Chanel Garland, in a labor tub, rests between contractions as Garrard Hunte offers encour- agement.


Obstetrician or Midwife?
Both obstetricians and midwives provide care during pregnancy, labor and birth.

Obstetricians (OBs) are medical doctors who have specialized education in the female reproductive system and surgical care. In addition to managing routine pregnancies, OBs are best able to oversee high-risk or complicated pregnancies. Women who have had previous complicated pregnancies generally choose an obstetrician for their care.

Certified Nurse Midwives (CNMs) have a nursing degree and additional training in midwifery. Midwives usually limit their care to women with low-risk pregnancies. If a midwife's patient ends up having a complicated birth, an obstetrician can be called in for assistance. Midwives are known for offering care that is flexible and individualized, and they use as little medical intervention as possible, based on each patient's needs.

Where to Give Birth
One hundred years ago, more than half of births in the U.S. took place at home under the care of a midwife. Today, most babies are born in a hospital, where emergency care can be provided if necessary. Both obstetricians and midwives can attend hospital births. Giving birth in a hospital is considered safer because even in a healthy woman with an uncomplicated pregnancy, there is always the possibility that an unanticipated event or emergency could occur.

Childbirth - "Natural" or with Intervention?<br /> The term "natural childbirth" refers to a birth in which medical intervention is minimized, drugs and anesthesia are only used minimally, and the mother has learned how to use relaxation and breathing techniques to control pain and ease delivery.

Even if a natural birth is planned, it is possible that during the course of labor and delivery some interventions may be necessary for health and safety reasons or because the mother desires.

Some Types of Interventions
ELECTRONIC FETAL MONITORING (EFM) is widely used to evaluate uterine contractions and the baby's response to contractions. Intermittent rather than continuous monitoring allows the mother to move and change positions more easily.

INDUCTION is an artificial way to start labor. Labor is induced if there is a clear medical reason, such as: the mother has gone past her due date or developed high blood pressure, the amount of amniotic fluid around the baby has become inadequate, or tests show that the baby has stopped growing at an expected rate.

The cervix needs to soften and dilate to allow the baby to pass out of the uterus. If the cervix is firm, an oral medication or a medication in the vagina may be administered to help prepare the cervix for labor.

Pitocin, an intravenous synthetic hormone, may be given to stimulate contractions, gradually increase their frequency and cause changes in the cervix.

PAIN MEDICATIONS. In the early stages of labor, a woman can sometimes control her pain with relaxation exercises, breathing techniques and by frequently changing position. As contractions increase in intensity and frequency, many women choose to have pain medication administered. This can be accomplished through injection, intravenous administration or epidural and spinal blocks, which provide pain relief to the lower body without significantly slowing labor.

EPISIOTOMY is a surgical cut to the perineum and the muscle beneath it during the pushing stage to make delivery of the baby easier and avoid vaginal tearing. Episiotomies used to be done routinely, but now they are performed only rarely when the baby is in an abnormal position or needs to be delivered quickly, or if extensive vaginal tearing seems likely.

CESAREAN BIRTH is major surgery that allows the baby to be removed through incisions in the abdomen and uterus. A Cesarean section is performed when the baby appears to be too large to deliver through the birth canal, if labor is not progressing, when changes in the fetal heart rate indicate a need for urgent delivery, or because the patient had previously delivered a baby by Cesarean. These days, breech presentations are also delivered by Cesarean.

What is a doula?
A birth doula is a woman who provides physical and emotional support during labor and delivery and just after the baby is born, following the old tradition of women being surrounded by other women during childbirth.

Does water help during labor and delivery?
Warm water is comforting and relaxing, and its buoyancy allows the mother free movement to reposition herself during labor. Warm water promotes more efficient uterine contractions and reduces pain sensations. Some women stay in the labor tub during labor and get out when they are ready to deliver their baby, while others choose to give birth in the water, provided that their midwife or obstetrician agrees.

Should I breastfeed my baby?
The National Institute of Child Health and Human Development recommends that women should try to feed their babies breast milk for at least the first six months of life. Breast milk contains a balance of nutrients that is especially suited for helping your infant to grow, and it also helps protect your baby against illnesses and infections. Studies have shown that certain types of cancers occur less frequently in women who breastfeed their babies.