Child Development From Infancy to Adolescence. Laura E. Levine
case, the doctor may try to rotate the baby into a better position, but sometimes an abnormal position necessitates a surgical delivery (Center of Excellence for Medical Multimedia, n.d.).
In recent years, there has been an increase in Western countries in the number of labors that are medically induced using medications or by purposely rupturing the amniotic sac. Sometimes labor is induced before a woman’s due date for the convenience of the family or a physician, but it also is used when a pregnancy is past its due date or there is a risk of the baby becoming too large. However, there is debate within the medical community about when induction is a safer alternative than letting a late pregnancy continue (Ault, 2016). Although the risks associated with any induction are relatively small, it can increase the chances of infection or of the uterus rupturing (Mayo Clinic, 2017a). A decision about if or when to induce labor should be an informed one, based on discussion between the woman and her physician.
Just born. This baby is immediately put onto the mother’s stomach after birth so she can touch and hold her baby right away.
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Birthing Options
Today there is a wide range of birthing options available. A woman can choose a birth setting, the type of assistance she receives, and a birthing technique. Which options are best depends on her personal preferences and medical condition, but she also needs to consider both the risks and the benefits of each alternative. Increasingly, pregnant women are getting their information about childbirth options from electronic sources. In a nationally representative sample of over 2,400 mothers, pregnancy and child-related blogs were the most widely used source of information, followed by online forums and discussion boards (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013). A majority of first-time mothers (59%) also reported taking a childbirth education class, most often at a hospital site.
When a woman decides to give birth in a hospital, she has access to medical professionals and medical technology, including pain medications, but hospitals are sometimes seen as impersonal settings in which the woman gives up much control over the circumstances of the birth. There also has been concern that medical interventions, such as labor induction or cesarean births, are overused when births occur in a hospital setting (Coxon, Sandall, & Fulop, 2014). As an alternative, birth centers provide a home-like atmosphere and give the woman greater autonomy during her labor. They are staffed by certified nurse-midwives rather than obstetricians. While they will have standard medical equipment, the staff does not perform surgical procedures and does not induce labor or administer drugs. For that reason, a woman might choose a hospital birth center rather than a freestanding center because pain relief, fetal monitoring, and surgery are all close at hand at a hospital birth center, if they are needed (Conaway, 2012).
Birthing options. Women have a choice about where and how they give birth. The birth can take place in a hospital, in a birthing center, or at home. The birth can be attended by a physician or midwife. What do you see as the advantages or disadvantages of each of these alternatives?
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The number of U.S. women who choose to give birth outside of a hospital has increased in recent years, but still only represents about 1.5% of births (Hamilton, Martin, Osterman, Curtin, & Mathews, 2015). While home births are generally considered safe, their safety is in large part attributable to the fact that only women with low-risk pregnancies tend to choose this option. When a woman plans a home birth, it is important that the midwife who attends the birth is a certified nurse-midwife who has the professional training required to safely oversee the delivery and who knows when it is necessary to transport the woman to a medical center. Being attended by someone who lacks such credentials could put both mother and newborn at risk (Tuteur, 2016).
In the United States, 90% of births are attended by a physician, who has most often been trained in obstetrics and gynecology. About 8% of hospital births and 31.4% of out-of-hospital births are attended by midwives (Martin, Hamilton, Osterman, Curtin, & Mathews, 2015). Although the number of births attended by midwives in the United States has risen every year since 1989, it still significantly lags behind the number in other parts of the world.
In addition to physicians and midwives, doulas and birth coaches may support a woman during her labor. Unlike a physician or midwife, a doula does not directly assist in the birth process but rather is a trained, knowledgeable companion who is present to support the woman through her labor and delivery. The support a doula provides has been associated with lower rates of cesarean section and forceps deliveries, less use of epidurals and other pain medications, shorter labors, greater satisfaction with birth experiences, and fewer low birth weight babies (Green & Hotelling, 2014; Gruber, Cupito, & Dobson, 2013). One explanation for these results is that when the doula reassures a woman that what she is experiencing is normal, it reduces the amount of stress hormones she produces during her labor. A husband, partner, relative, or close friend who has attended childbirth preparation classes with the woman can act as a birth coach who can help the woman relax, make her more comfortable during her labor, and provide emotional support.
Doula: A trained, knowledgeable companion who supports a woman during her labor and delivery.
One of the most dramatic changes in American childbirth in recent years is the number of children born by cesarean delivery, in which the baby is delivered through an incision made in the woman’s lower abdomen. In 2014, almost one third of all U.S. births were cesarean births (see Figure 4.8) (Hamilton et al., 2015). While cesarean deliveries were once the result of medical necessity, at least part of the recent increase has been attributed to nonmedical reasons that include maternal choice, more conservative medical practice guidelines that call for surgical intervention sooner, and physicians’ fear of litigation. In an evaluation of the benefits and risks of an elective cesarean compared to a vaginal delivery, the American Congress of Obstetricians and Gynecologists (2013, reaffirmed 2015) came to the conclusion that vaginal birth should be recommended whenever possible and cesarean birth not be recommended if the woman is planning to have several children because of the increased risks associated with subsequent births after an earlier cesarean.
Figure 4.8 Rates of Cesarean births, 2009, 2013, 2014.
Source: Martin, Hamilton, and Osterman (2015).
Although giving birth is universal, the birth process itself may be quite different from one culture to another, as these few examples illustrate:
An Ifaluk woman, who lives in Micronesia on one of two tiny islands in the Pacific Ocean, gives birth in a birth house, accompanied by a midwife and her female relatives (Le, 2000). When the baby is ready to be born, the woman kneels on a mat and helps the baby out by herself. She must try not to show distress or pain, in accord with the Ifaluk value of remaining calm at all times. If there are complications, the other women will help. After the baby is born, the woman’s mother helps by holding the baby and then bathes the baby in the ocean.
In the Netherlands, most expectant women are referred by their family doctor to a local