I need help understanding "natural birth", OB gyn recommendations and other stuff

[Anonymous]

Hello everyone!

I am a first timer and trying to figure out a few things. Hopefully you can all help me.

First of all, I read a lot about "natural birth", does this mean a vaginal birth without c-section, an unnecessary induction and an epidural? Does it mean that you use a midwife instead of a doctor?

I am struggling trying to decide what I want. I know I don't want a C-section unless the baby is in danger and is absolutely necessary, the same with induction. Now, the epidural... I like to think that I won't need one, but my gut tells me that I will. I am sort of a wimp for pain and I just see myself losing it as soon as it starts hurting.

My questions is, can you have a "natural birth" and have an epidural at the same time?

Now, I also hear that in DC we are not allowed to have babies with a midwife. So if you want to use one, what do you do? Go to VA or MD?

The idea of the midwife is tempting me but at the same time it scares me, for example, if you are about to have a natural birth and then something goes wrong, can they do C-section if necessary? or do they have to rush to the hospital? Can they induce if needed? and again, can you get an epidural if you ask for one?

I am with Reiter and Hill and they deliver at Sibley, but I am exploring. I like them so far, I have been happy with the people I've met and I heard they are one of the oldest practices in DC. That, personally, gives me a lot of confidence that if something goes wrong they will know what to do to provide safety for me and my baby . Now, I haven't yet met any of the doctors that assist birth there yet and I read the posts about Dr. Reiters' manners and other weird stuff, so I am not interested in people sharing that since I already read it.

What I would like to know is: Did anyone have an experience where Reiter and Hill induced and did c-sections without that being necessary? Or experiences with the opposite? And how about after the birth, spending time in the room with your husband/baby/breastfeeding?

I am sorry if this is confussing. I myself don't quite understand what I am asking, but I am just trying to get more of an idea.

thanks a lot in advance.

Maria

[Anonymous]

I think you'll find everyone's interpretation of natural birth is different. My interpretation is that a Natural birth is not induced, does not involve interventions (pain killers, epidurals, water breaking, etc.).

[Anonymous]

I'm no expert but here's my best guesses...

A vaginal birth refers to baby coming out the old fashioned way, whether the mom has drugs or not. In terms of the logistics of how the baby gets out, it's either vaginal or C-section.

A "natural" birth is often the way some folks refer to an unmedicated birth, in which the mom doesn't have drugs/other interventions.

A medicated birth could be used to describe one where mom has an epidural or other type of pain relief during labor/birth.

As far as I know about DC (and this info is from a year ago, so may have changed): There is a birth center in DC in NE, which started as a place for low-income women, but now accepts private insurance as well. Their midwives will deliver at the center or Washington Hospital Center.

I had a natural/unmedicated birth w/ the midwives at the Birth Center in Alexandria. We LOVED them, so I'm probably biased. My advice would be that if you are committed to the idea of a natural birth, being prepared is crucial. We took at the 12 week Bradley class w/ Susan Gunn in DC and it was a life-saver. My husband (totally gung-ho but kinda clueless to begin with) still raves about all he learned. I've heard that hypobirthing is also good. Even if you want a medicated birth, I'm a huge proponent of some form of childbirth/breastfeeding preparation.

All birth centers are required to have a plan for transporting to the hospital in a certain time frame should something go wrong. Trust me, those midwives are SERIOUS about this. They don't want a crisis as much as you don't. Midwives cannot perform Csections. They are in contact w/ a back-up doctor at the back-up hospital if there is a labor that looks like it might get complicated, and that is the doc who does the Csection. Midwives offer various methods of induction, including natural herbs, castor oil, stripping the membranes, and the use of cervidil. If you deliver w/ a midwife at the hospital, I imagine you could have an epidural. It is the anesthesiologist who administers this, anyway, not the OB. Although most midwives will probably discuss w/ you the theory of the "cascade of interventions" that MAY occur w/ an epidural, as they are more natural in their approach from their philosophy.

I don't have any experience w/ your OB practice, but I do have a friend who had a natural/unmedicated birth at Sibley. She and her husband basically kicked all the staff out of the room except when medically necessary. She had trouble w/ one nurse who wasn't too gentle w/ the internal exams, as she was used to doing them on women who had had epidurals, but all in all I believe she really had a good experience there. Most folks I know who chose to birth w/o medication in the hospital also had a doula, to help serve as an advocate for mom's desires while the mom's partner was busy being the labor coach.

It's great that you are seeking out info! Being informed will help you feel great about whatever you decide, plus it shows what a great mom you will be.
Congrats!

[Anonymous]

Hi there! I'll try to answer some of your questions.

My questions is, can you have a "natural birth" and have an epidural at the same time?

There's no official definition of "natural birth," but I think typically it would not include an epidural. However, in my opinion (and I had a natural birth and am a huge fan of natural birth in general) -- what is more important is that you have an empowered birth. That is, you have researched the options and possibilities ahead of time and can make educated choices.

Now, I also hear that in DC we are not allowed to have babies with a midwife.

That's actually not true. There is a midwife-staffed birth center in DC (the Family Health and Birth Center) where you can choose to deliver at the birth center or at the hospital, as well as at least one other midwife who delivers at the hospital. There are also homebirth midwives in DC. You can find listings for all of these and more info at the Birth Options Alliance website: http://www.birthoptionsalliance.org/midwifery_dc_area.asp

The idea of the midwife is tempting me but at the same time it scares me, for example, if you are about to have a natural birth and then something goes wrong, can they do C-section if necessary? or do they have to rush to the hospital? Can they induce if needed? and again, can you get an epidural if you ask for one?

Midwives never do C-sections; they are not surgeons. If you need a C-section, a midwife will transfer you to an OBGYN to perform the surgery. If you are delivering in a hospital, one will be on call; if you are delivering outside a hospital, then you would need to be transferred to a hospital in order to have a C-section. (Typically a midwife will have a relationship with an OB practice for this purpose.) However, C-section rates are dramatically lower for patients of midwives, in large part because they tend to be more willing to let nature take its course and are specifically trained to support women in natural/vaginal childbirth, and also because they evaluate women throughout pregnancy and will "screen out" (i.e. transfer to an OBGYN) women whose pregnancies are showing signs that a C-section might be necessary.

Epidurals are available only in hospitals, because they are administered by anesthesiologists. You absolutely can deliver with a midwife in a hospital and also have an epidural (for example, this is an option at Midwifery Care Associates, who deliver at Shady Grove Hospital, and I believe also with the Family Health and Birth Center, where you have the option to birth at Washington Hospital Center).

The most common way to induce labor is to administer Pitocin by IV, and that only takes places in hospitals. Midwives in general are less likely to try to induce you, because, as I said, they tend to be more willing to let nature take its course. Note that being induced increases the odds of ending up with a C-section pretty dramatically. I am not 100% sure, but I am pretty sure that if you are planning a hospital birth with a midwife and it's determined you need to induce, you can stay under the midwife's care for the induction.

If you find the idea of a midwife intriguing, call one up -- they often have orientation sessions you can attend to learn more. If you have specific fears or concerns, by all means bring them up. For example, I was afraid of hemorrhaging, but when I asked my midwife about it, she explained the likelihood of that actually happening as well as the steps they would take if it did -- it was totally reassuring to me. And they are never offended by that type of question. That's one nice thing about midwives -- they tend to be very client-centered and will spend time getting to know you and talking to you and answering your questions.

One good option if you want to stick with an OB but avoid a C-section is to hire a doula. That increases your odds of a vaginal delivery pretty substantially... don't have the stats offhand.

I think it's great you are thinking about this stuff -- I agree with PP that this level of thoughtfulness is one sign you'll be a great mom. Congratulations! Feel free to post again if you have more questions; I'll try to check back in to see if I can be helpful.

(FWIW, I'm a random mom -- not a medical professional -- who had a natural childbirth in a birth center with a midwife, and for me it was a beautiful, empowering, life-changing experience. I think the most important contributing factor, though, was that I empowered myself ahead of time with knowledge and forethought -- so that I was an active participant in the experience, rather than experiencing it as something being done to/around me and feeling powerless and bewildered. No matter where you end up birthing, and with whom, I wish you the same!)

[Anonymous]

Congratulations on your pregnancy!

Trying to answer some of your questions:
~ A natural birth, to me, is a vaginal birth without any medical interventions. Some say a natural birth is one that is done without medication (epidural). Regardless, if you opt to have an induction, chances of having a med-free birth or birth without interventions is greatly reduced. It's a slippery slope, IMO, which can lead to a c-section.
~ You do not have to have a midwife to have a natural birth, many women have one with an OB. However, and this is just my experience, an OB is trained for the worst to happen and is more likely to turn to an intervention. My midwife was able to recommend non-medical advice in getting me through my labor and delivery.
~ As for having a c-section only f it's necessary...well, again, if you have an induction, your chances of having a c-section increases (especially as a first timer). And having an induction is something that is often suggested. My advice is to do your homework and decide early on under what conditions you would consent to an induction.
~ Yes, you can have a natural birth with an epidural, if you define it that way.
~ I don't know about midwives in DC. I know I had one in VA.If you have a midwife a
~ I had a midwife in the hospital. So I would've just been wheeled to the OR if complications arose and needed to have a c-section. My midwife would've assisted in the c-section (trained to do so). Also, my midwife is backed by OBs, I was able to meet that OB during my pregnancy. This was my experience in VA.
~ My midwife was able to do any of the things an OB could except for perform surgery (c-section). So I could've been induced. I could've had an epidural with them. I could've had other medical interventions if I'd wanted them.
~ I know nothing about Reiter and Hill. Sorry.
~ It won't hurt for you to visit other OBs and midwives. It's much easier to change doctors than it is to change a doctor's mind, IMO. So if you aren't of the same mind as your doctor, move on.

[Anonymous]

Thank you everybody for all this information!

Maria

[Anonymous]

I had been going to Reiter and Hill and ended up swtiching to a midwife. I did not find the doctors I met there to be at all supportive of natural childbirth.