Get the birth you want...

Fran Molloy talks you through the possibilities and helps you think through the important choices and preparations

Who knew that the business end of pregnancy – when you actually deliver the baby – was going to involve so many options and decisions?
For the first-time mum, the range of alternatives bandied about by those in the know can be mind-boggling. And there’s a reason for that : the reality is, birth is something of a wild adventure where lots of unexpected things can happen. Still, while there’s no way you can sit down and ‘order’ the birth you want from a menu, if you go into labour with lots of information and resources to prepare you for the kind of birth you’d like, you’ll have a better chance of it all going smoothly.
A good plan of action is to read through the various alternatives, get a feel for the way you’d ideally like to approach your baby’s birth, and then make the necessary preparations. Meanwhile, keep in mind what you need to know and do if the birth doesn’t go according to plan. Finally, jot down all of the essentials in a birth plan (which is basically a recipe for your labour and birth). Also let your support people and carers know of your intentions. Okay, here you go…

You want: a vaginal birth with no drugs

Most babies are born vaginally and have been doing so, without their mothers using pain-relieving drugs, for about 60,000 years. Those who choose to forego drugs in childbirth often do so because some can affect the baby and increase the mother’s chance of a caesarean. But this does not mean you have to suffer. With the right preparation, a drug-free vaginal birth can be a very empowering and positive experience.



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Preparation is key. Talk to your caregiver about what you want to do. Most hospitals are very supportive of women who are keen to have a drug-free birth and will provide lots of information about alternative pain relief, such as showers, heat packs, massage, positioning, and relaxation and breathing techniques. Make sure you and your birth support person enrol in prenatal classes that go through these options in detail.
Prepare a birth plan and bring it along, together with extra non-drug support stuff like massage oils. And check what your hospital supplies.
Is there a microwave for heat packs and a freezer for icepacks? What else will you need to bring or source? Alternative non-drug pain relief like a TENS machine or acupuncture may be worth looking into well before you go into labour.



During labour...
When you arrive at hospital, let your carer know your plans straight away. Get your support person to source heat packs, showers and birthing stools or whatever else you need.



Special considerations
Be aware of what drugs are available and what their side effects are in case things don’t go to plan. Have a backup plan you are comfortable with so that you are not making decisions under pressure.

You want: a caesarean

Australia has one of the world’s highest caesarean rates, with almost one in three babies now born this way. In many cases, caesarean births are a necessary intervention that save many mothers’ and babies’ lives.
C-sections should only be performed due to medical necessity, because they are far riskier and involve a longer, more painful recovery for the mother. There’s also an increased risk of respiratory distress in the baby.



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If your doctor has told you that you’re likely to need a caesarean, do some reading. You will probably be given information about your anaesthetic options and risks, but most decisions will be made by the medical team. Caesareans can be costly, so it’s worth checking what payments will be needed and when. And make some plans for assistance after the birth, because you’ll be advised not to drive for four weeks and not to lift anything heavier than your baby for six weeks.

You want: a vaginal birth with drugs

Pain relief during labour and birth can include nitrous oxide, inhaled as a gas; narcotics (usually pethidine, sometimes called Demerol) by injection, usually into the buttocks; and spinal blocks and epidurals. A spinal block is an injection of anaesthetic into the spinal fluid, giving immediate relief that wears off in a few hours. An epidural involves the insertion of a fine tube into the lining of the spine through which the drug is given; it is left in place so the dose can be adjusted over time.



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It’s important to have a good understanding of what drugs are available, what their side effects and consequences are, and how they are administered. You also need to know at what stage of labour decisions about pain relief are made. Some hospitals and some medical personnel can be reluctant to administer pain relief if they think you’re unaware of what is involved. Speak to your caregivers and make sure your support person is going to be an advocate for you. A written birth plan will help.



During labour...
Advise the hospital of your plans as soon as you arrive. When you are assessed, talk to your caregiver about what pain relief is available and when this can be given.



Special considerations
Be prepared to go drug-free if things move too fast. Have a backup plan ready and be aware of the non-drug ways to relieve pain. Practise them beforehand, so you won’t panic if the pain-relief plans fall through.

You want: a HypnoBirth or calmbirth

HypnoBirthing and calmbirth are techniques involving deep relaxation, visualisation and self-hypnosis. They teach women to replace the concept of a long, painful labour with expectations of calm, relaxed, comfortable birthing. Women with this approach to birth are less likely to release ‘fear’ hormones that constrict the birthing muscles. It has been shown that women using deep relaxation techniques produce more endorphins
(‘feel-good’ hormones) and have shorter, less painful births.



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Look for a HypnoBirthing or calmbirth teacher in your area and give them a call, the earlier the better. It’s great to attend classes with your partner or support person if possible.



During labour...
Make sure you let your caregivers understand your plans when you arrive at hospital. HypnoBirthing usually means a drug-free birth, but it doesn’t have to. HypnoBirthing and calmbirth techniques have helped women cope with all sorts of unexpected events during birth, including emergency caesareans.



Special considerations
The most important part of this technique is good training and preparation, so organise yourself early in pregnancy so you have plenty of time to come to grips with the concept.

You want: an active birth

Until forceps deliveries became common in Europe three centuries ago, women usually moved around and birthed in an upright or squatting position, rather than lying uncomfortably on their backs. In recent years, many women have returned to upright birthing positions, arguing that gravity helps the baby descend through the pelvis and reduces complications.



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Maintaining your fitness and strength is important for active birth, so many women attend antenatal yoga or Pilates classes, or go for daily brisk walks to ensure they are ready for active birth. Antenatal classes will also give you some good strategies. As always, discuss your birth plan with your hospital and caregiver.



During labour...
Active birthis often instinctual when women have the freedom and privacy in labour to move and change positions at will between standing, walking, kneeling or squatting. Floor mats, chairs, beanbags, birthing stools and even fitness balls can help support you in ‘gravity effective’ positions.



Special considerations
Have a backup plan in case things don’t work out. For example, if your blood pressure is high or your legs hurt, are there alternatives that will help you? If your carer wants to use a monitor on the baby, talk to them about using a portable one.




You want: a natural birth with no intervention
Birth isn’t an illness, so if all is going well many women choose to have their baby in as natural a way as possible, with no intervention or interference.



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You need to find a sympathetic caregiver, doctor or midwife you trust and feel comfortable with who is willing to support your desire for a no-intervention birth. Lots of reading and mental preparation is essential. Understand the choices you are making and the options you have for non-medical pain relief during labour, and make sure your birth support people understand too.



During labour...
Be prepared. Pack all the things you will need well before you’re due to go into labour. Work out what things are important to you (perhaps you don’t want to be hooked up to a monitor or lie on a bed) and what things are flexible (does it matter if you have low electric lights instead of candles, if that’s the hospital policy?). Consider that sometimes things can happen much faster (or much slower) than you expected. Make sure your partner and support people are comfortable with your plans, your carer is aware and you are ready to change plans if there’s an emergency.



Special considerations
Birth is unpredictable, and the most important thing is the safe arrival of your baby. Remember that, and don’t set yourself up for disappointment if you don’t have a ‘perfect’ birth. Always have a backup plan and be prepared to use it if problems develop.

You want: a silent birth

Silent birth got a bad rap with the birth of Katie Holmes’ and Tom Cruise’s daughter Suri, but much of the hype around it was misinformed. This birth option is closely associated with The Church of Scientology, but you don’t need to be a Scientologist to practise silent birth. Nor do you have to be totally silent – just quiet and calm. The classic book Birth Without Violence by Dr Frederick Leboyer promotes silent birth. The idea is that the mother and everyone around speaks in hushed tones, the lights are low and the baby is born as gently as possible. Pain relief and caesareans are possible in silent birth and the mother can make noise if it helps her, though women often find that primal grunting noises will be the loudest sounds they want to make.



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It’s important to spell out clearly what ‘silent birth’ means to you, what you expect from your doctor and other caregivers and to discuss it with them as early as possible. If a caregiver isn’t sympathetic, this gives you a chance to find someone who is.



During labour...
When you arrive at the hospital, let all the staff know what you need from them. If your support people are talking in hushed tones and you have the lights low, it’s surprising how easily everyone else will fall into step. A sign on the door can help too.



Special considerations
Silent birth is all about your caregivers respecting your choices for your baby’s arrival. There’s no need for any medical priorities to change.
You simply do whatever is right for you, quietly and calmly, in line with any medical supervision, aiming to bring your baby into the world as calmly as possible.

Related articles
What is active birth?