Alternative and complementary childbirth techniques

DEFINITION: Alternative and complementary techniques and methods to aid in labor and childbirth.

Overview

With the growing openness of medical communities to complementary and alternative therapies, now often called integrative medicine, mothers-to-be are investigating and choosing new options for delivering their babies. So many parents elect nontraditional paths that “what used to be `alternative is now the norm,” says Loma Ellis, nursing manager for California’s Alameda Hospital Birthing Center. As a result, parents now have more birthing choices than ever before.

Birth Assistance

A birth assistant, or doula, is a professional person hired privately by parents to attend their child’s birth. A doula serves as a support and coach for the laboring woman. The doula does not replace the role of the pregnant woman’s partner and is not a member of the healthcare team. The doula is present solely to attend the laboring woman. Usually highly trained in childbirth, a doula can serve as a stand-in when a pregnant woman’s partner is not available. However, many parents hire doulas even if a partner is present. Doulas can cost any where from $1,600 to $2,000 in larger cities or urban areas, while in other parts of the country they can cost around $500.

“The doula is a safety net,” says Sandi Miller, owner of Before Birth and Beyond in San Jose, California. “Whatever happens, whether it’s a cesarean or whatever, the parents know what’s going on and the doula is watching out for them.” Doulas meet with parents prior to the birth to discuss and outline a preferred birth plan. The doula can then advocate for the parents if the birth plan starts to go awry, or if the healthcare professionals are acting against the parents' wishes.

Studies show that doulas have positive medical effects on both mother and newborn. A study published in the British Medical Journal suggests that the employment of doulas results in fewer cesareans and shorter labors and in a lower admission rate to neonatal intensive care for infants. A review found that continuous support by a doula reduces anxiety, shortens labor, decreases the need for cesarean deliveries and other forms of assisted birth, and reduces rates of postpartum depression.

Water-Birthing

Water can smooth away aches and drain off tension. Women who labor or deliver (or both) their babies in a birthing pool report less pain and greater relaxation. According to the Israeli medical journal Harefuah, water-birthing women are more relaxed and comfortable; water immersion may also speed the dilation of the cervix, leading to a shorter labor. The following benefits may also be passed to the infant:

Less fetal discomfort. Barbara Harper, director of Oregon-based Waterbirth International and the author of Gentle Birth Choices (2005), says that when the laboring woman is relaxed, the unborn child spends less time in the birth canal and undergoes minimal discomfort.

Less trauma. Proponents of water births also believe the method is less traumatic for newborns. “Babies seem to be very relaxed. They open their eyes and focus on people,” says Beah Haber of the Birth Home in Pleasanton, California, who has attended hundreds of water births. However, there is no scientific evidence to document this claim.

Smoother transition. The easier transition is partly a response to the relaxed state of the laboring woman and partly because of the insulating effects of water, according to Harper. “The baby has hearing even in utero, but it’s muffled and muted . . . the same way it is underwater,” she says. Underwater, the newborn is protected from harsh lights, sounds, and even touch and thus is more relaxed and comfortable. Again, however, scientific evidence is lacking.

Despite the rising interest in water-birthing, the American Congress of Obstetricians and Gynecologists (ACOG) has not endorsed this practice. They do, however, provide guidelines and suggestions for families interested in the procedure. ACOG warns that not enough information exists, specifically concerning rates of infection, to recommend warm-water immersion as a safe and appropriate birthing alternative. There are concerns, for example, that a baby can develop an infection if he or she begins breathing while underwater and inhales the soiled birthing water.

Marion McCartney, certified nurse midwife and director of professional services for the American College of Nurse Midwives, says, however, that “most research has found that healthy babies do not gasp upon delivery, rather they do not take a breath until they are removed from the water and reach the air.”

Although these studies have been quite small, evidence from larger studies involving almost two thousand women suggests that water birth does not increase rates of infection, and it may reduce the duration of labor and the need for pain control. Nonetheless, ACOG maintains that water-birthing should be performed only under the strictest measures of infection control. All experts agree that water-birthing should be considered for healthy women and healthy fetuses only.

Labor Pain

Many nonpharmaceutical options are available to manage the pain and discomfort of labor. These options include relaxation and alternative remedies, such as herbs, massage, acupressure, and acupuncture.

Relaxation techniques. The first step to pain management is relaxation. The tenser one is, the higher the sensation of pain. Relaxation starts with the environment. Even in the hospital, one can dim the lights, play soft music, light candles, or use aromatherapy to create a safe feeling. Lavender and sage are especially soothing scents. Other relaxation techniques include massage, showers, and baths.

The mind is one of the most effective pain-fighting tools available. Hypnotism, visualization, and imagery are all methods for pain relief, and there is some scientific support for their use.

Although red raspberry is an herb traditionally used during pregnancy and labor, a double-blind, placebo-controlled trial evaluating the effects of red raspberry in 192 pregnant women failed to find benefits. The herb blue cohosh is sometimes recommended by midwives, but it is a toxic herb and should not be used.

A study published in 2022 in the European Journal of Midwifery found that more than 30 percent of the healthcare professionals participating in the study used complementary treatment and supportive care methods with their patients. The most commonly used method was massage at 14 percent, and the least used method was chiropractic at almost 7 percent.

Bibliography

American College of Obstetricians and Gynecologists. “Committee Opinion No. 679: Immersion in Water during Labor and Delivery.” Obstet Gynecol, vol. 128, no. 5, 2016, pp. e231-6. ACOG Clinical, doi.org/10.1097/aog.0000000000001771. Accessed 5 Oct. 2024.

Bodner, K., et al. “Effects of Water Birth on Maternal and Neonatal Outcomes.” Wiener klinische Wochenschrift 114 (2003): 391-395.

Bolsoy, Nursen, et. al. "The Knowledge and Attitudes of Health Professionals Working in Mother-Friendly Hospitals about Complementary Therapy and Supportive Care Methods." European Journal of Midwifery, vol. 6. Apr. 2022, doi.org/10.18332/ejm/146166. Accessed 5 Oct. 2024.

Carson, James W. et. al. "Complementary and Alternative Medicine Services at Pain Treatment Clinics: A National Survey of Pain Medicine Specialists in the United States." The Journal of Alternative and Complementary Medicine, vol. 27, no. 4, 15 Apr. 2021, doi.org/10.1089/acm.2020.0487. Accessed 5 Oct. 2024.

Fehervary, P., et al. “Water Birth: Microbiological Colonisation of the Newborn, Neonatal, and Maternal Infection Rate in Comparison to Conventional Bed Deliveries.” Archives of Gynecology and Obstetrics 270 (2004): 6-9.

Hjelmstedt, A., et al. “Acupressure to Reduce Labor Pain.” Acta Obstetricia et Gynecologica Scandinavica 89, no. 11 (2010): 1453-1459.

Lieberman, A. B., et al., eds. Easing Labor Pain: The Complete Guide to a More Comfortable and Rewarding Birth. Boston: Harvard Common Press, 1992.

Nesheim, B. I., et al. “Acupuncture During Labor Can Reduce the Use of Meperidine.” Clinical Journal of Pain 19 (2003): 187-191.

Ramnero, A., et al. “Acupuncture Treatment During Labour.” BJOG: An International Journal of Obstetrics and Gynaecology 109 (2002): 637-644.

Scott, K. D., et al. “The Obstetrical and Postpartum Benefits of Continuous Support During Childbirth.” Journal of Women’s Health and Gender-Based Medicine 8 (2000): 1257-1264.

Simpson, M., et al. “Raspberry Leaf in Pregnancy: Its Safety and Efficacy in Labor.” Journal of Midwifery and Women’s Health 46 (2001): 51-59.

Skilnand, E, et al. “Acupuncture in the Management of Pain in Labor.” Acta Obstetricia et Gynecologica Scandinavica 81 (2002): 943-948.

Thoeni, A., et al. “Review of Sixteen Hundred Water Births: Does Water Birth Increase the Risk of Neonatal Infection?” Journal of Maternal-Fetal and Neonatal Medicine 17 (2005): 357-361.