As Rachel Levins of Charleston, SC, prepared to have her first child back in 2000, she recalls reminiscing with her parents about their experiences having her and her older siblings back in the late 1960s and early ’70s. “As we were all hanging out in my hospital room waiting for my labor to progress, my dad mentioned how when my siblings were born, the only times he was even acknowledged at the Florida hospital where they were born was when he was asked to pay the bill — before the baby was born, mind you — and to come in after the baby had been delivered,” Rachel shares. “And my mom talked about how when my older brother and sister were born, who are 7 and 5 years older than me, she just went to sleep and woke up with a baby. But five years later, when I was born, she stayed awake to have me, which shows there were trends and changes in childbirth methods even back then.”
At the beginning of the 20th century, childbirth was still largely an at-home experience, with only about half of women having a physician tend to them through the process. Eventually, hospitals began marketing to women, enticing them with the idea of pain-free childbirth thanks to the introduction of “twilight sleep,” a light dose of anesthesia that ensured they not only didn’t feel the pain, but that they didn’t remember the birthing experience either.
Today, women are taking charge of their childbirth experiences more than ever before — some still perhaps viewing a hospital stay as a little calm before the storm of going home with a newborn, while others are happy to either give birth at home or return home as shortly after childbirth as they can.
Jennifer Colburn, a Nashville mom of six, is the latter. She has been a champion of natural childbirth since she had her first baby more than a decade ago. She set out to do it her way as much as she possibly could. “Natural childbirth is what I wanted,” she says. “And I didn’t want to have to fight to get what I wanted.” She and her husband Todd just welcomed their sixth child on Christmas Eve morning; they had their daughter at a private birthing center called Baby+Company, and all were home by that evening starting life as a family of eight.
The freedom to choose your experience hasn’t always been the way children were brought into the world. In fact, laboring moms just a few decades ago weren’t even awake when their children were born, as Rachel’s mother pointed out, much less did they have family members in the room or could they get out of the hospital bed. But childbirth, and the parameters that traditionally go with it, have evolved. Today, as long as the mother and baby are safe, family members are allowed to not only watch, but they can participate in the birthing process. In some cases, the mom is even allowed to reach down and actually deliver her own baby.
“We are seeing a general shift in that the women having babies are wanting to be more active participants in their care,” says Sharon Norman, M.D., with WOMEN Obstetrics and Gynecology in Nashville. “We are asking women now about how ideally they want their birthing experience to go. Five to 10 years ago that wouldn’t have been asked.”
Jennifer has used certified nurse midwives with all of her births, because of their focus on letting nature take its course, versus medical intervention. “I wanted a venue where we were all on the same page,” says Jennifer of her experience at Baby+Company, which has locations in North Carolina, Tennessee and Colorado. “I was able to get whatever I needed for pain management. I could walk around, get in the shower or soak in the tub. If I had had the constraints of my mom’s generation, I would have had to have been flat in the bed the whole time. I couldn’t have done that.”
Dr. Norman says that there are some expectant moms whose risk profile will require the medical team to recommend what will be safest for mom and baby, but even in that scenario there will be some very family-centered options.
Donna Crowe, M.D., also with WOMEN Obstetrics and Gynecology, adds that when she was being trained in the ’90s, childbirth was very interventional as far as managing pregnancy and labor. “When I was doing my residency, it was very much about how can we speed this up?” she says. “That’s what was encouraged. We were always open to patients wanting to go naturally, but our training wasn’t about that.”
“Things have changed quite a bit,” adds Dr. Norman, explaining that even as few as five years ago it was a pretty rare occurrence when a woman came in asking to deliver without any anesthesia or intervention. But she’s seen a big shift in that mentality. “Patients want to discuss their goals and how they would like to see this happen. Some patients just want a safe delivery, but some have a very organized plan of how they want the process to go.”
Jennifer says she remembers her mom talking about how back in the day, husbands weren’t even allowed in the room during childbirth. “You had to ask permission for things even though it’s your body and your birthing process,” she recalls. “You were at the mercy of what they wanted to let you do. Now, they asked me who I wanted in the room, and I got to make that decision. Our 9-year-old daughter actually got to be involved in this birth.”
That shift in the mentality of the patient has driven a shift on the physician side as well. With laboring moms today asking to use essential oils, music, lighting, have family members present for and involved in the birth, as well as acupuncturists, physical therapists, midwives and doulas, the physicians have had to rethink how they’d originally been taught.
“Now childbirth is much more patient-centered,” Dr. Crowe says. “We have learned to collaborate so that the process is much more team oriented. Fifteen years ago, as physicians, we never would have considered a midwifery program at our practice, but there are a lot of women who prefer that model, which is a bit different, so we decided we can support a model where the midwife can spend more time with the patient.”
Kayleigh Holthaus, a Certified Nurse Midwife with the WOMEN Obstetrics and Gynecology practice, says midwives offer longer appointment times by design so they can spend more time with an expectant mom than a physician typically could. Midwives are specialists in normal, low-risk pregnancies.
“We like to give our patients information and let them choose what they want,” Kayleigh says. “We call it informed empowerment. We are with them during delivery as well.”
Physicians today are even working to make a higher-risk pregnancy feel customized by allowing some of these extra conveniences with a C-section, which is major surgery. “Over the past few years, the concept of a family-centered Caesarian birth has evolved,” Dr. Norman says. “In that situation, the birth partner can be in the operating room with the mom, and we use a drape with a plastic window so the patient can see the emergence of their baby if they want to. We can do delayed cord clamping and proceed to skin-to-skin contact as soon as we know the baby doesn’t need any intervention.”
She says this movement takes a surgical procedure, which traditionally felt very sterile and not very personal, and makes it as family-centered as it can be without compromising the sterility and safety of the procedure.
And that’s precisely what modern moms are seeking. Gone are the days of women going along with doing what they’re told. They want a personalized childbirth experience that meets their family’s wishes and needs, and an opportunity to create a magical, life-changing delivery. Yes, indeed, we’ve come a long way, baby!
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