In the United States, there’s a gap between what’s called “evidence-based” maternity care and normal maternity care. According to a 2006 survey, a mere 2% of women had an optimal birth experience. Instead, most women experience a host of routine medical interventions. Research shows that what a woman needs most in labor is support. Childbirth is a process that normally starts and progresses all on its own — the cervix begins to open, the uterus begins to contract, the baby begins to descend, and each of these accelerate until you can’t help but push the baby out. The body does this all by itself. Evidence-based care is essentially when the labor process is watched, supported, and protected with the least medical interference necessary.

So, in order to get optimal care, you need a provider who will provide support. Someone who will…

• wait for labor to begin on its own and progress on its own
• allow you to move freely during labor and help you find comfort
• provide what’s called “intermittent” human monitoring of the baby, rather than continuous machine monitoring, so you can stay mobile.
• protect your perineum while you’re pushing — by helping you into good positions, putting counterpressure on your bottom while you push, and most importantly not telling you how to push.
• catch the baby from whatever position you feel best pushing: standing, squatting, hands-and-knees, kneeling, sitting (you get the picture).
• give you the baby immediately so you can be skin-to-skin and initiate breastfeeding.

Who are these providers, you ask? Unfortunately, they’re not usually obstetricians or L&D nurses. Even midwives working in hospitals may not be able to offer intermittent monitoring and other evidence-based practices. Unfortunately, you need to do your research and be vigilant. Even if a provider has progressive ideas, hospitals are increasingly restrictive in how they manage labor (in fact, the medical term is “active management”).

Some nurse-midwifery practices (which typically work within traditional hospital maternity wards) have a great track record. Look for a low cesarean rate (below 10%). Midwives practicing outside the hospital maternity ward, in birth centers and at home births, have been shown in studies to have the most success in supporting normal, physiological birth.

Home birth — it’s not just for hippies. Two large studies following healthy women who chose to give birth outside the hospital with a trained midwife show that 95% had normal, vaginal births, meanwhile their babies did just as well as those who were born in the hospital.

If that’s not an option, there are still ways to reduce your risk of being pushed:

• get a doula
• labor at home with her until labor is really cooking
• prior to your due date, have your doc or midwife write on a prescription pad “intermittent monitoring, no IV, and OK to eat and drink.” Jackie Levine, a NY doula, calls this an “Rx for a Normal Birth.”
• during labor, have access to a shower or preferably a bathtub
• stay mobile and avoid immobilizing anesthesia
• avoid Pitocin, multiple vaginal exams, and artificial rupture of the bag of waters.
• negotiate upright, active positions for pushing and delivery
• refuse an episiotomy