Why Should I Consider a Holistic Approach to Pregnancy and Childbirth?

Pregnancy and childbirth are obviously physical events, but they are much more than that - they represent a major life transition. The changes that occur with pregnancy and childbirth affect your whole life: your identity, your relationships [1], your values, and your beliefs. So it makes sense to consider body, mind, and spirit during your pregnancy and childbirth.

You might be wondering: What will help me have the healthiest pregnancy possible? How can I achieve the best possible physical and emotional health and wellbeing? How can I increase my chances for a natural progression of labor? Reading about a holistic approach will help answer these questions.

What are the physical benefits of a holistic approach?

A holistic approach can help you maximize your physical health and minimize the common discomforts of pregnancy. A healthy diet [2] and exercise [3] build a firm foundation.

Additionally, research demonstrates that many complementary therapies and practices (for example, massage [4] or acupuncture [5]for low back pain [6]) offer comfort with a lower risk of undesirable side effects than many medications. Many of these can be found in the topic How Can I Best Prepare for Childbirth? [7]

What are the emotional benefits of a holistic approach?

Most families welcome the birth of a baby, and you may find that those around you expect you to be happy at this time. However, most women also have periods of ambivalence, anxiety or roller-coaster emotions [8]during pregnancy. After all, having a baby represents a great change, and this can be stressful. It is important to acknowledge those emotions and find strategies that help you reduce your stress [9] and cope with it in a healthy way.

When you cope well with stress, you experience better peace of mind, and you also reduce the harmful effects that stress can have on your physical health. Reducing stress decreases your heart rate and blood pressure, helps your digestion, reduces muscular tension, and enhances your immune system and your ability to deal with pain [6]and discomfort. All of these are especially important during pregnancy. Some ways to cope with stress include:

• Using stress-reduction techniques:  There are many techniques to help with stress reduction, and you can find the ones that help you the most: breath work [10], guided imagery [11], meditation [12], self-hypnosis, or gentle movement such as Tai Chi or Yoga [13]. The Mind-Body Therapies [14] topic has more information on these and other helpful therapies and practices, and even offers guided meditation and other exercises to help you relax.
• Gaining knowledge: You can also reduce your stress [9] by learning more about how your body works during pregnancy and childbirth and about your care options. The more you know, the more you can make important decisions confidently. This information can also help you identify a healthcare provider who encourages and supports your holistic approach. (See How Can I Arrange the Best Birth Support? [15]) 

How does a holistic approach help socially?

During pregnancy, you may begin to realize that your roles and your relationships [1] will change as you become responsible for a new child. You and your partner may realize that you will no longer have the freedom to come and go as you like, or to spend as much unplanned time together as you are used to.

If you are planning to be a single parent, you may begin to readdress relationships with your family and friends as you identify whom you can rely on for support.

If you have other children, you begin to prepare them for the presence of another child in the family and prepare yourself for expanding your time and love. You might also find your relationship with your own parents changing, as you transition from being someone's child to becoming the mother of your own child.

It's important to acknowledge and welcome these changes by talking about them with your family and others. You and your family members might approach these changes at different times and in different ways. A holistic approach recognizes this.

What about spirituality?

Just as pregnancy and birth are times of profound physical and emotional change, they can also be opportunities for tremendous spiritual [16] growth. As you reflect on your role in bringing the baby into the world, your core spiritual beliefs and values shape your expectations and experiences. You may find that pregnancy, birth, and parenting reinforce your beliefs or cause you to make great changes.

In the busy times while preparing for your baby and after the birth of your baby, it is often difficult to set aside time to reflect. However, if you do make time, either in structured ways, such as meditation, journaling, or prayer [17], or in an unstructured ways, such as walks in nature, you may find great rewards and growth await you.

Carrie has never journaled before. She started a journal at the beginning of her pregnancy as a gift to her baby, but instead has come to realize that it is a gift to herself. She has begun to better understand what it means to her to be a mother and to put words to some of the values she wishes to pass on to her baby.

What are the benefits of a holistic childbirth?

A holistic approach to childbirth aims to facilitate the most natural progression of labor possible.

Prepares you to be an informed participant

You and your support team will begin by learning what enhances the process of labor and childbirth. You will know what to ask so you can confidently give informed consent to the plan of care that your midwife or doctor proposes. Throughout, you will gain confidence in your decision-making and feel empowered to do what is best for your family.

Choosing a holistic approach means learning about the benefits and risks of all childbirth options so you can make good decisions if labor unfolds in an unexpected manner. Let's consider a few examples.

• Suppose that the midwife or doctor feels that labor needs to be artificially initiated (induced). Learning about options for induction will help you discuss this plan knowledgeably. You might decide to decline the induction. Or you may be able to help determine which of several options for starting labor best minimizes your risk for other interventions and maximizes your ability to move about or cope with labor pain.
• Suppose that cesarean section is the best birth method for you and your baby. Perhaps the baby is breech, or you have a medical concern that makes pushing risky. There is evidence that some babies whose mothers go into labor before having a cesarean section have better lung functioning than babies who are born after a scheduled cesarean section. Knowing this piece of information might help you decide whether to schedule surgery or wait until labor starts. The comfort level of your provider may also play a role in this decision-making.

Helps avoid the unnecessary use of technology 

Planning for a holistic childbirth may also mean choosing a healthcare provider who does not routinely use common labor interventions, such as electronic fetal monitoring, forceps, or vacuum extractors. Of course when needed, these can be beneficial. But when unnecessary, these same interventions can cause problems in labor, problems for the baby, a delay in initiating family contact, or long-term health problems for the mother.

Some evidence suggests that interventions are used far more often than needed during birth in the United States. Learning about these options can help you avoid some of the risks associated with the unnecessary use of technology.

We have much to learn from other cultures when it comes to holism and safety in childbirth. Despite its advanced healthcare system, the United States does not have the best statistics for healthy births; in fact, in 2003, it ranked 33rd in the world for infant mortality. In other developed countries, midwives attend the majority of births for healthy women. In some countries, such as the Netherlands, about one-third of all women plan to give birth at home. Interestingly, these countries have outcomes that are as good as, or better than, outcomes in the United States.

Choosing a holistic pregnancy and childbirth is a positive, affirming activity, which supports your ability to give birth because it enhances your health, improves your understanding about labor and childbirth, and helps you find  or develop supportive assistants.

What about pain management?

One of the questions that often surfaces when talking about holistic childbirth is the choice of pain [6]management. With a holistic approach to childbirth, you may choose to use techniques such as guided imagery [11], breathing [10], movement [18], hydrotherapy, or self-hypnosis in place of, or as a complement to, common options in labor, such as an epidural. But why, with easy access to technology that makes labor more comfortable, might you choose an alternative?

The answer is complex. Pain medication and epidurals may help you be more comfortable during labor. However, like all medical interventions, they do carry a degree of risk. For example:

• Narcotic-type pain medications, such as nubain, morphine, demerol, or fentanyl, are often used to alleviate labor pain. These medications are associated with longer labors and might also make you groggy, lightheaded, and nauseated, potentially interfering with your ability to move about freely.
• Narcotic-type pain medications might also cause a baby to be born sleepy and in need of breathing stimulation. Conversely, they might make a baby irritable. Either excessive sleepiness or irritability may interfere with the successful initiation of breastfeeding.
• There is conflicting evidence about whether the use of epidurals or other spinal anesthesia adversely affects the length of labor or increases the chances that you will have a cesarean section.
• The use of an epidural might lead to a baby who settles into an unfavorable position for birth, which might result in a cesarean section, forceps, or a vacuum extractor-assisted birth.
• Women with epidurals or other spinal anesthesia might experience a drop in blood pressure, which could affect the amount of oxygen that gets to the baby.
• After an epidural, women are generally restricted to bed and might require a urinary catheter to drain urine from the bladder. Some women also have difficulty passing urine even after the epidural wears off.
• The epidural procedure itself has a few risks and side effects, including itching, infection, the improper placement of the medication into a blood vessel instead of the appropriate epidural space, backache, a "spinal" headache after the procedure, or, rarely, permanent nerve damage.

On the other hand, using holistic measures to manage pain allows you to avoid the side effects of medication or epidurals. These measures help to promote the natural progress of labor, which brings many benefits: your recovery is likely to be quicker, you and your baby are less likely to be exposed to the side effects of medical interventions, and your baby is more likely to breastfeed readily.

Lucia did not use pain medication or have an epidural during her first two labors. She stood during most of her labor, and then sat in a rocking chair toward the end of labor when her pain was the most intense. Roberto's sister combed her hair between contractions, which helped her to relax and conserve her energy. Lucia found that having freedom to get into the most comfortable position was helpful as she coped with pain during contractions. Her babies were eager breastfeeders soon after delivery, and Lucia feels that avoiding medication helped to get her off to a good start at breastfeeding.

What about cesarean sections?

Another major issue in childbirth concerns cesarean sections. When necessary, a cesarean section benefits both the baby and the mother. But it is not without risks. These include infection to the mother, risk of injury to the mother or baby, a period of prolonged pain and healing after childbirth, the risks associated with the surgical anesthesia, and even a small risk of death. 

The best rate of cesarean sections is the rate at which the health benefits for the baby and the mother are maximized, and women are not unnecessarily exposed to the risks involved in cesarean sections. The World Health Organization (WHO) states that an optimal cesarean section rate is between 10% and 15%. The United States Department of Health and Human Services agrees and set a goal in the Healthy People 2010 initiative to reduce the cesarean section rate among women having their first baby to 15%.

Despite that goal, the cesarean section rate in the United States has continued to grow and is now approaching 30%. This means that some women and their babies are unnecessarily exposed to the risks of cesarean sections without benefit to their babies or themselves. There is even a growing trend in the United States toward an "elective" cesarean section, which means that there is no current medical reason, just a theory that it might help avoid problems such as pelvic floor relaxation later in life.

Taking a holistic approach to childbirth enables you to become educated, make informed choices, and to understand how to reduce the chances of having an unnecessary cesarean section.

Additional readings

Obstetric Myths Versus Research Realities: A Guide to the Medical Literature. 1995. Henci Goer & Robert McNamara.

The Whole Pregnancy Handbook: An Obstetrician's Guide to Integrating Conventional and Alternative Medicine Before, During, and After Pregnancy. 2005. Joel Evans & Robin Aronson.

References

Enkin, M., Keirse, M.J.N.C, Neilson, J., Crowther, C., Duley, L., Hodnett, E., & Hofmeyr. (2000). A guide to effective care in pregnancy and childbirth, 3rd ed. New York: Oxford University Press.

Evans, J.M. (2007). Why we need holism in pregnancy care: A review. Alternative Therapies, 13(3).

Salim, R., Nachum, Z., Moscovici, R., Lavee, M. & Shalev, E. (2005). Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction. Obstetrics & Gynecology, 106,  p. 301-306.

Thorp, J.A., Hu, D.H., Albin, R.M, et al. (1993). The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. American Journal of Obstetrics & Gynecology, 169(4), p. 851-858.

Wong, C.A., Scavone, B.M., Peaceman, A.M. et al. (2005). The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. New England Journal of Medicine, 352, p. 655-665.