Guest blogger, Maura Winkler, CNM and owner of Fika Midwifery in Buffalo NY, shares her top five tips for physiologic birth.

Midwives are experts in supporting the normal physiology of labor and birth. Unfortunately, many years of routines and policies not based on evidence have disrupted the physiologic process of labor, particularly in the hospital environment. Every healthy mother and baby has a right to experience the full extent of physiologic labor that is possible for them in any birth location (home, birth center, or hospital) with any provider (physician or midwife). 

Here’s the top five things to discuss with your care provider prior to labor as well as ask for when you arrive at your birth location:

1.) Delay hospital admission until active labor.

Particularly for first time mothers, the latent (early) phase of labor is highly unpredictable. It can often be long, start and stop for hours or days, and has no bearing on how long active labor will be. First time parents should follow the 3-1-1 rule for deciding when to go to the birth location: contractions 3 minutes apart, 1 minute long, for at least 1 hour. While a cervical exam may not always be necessary, in general active labor for first time mothers is defined as > 6cm dilation. If contractions space out when you get there, go home! Just because you have arrived doesn’t mean you have to stay if active labor has not begun and everything else is normal.  

2.) Eat and drink regularly throughout all phases of labor.

The practice of restricting food and fluid during labor is not evidence based. Plenty of studies have suggested that intake of oral fluids and nutrition is important for maintaining energy throughout the labor process, even with an epidural. The concern about eating and drinking during labor is that a woman could aspirate (inhale) stomach contents into the lungs under general anesthesia. However, general anesthesia is only used during 1% of cesarean sections, and the risk of aspiration is much less, so the benefits of eating and drinking far exceed the risks.

3.) Request intermittent auscultation of your baby’s heartbeat.

Despite the fact that continuous fetal monitoring is standard at most hospitals, ACOG (American College of Obstetricians-Gynecologists), ACNM (American College of Nurse Midwives), AWHONN (Association of Women’s Health, Obstetric, and Neonatal Nursing), and WHO (World Health Organization) all recommend intermittent auscultation for low risk, healthy women. While it may not be possible with interventions like pitocin or an epidural, intermittent auscultation should be a standard of care for healthy women and babies and is well supported by evidence. For low risk women, continuous fetal monitoring has been found to increase the cesarean rate without any improvement in outcomes for babies.

4.) Keep moving--and consider moving into the water if it’s an option.

Labor isn’t meant to be done in a bed! Moving throughout labor helps the pregnant person to cope with the intensity of contractions and assists the baby in navigating the pelvis. Availability of showers and tubs for hydrotherapy can be immensely helpful for pain management, and the tub can help women assume positions that may be otherwise uncomfortable on land. Changing positions during the pushing stage of labor is also particularly important, and when women are left to choose a position for labor and birth, they almost never choose their backs!

5.) Hire a doula.

In our practice, we highly recommend all women planning their first vaginal birth (either first time parents or women planning vaginal birth after cesarean) hire a doula. A doula is the only individual in the room solely concerned with the family’s emotional well being and experience, and, as a result, can help families to navigate the various decisions they will face over the course of labor & birth. 

At our practice, Fika Midwifery, we use all of the aforementioned tools to support physiologic birth in the community setting (birth in your own home or at our birth home, the Coit House). However, we recognize that planning birth outside of the hospital may not be for everyone and enjoy spreading the word about how women can advocate for physiologic hospital birth. For any family considering midwifery care in the out of hospital setting, we offer complimentary consultations to answer questions about the benefits and risks of community versus hospital based care and insurance coverage of home birth. 

For more information about planning a positive birth experience, check out pages 3-7 of World Health Organization’s “Recommendations for Intrapartum Care for a Positive Childbirth Experience.”

Author Maura Winkler, CNM is a nurse midwife, lactation consultant, former doula, mother of two, and owner of Fika Midwifery, Buffalo’s only independent midwifery practice.