By Hayley Oakes LM, CPM ~
While birth can be an unpredictable process and approximately 23% of first-time mothers planning an out-of-hospital birth will transfer to the hospital (with the majority being due to non-emergent issues, i.e.‘failure to progress’ or a desire for pain relief), (2) there are a few things you can do during the pregnancy to stack the odds in your favor of having the birth you want.
1. Optimal nutrition is important in order to grow a healthy baby and maintain a low-risk pregnancy. Part of prenatal care with your midwife is assessing your and the baby’s health in making sure you are a suitable candidate for an out-of-hospital birth. Having a healthy diet (and lifestyle) reduces your chances of risking out of her care and transferring to a physician for conditions such as gestational diabetes, hypertension, preeclampsia (3) [complication of pregnancy characterized by high blood pressure which can lead to liver or renal failure], and polyhydramnios [excessive amounts of amniotic fluid that can lead to premature birth, excess fetal growth, cord prolapse].
Check with your care provider first about modifying or changing your diet, but in general, the above-mentioned conditions can be prevented by decreasing sugar and carbs and increasing protein and calcium rich sources.4 In fact, most sugar and carb cravings come from a lack of protein, so try a protein filled snack first, then have some water and see if you still feel that pang for a sweet treat.
2. Dates. Studies have shown that eating six dates a day shortens the total length of labor by ripening and softening the cervix in pregnancy and thus encouraging faster dilation during labor.5 However, six dates is a lot of sugar, about 75 grams (!), and since it is advised to reduce sugar in the pregnancy as mentioned above, this should really be the only source to prevent excessive weight gain, amniotic fluid, and the presence of group beta strep (GBS) [a common type of bacteria in the body but if a high concentration is present in the vaginal canal at the time of birth, it can be potentially very serious for the baby. It is treated with intravenous antibiotics in labor].
3. Incorporating 30-60 minutes of cardio activity daily helps maintain a healthy weight gain (25-35 lbs. for women with a normal BMI), prevents high-risk pregnancy conditions as mentioned above and physically prepares you to have a smoother birth (and a quicker recovery postpartum). The 2015 Guidelines from the American Congress of Obstetricians and Gynecologists report that women who engage in vigorous, heart-pumping exercise every day may have shorter labors and may require less interventions in labor, including a significantly decreased rate of cesarean birth. (6) Along with this, there are psychological benefits including reduced fatigue, stress, anxiety and depression. With all the hormonal and physical changes in pregnancy, who wouldn’t want to maintain a balanced (or improved) well-being?
If you were not physically active prior to the pregnancy, then it’s best to slowly work up to getting that much activity every day. Also, start with low impact activities like walking, swimming, and yoga. If you are already an active person and would like to maintain your exercise routine, just make sure to check with your care provider and trainer to modify as needed. (6)
Think of the birth as preparing for a marathon – it’s important to train and build your strength and endurance for what could be an 18-24 hour event for first-time mothers. (7)
4. Take a childbirth education series that specifically prepares you for a natural, out-of-hospital birth. Knowledge is power, and can help reduce fear around the unknown of childbirth. Active labor is the stage of labor when it’s time to be in the setting of your birth and with your care provider present to monitor the health of you and your baby. This stage is characterized by a dilation of at least 6 cm (10 cm is considered ‘full dilation’), which means a lot of the early labor will just be you and your partner (and your doula if you have hired one) at home prior to your midwife joining you. So it’s important to feel confident with the labor process and familiar with all the normal labor signs and symptoms so that your labor can progress normally without you (or your partner’s) fear or anxiety slowing things down. (8)
5. Read positive birth stories and write your birth story. We are not a culture that sees natural birth or know it to be a normal occurrence. We more often know birth to be a ‘condition’, one that is life threatening, scary, painful, and traumatic – or dramatic as depicted in the Hollywood films. It’s important to take the time during pregnancy to mentally undo the negative things you have been told about birth and become a blank slate, since your experience will always be inherently different from what you have observed in others.
When you read positive stories and watch normal birth videos, you familiarize yourself with the foreign and unknown process of giving birth – receiving the message again and again that birth happens in many different ways but most importantly that natural birth does happen!
It’s also helpful to have a back up reserve of healthy, normal birth experiences that you can draw on during that moment in labor if and when you think you can’t go on or it’s too much (which is very normal, by the way). Ina May’s Guide to Childbirth, Spiritual Midwifery is a great resources for familiarizing yourself with the wide range of what normal, empowering and beautiful birth looks like.
Lastly, a good exercise during the pregnancy is to write out your ideal birth story as a way to visualize and help manifest the birth you want. Some may think that it will ‘jinx’ the birth or cause you to become attached to one particular idea, but writing your dream birth story will instead help you face any fears and focus on what you want from your birth.
6. Pregnancy discomforts like symphysis pubis dysfunction, low back pain, sciatica, headaches, and heartburn are common side effects of pregnancy. As your body adjusts to accommodate a new human being growing inside of you, these conditions can arise. While they are normal occurrences they are not to be expected or accepted. These discomforts are signs of imbalance and should be addressed. Seek out routine chiropractic care and acupuncture to help bring harmony to the body, especially before birth to facilitate a comfortable pregnancy and smooth delivery.
7. Take at least 2 weeks of maternity leave before your estimated due date to rest up and flood your body with oxytocin (the labor hormone). If this is something that is financially feasible, there are many benefits.
Anecdotally, I have seen (and heard from other birth workers) that women who are working right up until their birth either go far past their due dates and/or enter the labor depleted and are at risk for transferring to a hospital for failure to progress and exhaustion.
When you are in work mode, you enlist a part of your brain that is the opposite of getting your body into labor. You are using hormones – adrenalin and cortisol – that literally stall the labor hormone, oxytocin. (8) Most likely you are hustling to get a lot of work done before the baby, but sure enough it will be that night that you go to bed really late, fatigued both mentally and physically that your baby will decide it’s go time. Even if you manage to labor and give birth naturally when exhausted, it’s a more risky place to start your labor (for both you and your baby).
Also, when you’re not working you have the time to exercise, take naps, eat well, and start to hone in on connecting with your baby and envisioning your birth.
The purpose in preparing so much for your birth is to control what you can in the pregnancy in order to ‘lose all control’ in the moment of birth. Once labor starts, the most important tool one has is to surrender to the contractions and labor pattern. Therefore, it’s important to take the time in the pregnancy to prepare physically and mentally so that you can allow for things to unfold as they will in the moment of birth (and trust that that was how it was meant to go).
Good luck and enjoy!
1. Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ : Canadian Medical Association Journal, 181(6-7), 377-383. http://doi.org/10.1503/cmaj.081869
2. Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D. and Vedam, S. (2014), Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health, 59: 17–27. doi:10.1111/jmwh.12172
3. Nutrition During Pregnancy. (2015, April). Retrieved November 23, 2016, from http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy
4. Frye, Anne. Holistic Midwifery. Comprehensive Textbook For Midwives in Homebirth Practice: Caring During Pregnancy. Portland: Labrys, 2010. Print.
5. Kordi, Masoumeh, Fatemeh Aghaei Meybodi, Fatemeh Tara, Mohsen Nemati, and Mohammed Taghi Shakeri. “The Effect of Late Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.” Journal of Midwifery & Reproductive Health2.3 (n.d.): 150-56. Web. 27 Apr. 2017.
6. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e135–42.
7. Varney, Helen, Jan M. Kriebs, and Carolyn L. Gegor. Varney’s Midwifery. 4th ed. N.p.: Jones & Bartlett Learning., n.d. Print.
8. Gaskin, Ina May. Spiritual Midwifery. 4th ed. Summertown: Book, 2002. Print.