What are alternative and complementary childbirth techniques?

Overview

With the growing openness of medical staff to complementary and alternative
therapies, now often called integrative medicine, mothers-to-be are
investigating and choosing new options for delivering their babies. So many
parents elect nontraditional paths that “what used to be `alternative is now the
norm,” says Loma Ellis, nursing manager for California’s Alameda Hospital Birthing
Center. As a result, parents now have more birthing choices than ever before.

Birth Assistance

A birth assistant, or doula, is a professional person hired privately by
parents to attend their child’s birth. A doula serves as a support and coach for
the laboring woman. The doula does not replace the role of the pregnant woman’s
partner and is not a member of the health care team. The doula is present solely
to attend the laboring woman. Usually highly trained in childbirth, a
doula can serve as a stand-in when a pregnant woman’s partner is not available.
However, many parents hire doulas even if a partner is present.

“The doula is a safety net,” says Sandi Miller, owner of Before Birth and Beyond in San Jose, California. “Whatever happens, whether it’s a cesarean or whatever, the parents know what’s going on and the doula is watching out for them.”

Studies show that doulas, whose services start at $100 on average for a
doula-in-training and can go as high as $1,000 or more, have positive medical
effects on both mother and newborn. A study published in the British
Medical Journal suggests that the employment of doulas results in
fewer cesareans and shorter labors and in a lower admission rate
to neonatal intensive care for infants. A review found that continuous support by
a doula reduces anxiety, shortens labor, decreases the need for cesarean
deliveries and other forms of assisted birth, and reduces rates of
postpartum
depression.

Water-Birthing

Water can smooth away aches and drain off tension. Women who labor or deliver (or both) their babies in a birthing pool report less pain and greater relaxation. According to the Israeli medical journal Harefuah, water-birthing women are more relaxed and comfortable; water immersion may also speed the dilation of the cervix, leading to a shorter labor. The following benefits also may be passed to the infant:

Less fetal discomfort. Barbara Harper, director of Oregon-based Waterbirth International and the author of Gentle Birth Choices (2005), says that when the laboring woman is relaxed, the unborn child spends less time in the birth canal and undergoes minimal discomfort.

Less trauma. Proponents of water births also believe the method is less traumatic for newborns. “Babies seem to be very relaxed. They open their eyes and focus on people,” says Beah Haber of the Birth Home in Pleasanton, California, who has attended hundreds of water births. However, there is no scientific evidence to document this claim.

Smoother transition. The easier transition is partly a response to the relaxed state of the laboring woman and partly because of the insulating effects of water, according to Harper. “The baby has hearing even in utero, but it’s muffled and muted . . . the same way it is underwater,” she says. Underwater, the newborn is protected from harsh lights, sounds, and even touch and thus is more relaxed and comfortable. Again, however, scientific evidence is lacking.

Despite the rising interest in water-birthing, the American Congress of Obstetricians and Gynecologists (ACOG) has not endorsed this practice. ACOG warns that not enough information exists, specifically concerning rates of infection, to recommend warm-water immersion as a safe and appropriate birthing alternative. There are concerns, for example, that a baby can develop an infection if he or she begins breathing while underwater and inhales the soiled birthing water.

Marion McCartney, certified nurse midwife and director of professional services for the American College of Nurse Midwives, says, however, that “most research has found that healthy babies do not gasp upon delivery, rather they do not take a breath until they are removed from the water and reach the air.”

Although these studies have been quite small, evidence from larger studies involving almost two thousand women suggests that water birth does not increase rate of infection, and it may reduce the duration of labor and the need for pain control. Nonetheless, ACOG maintains that water-birthing should be performed only under the strictest measures of infection control. All experts agree that water-birthing should be considered for healthy women and healthy fetuses only.

Labor Pain

Many nonpharmaceutical options are available to manage the pain and discomfort of labor. These options include relaxation and alternative remedies, such as herbs, acupressure, and acupuncture.

Relaxation techniques. The first step to pain management is
relaxation. The tenser one is, the higher the sensation of pain. Relaxation starts
with the environment. Even in the hospital, one can dim the lights, play soft
music, light candles, or use aromatherapy to create a safe feeling.
Lavender and sage are especially soothing scents. Other relaxation techniques
include massage, showers, and baths.

The mind is one of the most effective pain-fighting tools available. Hypnotism, visualization, and imagery are all methods for pain relief, and there is some scientific support for their use.

Alternative remedies. Acupressure and acupuncture
have been studied as natural treatments for reducing labor pain. Each of these
methods may offer some benefits, but more research is needed.

Although red raspberry is an herb traditionally used during pregnancy and labor, a double-blind, placebo-controlled trial evaluating the effects of red raspberry in 192 pregnant women failed to find benefit. The herb blue cohosh is sometimes recommended by midwives, but it is a toxic herb and should not be used.

Bibliography

Bodner, K., et al. “Effects of Water Birth on Maternal and Neonatal Outcomes.” Wiener klinische Wochenschrift 114 (2003): 391-395.

Fehervary, P., et al. “Water Birth: Microbiological Colonisation of the Newborn, Neonatal, and Maternal Infection Rate in Comparison to Conventional Bed Deliveries.” Archives of Gynecology and Obstetrics 270 (2004): 6-9.

Hjelmstedt, A., et al. “Acupressure to Reduce Labor Pain.” Acta Obstetricia et Gynecologica Scandinavica 89, no. 11 (2010): 1453-1459.

Lieberman, A. B., et al., eds. Easing Labor Pain: The Complete Guide to a More Comfortable and Rewarding Birth. Boston: Harvard Common Press, 1992.

Nesheim, B. I., et al. “Acupuncture During Labor Can Reduce the Use of Meperidine.” Clinical Journal of Pain 19 (2003): 187-191.

Ramnero, A., et al. “Acupuncture Treatment During Labour.” BJOG: An International Journal of Obstetrics and Gynaecology 109 (2002): 637-644.

Scott, K. D., et al. “The Obstetrical and Postpartum Benefits of Continuous Support During Childbirth.” Journal of Women’s Health and Gender-Based Medicine 8 (2000): 1257-1264.

Simpson, M., et al. “Raspberry Leaf in Pregnancy: Its Safety and Efficacy in Labor.” Journal of Midwifery and Women’s Health 46 (2001): 51-59.

Skilnand, E, et al. “Acupuncture in the Management of Pain in Labor.” Acta Obstetricia et Gynecologica Scandinavica 81 (2002): 943-948.

Thoeni, A., et al. “Review of Sixteen Hundred Water Births: Does Water Birth Increase the Risk of Neonatal Infection?” Journal of Maternal-Fetal and Neonatal Medicine 17 (2005): 357-361.