Hi mama! Congratulations on the impending arrival of the world’s cutest baby (or babies!). I’ve given birth four times myself, and I know what it’s like to want to do everything right for your child. If you’re reading this, I imagine you’re at least somewhat natural-minded, planning for an unmedicated or at least low-intervention birth in a hospital. Like me, you probably want the security of knowing you’re in a hospital in case, God forbid, something goes south fast during labor, birth, or afterwards, but still hope to have as close to a “natural” or physiological birth as possible.
You’re not alone! Many moms desire a natural birth experience–yes, even in a hospital–and many also dread being pressured to do things they don’t want to do, like pushing on one’s back, just because hospital policies or staff insist “that’s the way we do things here” or “that’s what we’ve always done.” So it’s good to remember that even the American College of Obstetricians and Gynecologists (ACOG) acknowledged in 2019 that “many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor.” (Spontaneous labor refers to labor that started on its own, without an induction.)
Plan to chat about these things with your provider before labor if you’re planning on an unmedicated hospital birth
There are several main ways that many Labor & Delivery units unfortunately don’t tend to “follow the science” in terms of best practices for moms and babies during labor and immediately after birth. I’ll cover them here so that you can anticipate and hopefully address them ahead of time with your healthcare provider (and doula, if applicable), and be especially sure to include them in your written birth plan. And while these practices are particularly applicable to women seeking an unmedicated hospital birth, some will still be relevant epidural or other pain medication use. Forewarned is forearmed, my friend. You can do this!
Eating and drinking during labor
This is such an important topic that we devoted a whole article to it, complete with suggested foods and drinks! In short, if you’re low-risk, there’s no reason why you shouldn’t be allowed to eat and drink what you want during labor. Whether you’ll actually be hungry during that time is another question, but the data are firmly on the side of low-risk moms listening to their bodies for nutrition and hydration during labor. And what about if you’re considered high-risk or being monitored extra closely during your pregnancy? If you’re planning to give birth vaginally, how you’ll stay hydrated and nourished during the marathon of labor and delivery is still a worthwhile conversation to have with your healthcare provider.
Fetal monitoring during labor, or: Why you don’t need continuous fetal monitoring
Continuous fetal monitoring (CFM), characterized by the ubiquitous pink and blue bands that encircle your belly during labor (with one to monitor contractions and the other to monitor your baby’s heart rate), is a common practice during labors in hospitals. But did you know CFM isn’t actually recommended for low-risk moms who have an unmedicated (meaning no epidural and no IV pain meds), and unaugmented (meaning not on Pitocin for induction) labor?
That’s right. As ACOG noted, “The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies.” Worse, CFM is actually associated with higher rates of unnecessary Cesarean sections (C-sections), as pointed out by the former director of Women’s and Children’s Health for the World Health Organization in the documentary The Business of Being Born.
So what’s the alternative to CFM? It’s called intermittent monitoring or intermittent auscultation. Your nurse comes in and checks the baby’s heart rate (either with a hand-held Doppler like at your OB’s office or by holding on the monitor that would otherwise be continuously strapped on your belly) for a few minutes every half hour. The rest of the time, you’re belly-band free, which is particularly nice if you’re up walking the halls.
Breaking your bag of waters, aka amniotomy
Sadly, many women have experienced pressure from their own healthcare provider (or the provider on call at the hospital when a laboring mom is admitted) to undergo amniotomy, or breaking the bag of waters, to “speed up labor.” The only reason given to these low-risk women, myself included, is essentially “what’s the point of being in the hospital if it’s not to have this baby (now)?” But this viewpoint misses the fact that labor is an age-old and sacred process for women.
And it ignores the fact that contractions are more painful after your water is broken because your internal “cushion” is gone, which may lead you to request pain medicine to cope. In short, there’s simply no need to put healthy, low-risk laboring women on a conveyor belt of interventions, rushing them along from one stage to the next. Unless there’s a clear medical reason for mom or baby or both to make labor progress faster, routine amniotomy is unnecessary and you have every right to refuse it.
If you receive pushback on this from a medical provider, again, you can turn to ACOG, which has stated: “Overall, [current] data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring.”
Pushing on your back
Here’s another topic we covered in this great primer on pushing positions to decrease risk of severe vaginal tearing. Pushing on your back may be most convenient for your healthcare team, but it doesn’t benefit you or your baby. Here again, ACOG admitted that back-lying positions can lead to low blood pressure in mom and troubling heart rate drops for baby. Evidence-Based Birth covers all the research on this topic. And know that even if you choose to have an epidural, (lying on your) back is still not the best (or only) possible position when it comes to pushing!
Cord clamping
Historically in hospital-based births, the baby’s umbilical cord was clamped immediately after birth. Logistically, this was necessary so that the baby could be taken to the warmer to be weighed, receive the Vitamin K shot, etc. But research shows that delayed cord clamping, which means that you wait to clamp the cord until it no longer pulsates, is best for both you and baby. At birth, delayed cord clamping “increases hemoglobin levels at birth and improves iron stores in the first several months of life,” writes ACOG. Of note, these benefits are especially strong for preterm babies.
Unequivocally, ACOG states, “Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.” While delayed cord clamping may slightly increase the risk of jaundice in newborns, this can be easily treated in the hospital with blue light (“bili light”) therapy.
Skin-to-skin time: before or after the baby is weighed?
The single most important thing for you and baby immediately after birth is skin-to-skin time. This means your baby is laid right on your bare chest. Skin-to-skin, or kangaroo care, is almost unbelievably beneficial for both you and your baby, according to the Cleveland Clinic. It stabilizes your baby’s heart rate, breathing, and temperature. It helps the baby latch better if you’re breastfeeding. And it decreases stress for both of you.
But some hospitals routinely take the baby to a warmer for weighing or other measurements before initiating skin-to-skin. This is not evidence-based. Unless your baby requires medical stabilization, meaning that he or she has unstable vital signs due to breathing problems, etc., your healthcare team can absolutely wait to weigh your baby. Yes, suctioning a baby’s nose after birth is typical to clear out meconium and other fluids. But this can still happen while your baby is lying on your chest.
How to ensure your care team follows the science on unmedicated hospital birth
The best way to advocate for yourself and your baby in labor is to advocate for yourself and your baby before labor. Talk with your provider about which of the above practices are standard in the hospital where you plan to give birth. If your provider isn’t on call around your due date, ensure that you write up a birth plan stating your preferences in each of these areas. If your provider signs off on it and scans it into your electronic medical record, you will hopefully experience less pushback about your labor and delivery preferences for an unmedicated birth when you get to the hospital.
Labor is such a vulnerable time, both physically and emotionally. Despite your very best preparation, you may still encounter outmoded practices when you go to the hospital. Give yourself a leg up (pardon the pun!) by communicating your preferences for an unmedicated hospital birth clearly in advance with your doula and/or spouse, partner, or whoever accompanies you. You can do this!
Additional Reading:
What’s the best position to give birth in to avoid tearing?
The 6 things every woman considering a natural childbirth needs to know
