Archive | August 31, 2011

Active Birth in the Hospital

One of the inspiring images in ICAN of Atlanta's "Laboring on the Monitors" slideshow.

The vast majority of my birth class clients are women desiring a natural birth in a hospital setting. My classes are based on active birth and include a lot of resources for using your body during labor and working with gravity to help birth your baby. Sometimes I feel like active birth and hospital birth are incompatible—i.e. the woman’s need for activity runs smack dab into the hospital’s need for passivity (i.e. “lie still and be monitored”). So, I was delighted to discover this awesome series of photos from ICAN of Atlanta of VBAC mothers laboring on the monitors. It IS possible to remain active and upright, even while experiencing continuous fetal monitoring.

In my own classes, we talk about how to use a hospital bed without lying down—the idea that a hospital bed can become a tool you can use while actively birthing your baby. Here is a pdf handout on the subject:How to Use a Hospital Bed without Lying Down. In this handout, I offer these tips for using the bed as an active assistant, rather than a place to be “tied down”:

While being monitored and/or receiving IV fluids that limit mobility, try:

  • Sitting on a birth ball and leaning on bed
  • Sitting on bed
  • Sitting on bed and lean over ball (also on bed)
  • Kneeling on bed
  • Hands and knees on bed
  • Standing up and leaning on bed
  • Leaning back of bed up and resting against it on your knees
  • Bringing a beanbag chair, putting it on the bed and draping over it (can also make “nest” with pillows)
  • Partner sitting on bed and woman leaning on him/supported squats with him
  • Partner sitting behind woman on bed (with back leaned up as far as it will go)

While giving birth, try:

  • Hands and knees on bed
  • Kneeling with one leg up (on bed like a platform or “stage”)
  • Holding onto raised back of bed and squatting or kneeling
  • Squatting using squat bar

While most of the above tips can be used during monitoring, additional ideas for coping with a simultaneous need for monitoring AND activity include:

  • Kneel on bed and rotate hips
  • Sit on edge of bed and rock or rotate hips
  • Sit on ball or chair right next to bed (partner can hold monitor in place if need be)

If something truly requires being motionless, it can be helpful to have some breath awareness techniques available in your “bag of tricks.” One of my favorites is: Centering for Birth

Some time ago, a blog reader posed the question, can I really expect to have a great birth in a hospital setting? I definitely think it is possible! I also think there is a lot you can do in preparation for that great hospital birth! When planning a natural birth in the hospital, it is important to consider becoming an informed birth consumer. I always tell my clients that an excellent foundation for a simple, effective, evidence-based birth plan is to base it on Lamaze’s Six Healthy Birth Practices. My own pdf handout summarizing the practices is also available: Six Healthy Birth Practices. Don’t forget there is also a great video series of the birth practices in action! You might also want to get a copy of the book Homebirth in the Hospital. And, check out this post from Giving Birth with Confidence: Six Tips for Gentle but Effective Hospital Negotiations.

Before you go in to the hospital to birth your baby, make sure you have some ideas about this very popular question, how do I know if I’m really in labor?

And, finally, be prepared for the hospital routines you may encounter by reading my post: What to Expect When You Go to the Hospital for a Natural Childbirth.

For some other general ideas about active birth, read my post about Moving During Labor (written for a blog carnival in 2009).

Best wishes for a beautiful, healthy, active hospital birth! You can do it!

Book Review: Homebirth in the Hospital

Homebirth in the Hospital
by Stacey Marie Kerr, MD
Sentient Publications, 2008
Softcover, 212 pages
ISBN: 978-1-59181-077-3

Reviewed by Molly Remer, MSW, ICCE,

I would venture to say that most midwifery activists and birth professionals have said at some point, “what she wants is a homebirth in the hospital…” This comment is accompanied with a knowing look, a bit of head shaking, and an unspoken continuation of the thought, “…and we all know that’s not going to happen.”

Well, what if it is possible? A new book by Dr. Stacey Kerr, Homebirth in the Hospital, asserts that it is. She was originally trained at The Farm in TN (home of legendary midwife Ina May Gaskin) and after going to medical school realized that she, “…needed to balance my new knowledge with my old priorities. I missed the feeling of normal birth, the trust that the birthing process would occur without technology, and the time-tested techniques that help women birth naturally. And so it was that I went back to midwives to find the balance.”
If you are a dedicated homebirth advocate, I recommend reading Homebirth in the Hospital with an open mind—clear out any cobwebs and assumptions about doctors, hospitals, and birth and read the book for what it is: an attempt to create a new model of hospital birth. What Dr. Kerr proposes in her book is a model of “integrative childbirth”—the emotional care and support of home, while nestled into the technology of a hospital.

The opening chapter explores the concept of integrative childbirth and “the 5 C’s” of a successful integrative birth: choices, communication, continuity of care, confidence, and control of protocols (“protocols are the most disempowering aspect of modern maternity care…”).

This section is followed by fifteen different birth stories, beginning with the author’s own (at a Missouri birthing center—my own first baby was born in a birth center in Missouri, so I felt a kinship there).

The births are not all happy and “perfect,” not all intervention-free, and most are quite a bit more “managed” and interfered with than a lot of homebirthers prefer (one is a cesarean, several involve epidurals or medications). I, personally, would never freely choose a “homebirth in a hospital” (I also confess to retaining a deep-seated opinion that this phrase is an oxymoron!). However, that is not the point. Over 90% of women do give birth in a hospital attended by a physician and I appreciate the exploration of a new model within the constraints and philosophy of the hospital.

The book closes with a chapter called “how to be an integrative childbirth provider.” The book has no resources section and no index.

I certainly hope that doctors read this book. I am also glad it is available for women who feel like homebirth is not an option or not available and would like to explore an integrative approach. Even though my opinion is that none of the births are really “homebirths in the hospital” as most bear little resemblance to the homebirths I know and love, unlike the content of the standard hospital birth story, they are deeply respectful births in the hospital and that’s the issue truly at the heart of this book.


Disclosure: I received a complimentary copy of this book for review purposes.