Hospital Birth.

The vast majority of U.S. births occur in the hospital setting. Hospitals specialize in treating acute illness and injury, so they are an obvious choice for women who have underlying morbidities, pregnancy complications that require medical or surgical intervention, or who choose to have high-intervention births. A hospital delivery is also a good choice for women who elect to use pain medication or feel the most safe and relaxed knowing that surgical facilities are on the premises should the birth deviate from it's normal course.

A healthy woman with an uncomplicated pregnancy can optimize her chances of a normal, physiologic birth in the hospital setting by making certain considerations.

• Hire a doula. According to DONA International, a doula is a professional who is trained in childbirth and provides continuous support to a mother before, during, and just after birth. A Cochrane Review (July, 2013) concluded, "Continuous support in labour increased the chance of a spontaneous vaginal birth, had no harm, and women were more satisfied." See, more evidence for doulas. The American College of Obstetrician and Gynecologists (ACOG) released a Consensus Statement (March, 2014) in which they urge the use of doula's as a means of lowering the primary cesarean delivery rate. Doula's are also available for hire postpartum, to attend to and nurture the mother and her family in the weeks following the birth.

• Seek out the Midwives Model of Care. Certified Nurse Midwives (CNMs) are legal and licensed to practice in Alabama, however, much work needs to be done before they are readily available to deliver in area hospitals and receive insurance reimbursement by all plans. And remember, sometimes the best local providers of the Midwives Model of Care are OB-GYNs and Family Physicians! Visit ABC's regional Facebook groups on the Home page to get provider recommendations from local supporters.

• Compare local hospitals. A hospital's cesarean section rate and vaginal birth after cesarean (VBAC) rate can give you some idea as to the birth culture of the facility. Research on the geographic variation in the appropriate use of the cesarean section suggests that the surgery often has more to do with provider and facility characteristics than maternal health characteristics. Ask your health care provider for her individual rates because they may not reflect the facility. Exercise caution when interpreting rates derived by small numbers and from small populations. Some hospitals may have higher than average cesarean section rates because they primarily serve high-risk populations. Interview hospitals about any restrictive policies that could hinder normal birth. If you desire maximum support for early breastfeeding, the Baby-Friendly Hospital Initiative, a program launched by the World Health Organization, encourages and recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. Alabama currently has three certified Baby-friendly hospitals, Regional Medical Center in Anniston, East Alabama Medical Center in Opelika, and UAB in Birmingham.
  

• Educate yourself. On-line research is no substitute for years of rigorous professional training which is why it is so important to choose a licensed care provider that you trust. An empowered maternity care consumer equips herself with knowledge of evidence-based practice and discusses it with her care provider to gain new insights and apply it to her unique situation. For example, ACOG has made new recommendations for the Safe Prevention of the Primary Cesarean Delivery, including
  - Slow but progressive labor in the first stage of labor should not be an indication for cesarean.
  - Adverse neonatal outcomes have not been associated with the duration of the second stage of labor.
  - Induction of labor can increase the risk of cesarean.
  - An induction should only be considered “a failure” after 24 hours of oxytocin administration and ruptured membranes.
  - Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia (large baby) is not an indication for cesarean.
  - Continuous labor support, including support provided by doulas, is one of the most effective ways to decrease the cesarean rate.

• Join support groups. In addition to the Alabama Birth Coalition, your local chapter of the International Cesarean Awareness Network (ICAN) is an invaluable resource for first time mothers, mothers considering VBAC, information about family-centered cesarean, informed consent and refusal, and physical and emotional recovery from surgery. Mothers planning to breastfeed benefit enormously from the information and peer support found at local chapters of La Leche League International. And you need not wait until the birth. Pregnant mothers are welcome at meetings. Mothers planning unmedicated childbirth may wish to attend a class that specializes in alternative comfort techniques such as The Bradley Method, Lamaze International, or Hypnobirthing.

• Take care of yourself and your growing baby. Most importantly, safeguard your health. Ideally, you should prepare your body for pregnancy even before trying to become pregnant. Avoid smoking and using other substances that have been shown to be unsafe during pregnancy. Exercise regularly and eat twice as well, not necessarily twice as much. Take advantage of prenatal wellness classes such as yoga, aqua aerobics, and walking clubs. These groups contribute to physical and mental well-being as well as serving as support groups, sometimes continuing long after the birth.