Choices During Childbirth

Many are noticing a trend toward more patient-centered birth experiences focused on the mom’s options, values and preferences

Christy Tolar and her husband Stephen paced past the fish, seahorses and sharks at the Oklahoma Aquarium. The theory that walking can induce labor proved true for Tolar. She woke the next morning, May 16, 2004, and after years of struggling with infertility, she knew it was time to meet their daughter.

“I’m trying to figure out how to get from the sofa to the bathroom without messing up the new carpet,” Tolar recalls with a chuckle. “I take about three leaps and scream at my husband and say, ‘Give the doctor a call; my water broke.’”

Tolar can recount many delicate details from that day and the day her son was born a few years later. The two birth experiences were vastly different—“an easy labor and recovery” with one, and a C-section that was “a very scary experience” with the other—but, there’s one striking similarity: “I had several moments where I just didn’t feel in the know and felt uncomfortable,” Tolar said.

“It’s empowering to know that you have choices, and I didn’t know that I had any choices. All I knew is that women had been giving birth for centuries, and it was supposed to be something easy for your body to do, but my body had already let me down with the whole creating children, so I didn’t have a lot of faith in it.”

Missy David, a mother, writer, educator, and certified birth doula with Tulsa Family Doulas, said one of her goals as a doula is to make sure patients know they have options.

“For me, it’s all about knowing who you are, what you want, what’s going to make you happy, what’s right for you—knowing that you have options,” David said. “It’s not about epidural or not epidural, but did you have a good experience, do you feel empowered going into motherhood?”

David has been a doula since 2007 and has been part of about 55 births. She said she is seeing a shift toward more patient-centered care for expectant parents.

“There’s been patient-centered care before, even since the ‘70s, but I think what that means or how people would interpret that is starting to look a little bit different,” David said.

The Institute of Medicine defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

“In 2007 when I started, there were some things like skin-to-skin contact with your baby or rooming in with your baby versus going to the nursery, even IV fluids or intermittent fetal monitoring, those were things that you may have had to ‘quote’ put up a fight for a little bit more… where as now, that’s more and more routine,” David said.

Also becoming more routine, according to David, are things such as delayed cord clamping, the expectation by nurses that laboring moms have a birth plan and asking for it. Labor and delivery floors are also showing more general acceptance of patients’ personal desires such as using essential oils and supplements.

“I think the medical community is saying, ‘okay, I can’t necessarily take away all the medical interventions, but what are other things that I can do to help you feel good, respected, cared for, informed, connected to the people you care about?’” David said.

David isn’t the only one noticing changes to the childbirth experience. Catherine Drummond, Hillcrest Medical Center’s prenatal education coordinator and a Lamaze childbirth educator for nearly 26 years, said she’s seen patient-centered births “come back full circle.”

“I had that myself, 20/25 years ago,” Drummond said. “Our technology is such these days that we are at risk for losing the natural, the normal, the family-centered. We don’t want to lose that touch.”

Drummond believes that birth needs to be treated like a normal, natural process, not like an illness that needs to be fixed.

“If you have a mom who’s low risk and we don’t have any factors causing us extra concern, I think the most vital part would be that psychological, that emotional support,” Drummond said. “She needs to feel safe. She needs to feel supported to do what feels natural to her.”

First-time mom Amanda Hahn wanted “a little more support than a routine hospital birth,” when she had her son in May. Hahn worked with a doula and said it felt like having a “personal advocate” who was focused on her while nurses were focused on her baby.

“It’s funny,” Hahn said, “birth is happening to you, but you still don’t really know what’s going on necessarily, so the doula just helped us know where we were in the process and what was going on and what to expect.”

The desire for additional encouragement and support—outside of medical staff and family—seems to be on the rise. Listening to Mothers II, a 2007 Report of the Second National U.S. Survey of Women’s Childbearing Experiences, reported that 3 percent of women said they used a doula during childbirth. However, the Listening to Mothers III survey published in 2013 reported 6 percent of women using a doula.

Doulas are one way for mothers and families to feel supported through childbirth, but Tulsa-area hospitals have also made changes to provide patient-centered experiences.

Hillcrest offers a Labor of Love program, a free perk for expectant mothers regardless of insurance, birth plan or provider. The program includes complimentary classes (childbirth education, breastfeeding, prenatal and postnatal yoga, Boot Camp for New Dads, Dancing for Birth, and more), a free nightly snack cart, and other hotel-like gifts.

Oklahoma State University Medical Center opened a newly renovated maternity facility in the spring. The hospital now has 13 larger rooms where mothers and babies are cared for during all phases of the birth experience, instead of being moved from room to room.

Saint Francis Hospital has an OB hospitalist program “to help provide an extra layer of safety for mothers and babies,” said Shannon Filosa, executive director of Women’s and Children’s services at Saint Francis. “This is a team of board-certified OB/GYN physicians who are on-site 24/7 to manage emergency deliveries and provide support to patients until their regular OB/GYN arrives at the hospital.”

St. John Medical Center also has an OB hospitalist program.

Filosa said there is also a “nationwide focus on providing a more ‘baby friendly’ hospital environment. This initiative is designed to keep infants in the mother’s room, instead of the nursery, as much as possible. The goal is to facilitate bonding, to help parents recognize their babies’ feeding cues, to allow parents a safe and supportive environment to get to know their newborn during those first couple of days after birth.”

Christy Tolar acknowledges that a lot has changed since she first gave birth for the first time nearly 12 years ago.

“I think things have changed a great deal, and I think that they are going in a better direction where it is more about the mother and her experience and not about, we’ve got a job to do, let’s do it.”

However, if she could go back in time, she may have handled her birth experiences differently. Her advice for expectant parents: “Advocate for yourself, and follow your gut. If something doesn’t feel right, or if you feel like you need more information, love yourself enough to get it. Be bold.”

Do’s and Don’ts on taking charge of your birth experience

Do educate yourself.

“I would first of all say educate yourself,” said Catherine Drummond, Hillcrest Medical Center’s prenatal education coordinator. “That means reading, that means coming to class, that means asking questions of your care provider and your educators and really learning the process—what’s a normal process of birth, what are some choices I’m going to have? Educate yourself on the pros and cons of those choices, including medication.”

Do consider creating a birth plan.

“A generalized birth plan is a valuable tool to have in place prior to delivery,” said Shannon Filosa, executive director of Women’s and Children’s services at Saint Francis Hospital. “It helps expectant parents prepare for the birthing process and can provide valuable information to the hospital staff so they know what is important to the mother.”

Do keep your birth plan simple (if you have one).  Don’t expect to follow every detail of your birth plan.

“I think the biggest thing that I try to get across to people is it’s not about the stuff on a birth plan,” said Missy David, certified birth doula with Tulsa Family Doulas. “You can get everything on your birth plan that you requested and still walk away feeling disappointed. The birth plan is there to create the kind of birth that you’re going to feel good about, that you’re not going to regret, that you’re going to think fondly of for years to come.”

Do talk to your doctor ahead of time.

Discuss your birth plan. Ask questions. Share fears and expectations. “If there are things that are really, really important to you that you know are contrary to typical hospital procedure or your doctor’s typical protocol, talk about it,” David said. “And if you don’t know, ask.”

Don’t be afraid to share your preferences.

“Communicate, and don’t be afraid to say what you’d like and dislike,” Drummond said. “We get intimidated in a hospital. The doctors are important, and they know so much, and so we’re very vulnerable if we haven’t prepared ourselves.”