How to have a natural birth in a hospital

I asked my friend, Rachel, who blogs at The Beginning of Motherhood, to share some thoughts about how to achieve a natural birth in a hospital setting. Rachel has a lot of experience with this, as she has had five children naturally and works as a nurse in Labor and Delivery. Thank you so much for sharing your wonderful tips!

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I have seen all sorts of births and all sorts of birth plans. I have seen women do fabulous going natural on pitocin, laying in bed, and in all sorts of other situations. I have also seen some women who have been doing great soaking in a tub, but ask for an epidural. I have seen some who I would have thought regretted not getting an epidural, but when asked, said they appreciated the experience. Any way it happens, a natural birth(going without pain medication) is something that you need to have a reason for wanting. To me, that has been the key ingredient. Also, your desire may change further down the road through labor, and that's OK. So, I would say the first step in having a natural birth in the hospital, is to decide if you really want to and why. These are not questions that anyone can really give you an answer too, but yourself, but I'll attempt to start you on your path.

First off, you can do a natural birth. Women have been doing them forever. So the real question is do you want to. The main reason for getting an epidural is the obvious: pain relief. Labor is hard work, and can be very painful. But, pain tolerance is not really an indicator of whether or not you will want an epidural. What you need to decide is if your reason for wanting one is greater than your reason for not wanting one. A few case examples. Many women are afraid of the needle in an epidural, or the pain of the epidural itself. I have had one woman tell me that when her contractions are so intense that she no longer is afraid of the needle then she gets the epidural. She always gets them. Therefore, for her, the labor is worse than the epidural. On the other hand, another woman I took care of felt like her fear of the epidural was greater than her fear of labor. Therefore, she always went natural. Some other factors to think about when it comes to reasons for/against getting epidurals: 1)you ability to move is greatly reduced when you have an epidural. Once you have one you are in bed, with a tube to drain your urine, and the nurses have to help with movement of the legs. This may be OK with you, and may be worth it, but again, it's just something to think about. Many people are worried about drugs being introduced. From what I have researched, the drugs given in epidurals will not cross into your babies body, but it does effect immediate breastfeeding(though not long term). It does tend to slow down labor, and there is an increased use of forceps or vacuums with them. For those who are experiencing exhaustion or can not relax, though, it may be useful. These are just some of the factors involved, and I would suggest thoroughly researching them.

So onto how to work through a natural labor in the hospital.

Request a hep-lock(where the iv is in you, but not connected to any tubing), or no iv at all if you feel comfortable with that. If you are not receiving iv fluids, make sure you are eating and drinking. If your hospital only allows ice chips, eat as many ice chips as possible and add sugar:) I would even bring some Gatorade pre frozen just for you to suck on. As long as it's ice, it fits in the policy. Some research I have read suggests that a woman needs at least 125-250 ml of water and hour. That's 1L of fluids every 4-8 hours. If you have to have an iv, you are still capable of moving. Request that you have an iv pole for the fluids to hang on so that you can walk around with it. If you do have any fluids running in, keep in mind that you can also get too much. Especially if you are on pitocin as that tends to increase water retention. One bag of iv fluid equals a liter, so keep that in mind when gaging how much you are drinking. Make sure you are going to the bathroom often, at least every one or two hours. An empty bladder will facilitate labor. Sitting on the toilet is also a comfortable position:) An iv pole can actually be very useful to hold onto during contractions. When you are feeling weaker, but still want to stand, an iv pole makes a good brace to pull down on. It is also useful during pushing. If you are wanting to squat, the pole can be used to hold onto.

Request intermittent monitoring. Keep in mind that this may only be possible if the nurses aren't busy, and your babies heart rate is looking OK. Intermittent monitoring has been shown to be safe and effective in monitoring the heart beat of the baby. ACOG guidelines suggest listening to the babies heart beat every 15-30 m while in active labor. This also needs to be done during a contraction and immediately after. This allows the nurse to check the heart rate while you are in different positions or different places. If you have to be connected to the monitors, you can still sit up and move around. You can stand, squat and walk. The difficulty in this comes from making sure that the heart rate stays on the monitor. It is helpful to have someone hold it on tighter during contractions, while sitting up, or squatting. Anyone can do this, it doesn't have to be a nurse. If you notice that the babies heart rate isn't picking up at different times during your labor, try having someone hand hold it. While I normally, don't like internal monitors, for someone who is going natural and having to be on the monitor, they can be useful. With internal monitors, the babies heart rate is picked up much easier and movement is not restricted as much. This would be something that I personally would like at on a case by case basis, and only if the mothers bag of water is already broken.

Which leads me to the bag of water. I would suggest not getting it broken as a matter of policy. Research shows that it does tend to decrease labor time, but only by about 20m. Once your water is broken, contractions tend to be stronger and harder. If you want to shave off time in labor, I would suggest having your water broken during transition or after(around8-10cm). At this point, your labor is already pretty intense, and shaving off time at this point is usually very welcomed. This really is just my opinion. Also, once the water is broken, it allows for germs to be introduced. So often the water is just broken, without a thought as to the individuals preference. Just make sure you at least think about it.

The bed in the hospital can actually be very useful. There are a lot of different positions that it can help you obtain. If you want to kneel, you can kneel over the top, bring the bottom down and kneel on that, or just be on your hands and knees on something soft. During pushing, you can bring the head all the way up and the feet all the way down to simulate a squat or birthing chair. I would play around with it and see how you might find it the most useful. It is also useful to use to kneel on, or put a birthing ball on and lean on.

Water....this has been shown to be one of the most effective pain relief measures for those who are going natural. If you find yourself getting tired, afraid you can't go on, or just needing to try something different, try a hot bath. Some hospitals do not allow this. If this is the case, bring a heating pad that you can use to sit on on the birthing ball, use with counter pressure, or just relax muscles and tension.

If you need to have pitocin, don't sell your selves short and feel like it's impossible to have a natural birht. I have seen many women do fantastic with pitocin. Some key things to remember...you can do it. You have to have a reason for wanting to do it, but it's OK if you don't want to. Ask your provider if you can do low dose pitocin. This will add the pitocin more gradually. You can also request that your pitocin be turned off once you have reached active labor. At this point, your body will sometimes take over and you will no longer need pitocin.

For some it is useful to try not to think about the contractions in terms of pain, but just intensity. If you prefer this, make sure you ask your nurse not to ask you your what level your pain is at. But let her know whether or not it is getting more intense. This is an important indicator of how your labor is progressing and how well a woman is coping.

One last point, when you first arrive at the hospital there is a whole admittance procedure. If you are not in too much pain, it's not that big of a deal. But if you are having to work hard through contractions, appoint someone else to answer the questions that are needed.