Giving Birth With Confidence (Official Lamaze Guide, 3rd Edition)

GLOWING PRAISE FROM LEADING CHILDBIRTH EXPERTS

“This is a superb book. Though it’s called “official,” it isn’t written in bureaucratic language and isn’t heaped with instructions. It’s humane, funny, tender, down-to-earth and joyful. Essential reading for all pregnant women who seek autonomy in childbirth.”

—Sheila Kitzinger, author of The Complete Book of Pregnancy and Childbirth

“The Official Lamaze Guide: Giving Birth with Confidence is the first book that every pregnant woman should read before she makes any decisions about her maternity care. This book is a breath of fresh air. By following these explanations and recommendations women will gain the best chance of having a normal, natural, healthy, and empowering birth.”

—Marshall Klaus, MD, and Phyllis Klaus, MFT, CSW, authors of The Doula Book, Your Amazing Newborn, and Bonding

“This book is a wonderful resource that provides information, knowledge, and skills to expectant parents who want to play a central role in their children’s births.”

—Penny Simkin, coauthor of Pregnancy, Childbirth, and the Newborn

“At last there is a resource that emphasizes normal birth and increases parents’ confidence. The honest information and reassuring tone of the authors truly get to the heart of women’s fears and allow them to explore those fears in a safe way. The book contains life skills such as communication and negotiation and tells the simple story of birth in a manner that left me in awe. I wish I had been able to share this book with expectant families during my first seventeen years of teaching and being a doula.”

—Ann Grauer, LCCE, CD(DONA), PCD(DONA), Past President of DONA International

“The Official Lamaze Guide: Giving Birth with Confidence is a no-nonsense handbook for laboring without medical interventions. The authors point out that Lamaze is no longer a method but a philosophy: Birth is normal and women can handle it.”

—Melissa Chianta, Mothering magazine

“The Official Lamaze Guide: Giving Birth with Confidence is one of the rare books today containing an unapologetically woman-centered view of birth…. The authors strongly advocate natural birth…. They emphasize that women’s bodies are beautifully designed to grow, birth, and nurture babies. The Official Lamaze Guide…should be in every [pregnant mother’s] hands.”

—Jane Pincus, BA, MAT, MFA, Birth: Issues in Perinatal Care

“Warm and wise, honest yet reassuring, chock full of information, and based on the latest and best research—any pregnant woman who wants a normal birth should put this book on her A list.”

—Henci Goer, author of The Thinking Woman’s Guide to a Better Birth

No. 1 pick on About.com Top 10 Pregnancy Books:

“This book is an instant classic! With great advice, humor, and birth stories, Lothian and DeVries share the truth about birth and how to make it a wonderful time in your life. The factual information is provided in a practical way, including how to pick a place of birth, talk to your doctor or midwife, and most importantly how to trust your body.”

—Robin Elise Weiss, LCCE, About.com

“The Official Lamaze Guide is a source of information that women need to have and a message that women need to hear. I think it accomplishes its purpose skillfully and has the potential to be a transformative influence. I hope women read it, absorb it, and begin to celebrate birth!”

—Molly Remer, MSW, CCCE

Library of Congress Cataloging-in-Publication Data

Lothian, Judith.
Official Lamaze guide: giving birth with confidence / by Judith Lothian and Charlotte DeVries.—[New ed.]
p. cm.
ISBN 978-0-88166-566-6 (Meadowbrook Press) — ISBN 978-1-4391-7979-6 (Simon & Schuster)
eISBN-13: 978-1-4516-1922-5
  1. Childbirth—Popular works. 2. Natural childbirth—Popular works. 3. Labor (Obstetrics)—Popular works. I. DeVries, Charlotte. II. Lamaze International. III. Title.
  RG525.L63 2011
  618.4—dc22
  2010023626

Editors: Christine Zuchora-Walske, Angela Wiechmann, and Megan McGinnis
Creative Director: Tamara JM Peterson
Production Manager: Paul Woods
Cover Photo: © Larry Williams/Corbis
Interior Photos: © BananaStock, Ltd; © Brand X Pictures; © Comstock, Inc; © Getty Images;
             © Marilyn Nolt (noltphotos@mail.com).
Index: Beverlee Day

Text © 2005, 2010 by Judith Lothian and Charlotte DeVries

“Safe, Healthy Birth: What Every Pregnant Woman Needs to Know” is printed with permission of Lamaze International. “The Mother-Friendly Childbirth Initiative” is reprinted with permission from the Coalition for Improving Maternity Services, http://www.motherfriendly.org. “The Rights of Childbearing Women” is reprinted with permission from Childbirth Connection. The Lamaze International Position Papers “Breastfeeding Is Priceless: No Substitute for Human Milk,” and “The Hazards of Cesarean Surgery for the Mother and Baby” are reprinted with permission from Lamaze International. “The Birth Doula’s Contribution to Modern Maternity Care” is reprinted with permission from DONA International.

Lamaze is a registered trademark of Lamaze International.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or using any information storage and retrieval system, without written permission from the publisher, except in the case of brief quotations embodied in critical articles and reviews.

Although the authors and publisher have made every effort to ensure that the information in this book is accurate and current, only your caregiver knows you and your health history well enough to make specific recommendations. The authors, editors, reviewers, and publisher disclaim any liability from the use of this book.

Published by Meadowbrook Press, 5451 Smetana Drive, Minnetonka, MN 55343

www.meadowbrookpress.com

BOOK TRADE DISTRIBUTION by Simon and Schuster, a division of Simon and Schuster, Inc. 1230 Avenue of the Americas, New York, NY 10020
www.SimonandSchuster.com

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Printed in the United States of America

DEDICATION

PREFACE

Why Another Birth Book?

In the previous edition of The Official Lamaze Guide: Giving Birth with Confidence, we noted that stepping into a bookstore revealed hundreds of birth books on the shelves. Some claimed to be the “complete guide” or the “better way” to have a baby. Some were filled with illustrations of developing babies, charts listing possible complications, and intricate biological details. Some were technical and scientific; others were warm and even funny.

When we reviewed all those birth books, we found that instead of encouraging women, the bestsellers cataloged what to fear when you’re expecting. It was no surprise that their readers often ended up alarmed, afraid, and eager to choose medical interventions like epidurals and cesareans.

As we prepared to write this new edition of our book, we discovered that things have not changed much. Today, as in 2005, very few pregnancy books deliver the simple message that we think pregnant women need to hear most: Birth is a natural part of life. We conceived this book nearly a decade ago from our deep conviction that women know how to give birth—and that women need to rediscover this very important, basic truth.

Throughout history, the wisdom of birthing has belonged to the family and community. The majority of the world’s women have given birth among people they know, in a familiar and comfortable place. Birth has been considered a family event, not a medical one—until recently. In our modern, technology-centered culture, birth has moved from the home to the hospital, from the care of friends and family to the oversight of medical professionals, where touch and patience often give way to tests and timekeeping.

We believe deeply that birth is a process you can trust, just as millions of women before you have. This belief isn’t sentimental; it’s based on our thorough understanding of the physiologic birth process and research that confirms interfering in that process is harmful, unless there’s clear evidence that interference provides benefit.

Unlike many other pregnancy and birth books—and, surprisingly, much of standard obstetric care—this book is evidence-based. We often refer to The Cochrane Library (a collection of careful studies and systematic reviews of current research) and A Guide to Effective Care in Pregnancy and Childbirth (a summary of The Cochrane Library’s maternity research findings with recommendations for practice). In this edition, the research has been updated. As you read this book, you’ll see that research continues to support the excellence of nature’s design for birth.

Simply said, it’s safer and healthier for you and for your baby to allow the natural process of labor and birth unfold in the way that nature intended. In this new edition, we highlight over and over again that the best way to ensure a safe and healthy birth is to not interfere in the natural process without a serious medical indication.

Lamaze: It’s Not Just about Breathing

Lamaze has been around for a long time. In the 1950s Fernand Lamaze, a French obstetrician, developed a method of breathing and relaxation that helped women manage childbirth pain. The Lamaze that people have come to know is women puffing and panting their way through labor.

But Lamaze isn’t just about breathing techniques. In the years since 1960, when the Lamaze organization began, we’ve learned many lessons from research and women’s experiences giving birth naturally. Lamaze classes provide opportunities to understand the process of birth, gain confidence in your ability to give birth simply, and have the safest, healthiest birth possible. Lamaze provides women with the latest, best information about birth and breastfeeding, and it helps women make sense of that information by simplifying maternity care decisions. In this edition, we share Lamaze’s belief that it takes an entire pregnancy to prepare for birth and motherhood, not just six weeks of formal classes at the end of pregnancy.

In 1960, many women wanted more control of their pregnancy and birth experiences than women typically had at that time. These women wanted their husbands with them during labor and birth; a say in who would attend to their needs; safer, more humane treatment; and more comfortable surroundings for this important life event. Thanks to the efforts of these informed, vocal women who knew things could be better, midwives reemerged as caregivers, labor and birthing rooms became more homelike, and hospitals eliminated some unnecessary routine procedures, like enemas and perineal shaving.

Recently, the birth pendulum has taken an alarming swing backward. Our high-tech healthcare system is designed to look for trouble, and as a result, it labels more and more pregnancies and births as “complicated” or “high-risk.” By the end of pregnancy, few women trust their bodies enough to believe they can give birth without drugs and machines. Today we see epidurals used almost routinely, labor induced (started artificially) at epidemic rates, women still confined to their beds in labor and on their backs during birth (the worst position for birthing a baby), and record-breaking numbers of cesarean surgeries performed.

Since the previous edition of this book was published, things have gotten even worse. The cesarean rate has continued to rise. Now almost one third of women in the United States give birth by cesarean. There has been a shocking rise in the maternal mortality rate. More babies are being admitted to the neonatal intensive care unit (NICU), and there has been an alarming increase in postpartum depression and post traumatic stress disorder related to childbirth. Evidence-Based Care: What It Is and What It Can Achieve,¹ published jointly by Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, outlines problems with the current maternity care system and identifies the evidence-based care that will make birth safer and healthier for mothers and babies.

In spite of what women may hear—from their doctors, their hospitals, the media, or the books they read—women do know how to give birth simply. And doctors, hospitals, and technology have not made birth safer for mothers or babies. We hope this book will help you understand that pregnancy is not a disease requiring medical heroics, and that you, like all women, are well equipped to give birth.

Although the name Lamaze will seldom appear in these pages, it’s inspired by the plain wisdom of the Lamaze belief that birth is simply and beautifully designed, and that interfering in that process without a medical reason increases risk to mothers and babies.

This book is a simple guide for the journey to motherhood. It’s written clearly in plain English. It’s not an encyclopedia of everything that anyone could possibly know about pregnancy, birth, and breastfeeding. It’s not an endless list of obscure and unlikely complications. It’s not a textbook laced with clinical terms that ends with a quiz. It’s not a guide to medical birth but a guide to safe and healthy birth. It encourages you to lay down the heavy burden of what-ifs that can squash confidence. It invites you to replace fear with knowledge, and to build confidence in your ability to give birth on that foundation of knowledge.

In the pages that follow, we’ll walk beside you on the path to motherhood. We’ll invite you into conversations with other women who’ve faced the many choices you now face. We’ll challenge you to consider which options are right for you and whether standard American obstetric care is actually conducive to safe, healthy, uncomplicated birth. When you look beyond the menu of options typically offered to expectant mothers, you’ll find that birthing a baby is a much simpler event than you may have thought.

We believe that you have the right and the responsibility to get full and accurate information, and to choose what’s best for you and your baby based on that information. We believe that the best start for mothers and babies is a safe and healthy pregnancy and birth. We believe the facts speak loudly that the safest and healthiest way to give birth is to avoid unnecessary medical interventions. This book will provide evidence that supports this belief and will show you how to give birth in the safest and healthiest way.

You are not an accident.

Even at the moment of your conception,
out of many possibilities,
only certain cells combined,
survived, grew to be you.

You are unique, created for a purpose.
Go confidently into the days ahead.

CONTENTS

Preface

Chapter 1: Having a Safe, Healthy Birth

Chapter 2: The History of Birth: Back to the Future

Chapter 3: You’re Pregnant!

Chapter 4: Choosing a Caregiver and Birth Site

Chapter 5: Moving through Pregnancy

Chapter 6: Preparing for Labor and Birth

Chapter 7: The Simple Story of Birth

Chapter 8: Keeping Your Birth Safe and Healthy

Chapter 9: Finding Comfort in Labor

Chapter 10: Birth Plans and Baby Plans

Chapter 11: Getting the Safe, Healthy Birth You Want: Communication, Negotiation, and Decision-making

Chapter 12: Greeting Your Newborn

Chapter 13: Early Parenting

Afterword

Appendix A: Safe, Healthy Birth: What Every Pregnant Woman Needs to Know

Appendix B: The Mother-Friendly Childbirth Initiative

Appendix C: The Rights of Childbearing Women

Appendix D: Lamaze International Position Papers

Appendix E: The Birth Doula’s Contribution to Modern Maternity Care

Notes

Recommended Resources

Index

Chapter 1
HAVING A SAFE, HEALTHY BIRTH

The mission of Lamaze International and this book is to promote, support, and protect safe and healthy birth. We—like midwife Ina May Gaskin and the millions of other women who have witnessed and experienced simple, natural birth—believe that a woman’s body is beautifully designed to grow, birth, and nurture a baby. To work properly, this elegant design requires patience and trust. For most women, the safest birth is one that unfolds naturally, free of unnecessary interventions. (See Chapter 7.)

PORTRAIT OF BIRTH TODAY

Many women are surprised to learn that pregnancy, birth, and breastfeeding happen quite simply for most mothers and babies. But it’s true. A woman conceives, and as she moves through her life—often without even thinking about pregnancy—a miracle happens. Cells divide, a tiny heart starts beating, brain and nerves grow. Nature orchestrates a baby’s second-to-second development. It also orchestrates the release of hormones that help the mother’s body adapt; that trigger labor and birth at just the right time; that help her cope with the pain and work of labor; that prepare her emotionally and physically to feed and care for her baby; and that ensure that her baby is alert and ready to nurse and meet the world.

Women don’t need to read books to grow babies. Women shouldn’t need to read books or take classes to give birth either. (But these days, a good book or class can be helpful in achieving a safe and healthy birth. For more on childbirth education, see pages 99–104.) We are designed perfectly for both jobs, with very few exceptions.

Let’s be clear. Some labors and births do require intervention. Some women with very long, difficult labors benefit from medication. The few women who don’t go into labor by forty-two weeks may need their labors jump-started. Some babies experience distress that mandates immediate intervention. Some pregnant women have preexisting health problems, like diabetes or heart disease, that require treatment affecting labor and birth. But medicalized births should be a very small percentage of all births.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt hormone release and create problems that, in turn, must be managed with more interventions. (For more on this “cascade of interventions,” see Chapter 4.) In light of such evidence, the World Health Organization (WHO), a leader in the international public health effort to promote safe birth, says that maternity care should aim to achieve a healthy mother and child with the least intervention as possible.¹

In the United States, reality falls far short of this goal.² Most births in the U.S. today are interrupted by procedures designed to start, maintain, and finish labor according to an arbitrary schedule. Few women experience their pregnant bodies unfolding and opening in their own time, in their own way.

Nearly half of all expectant mothers in the U.S. receive drugs to begin labor, more than half receive drugs to speed up labor, and more than 76 percent receive drugs to dull labor pain. In contrast, pain management strategies that women describe as very helpful, like birth balls and showers and tubs, are rarely available at hospital births.³ According to the National Center for Health Statistics, more than 90 percent of laboring women have their babies’ heart rates tracked continuously by electronic fetal monitors (EFMs),⁴ even though no research has shown that routine EFM use keeps babies safer.⁵

Despite all these “helpful” interventions, the U.S. cesarean rate is at an all-time high: Almost one third percent of American babies are born surgically.⁶ This far exceeds the 6-percent rate considered reasonable by the WHO.⁷ Although cesarean surgery is safer today than in the past, it still carries significant short-term risks for babies, and both short- and long-term risks for mothers.⁸

We’re just beginning to understand the impact of birth practices on breastfeeding, but already it’s clear that intervention-intensive labors and routine separation of babies and mothers interfere with nature’s plan for babies’ easy transition to life outside the womb. (See Healthy Birth Practice #6 on page 129.) Yet despite a wealth of research and history that prove “babies were born to be breastfed”⁹ and show the many negative effects on mothers and babies who don’t breastfeed,¹⁰ formula feeding continues to be the norm in our society. Women are bombarded with advertising—and other cultural images and messages—that imply formula feeding is just as good as breastfeeding.

PRACTICES THAT PROMOTE SAFE, HEALTHY BIRTH

Research reveals not only the dangers of interfering in the natural process of birth, but also six simple strategies for keeping birth safe and healthy. The WHO identifies four practices, and Lamaze adds two more (marked with asterisks: *).

1.   Let labor begin on its own.

2.   Walk, move around, and change positions throughout labor.*

3.   Bring a loved one, friend, or doula for continuous support.

4.   Avoid interventions that aren’t medically necessary.*

5.   Avoid giving birth on your back and follow your body’s urges to push.

6.   Keep mother and baby together—it’s best for mother, baby, and breastfeeding.

We explain these practices in detail and give you evidence to support their importance in Chapter 8. (Also see Appendix A.)

WHY DO SO FEW WOMEN GIVE BIRTH NATURALLY?