Giving birth can be a straightforward hospital bed affair, or it can involve one of the more controversial methods. We consider your options.
Having a baby has never been safer than it is today. The very latest in modern technology is available to assist mother and baby if things go wrong and, because of this, most women are encouraged to have their babies in hospital.
Some people, however, are alarmed at what they see as the dehumanization of childbirth, with mothers playing a relatively unimportant part while machines and drugs take over.
Women used to give birth sitting upright on a ‘birthing stool’ until doctors decided that it would be easier for them to give birth lying on their backs.
Now it has been accepted by most experts that this position is far from ideal. It works against gravity and can have adverse effects on uterine contractions and the position of the baby, and it can be painful.
The majority of babies are delivered in the traditional hospital consultant unit. Hospital is the only really safe place to give birth for women suffering from conditions such as diabetes, TB, epilepsy, heart and kidney complaints or certain sexually transmitted diseases. Those women who have suffered during their pregnancy from raised blood pressure, or placenta praevia (low-lying placenta) or who go into premature labour should also choose to give birth in hospital.
Until recently, many women felt hospitals ‘took over’ the birth too much and were too controlling. But hospitals are much more enlightened now.
There are three sorts of pain relievers: analgesics, which are pain-killing drugs, gases (such as nitrous oxide, which numbs sensation) and anaesthetics, which dull the consciousness. Tranquillizers, which calm the patient, are sometimes also given.
An epidural is a form of anaesthetic which is injected into the lower back. This should not only make labour painless but it should also allow the uterine contractions to continue so the woman can take part in the birth and help ‘push’ her baby out of the womb.
The advantage of an epidural is that the woman can remain awake and enjoy the experience of birth. It is usually necessary, however, to accompany an epidural with an intravenous drip, in case of a sudden fall in blood pressure.
There tend to be more babies delivered with forceps after an epidural, and it can leave some women with headaches and numbness in the legs for a while afterwards.
When the baby is born, it is covered in a protective film of vernix. Until recently, the baby was cleaned up before being handed to the mother. Now, the baby is usually handed to the mother immediately.
Sometimes labour has to be induced artificially, and although some hospitals have been accused of performing inductions merely for convenience, nowadays most obstetricians will only induce labour if the mother or baby is at risk.
An induction may be considered if the baby is more than two weeks overdue, if it is not growing as it should, if the mother suffers from diabetes, kidney disease or raised blood pressure, or simply if labour is not progressing well.
Labour is started artificially, usually by rupturing the membranes (breaking the waters) with a special instrument, and then a synthetic hormone can either be administered intravenously or as a pessary to start off the contractions.
Induced labours are usually shorter than those which start naturally, but sometimes the contractions can be quicker and more severe.
A caesarean section is performed when a baby, for one of several reasons, cannot be born through the birth canal. An incision is made into the lower part of the abdomen and then the uterus. The baby is removed through the incision, and the wound is then sewn up.
The operation is often performed under a general anaesthetic, but it is becoming increasingly more common to perform it using an epidural or spinal anaesthetic. This allows the mother to witness her baby being born.
Sometimes a vacuum extractor known as a ventouse is used instead of forceps. It works along the same lines except that a cup is fitted over the baby’s head and connected to a vacuum which fixes the cap to the baby’s scalp. The cap is connected to a small handle which the obstetrician uses to draw the baby’s head down through the vagina.
Just like home
Some hospitals have GP units attached to them. These are small wards run by general practitioners with an interest in obstetrics. They are small and more homely than ordinary hospital wards, and the woman is attended by her own GP and the community midwife who has seen her through her pregnancy (the ‘domino’ system).
There are many advantages in having a baby at home, not the least being that it makes the event more special and more personal. The whole family can be present and the woman is not subjected to unnecessary hospital routines.
However, many doctors are reluctant to attend home births, considering a hospital to be the safest place for giving birth. The decision for a home birth should be given long and careful thought.
From the mid-1970s, two French doctors, Frederick Leboyer and Michel Odent, introduced innovative ways for women to give birth.
Leboyer believed that too many hospital deliveries are noisy, unnatural and positively violent as far as the baby is concerned, and that a baby’s first glimpse of the world should be as much like that of the womb from which it has emerged as possible.
His technique involves the baby being born as gently and as naturally as possible into a dimly-lit delivery room, perhaps with gentle music too.
The baby is placed on her mother’s abdomen as soon as she is born, she is talked to in a soothing voice, and everything is done to ensure her passage into the world, and first impressions of it, are as untraumatic as possible.
The umbilical cord is cut later than usual so the baby does not suffer a shock from suddenly being separated from her mother, and soon after she is put into a warm bath.
All this, Leboyer maintained, makes for a happier, more settled baby.
Dr Michel Odent was so appalled at how impersonal childbirth was becoming when he took over the maternity unit at the hospital in Pithiviers, France, that he decided to try and make it as natural and joyful as possible.
He realised that women, like animals, preferred quiet, dark and secluded places in which to give birth, not bright hospital delivery rooms.
He encouraged women to find their own positions in labour – squatting, kneeling on all fours or standing. He thought women should be free to choose instinctively the position they prefer at every stage of the birth.
Dr Odent is probably most famous for his birthing pool, a pool in which ‘labouring’ women can sit to relax or even give birth. He argued that a baby does not begin to use its lungs until its skin is exposed to the air, so there is no risk of him or her drowning. Women who have given birth in the pool maintain that it is very relaxing and lessens pain. However, there have been incidents in Europe when the baby has died as a result of this way of birth. The practice is being reconsidered.