Pregnancy, Childbirth, and the Newborn

Pregnancy: A Time for Change and Preparation

Like most expectant parents, you want a healthy pregnancy so you can provide a safe environment for your developing baby. Pregnancy is the time to assess your diet, fitness level, lifestyle, finances, and relationships—and make any necessary changes for optimal health. It’s also the time to arrange for prenatal care and seek help to resolve or manage any medical problems or mental health challenges. Chapters 4 through 6 discuss ways to have the healthiest pregnancy possible for you and your baby.

Because pregnancy puts extra demands on your body, you may have questions about the health of your pregnancy. Chapter 3 describes common changes and concerns that can arise in pregnancy and what you can do to address them, and chapter 21 discusses what changes you can expect if this pregnancy isn’t your first. During pregnancy, you’ll also discover that you want to talk with other expectant parents as well as new parents so you can learn from their experiences and benefit from their support. Use this time to draw upon or develop a support system that can help you long after your baby is born.

Looking ahead to the birth, you may wonder how you’ll manage labor. Will you want to use medications to reduce or eliminate pain? Will you want a natural, drug-free birth? What kind of support will you want your partner to provide? Pregnancy is the time to prepare for how you’ll cope with childbirth; reading this book is a good place to start, and taking childbirth classes will enhance your knowledge of your options. Chapters 9 and 10 describe when and how labor begins and what childbirth is really like, while chapters 11, 12, and 13 provide information on the various medications and nonmedicated options for managing labor pain.

Just as most pregnancies are normal, so are most labors and births. However, just as problems can arise in pregnancy, complications can develop during childbirth, and medical interventions may become necessary for the health of the mother and baby. If your pregnancy, birth, or postpartum becomes complicated, it’s helpful to be aware of the possible problems and potential solutions. Chapters 7, 14, 15, 17, and 20 describe pregnancy and childbirth complications and the options for treatment

As you anticipate parenthood, questions and deep feelings may come up about your childhood, and about your parents’ relationships with each other and with you. Your partner may have the same experience. Pregnancy is a good time to strengthen bonds, mend fences, or clarify boundaries with your parents so you can enter parenthood on your own terms.

You and your partner may also spend a lot of time thinking about the amazing responsibility of physically, emotionally, and spiritually nurturing a child. Pregnancy is a good time for you and your partner to explore your expectations of parenthood and develop the qualities essential for parenting, perhaps by taking parenting classes, reading parenting books, or speaking to friends and relatives about their parenting experiences.

Birth as a Long-Term Memory

Research shows that women vividly recall their birth experiences for many years.¹ After you give birth to your baby, you’ll remember the major facts of the experience, such as how long you were in labor, the time of her birth, and her birth weight. But you’ll also remember other details, such as how you knew you were in labor, how you felt during contractions, what you did to relieve the pain, and how others comforted you and helped you cope. This information will make up your unique, unforgettable story of giving birth to your child.

Some parents have positive, fulfilling, and empowering memories of childbirth. These parents feel that they were treated with kindness and their priorities and preferences for care were respected—even if labor was long and complicated. Other parents remember their birth experiences with shame, anger, remorse, or resignation. These parents feel that they were disrespected, abandoned, or powerless during childbirth, and this negative treatment tarnished their memories of the experience.

No one has complete control over pregnancy and childbirth, but the decisions you make during pregnancy will affect your memory of your birth experience. By making decisions that will help you have a satisfying birth, you increase your chances of having good memories of the experience. (See here for steps to improve your chances of having a satisfying birth experience.) Conversely, if you make decisions that will hinder your ability to have a satisfying birth—or if the decisions you make aren’t respected—you increase your risk of having unhappy memories of the experience.

Your Mother’s Memories of Giving Birth

Ask your mother to tell you her story of giving birth to you, and have your partner do the same with his or her mother. What does your mother remember about going into labor? What did your father do? What did her caregivers do and say? What did she feel when she first saw you and held you? How does your mother feel now about your birth? Unless she was heavily drugged during labor, she’ll probably have clear and detailed memories, and the intensity of her emotions as she recalls them may surprise you.

Making Decisions for a Satisfying Pregnancy and Birth

Because pregnancy and birth are normally healthy processes and highly personal, emotionally significant experiences, you typically have more choices for care than you would for a medical condition that involves disease or injury. You usually have the opportunity to make the following decisions: where you have your baby, who your caregivers are, how educated you become about pregnancy and childbirth, who provides you companionship and support in labor, how you want to manage labor pain, and to what extent you want your caregivers to manage your care.

If you’re surprised by the number of decisions you’ll have to make during pregnancy, you may be overwhelmed by the staggering amount of information available to you on maternity care. Some resources provide sound, reliable advice (such as this book); others don’t. Chapters 2 and 8 discuss how you can find and evaluate maternity care information so you can make decisions that are right for you and your family.

This book is based on the importance of your active participation in every aspect of your care. When you’re well informed of your choices and can communicate your questions, needs, and preferences, you help ensure maximum safety for you and your baby, and enhance your satisfaction with the birth experience.

More Than the Birth of a Baby

Cultures around the world celebrate birth as a significant, joyous event marked by rituals of hope, promise, and new life. At the moment of birth, many lives are transformed. For you and your partner, your baby’s birth marks your birth as parents. For your family, the birth creates their new roles as siblings, grandparents, aunts, uncles, and cousins.

When you meet your baby, you may feel that you’ve always known him—or you may be totally surprised by him. As you gaze at him and stroke, sniff, and snuggle him, you’ll begin to fall in love as only parents and babies can. During the first few hours and days of your baby’s life, you’ll begin to fully appreciate the fact that this tiny person is the same mystery being you knew in the womb.

After the initial awe of new parenthood fades, you’ll realize that your life has permanently changed and is more uncertain and less simple than it was before you became a parent. You may wonder how our species has ever survived when birth, breastfeeding, and baby care seem so challenging. A newborn’s needs are almost constant and sometimes hard to understand. When your baby cries, you may ask yourself, “Is he hungry, wet, cold, sleepy, lonely, in pain? How do I soothe him, hold him, change him, bathe him, feed him? How do I know I’m doing a good job?” Chapters 18 and 19 describe the basics of baby care and feeding; your confidence will grow as you become more experienced with nurturing and nourishing your baby.

In the first few weeks of your newborn’s life, you may have other worries, such as, “How can I get enough sleep? Can we afford a longer maternity leave? Will I ever have time to be romantic with my partner again? Will I ever want to be romantic again?” Chapters 16 and 17 describe what life is like for a new mother and discuss concerns, doubts, and problems that can arise in the postpartum period and what you can do to address them.

After these early challenges, the rewards will start to come. Your baby will settle down when you cuddle him. He’ll gain weight. He’ll smile and coo. He’ll stop crying when you sing to him. His sleeping pattern will become more predictable. He won’t be able to take his eyes off you, and you won’t be able to take your eyes off him. At that point, you’ll realize that you wouldn’t return to your prebaby life, even if you could.

The time spanning pregnancy, childbirth, and your newborn’s first weeks will be an unforgettable experience, one that will have a lasting impact on your life. This book will help you discover that you already know how to grow your baby, give birth to him, and nourish and nurture him. Besides good health and good care, all you really need are confidence, support, and the practical skills and knowledge provided in the following chapters.

So Many Choices

After discovering you’re pregnant, you begin to make choices that will affect your entire childbearing experience. You choose how you’ll gather information on pregnancy and birth. You select the kind of maternity care you’ll want and decide where you’ll want to give birth. You arrange for the support you’ll need in the days and months after the birth and plan for your return to work. Because these choices most affect you, your baby, and your early days as a family, it’s important that you play a key role in the decision-making process. Your active participation now will give you satisfaction and fulfillment for years to come, because you’ll feel that your wishes were honored with kindness and respect.

Informed Decision Making

In the United States and Canada, it’s your legal right to play a central role when making decisions that affect you and your baby. To help you make an informed decision (or informed choice) about a health-care option or medical treatment (a procedure, test, intervention, or medication), you can consult with your caregiver and other knowledgeable medical professionals, as well as with supportive friends and family.

If you agree to an option or treatment after becoming informed about it, you’ve given your informed consent. By law, your caregivers can’t give you medical treatment in either of the following cases:

A more collaborative approach to making an informed decision is shared decision making, in which you and your caregiver discuss the medical risks and benefits of treatment and any possible alternatives. You also discuss any questions or concerns you may have, as well as your priorities and preferences. Shared decision making enhances trust and understanding between you and your caregiver.¹

YOUR CAREGIVER’S ROLE IN DECISION MAKING

Your caregiver’s approach to maternity care depends on training, experience, and general perception of pregnancy and birth. If your caregiver perceives the childbearing process as usually normal and healthy, medical interventions aren’t recommended unless problems develop. If your caregiver perceives the process as potentially dangerous, medical procedures, tests, and medications may be recommended more often in case they’re needed later. Even though these perceptions result in different types of care, everyone’s intention is to ensure a healthy mother and baby.

Sometimes, a procedure or treatment is routine, which means it’s offered to all pregnant women or newborns. Other times, it’s individualized to the current situation. Before recommending any treatment, your caregiver considers many factors, including your health; care standards set by professional organizations or government agencies; the caregiver’s experience and preferences for interventions, hospital routines, and policies; the usual care practices among peers; cost; and staffing issues.

In addition, your caregiver considers whether a treatment will achieve the desired results or create problems, then weighs the treatment’s benefits against its risks. This benefit-risk analysis sometimes shows that a relatively risk-free option is the best treatment to achieve desired results. Other times, the analysis reveals that the best treatment is the one with the greatest risk of side effects. Some caregivers always choose the treatment that best achieves results, despite any risks that come with it. Others choose a less risky option first—even if its chances of success are lower—then move to a more risky option if the first option is unsuccessful.

What to Do If You and Your Caregiver Disagree about Treatment

Almost all treatment carries some risks or disadvantages, but you and your caregiver may disagree on just how risky or disadvantageous a treatment is. For example, your caregiver may believe a medical procedure is safe and low-risk, but you may feel the risks aren’t worth taking. You may prefer to learn more about pros, cons, and choices regarding that procedure and to discuss them with your caregiver. If a disagreement about treatment arises, you and your caregiver can usually settle it with respectful discussion and good communication—the foundation of shared decision making.

But what if it can’t be settled? Although rare, relationships between caregivers and pregnant women may fall apart because of a troubling mismatch in attitudes or opinions. When settling a disagreement is unlikely, in the United States and Canada, a pregnant woman has the legal right to change to a different caregiver, and a caregiver has the right to discontinue care if there are other care options available to the pregnant woman. See here for further information on changing caregivers.

MAKING INFORMED DECISIONS

This chapter covers many of the important decisions you’ll make during pregnancy, during birth, and after the birth. You should make some decisions early in pregnancy (such as finding your caregiver); you can delay making other decisions until mid- to late-pregnancy. The following sections discuss topics that require you to make decisions, and they’re presented roughly in the order that you should address them.

Whenever you’re asked to make a choice about your or your baby’s health care, ask the key questions on the right to learn more about your options. Always remember that your caregiver can provide information about treatment and recommend options, but only you can decide what’s best for you and your baby.