Trending in the Delivery Room: Mothers' Methods for Making Their Birth Plan

Brooklyn Brewer Tanner
Utah Valley University

Submitted to Rongxun Liang, Ph.D.
Summer 2018


Abstract
This paper explores the research that has been completed about the potential risks and benefits of natural and medicated childbirth. In depth, the research is examined that has been performed about epidural use and natural birthing in order to determine the overall safety of each method. Considering the variety of choices a woman has in planning her birth, the paper will also evaluate the effect of internet information on expectant mothers' birth plan choices. It is found that internet searches involving pain management during birth have risen significantly in recent years, demonstrating women's dependence on the internet for reputable information. The role of a mother in giving birth to her child can be helped or hurt by the information found online.
Key Words
Birth, Birth Centers, Childbirth, Doulas, Epidural, Homebirth, Internet, Medicine, Midwifery, Millennials, Mothers, Natural Childbirth, Obstetrics, Pain Relief, Pregnancy, Social Media.
Introduction
The common, yet miraculous occurrence of birth is experienced by the majority of women at least once in their lifetime. That first pregnancy spurs a myriad of feeling to the inexperienced mother including excitement, fear, happiness, confusion, and determination. Among the many choices a woman will make during her pregnancy is the consideration of natural birth and medicated birth. In most low-risk pregnancies, women have the option of bearing their child naturally, or without medicinal pain relief, whether it be in a hospital, birthing center, or home. They also are commonly offered an epidural to numb the pain of childbirth when delivering in a hospital. Now that information on the internet has been widely available for two decades, women have an enormous pot of information, research, opinions, and experiences from which to draw considerations as they make their decision. This topic is particularly pertinent to the rising generation of mothers, who have more access to a variety of internet resources than any generation of mothers before. The topic of internet-influenced birth planning has been chosen in order to assist the modern mother in navigating the risks and benefits of natural and medicated birth methods.
Purpose
The purpose of this paper is to explore the research that has been completed about the potential risks of natural and medicated childbirth. The paper will also evaluate the effect of internet information on expectant mother's birth plan choices. When women can receive unbiased, true information regarding pregnancy and birth, they are better able to make sound decisions for their health and the safety of their infant. This paper strives to provide that reliable information to expectant mothers.
Definition of Concepts
Mentioned in this paper are many medical, pregnancy, and labor and delivery terms.
Caesarean Section: commonly known as C-section, the surgical delivery of an infant through an abdominal incision
Doula: a non-medical personnel that coaches and assists women in giving birth by giving suggestions for positioning, providing encouragement, and giving massages.
Epidural: anesthetic used mainly in childbirth to reduce sensation below the waist.
Natural Childbirth: the birth of an infant without any type of medicinal substance assistance. May also refer to birth taking place in the home or in a birthing center.
Medicated Birth: the birth of an infant that is assisted by one or more medicinal substances, such as an epidural anesthetic, Pitocin, narcotics, or instrumental/surgical assistance such as forceps, vacuum extraction, or C-section. 
Research Questions and Hypotheses
What are the benefits and drawbacks of a natural childbirth? What are the benefits and drawbacks of an epidural-assisted childbirth? What influence does the internet have on an American woman's choice to receive an epidural or strive for a natural childbirth?
It is predicted that the research will suggest potentially adverse side effects of a medicated birth, but further danger in natural birthing. It is predicted that in the United States, mothers receive most of their medical information from the internet, most of it non-credible, which can inhibit their ability to make sound birthing decisions.
Literature Review
Plenty of research has been conducted around pain relief during childbirth. However, most of the research has been done in the medical field, considering the scientific nature of medicine. The homeopathic and natural community is not as abundant in research or research methods around natural childbirth. However, there are a few published studies available focusing on the social science of women's birth experiences. The data sources used in this paper come mainly from articles in medical journals published after the year 2000. In an attempt to provide information that is as accurate and current as possible, this paper uses almost exclusively peer-reviewed research and data.
The research published in medical journals has generally been well-documented with legitimate research methods. Medical case studies are thorough in disclosing the details of possible side effects in the use of an epidural, even rare occurrences. The information published about natural childbirth occasionally has a biased tone, sometimes disregarding previously proven medical research. However, the research is clear in explaining the need for trained and competent professionals to be present at any birth to avoid fatal complications. It would be beneficial to see more research on childbirth and pain management conducted in the United States. Finding studies, especially those involving the personal experiences of women, concerning American families requires some elongated searching.
Natural Childbirth: The Benefits
What is now defined as "natural" childbirth has been the method of delivery for women for centuries. Many women, mostly in the holistic, alternative, and natural care community profess strongly of the benefits of a natural childbirth. Many mothers enjoy the freedom of movement that comes with not being tied to a hospital bed by IV or epidural. It is believed that for the mother to be able to move around and choose a position that feels right to her, labor is more effective (Howland, 2017). Some naturally-minded mothers feel that naturally birthing their child will give them a sense of accomplishment, or badge of true motherhood. By enduring the pain of childbirth, they feel committed and connected to their baby (Lothian, 2000). In a natural childbirth occurring at home or a birthing center, mothers find comfort in avoiding the pressure for medical intervention. Having a baby in the comfort of their own home accompanied by a midwife and doula is appealing.
Along with benefits during labor, benefits are reported for mother and baby after birth as well. Mothers are generally able to recover more quickly after a natural childbirth, which is mostly attributed to the less frequent occurrence of episiotomy and tearing (Panazzolo & Mohammed 2011). Howland (2017) claims that without the use of drugs in delivery, babies are born more alert, and without the lethargy, they are better able to quickly cultivate an effective breastfeeding habit. It is also believed that pursuit of natural childbirth lessens the chance for the need of a Caesarean section. When the infant passes through the vaginal canal, essential bacteria are picked up that help in the development of baby's immune system (Howland, 2017). The report of these benefits is found on multiple platforms online, including in articles, blogs, videos, and lifestyle and pregnancy websites. Many mothers are drawn to natural childbirth by these benefits the testimonials promise.
Natural Childbirth: The Drawbacks
The main drawback associated with natural childbirth, and the reason nearly 90% of births are medicated, is the immense pain associated with childbirth (Lothian, 2000). Compared to other mammals, the head-to-birth canal ratio is jarring in humans. The average head of a baby is actually larger than the dilated birth canal, requiring the cervix and vagina to stretch painfully to allow for passage of the baby (Shipman, 2014). The fear of or realization of this pain can drive most women to demand the assistance of an epidural.
While the benefits of a natural childbirth, especially at home, seem attractive, women must technically fit a certain criterion to qualify. Due to the enormous progress in mother and baby mortality, there are many measures in place in medical settings to save a mother and /or baby if something is to go wrong. Panazzolo and Mohammed (2011) in analyzing natural childbirth noted, "Although this option can seem to be the optimal choice, women seeking natural births must be healthy, low-risk women without serious medical conditions such as diabetes and high blood pressure." Properly and improperly attended home births have a much higher mortality rate than those attended to in a hospital or birth center (Grünebaum, McCullough, Arabin, Brent, Levene, & Chervenak, 2016).
Childbirth with Epidural: The Benefits
The modern epidural is a remarkable feat of analgesia (pain relief). A woman is able to have a thin, cord-like tube inserted into her back with a needle that will pump appropriate amounts of medication to the lower half of her body on demand. The analgesia provides pain relief, instead of anesthesia, which would numb the entire area of feeling ("Epidural," 2017). Complications associated with epidural use are very rare, and the majority of hospitals are equipped with competent providers to properly install the epidural (Rajkalyan & Kaumudi, 2014).
The epidural reduces or eliminates pain associated with childbirth, including the feeling of a tearing perineum, or episiotomy. Many mothers are able to regain energy to birth their child once the pain of labor is lessened. This potentially allows for a more pleasant birth experience, where mama can enjoy laboring and focus on her growing family, instead of constant, intense pain. Doctors, nurses, and doulas are available for coaching the mother on what to do, since she may not feel the urge to push as strongly as one does in a natural childbirth. 
Childbirth with Epidural: The Drawbacks
As with any medicine, studies have confirmed possible risks and side effects associated with the use of epidurals in childbirth. Some women who use an epidural complain of intense postpartum headaches. One case study examined in depth the occurrence of Cerebral venous thrombosis (CVT), a rare but extremely painful disease postpartum, due to the improper installation of an epidural (Raj & Rupasinghe, 2016). While misplacement is not common, human error is always possible in medical procedures. Patients more commonly experience postdural patient headaches (PDPH), due to the puncture the epidural requires near the spine. These headaches can last indefinitely, and a lasting cure has not been found. "Although not life-threatening, PDPH carries substantial morbidity by restricting activities of daily life. Current noninvasive treatments, including bed rest, fluids, analgesics, caffeine, and sumatriptan, only temporize the discomfort" (Ghaleb, 2010).
Some women may feel very restricted by the effects of an epidural. With an epidural, and subsequently an IV, in place, mama is restricted to her hospital bed, due to the hookups and the numbing effect. This means she will labor on her back, which may not be the optimal position for delivery, depending on the baby's descent. Since the epidural reduces feeling in the lower body, mama is not able to move around or change positions to expedite labor. Mama may also be hooked to a catheter, which many women do not realize comes with the epidural experience before agreeing to one (Howland, 2017). Some studies speculate that medical induction and epidural use lead to a higher likelihood for doctors to determine the need for instrument-assisted birth (forceps or vacuum extraction) and C-section.
Influence of the Internet on Birth Plan Choices
There has been much research published on the benefits and drawbacks of natural and medicated childbirth. Ultimately, either birth, if properly attended, has proven to be generally safe for most mothers and babies. This concept has been researched over and over in the last two decades: "Pain and anxiety...appear to have been relieved as effectively by social support as by medical assistance" (Fox & Worts, 1999).
Accurate information puts a mother in a very strong position to make sound choices for the care of herself and her baby. Some research indicates that many mothers do not attempt any personal research beyond the advice of their chosen care provider, which can limit her opportunities to understand the best birth plan for her situation (Panazzolo & Mohammed 2011).
On the other end of the spectrum, women can receive heavily biased material from non-credible sources seeking to antagonize the opposing party. This content is often infiltrated with strong, hyperbolized, advertisement-like wording to hook readers/viewers into their material. It is essential that women understand how to do effective research and discern content for what it is. Google searches regarding epidurals have skyrocketed in the last five years. Women are turning to the internet as their main source of medical education. "Identifying the most common and rapidly increasing online search queries may guide physician-parturient interactions and online content creation, to address labor analgesic topics that most interest users" (Sutton & Carvalho, 2017). The information, credible or not, that women find on the internet about pregnancy and birth strongly influences the choices they make in the delivery room. Holistic and medical caretakers urge expectant families to understand the options available to them (Christieans & Nieuwenhuijze, 2013).
Conclusion
Pregnancy and childbirth are miraculously and commonly experienced each day by women around the world. Pain management has a variety of safe options, including medicated and unmedicated methods. When attended by a trained, competent professional, the birth of a child has a high rate of a healthy outcome. A mother's planning for birth is affected by family traditions, culture, the opinion and practice of their chosen provider, and most recently, information found online. Websites, blogs, video blogs, articles, instructional videos and advice columns can now be created and published by anyone with an internet connection.
As women strive to obtain credible information, their decision process is well-informed. Ultimately, the mother is the main participant in the birth. As she is able to understand her role in the process, she will be empowered to use any information she meets to her benefit, and for the benefit of her growing family. 

 

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