Gone is the stark delivery room and administration of heavy duty anesthetics. Parents now have more choices than ever as to the environment into which their babies will be born.

With the growing openness of medical staff to complementary and alternative therapies, now often called integrative medicine, moms-to-be are investigating and choosing new options for delivering their babies. In fact, so many parents elect nontraditional paths that "what used to be 'alternative' is now the norm," says Loma Ellis, nursing manager for California's Alameda Hospital Birthing Center. As a result, parents now have more birthing choices than ever before.

Giving Moms a Helping Hand

A doula, or birth assistant, is a professional woman hired privately by parents to attend their child's birth. A doula serves the role as support and coach for the laboring woman. The doula does not replace the role of partner; and, very importantly, is not a member of the health care team. She is present soley to attend the laboring mom. Usually highly trained in childbirth, doulas can serve as a stand-in when dad's not available. But doulas can be an asset for any mother; many parents hire doulas even if dad is present.

"The doula's a safety net," says Sandi Miller, RN, CD, owner of Before Birth and Beyond in San Jose, CA. "Whatever happens, whether it's a cesarean or whatever, the parents know what's going on and the doula is watching out for them."

Miller, a certified member of Doulas of North America (DONA), says that a doula's main purpose "is the continuity of someone who is not only trained and experienced, but is there for you and has no other agenda."

Although doctors may not have worked with a birth assistant before, most doulas accompany moms to a prenatal visit in order to meet the doctor before the big day. Once the doctor knows the doula is there for support and not to replace or interfere with the medical staff, he or she is likely to welcome this additional member of the team.

Studies Support Doulas' Role

Studies also show that doulas—whose services start at $100 on average for a doula-in-training and can go as high as $1000 or more—have positive medical effects on both mother and baby. A study published in the British Medical Journal suggested that doulas result in fewer cesareans and shorter labors for mothers, and a lower admission rate to neonatal intensive care for infants.

A review published in 2000 indicated that continuous support by a doula reduces anxiety, shortens labor, decreases the need for cesarean deliveries and other forms of assisted birth, and reduces rates of postpartum depression.

The Wetter, the Better

Water can smooth away aches, drain off tension, and float us to a state of bliss. It's no surprise, then, that moms who labor and/or deliver their babies in a birthing pool experience less pain and greater relaxation. According to the Israeli medical journal Harefuah, waterbirthing moms are more relaxed and comfortable; water immersion may also speed the dilation of the cervix, leading to a shorter labor.

These benefits may be passed on to the infant as well:

  • Less discomfort—"If mom is having a positive, easy birth, it makes it positive and easy for the baby," says Barbara Harper, RN, director of Oregon-based Waterbirth International and the author of Gentle Birth Choices. When the mother is relaxed, says Harper, the child spends less time in the birth canal and undergoes minimal discomfort.
  • Less trauma—Proponents of waterbirths also believe the method is less traumatic for babies. "Babies seem to be very relaxed. They open their eyes and focus on people," says Beah Haber, CNM, of The Birth Home in Pleasanton, California, who has attended approximately 200 waterbirths. However, there is no scientific evidence to document this opinion.
  • Smoother transition—The easier transition is partly a response to the relaxed state of the mother, and partly due to water's insulating effects, according to Harper. "The baby has hearing even in utero , but it's muffled and muted…the same way it is underwater," she says. Underwater, the baby is protected from harsh lights, sounds, and even touch, and thus is more relaxed and comfortable. Again, however, scientific evidence is lacking.

Caution Regarding Waterbirthing

Despite the rising interest in water birthing, the American Congress of Obstetricians and Gynecologists (ACOG) has not been so quick to endorse this practice. ACOG does not feel there is enough information, specifically concerning rates of infection, to recommend warm water immersion as a safe and appropriate birthing alternative. There are concerns that a baby can develop an infection if he or she begins breathing while underwater and inhales the soiled birthing water.

"However," explains Marion McCartney, certified nurse midwife and director of professional services for the American College of Nurse Midwives, "most research has found that healthy babies do not gasp upon delivery, rather they do not take a breath until they are removed from the water and reach the air."

Although these studies have been quite small, evidence from larger studies involving almost 2000 women suggests that, in fact, water birth does not increase rate of infection, and may reduce duration of labor and need for pain control. Nonetheless, ACOG maintains that water birthing should only be performed under the strictest measures of infection control. And all experts agree that water birthing is only a consideration for healthy moms and babies.

Pain, Pain, Go Away

The bad news is, labor will probably hurt. The good news is, there are many nonpharmaceutical options when it comes to managing the discomfort.

Relaxation Techniques

The first step to pain management is relaxation. The tenser you are, the higher the sensation of pain.

"Get the woman to relax and her perception of pain goes way down," says doula Miller.

Relaxation starts with the environment. Even in the hospital, you can dim the lights, play soft music, light candles, or use aromatherapy to create a safe feeling. The Birth Home's Haber says that lavender and sage are especially soothing scents. Other relaxation techniques include massage, showers, and baths.

The mind is one of the most effective pain-fighting tools available. Hypnotism, visualization, and imagery are all methods moms have used for pain relief, and there is some scientific support for their use.

"The psychology involved in birth is pivotal," says Miller, who says relaxation tapes are also effective.

Alternative Remedies

Acupuncture has shown some promise for reducing pain in labor, but the quality of most of the supporting evidence is relatively poor.

Although red raspberry is an herb traditionally used during pregnancy and labor, a double-blind, placebo-controlled trial evaluating the effects of red raspberry in 192 pregnant women failed to find benefit.

The herb blue cohosh is sometimes recommended by midwives, but it is a toxic herb and should not be used.

Have It Your Way

When planning your baby's birth, investigate the options and be realistic about your personality and desires. Work with your doctor or midwife early on, and check policies of the hospital or birthing center you've selected (for instance, some may allow only family members in the delivery room; others might have policies against candles or other open flames). And be flexible; even the best laid plans can go awry. After all, babies have their own ideas about the way things should turn out!