with whom they delivered their babies.
What women often don't know, however, is that artificially starting labor can lead to their having less control over the experience. Studies show that inductions can bring on more painful contractions and longer labors (the average lasting between 24 and 36 hours), which in turn, can lead to further medical interventions -- from using external fetal monitors to epidurals to having c-sections. Inductions are also linked to an increased incidence of uterine rupture. It's important that women considering an induction confer with their healthcare providers before D-day to weigh the benefits against the risks.
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