Maternity Care

Having the skills, knowledge and confidence to wisely navigate your maternity care is important because:

1. The quality of maternity care varies a lot across providers and care settings. The care arrangements you make affect what happens to you and your health.
2. There is broad agreement that cesareans and many other maternity practices are overused and can cause needless discomfort and harm. Becoming informed and following proven tips can help you avoid these problems.
3. High-quality research points to many safer, more effective practices for you and your baby. But it can take many years before these practices are reliably provided to women and babies at the point of care. Knowing about and seeking best practices can make a big difference for both of you.
4. Your baby is counting on you to advocate for her or his best start.

You are embarking on many years of responsibility for managing health care across generations. Pregnancy and birth is an ideal time to develop skills, knowledge and confidence for a lifetime. You’ve come to the right place!

Choose your maternity care provider and birth setting wisely. There are better and worse care providers and better and worse hospitals in every community. When available, birth centers are an excellent care setting for most women. Check the quality of the options in your area. Try to find care providers who offer safe, effective care options and a safe, family-friendly birth setting.

Think about what is important to you, and communicate this to your care team. Your preferences and values matter. In maternity care there are often multiple options, each with their own potential benefits and harms. Often one is safer for you and your fetus/newborn than another. You are the one who should decide which benefits and harms matter most to you.

Take responsibility for your health during pregnancy. This means eating well, staying active and fit, getting rest and limiting stress as much as possible. It also means learning as much as you can about pregnancy and birth, and working with your care provider to get the care you need when you need it.

Get the best labor support possible. Good support goes a long way to help you cope with the physical and emotional challenges of labor. Continuous labor support from a knowledgeable companion like a doula also has surprising health benefits. Such support has been shown to decrease the chance of a C-section, the need for pain medication and feelings of dissatisfaction about the birth.

Plan ahead for help with labor pain.There are many options available to help you cope with labor pain. Become informed and work with your care providers to determine the best plan for you.

Learn how to safely prevent unneeded cesarean sections. It’s important for pregnant women to learn about cesarean (C-section) birth. This procedure is overused in the United States for a number of reasons. Fortunately, there are many things women can do to help avoid an unneeded cesarean. Get the information you need about the risks and benefits of C-section and vaginal birth after C-section (VBAC) so you can make informed decisions.

• Reduce the risk of pregnancy complications.
• Reduce the fetus’s risk for complications or problems.
• To detect abnormalities and prevent illness in mother and baby.

Prenatal diagnosis or prenatal screening (note that “Prenatal Diagnosis” and “Prenatal Screening” refer to two different types of tests) is testing for diseases or conditions in a fetus or embryo before it is born. Obstetricians and midwives have the ability to monitor mother’s health and prenatal development during pregnancy through series of regular check-ups.

Physical examinations generally consist of:

• Collection of (mother’s) medical history.
• Checking (mother’s) blood pressure
• (Mother’s) height and weight
• Pelvic exam
• Doppler fetal heart rate monitoring
• (Mother’s) blood and urine tests
• Discussion with caregiver

Counseling and health education on recognition of danger signs and appropriate care-seeking (both mother and newborn)

Counseling and health education on routine care preventive interventions such as breastfeeding and good thermal care practices.

Dispensing and related counseling for routine preventive interventions.

Assessment and case management and referral for any identifies complications or risk conditions.

Preterm labor is labor that starts before 37 completed weeks of pregnancy. It can lead to premature birth. Premature babies may face serious health risks.

Symptoms of preterm labor include

• Contractions every 10 minutes or more often
• Leaking fluid or bleeding from the vagina
• Feeling of pressure in the pelvis
• Low, dull backache
• Cramps that feel like menstrual cramps
• Abdominal cramps with or without diarrhea

If you think you might be having preterm labor, contact your health care provider.

While childbirth usually goes well, complications can happen. They can cause a risk to the mother, baby, or both. Possible complications include

• Preterm (premature) labor, when labor starts before 37 completed weeks of pregnancy
• Problems with the umbilical cord
• Problems with the position of the baby, such as breech, in which the baby is going to come out feet first
• Birth injuries

For some of these problems, the baby may need to be delivered surgically by a Cesarean section.

A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother’s abdomen. In the United States, almost one in three women has their babies this way. Some C-sections are planned, but many are done when unexpected problems happen during delivery. Reasons for a C-section may include

• Health problems in the mother
• The mother carrying more than one baby
• The size or position of the baby
• The baby’s health is in danger
• Labor is not moving along as it should

The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. It can raise the risk of having difficulties with future pregnancies. Some women may have problems attempting a vaginal birth later. Still, many women are able to have a vaginal birth after cesarean (VBAC).

Almost every intervention has some potential to cause harm. You should use care in deciding whether to have an intervention. We encourage you to accept only those interventions that are more likely to offer benefit than harm. In weighing possible benefits and harms, it is important to rely on the best available evidence about potential effects, and to consider how you feel about the possible outcomes. It is also important to learn about other options that may be available.

Unfortunately, it is impossible to predict in advance exactly what may happen during your labor and delivery, or how a given intervention may affect you or your baby. The best way to limit a cascade of intervention is to become informed, get all of your questions answered, and put plans in place in advance that will help avoid potentially harmful interventions.

Here are some tips for avoiding unnecessary interventions:

– Choose a care provider and a birth setting that have low rates of using common interventions.

– Become familiar with the best available research about interventions that are most likely to trigger a cascade of intervention, including induction of labor, epidural analgesia and other pain medications and cesarean section.

– Have an open and respectful conversation with your care provider about why you need any recommended interventions. It’s ideal to have this conversation well before you may need the intervention so you can express your wishes and discuss plans.

– Talk to your care provider about options like “watchful waiting” (doing nothing and waiting for labor to move along or for issues to resolve on their own) or using simpler, less invasive alternatives.

– Learn about the benefits of continuous labor support and consider engaging a doula to help you achieve your objectives.Clearly communicate your wishes to your care providers, and get the support of your spouse, partner, doula or other companions to reinforce your wishes throughout labor and delivery.

– Know that you have the right to accept or refuse procedures, drugs, tests and treatments, and to have your choices honored.

Epidural analgesia is a good example of the cascade of intervention. It can provide very effective pain relief during labor, but it also increases the risk of experiencing a sudden drop in blood pressure, a longer labor, difficulty moving about, difficulty urinating, difficulty pushing the baby out, fever and other negative effects.

Interventions like electronic fetal monitoring and intravenous fluids are often used with epidurals to monitor, prevent or treat these effects. And others become more likely (synthetic oxytocin to strengthen contractions, catheter to empty the bladder, vacuum extractor or forceps to help move the baby out). These in turn may have side effects that lead to the use of yet more interventions.

Babies can also be affected. For example, epidurals increase a woman’s likelihood of developing a fever, which can make doctors worry that the baby has a fever. This leads to blood tests and antibiotics for the baby after birth. They may also be observed in a special nursery, which can interfere with mother-baby bonding and breastfeeding.

Birth hormones are chemical “messengers” that your body makes. Your baby makes birth hormones, too. These hormones work together to guide important changes in your bodies — changes that help make labor and birth go smoothly and safely for both of you.

Birth hormones help guide you and your baby in many ways, including:

• Getting your body ready to give birth
• Starting your labor contractions
• Preparing your baby for labor and life outside your body
• Telling your breasts to make milk and getting your baby ready to breastfeed

 

And when you and your new baby fall in love, birth hormones are part of those feelings, too!

Here we discuss four hormones that are important for reproduction: oxytocin, endorphins, adrenaline and related stress hormones, and prolactin. These hormones play a major role in regulating labor and birth. Learning about them can help you understand what will happen during labor and birth. Decisions you make about your care can support or disrupt the way hormones work, so understanding how they work and how they are affected is important for making informed decisions.

Oxytocin is often known as the “hormone of love” because it is involved with lovemaking, fertility, contractions during labor and birth and the release of milk in breastfeeding. It helps us feel good, and it triggers nurturing feelings and behaviors.
Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labor. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta. During labor and birth, the pressure of the baby against your cervix, and then against tissues in the pelvic floor, stimulates oxytocin and contractions. So does a breastfeeding newborn.

Low levels of oxytocin during labor and birth can cause problems by:

• Causing contractions to stop or slow, and making labor take longer.
• Resulting in excessive bleeding at the placenta site after birth.
• Leading health care providers to respond to these problems with interventions.

 

You can promote your body’s production of oxytocin during labor and birth by:

• Staying calm, comfortable and confident.
• Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures.
• Staying upright and using gravity so your baby is pressed against your cervix and then, as the baby is born, against the tissues of your pelvic floor.
• Stimulating your nipples or clitoris before birth, and giving your baby a chance to suckle (breastfeed) shortly after birth.
• Avoiding epidural analgesia.

When you face stress or pain, your body produces calming and pain-relieving hormones called endorphins. You may have higher levels of endorphins near the end of pregnancy. For women who don’t use pain medication during labor, the level of endorphins continues to rise steadily and steeply through the birth of the baby. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.)
High endorphin levels during labor and birth can produce an altered state of consciousness that can help you deal with the process of giving birth, even if it is long and challenging. High endorphin levels can make you feel alert, attentive and even euphoric (very happy) after birth, as you begin to get to know and care for your baby. In this early postpartum period, endorphins are believed to play a role in strengthening the mother-infant relationship. A drop in endorphin levels at this time may contribute to the “blues,” or postpartum depression, that many women experience for a brief time after birth.

Low levels of endorphins can cause problems in labor and birth by:

• Causing labor to be excessively painful and difficult to tolerate.
• Leading health care providers to respond to this problem with interventions.

 

You can enhance your body’s production of endorphins during labor and birth by:

• Staying calm, comfortable and confident.
• Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures.
• Delaying or avoiding epidural or opioids for pain relief.

Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labor (for example, by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety.

Too much adrenaline can cause problems in labor and birth by:

• Causing distress to the baby before birth.
• Causing contractions to stop, slow or have an erratic pattern, and lengthening labor.
• Creating a sense of panic and increasing pain in the mother.
• Leading health care providers to respond to these problems with cesarean surgery and other interventions.

 

You can keep adrenaline down during labor and birth by:

• Staying calm, comfortable and relaxed.
• Being informed and prepared.
• Having trust and confidence in your body and your capabilities as a woman.
• Having trust and confidence in your care providers and birth setting.
• Being in a calm, peaceful and private environment and avoiding conflict.
• Being with people who can provide comfort measures, good information, positive words and other support.
• Avoiding intrusive, painful, disruptive procedures.

Prolactin is known as the “mothering” hormone. The role of prolactin around the time of birth has been less researched than the hormones described above. It increases during pregnancy and peaks when labor starts on its own. As has been shown in other mammals, continued prolactin production during and after labor appears to be readying a woman’s body for breastfeeding. It may also play a role in moving labor along and helping the newborn adjust to life outside the womb. Prolactin is central to breast milk production. High levels of prolactin with early breastfeeding may foster women’s caretaking behaviors and adjustment to being a mother. This hormone may also support the infant’s healthy development.

Low levels of prolactin may cause problems through:

• Poorer transition of the baby at the time of birth.
• Poorer growth and development of the baby.
• Poorer adjustment of a woman to motherhood.

 

You can likely promote your body’s production of prolactin by:

• Waiting for labor to start on its own.
• Minimizing stress during labor and after birth.
• Keeping woman and baby together after birth.
• Breastfeeding early and thereafter on cue from the baby.