In our latest book, Getting Ready for Baby, we recommend that pregnant women read Creating Your Birth Plan by Dr. Marsden Wagner.  Well, luckily enough for us, Dr. Marsden Wagner, author of Creating Your Birth Plan, has graciously given his time to answer a few of my questions on advice that he would give to pregnant women. 

Dr. Wagner is an independent consultant on maternity care and has been featured in US News and World Report, Health, Mother Jones, the New York Times, and the Los Angeles Times, as well as appearing on Dateline and Good Morning America.  He is a former director of Women’s and Children’s Health for the World Health Organization, and the author/editor of eight books including Creating Your Birth Plan: The Definitive Guide to a Safe and Empowering Birth.

Dr. Wagner’s personal story about how he has come to view a woman’s birth and the power that she has is found in his book.  He has given me permission to print the following excerpts:

The first time I was present at a natural, unmedicated birth a transformation took place near the end of the woman’s labor.  Her face began to glow and she shouted her feelings of determination to everyone within earshot.  She was going to do this! The moment she pushed the baby out of her body, she triumphantly yelled, “I did it!” Then she leaned over, took her newborn infant in her arms, and looked around the room proudly, wearing an angelic expression that would have put Michelangelo to shame.  It was awe inspiring. Every woman should feel as much pride and euphoria at her labor’s end.

As for me, at that moment my understanding of childbirth would never be the same.  Even with all my experience as a physician, it was surprising for me to see a woman give birth in her full power and autonomy: making strange sounds, moving however she wanted to make herself comfortable, and clearly demanding her needs be met—and having her birth attendants support all her choices.  It was unlike most hospital births.  I had been trained to take charge of birth and use my medical skills to make sure that women in labor wouldn’t be harmed, to arrange the risks with technology and action.  I had been trained to believe that I “delivered” a baby, even though healthy women push out their babies.  Before that day it never occurred to me that a healthy woman having a normal labor wouldn’t need my services, that there would be nothing to do— except give her room and stand by.  But on that day my medical approach was superfluous.  This event helped me understand that there needed to be a better balance of medicine and nature.

There is a biological as well as a psychological explanation for what I had just witnessed.  The birthing woman’s amazing transformation—her clarity of purpose and strength—was the result of the release of endorphins (naturally occurring hormones in the body that relieve pain and enhance the sense of overall well-being),  basically acting like an internal dose of morphine without any of the risks or side effects.  Athletes call the painkilling and euphoric effects of endorphins the “second wind” or “runner’s high.” It was the powerful sensations of childbirth itself that triggered her rush of endorphins.  Her pride of achievement was also based in knowing that she was a capable woman.  She had risen to the occasion, handled the physical challenges, and brought forth a new life.

More than four million American women give birth each year, with more than 95% of them in hospitals.  They choose hospitals for a variety of reasons having to do with the incorrect idea that hospitals can provide the safest births.  Although women sometimes choose to labor in hospitals because they have no access to a home-birth midwife, or because an insurance company mandates the decision, often it’s because they believe that a doctor can guarantee their safety in case of an emergency. While midwives oversee some hospital births, obstetricians and labour-and-delivery nurses manage the majority. Another reason women choose hospitals is to have access to strong pain medication—epidurals.

As a result of our reliance on hospitals and doctors, birth in America has come to be perceived as a medical event rather than a natural one—we literally view it through the eyes of doctors.  We spend twice as much as any other country in the world per birth, because medical technology and drugs are highly esteemed and widely available, and we want to purchase the best care.  Even in normal pregnancies, our rate for interventions, like electronic fetal monitoring, labor induction and augmentation, and cesarean section is skyrocketing. Nonetheless, many other countries get better results than we do using less technology and fewer medications.  What are the pregnant women and the maternity caregivers in those countries doing or not doing that would benefit you?

Creating Your Birth Plan will explore the standards of care in hospitals, out-of-hospital birth centers, and at-home births.  According to scientific evidence, do hospitals and doctors adhere to the best and safest practices? Do midwives adhere to the best and safest practices? Under what types of emergency conditions is it important to be under the care of an obstetrician? What factors are valuable for you to take into consideration before giving birth in a hospital is an independent birth center, or at home? What would a truly natural birth, one without any interventions and medications, be like?

As an expectant mother you need to be an active participant in your own care.  You need to know how to recognize excellent professional caregivers as well as how to protect yourself from the less-scrupulous type of practitioners who allow fear of litigation to influence their decision-making about childbirth and outweigh research studies.

As a physician and scientist, and a former director of Women’s and Children’s Health at the World Health Organization (WHO), I headed a team for fifteen years that gathered scientific data on different forms  of maternity care throughout the worlds’ industrialized nations. We investigated everything from labouring postures and whether or not a woman should eat, drink, and move around, to the efficacy of electronic fetal monitoring, ultrasound, intravenous drips, anesthesia, episiotomies, forceps and vacuum extraction, and cesarian section. Creating Your Birth Plan incorporates those findings.

In North America today, there is often profound misunderstanding and mistrust of the midwifery model of care that other highly industrialized countries worldwide embrace and find essential for the management of normal, healthy labor.  Statistics have shown that home birth and hospital birth managed by midwives tend to be safest for women and their babies, as well as most fulfilling.  Hopefully this book can help you understand midwives, so that you can carefully evaluate the services they provide based on facts, not myths.

Producing a healthy baby is a major goal of birth.  But a successful birth outcome involves so much more than mere survival.  We should not disregard the human impact of childbirth. Positive laboring experiences set women up to become good mothers and more confident people.  Some people climb mountains or run marathons to find out what they are capable of.  Giving birth presents a comparable opportunity for the woman who decides to become a mother.  It can reveal her to herself and transform her self-image.

My questions for Dr. Wagner wereasked specifically for pregnant women who need to know about birth plans, what they do and what they should consider when they write theirs.

Choose a midwife to be your primary birth attendant.  Choose a free-standing birth center for your birth or choose a home birth.