Today there are as many ways to have a baby as there are names to give one. Women no longer have to rush into the waiting forceps of a male obstetrician or rely on an herbal, unlicensed midwife. Freestanding birthing centers, certified nurse-midwives, doulas, and widespread acceptance of natural birthing techniques have allowed more women to get creative with how they bring babies into the world, without compromising safety.
'If you told me you really want to give birth with a cross-dressing midwife in a freestanding birthing center with a commune attached to it, I could probably find that for you,' says Lisa Gould Rubin, a doula and childbirth educator at the Good Birth Company in South Salem, New York, and coauthor of The Birth That's Right for You (McGraw-Hill, 2005).
Even as women have more options, birthing experts and surveys have found a phenomenal number of women coming away from their birth experiences feeling let down at best, violated at worst. Jennifer Block, a New York City-based journalist who interviewed dozens of mothers for her new book Pushed (Da Capo, 2007),
says many of the women she spoke with imagined themselves dealing with labor in time-tested ways, but their experience resembled an intensive care unit more than a candlelit sanctuary.
'They saw themselves walking around the hospital, taking a bath, breathing through the contractions, and bouncing on a birth ball,' Block says. Instead, many were tethered to their hospital beds by monitors, catheters, and tubes. 'One woman told me that she felt like a science experiment.'
Carol Sakala, program director at the nonprofit Childbirth Connection in New York City, says if women feel that they were duped by their hospital birth, it's because they probably were. Hospital caregivers and marketing messages often tout options and choice, but when contractions begin, much hospital birth care is in fact quite standardized. 'For women who want a natural, unmedicated birth, the hospital environment really is a square peg in a round hole,' says Sakala.
The good news is that women have options and information. All it takes is some research and self-exploration.
The first step to building the ideal birth experience is to visualize what ideal means to you-not your sister, your mother, or your best friend. 'It's important to think about who you are, and how you live your life, and what's important to you,' says Gould Rubin.
Start by being inquisitive. Have coffee with a midwife or a doula. Tour a freestanding birth center and your local hospital. Explore natural birthing philosophies such as the Bradley Method (www.bradleybirth.com), the Alexander Technique
(www.alexandertechnique.com), HypnoBirthing (www.hypnobirthing.com), water birth (www.waterbirth.org), and Lamaze (www.lamaze.org).
'Women need to ask themselves, 'Where, and with whom, am I best able to deal with this process of labor?' ' says Block. ' 'In this huge physiological process-where my body needs to do this crazy thing of pushing out a baby-where am I going to feel safest and most comfortable?' '
Once you have an idea about your ideal birth, you can start assembling a team of experts who share your beliefs. According to the national Listening to Mothers II survey, women often choose a caregiver based on insurance coverage, personal recommendations, or past experience with the caregiver (for example, the person is her gynecologist). 'What struck us was that women gave very low priority to whether their chosen person fit with them, what their record was, or their beliefs,' says Sakala. 'I don't think women really understand the tremendous amount of variation between the provider classes.'
Interview at least two different practitioners, says Gould Rubin, and trust your instincts. If you're a healthy woman without extenuating circumstances, then a midwife birth could be a perfect fit, but be sure to research midwife licensure laws, as they vary from state to state. (For a guide, visit http://cfmidwifery.org/states.)
Certified nurse-midwives (CNMs) are advanced-practice nurses with specialized training in childbirth and gynecological care. They can prescribe medication in 48 states and can do routine procedures, like IVs, if necessary. The downside is that many CNMs do not attend birthing center or home births, and work only in hospitals. If you choose a hospital because it has a midwife on staff, ask about the odds of her showing up at your birth, says Gould Rubin; the midwife may be on
a rotation with the doctors.
Other midwives, generally called direct-entry midwives, include certified professional midwives, or CPMs, who are required to have out-of-hospital experience. Another group includes licensed (in 24 states) midwives, who may also be CPMs or CNMs, and lay midwives, who may have received training through apprenticeship or self-study.
No matter what road you take, says Gould Rubin, your goal should be to find caregivers who respect your needs and wants: 'Whether you want to give birth squatting and chanting to the sounds of the Brazilian rainforest, or you want to listen to Motley Crue and have a scheduled C-section, it's all good. The ultimate goal is not just a healthy mom and baby, but also a woman who comes through the experience feeling good about herself.'