REPOST: A big push for a different birthing experience

Cedars-Sinai Medical Center promotes the"Rock and Roll Program," which allows pregnant women to move around and be with their husbands, midwives, or doulas during labor. Read this Los Angeles Times article for more details.

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For most of the last 25 years or so, the experience of pregnancy, labor and delivery has changed little for most women. But change is coming to the most traditional setting, the hospital.

And it's being spurred by midwives, labor coaches called doulas, forward-thinking physicians and women who don't want "medical" births but don't necessarily want to have their babies at home either.

"We are mammals, and we birth like mammals," says Ana Paula Markel, a certified doula and founder of Bini Birth, a childbirth education and doula-training center in Sherman Oaks. "Women need very simple things during labor: We need to feel safe and warm, we need quiet and darkness, we need to feel like we aren't being observed and we need to be able to move around."

In a hospital, she says, women haven't typically been free to try those simple things. Until now.

Her last point, about being free to move, is one that Cedars-Sinai Medical Center in Los Angeles is embracing with its new "Rock-and-Roll" program. Often, when a woman is in labor and has been admitted to a hospital, she is also in bed. But staying in bed slows labor and, some experts believe, increases the need for medication and the risk of a caesarean section delivery. At Cedars-Sinai, women are encouraged to change position every 20 minutes or so, even if they've had an epidural for pain relief.

"The program has reduced the number of C-sections at Cedars by 8% and reduced the length of time that women labor by 20%," says Nicole White, a hospital spokeswoman.

Cedars-Sinai, along with St. John's Health Center in Santa Monica, offers delivery privileges to midwives. "One of our jobs is promote a sense of normalcy about labor and birth, and less fear," says Deborah Frank, a certified nurse midwife and the first CNM to be granted privileges at Cedars-Sinai. Frank says that most midwives aren't "anti-technology or even anti-medication," but neither do they believe that every birth calls for medical intervention.

Frank encourages laboring women to walk and to have her partner, a midwife or a doula at her side. Having a midwife in attendance is still relatively rare: According to a 2012 report in the Journal of Midwifery & Women's Health, 11.4% of vaginal births were attended by midwives in 2009 (the most recent statistics available).

As for women who give birth by caesarean, they can expect changes too.

Even though the percentage of caesarean births in the U.S. has stabilized — it increased steadily from 1996 to 2010 from just more than 20% to 32.8% — nearly one-third of babies are born by C-section each year.

In the March issue of OBG Management, Dr. William Camann, director of obstetric anesthesiology at Brigham and Women's Hospital in Boston and an associate professor of anesthesia at Harvard Medical School, co-wrote an editorial, "Mother-, Baby-, and Family-Centered Cesarean Delivery: It Is Possible," in which he explained some of the options that have become available in the last couple of years.

For example, instead of using an opaque drape to create a surgical shield, two drapes are put in place: a solid one and a clear one. Once the doctor has made the necessary incisions and is ready to deliver the baby, one drape is lowered, leaving the clear plastic drape in place. This allows the mother and her partner to view the birth and touch the baby through the clear drape, while preserving a sterile surgical area.

A second change is one that Camann describes as "slowing the delivery process." Normally a baby is removed from the mother's uterus within seconds. But by allowing the baby to remain in the uterus after the head emerges, the uterus can contract around the baby, and at the same time, the baby starts to breathe and cry. Some experts believe this helps babies clear their respiratory system of fluid (babies born by C-section have a higher risk of respiratory problems), Camann says.

There are even doulas who specialize in assisting women during a surgical delivery.

"The mothers who have doulas in the OR are more involved and not as detached from the birth experience if their physician is more open to the concepts of a family-centered birth," says Tara Poulin, a certified doula in Boston. Even small changes, such as putting the IV in the non-dominant hand, putting the heart-monitor leads on the woman's back and letting her initiate breast feeding make the experience less stressful, she says.

The bottom line: "There seems to be more willingness among [obstetricians and] anesthesiologists to involve the dad/partner into the process, and even to welcome doulas and midwives into the delivery room, whether it is a caesarean or vaginal delivery," Camann says.


With years of experience as an obstetrician-gynecologist, Cristian Andronic is knowledgeable of the specific healthcare needs of women. Follow  this Twitter page for more updates.

REPOST: In Healthy Pregnancies, Let the Baby Set the Delivery Date

In a recent article in The Huffington Post, Dr. Guttmacher describes his experience of becoming a new grandfather within the context of his training as a pediatrician. His column presents the scientific evidence that, in a healthy pregnancy, waiting until at least 39 weeks to deliver improves outcomes for the mother and the baby.

A few months ago, I became a grandfather, and I love it. In the final weeks leading up to my grandson's birth, I didn't think he could get here fast enough. My step-daughter, too, had grown impatient, in anticipation not only of the new baby, but of the end of the discomfort and exhaustion of that final month.

But while my grandfatherly instincts made me eager for my first grandchild's arrival, as a pediatrician, I knew that in a normal, healthy pregnancy it's the baby, not a grandfather, or even the mother, who best sets the delivery date. The outcomes for mom and baby are best when delivery occurs after 39 weeks. Obstetricians recognize this as a best practice.

Yet some families still request delivery, or their doctors may even suggest it for scheduling purposes, before 39 weeks. In these instances, labor is initiated even though the pregnancy could progress further with less risk to the mom and the baby.

Of course, for some pregnancies, there is a medical need for delivery before 39 weeks. This need may arise from any number of health problems affecting mom, baby, or both. In such cases, the mom's health care provider will recommend an early delivery.

But for most pregnancies, it's best to wait.

Why?

Much of a baby's development happens in the final weeks.

At 35 weeks, a baby's brain weighs only two-thirds of what it will weigh at 39 to 40 weeks. During this time, brain growth surges to accommodate such important functions as balance, coordination, learning, and social functioning. The lungs, liver, and other internal organs undergo important development in the final weeks, too.

Later deliveries bring fewer health risks for babies.

Babies delivered at 39 weeks or later have fewer health risks than babies delivered earlier. In the short term, babies delivered before this time have more trouble breathing, feeding, and keeping warm, so they're more likely to require medical attention and a stay in a neonatal intensive care unit. Deliveries before 39 weeks also carry a higher risk of cerebral palsy, vision and hearing loss, learning difficulties, and even death. Forgoing elective delivery in the final weeks may reduce these risks.

Later deliveries mean fewer complications for moms, too.

Elective early delivery increases the risk of cesarean delivery. And C-sections, while common, carry risks for the mother, such as wound infection and anemia, and require longer recovery time. Having a C-section also makes C-sections more likely for subsequent pregnancies. Mothers who deliver after 39 weeks typically have better outcomes.

Of course, because the estimated due date may be off by even two weeks, some women who think they are delivering on time are actually delivering early. So, unless there's a medical need to induce labor, it's usually best to wait for labor to begin on its own.

Right now, many dads and moms eagerly are awaiting the birth of their babies. Parents worry about enough things during pregnancy -- avoidable risks shouldn't be among them.

My family was fortunate. The delivery went smoothly, and both my stepdaughter and grandson are healthy and doing well.

All families want the same for their loved ones. That's why it's best -- unless the health of a mom or her baby is in danger -- to wait to deliver until at least 39 weeks of pregnancy.


Dr. Cristian Andronic specializes in advanced gynecologic and robotic pelvic reconstructive surgery. Follow this Twitter page for more updates.