The Complete Book of Pregnancy and Childbirth

Written by Sheila Kitzinger.

This was, by far, the best pregnancy book I’ve read.  It was very natural-friendly, birth center and homebirth advocating, and had none of the “here’s what could go wrong, ask your doctor how you should proceed at every turn” undertones that “What to Expect…” has.

It is filled with facts and statistics to back the claims it makes in support of natural birthing methods.

It is often claimed that, because far fewer mothers and babies die than say, 60 years ago, when most women had their babies at home, hospital birth must be the cause of this.  But, of course, the fact that two things happen at the same time does not mean that one causes the other.  Nor should we use statistics of home births from the past, or in developing countries.  Many other things are different, including our health, our access to contraceptives, and abortion, and our socioeconomic conditions.  These have a profound effect on perinatal mortality.  As the standard of living rises, fewer babies die at birth in every country, whether or not they are born in a hospital.  (pg 45)

There are full-color pictures of real-life people to demonstrate exercises to alleviates pain and strengthen the body, positions to try in labor, and examples of various other things to expect.

It also does a good job of explaining the why instead of just the how and what.

Childbirth is not primarily a medical process but a psychosexual experience.  It is not surprising that adapting your responses to the stimuli it presents should involve a subtle and delicate working together of mind and body. (pg 181)

Kitzinger explains the differences between locations of birth and stressed the importance of making the space a woman chooses her own and having privacy.

When women describe their birth experiences in hospitals, especially large ones, they often talk about all the people who wandered in and out, anonymous faces looking through the porthole window in the door, and conversation about them, not with them, conducted over their supine bodies.  Can you imagine the effect of having strangers and other observers around you when you took a bath, sate on the toilet, tried to sleep, or were making love?  Birth is a psychosexual activity that involves revealing that which is usually physically and emotionally private…To be watched by someone with whom you have you have no intimate and trusting closeness, to be inspected, criticized, applauded, and urged to do better, can interrupt and prove an obstacle to psychophysical coordination.  This is why it is important to create your own space for birth, and to arrange to have one or more companions with you with whom you feel not just comfortable but completely at ease…You need to choose a birth companion who will be like an anchor for you in a stormy sea. (pg 187)

She goes on to urge the woman to choose a female companion to attend the birth with her.

Research shows that if a woman has another woman with her during labor and birth she has a less need for pain-relieving drugs and her labor is shorter.  There are fewer operative deliveries (forcepts, vacuum extractor, and Cesarean sections) and episiotomies.  Babies are in better condition at birth and mothers are much more likely to look back on the birth as a positive experience.  Studies also have revealed that these women have fewer perineal lacerations, are more likely to be breastfeeding at six weeks, and are less likely to be depressed.

This all agrees with the research and findings behind professional doulas.  Statistics all favor doulas in every case.  Even women who end up with a necessary c-section are happier with the outcome because they feel supported and informed when making the decision instead of coerced into it as so many women feel these days.  Even in situations where the birthing mother didn’t know her female companion, such as a hospital-provided doula, reported benefits of a non-medical female support person.

Being in tune with the body and nature are big factors in a good birth experience.  “Purple pushing” consists of waiting for the beginning of a contraction, exhaling, then taking a deep breath holding the breath while pushing to the count of ten, then exhaling and repeating two more times before the end of the contraction.  But all evidence-based birth shows this is a horrible way to navigate the second stage of labor!

If we watch any mammal giving birth, a cat, for example, or a sheep, we notice that it does not take great breath and then “block” the birth canal by holding its breath.  A sheep gives birth with rather light, quick breathing. (pg 213)

Different positions for birth can help different situations.  While most OBs prefer a woman to be sitting or lying on her back, evidence shows that there isn’t a worse position.

There is no reason that you should have to be tucked up in bed.  there are definite disadvantages to the supine position (lying flat on your back) for your baby, since the blood flow in the large veins is in the lower part of your body may be obstructed by the heavy weight of your uterus, and this can reduce the blood flow through the placenta to and from the baby. (pg 213)

There is a chapter on the screens and tests that can be run to assess the baby’s health.  Doctors tend to rely too heavily on these tests and many times they give false-positives and lead to unnecessary interventions.

[Ultrasounds] are not good at estimating birth weight, although they can be more accurate with premature babies.  Research shows that the mother’s guess at her baby’s weight is more accurate. (pg 230)

So a woman must decide if the potential information that may be gained from the test is worth the risks involved.  In the case of ultrasounds, they are assumed to be safe.  But that has recently been called into question.

As far as we know, ultrasound is safe…On the otherhand, it is known that high-frequency sound waves continued for a long time can damage an adult’s hearing.  Questions have therefore been raised about effects on the baby’s hearing, since, although the sound waves are bounced off the baby for only a short time, the baby may be vulnerable at certain stages of its development…no one yet knows if any [babies] will suffer delayed effects in later life. (pg 231)

While many people will tell you there are different kinds of labor, many don’t know just how different labor can be.  Sadly, too many doctor have expectations of what “normal” birth should look like.  Women then get the impression that their bodies can’t give birth without help from drugs and machines.

In the U.S., the most common reason for a Cesarean is the diagnosis of dystocia – prolonged labor.  Thirty-eight percent of Cesareans are done for this reason.  Another 20 percent are augmented with intravenous oxytocin in its synthetic form (pitocin) for the same reason.  As a result, women suffer more infection, bleeding, and a longer hospital stay – and many are left with the feeling that their bodies have failed them. (pg 285)

So how slow is too slow?  Many doctors will suggest intervention at 12 hours after active labor has started.  The assumption is that labor should progress at 1cm per hour and that 12 hours is longer than the body really needs.  But the average first labor, when left to labor and not in a hospital setting with strangers and monitors and interventions is 15-17 hours!  And nothing under 24 hours is really considered to be “long” in the natural birthing world.  No more babies or mothers die when labor is left to a natural course and time-line.  Many doctors will even suggest minor interventions to “speed up labor” after only a few hours, telling the mother that breaking her amnio sac will help things move along.  But this practice isn’t proven and can lead to more painful contractions and introduces bacteria into an other-wise sterile environment.  Plus, the minute the sac is broken, the clocked is watched because most doctors won’t let a woman labor more than about 24 hours with her water broken for fear of infection.

Many women think that birth has to be painful.  They can’t imagine a natural birth because they think that they won’t be able to deal with the pain.

People often think that pain is just a matter of a “high” or a “low” pain threshold.  There are very few women who think that they have a high pain threshold and can bear pain well.  in fact, the idea of pain threshold being like a wall, with some of us possessing high walls and others low ones, is a myth.

It is now known that the pain sensation threshold is the same in all human beings.  In one research study in the United States, members of Italian, Irish, and other ethnic groups were given electric shocks ranging from mild to fairly strong, and every single person said pain occurred at exactly the same point.  Yet obviously we do not all react to the pain in the same way, because it depends on what is going on in our minds. (pg 304)

So each woman needs to learn how to deal with her pain.  How to handle it in a constructive way instead of dwelling in it and saying she can’t get passed it.  There are different ways to do this and they are as varied as the women who use them.  Hypnosis is a fairly new option in the US.

[Hypnosis] has the great advantage over chemical anesthetics of not reducing the baby’s oxygen intake or making the woman feel drugged and drowsy.  In fact, about a quarter of women who have had hypnosis in childbirth say that they experienced no pain… (pg 310)

Acupuncture is another option if the mother can find a provider.

In labor, electroacupuncture may be used at points in the ear for analgesia, and with this technique the woman herself can control the degree of stimulation.  In Bejing today, acupuncture is performed in preference to epidural anesthesia for 98 percent of Cesarean sections. (pg 311)

There are many other natural remedies that can and should be tried before resorting to chemical therapies.  Aromatherapy has long been used to calm or excite a person.  A cold wash cloth with some lavender oil is very calming when the woman is warm and anxious.  There are also different types of homeopathy available if you seek them out.

Lavender can be put directly on the skin.  It can be mixed with one or two other essences…Some essential oils are overpowering if you use more than one or two drops, so sniff the bottles first before you concoct your recipe to make sure that it is well balanced. (pg 312)

Unlike conventional medial treatments, homeopathy aims to treat the whole person, including the mental and emotional states that have an adverse effect on physical well-being…The more diluted the remedy, the more effective it is. (pg 313)

There is a section on the medical pain remedies available.  It explains what each option does, how it is administered, and the risks involved for both the mother and baby.  After her own research, the author found that:

…18 percent of women very much regretted having had the epidural and said in effect, ‘Never again!’ (pg 322)

She goes on to conclude that the circumstances around the choice of the epidural has a lot to do with the feeling afterward.  A woman who plans to get it all along, or knows that she will wait as long as possible, and then asks for it is much happier with her decision that the woman who feels that it was her only choice, or that the doctors or other people around her were pushing her to get the epidural.  It has to be her own choice while the others in her environment are supportive of any choice she makes.

You have the right to decide what happens to your body before during, and after childbirth.  You are not bound, either by law or out of politeness, to agree to procedures and investigations to which you object.  If things are done without your consent, it is a form of assault on your body. (pg 324)

Many time women don’t think past the point that the baby emerges, but there is a whole third stage to go through.  The placenta needs to be birthed, the cord clamped and cut, the perineum needs to be checked and repaired if needed, etc…One question that comes up is when the cord should be cut.  Standard practice is to clamp it and cut immediately after the baby is out.  But evidence shows that it’s better to wait until the cord stops pulsing.

If the placenta is left to separate naturally, it may take about half an hour or longer.  Clamping the cord immediately at delivery may make the chances of a retained placenta more likely.  If the cord is not clamped until after it has stopped pulsating, there is much less chance of a retained placenta.  This is because when the cord is clamped, blood cannot flow out of it, which would encourage the now defunct placenta to peel away from the uterine wall.  A blood-packed placenta stays firm and full and is less likely to separate. (pg 334)

Inducing labor is risky.  There’s no question about that.  However, there are many doctors who push women to induce so they can plan it into their weekly schedules, or because they say it will be easier or faster, or just because the woman is over 40 weeks.  So, it’s important to know the risks.

Extremely strong contractions are likely to interfere with the blood flow through the uterus.  In one study it was discovered that fetal distress was significantly more common in women taking pitocin, that babies were more likely to have low Apgar scores, and that far more of them than usual went to the nursery for special care. (pg 338)

Electronic Fetal Monitoring is very helpful when used sparingly.  The problem occurs when it is relied upon solely, instead of using it as a tool among others.

A major disadvantage of EFM is that it increases the Cesarean section rate by 160 percent, without any benefit to the baby.  The rate is reduced if fetal blood sampling is done before the decision to proceed to operative delivery, but there is still a 30 percent increase in the Cesarean section rate, again without any benefit to the baby. (pg 342)

Interpretation of electronic monitoring data sometimes causes more harm than good.  Half of all babies show some irregularities of heartbeat during labor.  Usually this is of no significance.  We don’t know how they manage it, but babies actually sleep during labor…But it has now been discovered that the baby only has to be roused a little for the heartbeat to pick up.  One way of doing this is to touch the top of the baby’s head.  Mothers have their own ways of achieving the save result – changing position, for example – and this may reassure the doctors. (pg 344)

Emergency Cesarean sections are often performed because of changes in the fetal heart rate that are judged to be signs of asphyxia.  Yet more than 50 percent of babies delivered by Cesarean section turn out to be in good condition, so operating was unnecessary.  What has actually occurred is a series of complex changes in the baby’s heartbeat as a result of a normal catecholamine (stress hormone) surge.  These alterations have then been misinterpreted as signs of fetal distress.

The Amercan College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), and now the British Royal College of Obstetricians and Gynecologists (RCOG) support a policy of regular, frequent listening with an ultrasound stethoscope as equal or superior to electronic fetal monitoring in a low-risk pregnancies.  Despite this reversal of support for electronic fetal heart monitoring, most doctors and many midwives and nurses have not been well trained in auscultation, which also requires more staff time, and so continue to rely on EFM.

If the fetal monitor suggests that the baby is under stress, the baby’s blood should be tested in order to check the findings.  if the baby is having difficulties, this shows up in the blood chemistry.  But this testing is not often done.  A biochemical test carried out in order to assess the pH level of the baby’s blood cuts down the number of unnecessary Cesareans. (pg 345)

C-sections are also covered in a manner that both explains when and why they may be needed and when  and why they should be avoided.  It includes quite a lot of information about what to expect if it comes up, and the safety information needed to make a decision if the doctor says it’s necessary.  Many women feel pushed into a c-section that isn’t totally necessary, but just because it’s been a while and the doctor claims to be worried about the baby after a “long” labor.  But there are also medical reasons that doctors claim necessitate when they actually don’t have much benefit.

Research has been carried out on the outcomes of automatic Cesarean sections for multiple births and when women have diabetes, and it has been shown that this practice is unlikely to be of benefit.  Delivering all twins by Cesarean section does not save lives or produce babies in better condition…

…The Cesarean rate in the United States is approximately [33] percent and in some hospitals 50 percent or more.  But there has not been a corresponding rise in the fetal survival rate…

…Some doctors like to do Cesarean sections just because a baby looks as if it is going to be big.  This is not a good reason…(pgs 348-349)

And finally Kitzinger covers the “Once a section, always a section” mentality against VBAC, saying that many are unnecessary but aren’t given a chance at a trial of labor.

One professor of obstetrics says that problems of scar separation are ‘much less than the one percent that is often quoted,’ and that even if the scar is pulled open by strong contractions, “careful monitoring of the fetus and mother usually means that any harm to either is rare.’ (pg 349)

Many women don’t know about the ongoing and future problems a Cesarean can cause.

A Cesarean may have long-term effects, too.  A study in the British Journal of Obstetrics and Gynacology reveals that nearly half of all women who have a baby by Cesarean section do not go on to have other children – almost one in three because of infertility problems, and one in five because the Cesarean experience was so awful they could not face another birth by this method.  Three times as many women are infertile following a Cesarean as those who have a spontaneous vaginal birth, and six times as many women suffer from the effects of emotional trauma. (pg 350)

Too many women aren’t told these types of statistics.  They look solely at present situation.  That is understood when the baby or mother is in immediate danger, but most the time there is time to take a break and reassess what is going on and maybe even try something differently before charging off to the OR.  Most c-sections are life-or-death situations, they are done “just in case”.

After the section about the medical side of birth and the hazards it can bring, the author delves into “Gentle Birth”.  She stresses the importance of a low-key vaginal birth.

…in spite of the relentless onslaught of contractions as full dilation approaches, the baby who is pressed through the cervix and down the 9-inch (23-cm) birth canal responds more vigorously to life than do most babies who are merely liften out through an abdominal incision. (pg 359)

The Gentle Birth section takes issue with many hospital policies,  practices, and attitudes.  Against all research, many hospitals continue to demand that certain things happen.  Unless women specifically demand otherwise, the vast majority of hospitals take the baby from birth to be cleaned, measured, and then placed in the warmer to keep warm or given to the mother swaddled in a couple blankets.

Research has shown that even a low-birth-weight baby keeps warmer when in flesh-to-flesh contact with her mother and nestling against her breast than when wrapped and put in a crib.  So ask a helper to slip your gown down over your shoulders or take if right off before the birth.  A blanket can easily be thrown over you and your baby or a heater can be placed over you both. (pg 365)

The immediate clamping of the cord comes again in this section as well.

Immediate clamping may reduce the baby’s red blood cells by over 50 percent. (pg 365)

Many hospitals also insist on bathing babies soon after birth which can be problematic as their bodies can’t yet regulate temperature.

But babies who have received drugs from their mothers’ bloodstreams, including narcotics, are not only sedated but also unable to prevent heat loss efficiently.  So if you want a bath given, you should not have had narcotics in the last five hours, your baby should be full term, weigh more than 5 lb (2.5kg), and not have breathing difficulties at delivery, and the room should be warm. (pg 367)

The book is very pro-breastfeeding , but a short segment explains how a baby will feed for pleasure and how a bottle-fed (formula or expressed milk) baby can be accommodated.

When bottle-feeding, remember to hold the baby close, cheek against your breast, just as if you were breast-feeding.  Although it may produce a less comfortable cushion for the baby’s head, a man can also do this.  The baby may sometimes like to lie nestled against your partner’s bare skin, and fathers who give a feeding like this in the middle of the night say how much they enjoy it.  Never feed a baby while he is lying in a crib or stroller, or even worse, prop up a baby to feed on his own in a crib, however rushed you are.  It can be dangerous. (pg 408)

The book concludes with a chapter covering baby care and postpartum recovery.  It stresses the importance of keeping healthy, both mentally and physically, in order to take care of the baby.

It’s best to do as much research as you can on your own, but if you don’t have the time or drive to do so, this is a great place to get the information you need to make solid decisions based in facts instead of assumptions.  Happy Learning!!

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2 Responses to “The Complete Book of Pregnancy and Childbirth”

  1. Personal Care 101 Says:

    The Complete Book of Pregnancy and Childbirth « My rants on ……

    I found your entry interesting do I’ve added a Trackback to it on my weblog :)…

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