In 2014 I wrote this article about the three steps to having a natural/low-intervention birth in the Twin Cities. The steps are:
1. Assemble Your Team
2. Prepare your mind
3. Prepare your body
Today I want to share my thoughts on one component of this process that is sometimes overlooked or minimized. The secret is...CONFIDENCE.
Recently a doula client/Hypnobabies student of mine had a birth (with her first baby) that was so fast (8 hours) and straightforward that they barely made it to the birth center and most of their birth support team didn't make it there before baby arrived. (Read the story here.) She asked me afterwards why I thought her birth went so well. And my answer was "confidence." This family choose to birth at a free-standing birth center where pain medication like epidurals are not available. When families choose to birth at home or a free-standing birth center, they *believe* they CAN birth without medications. And often, that is exactly what they do!
This mom also took my Hypnobabies class and spent many hours programming her mind to believe she could do it and preparing her body to physically do it through exercises and nutrition. She believed that her body was designed to give birth and she spent her time visualizing her birth going *right*. She had supportive providers who reinforced these messages at every appointment. Her midwives are experts at normal birth, see it all the time, and are fully comfortable supporting moms having that type of birth. They are also fully trained to handle any emergencies that can arise during birth in rare situations.
This particular mom had one other benefit. Both her mother and her partner's mother had relatively easy births. From a young age she had been taught that normal birth was possible in their family. She was taught to believe that she too could do it. Now, I don't know if a family history of fast births is a real thing or if it's actually the CONFIDENCE that this family history creates to make more family members have positive or faster birth experiences. Either way, it's a benefit and not all birthing people have this advantage.
Maybe you want a natural birth but have a scary family history and don't feel confident about your body's ability? Maybe you are with a provider who has said scary things and further destroyed your confidence? Maybe you have physical or health challenges that limit your choices of provider or birth location? It is STILL possible to gain the confidence you need to have a really positive birth experience. I still believe provider choice is THE #1 most important step in having a low intervention birth. Review the 3 steps article again for more information about provider selection. And keep reading for other ways to boost your confidence!
When I was pregnant with my first baby I wanted a home birth but I was scared. My husband was scared. We choose a hospital birth with a small midwife group. I got lucky and had a very straightforward birth with very few interventions and even got "my midwife" (the one I'd been seeing) as the on-call midwife that day. Looking back now I feel fortunate that things went so well overall. Not all of my clients are so lucky. Maybe it helped that I believed in myself. I wasn't at the hospital in case in needed medication, I was there because my partner and I had agreed on that being the best option for us but I was very set on avoiding medication and felt strongly that I could. No doubt my anthropology background helped me feel confident that I could birth like millions of women have before me. Having my friend who had already had one natural birth there as my doula also boosted my confidence.
But then, 2.5 years later I had my second at home and the experience was 100x more wonderful. Home birth and birth center birth are amazing and the evidence is clear that out-of-hospital birth is SAFE. I didn't full understand the reality of this with my first baby. If I could go back in time and birth my first at a free-standing birth center (none existed around here in 2006) or at home I definitely would.
There is a perception that hospital birth is safer. However some would argue it is actually less safe. Interventions used in birth and the high c-section rate as I discuss below definitely carry many risks to consider. I encourage you to do your own research and choose to birth where YOU feel the most safe and supported. Tour a variety of birth locations and interview providers until you are confident that YOUR provider group will support your birth wishes 100%.
So just how safe is birthing at a free-standing birth center?
A 2013 National Birth Center Study gives us a clear picture of the safety of birth centers. Of the 15,000+ women who ended up in the final study, 94% had a vaginal birth which means 6% had a c-section. Compare this with the overall c-section rate in the U.S which was 31.9% in 2016 according to the CDC. This article shines even more light on the safety of birth centers:
"Out of the 15,574 women who planned to give birth at the birth center at the start of labor, most women (84%) ended up giving birth at the birth center. Out of the entire sample, 4.5% were referred to a hospital before being admitted to the birth center, 11.9% transferred to the hospital during labor, 2.0% transferred after giving birth, and 2.2% had their babies transferred after birth. Most of the in-labor transfers were first-time moms (82%).
Out of the 1,851 women who transferred to hospitals during labor, 54% ended up with a vaginal birth, 38% had a Cesarean, and 8% had a forceps or vacuum-assisted vaginal birth.
Most of the in-labor transfers were done for non-emergency reasons, such as prolonged labor. Less than 1% of the study sample (0.9% overall, number [n] = 140) transferred to the hospital during labor for emergency reasons. A very small percentage of women (0.4%, n = 67) and infants (0.6%, n = 94) transferred after birth for emergency reasons.
The most common reason for emergency transfer during labor was for non-reassuring fetal heart rate patterns (0.5%, n = 72), while the most common reasons for postpartum and newborn emergency transfers were postpartum hemorrhage (0.2%, n = 36) and newborn respiratory issues (0.4%, n = 66). Most cases of postpartum hemorrhage were handled safely in the birth center without any need for transfer. There were no maternal deaths."
And what about babies? Here is information from that article that reassures us that babies also do very well when born in a free standing birth center or at home:
"The stillbirth and newborn death rates in the National Birth Center Study II are comparable to what other researchers have reported when they studied low-risk women. The results are strikingly similar to the National Birth Center I Study, which took place about 25 years ago. At that time, researchers found a stillbirth rate of 0.3 per 1,000 and a newborn death rate of 0.3 per 1,000.
The stillbirth and newborn death rates in the new National Birth Center Study II were also similar to what researchers in the United Kingdom found among low-risk women in hospitals, freestanding birth centers, and home births. In the 2011 Birthplace in England study, stillbirth rates ranged from 0.0-0.7 per 1,000 in hospitals, to 0.1-2.2 in freestanding birth centers, and 0.1-1.0 in homes. Newborn death rates ranged from 0.1-0.8 in hospitals, to 0.1-1.3 in freestanding birth centers, and 0.1-1.0 in homes.
Because the National Birth Center Study II did not include a hospital comparison group, it is impossible for us to tell whether there is a statistical difference in deaths between planned birth center and planned hospital births. However, it is important to note that the rates that the birth center study reported are similar to what other researchers have observed in many different birth settings. The up-to-date statistics from the newly published National Birth Center Study II can better help families make informed decisions about where they choose to give birth."
Why the c-section rate matters
The different between a 6% cesarean section rate and a 31.9% rate is enormous. Cesareans include many risks including a 3 times higher risk of maternal death, risk of postpartum infection, risks to future pregnancies including placenta previa, placental aburption, stillbirth and hemorrhage, injury to organs, injury to baby, adhesions, reactions to medications and issues like postpartum depression and anxiety. Click here to learn more about the risks of a cesarean birth from AmericanPregnancy.org.
How to Gain Confidence
Still not feeling confident? You can get there! People who don't feel confident about their ability to give birth naturally simply need to put in the time and effort to change their belief system. The best way I know for folks to do this is through the Hypnobabies course: live class or home study. Through self-hypnosis and extensive education and empowerment, Hypnobabies families reprogram their mind to give them the confidence they need. Families who have the best outcomes are generally the ones who really give it their all. They let their fears and worries fade away, they do their daily hypnosis practice, they surround themselves with positivity and they choose their team wisely. This team should ideally include a Hypnobabies-trained doula and a care provider (midwife or doctor) who follows the midwifery model of care.
Bottom line? Plan to birth where they do the kind of birth you want. Every day. If you want a natural birth, know that it IS possible. I see it. Often. It takes preparation and work but is worth the time and effort. With a trained provider watching over you, ready to jump in IF complications arise, you will be well-cared for in any setting you choose. You'll be less likely to ask for medications in an out-of-hospital setting because you'll know they are not a readily available option. And IF they become necessary, they are just a car ride away.
Birth Centers in the Twin Cities:
Roots Midwifery (North Minneapolis)
Willow Midwives (near Uptown Minneapolis)
Minnesota Birth Center (Minneapolis and St. Paul Locations)
Health Foundations (on Grand Avenue in St. Paul)