Have you decided how to have your baby? The choice is yours!
First, you should learn as much as you can about all your
choices. There are many different ways of caring for a mother and
her baby during labor and birth.
Birthing care that is better and healthier for mothers and
babies is called "mother- friendly. "Some birth places
or settings are more mother-friendly than others.
A group of experts in birthing care came up with this list of
10 things to look for and ask about. Medical research supports all
of these things. These are also the best ways to be
When you are deciding where to have your baby, you'll probably
be choosing from different places such as:
- birth center,
- hospital, or
- home birth service.
Here's what you should expect, and ask for, in your birth
experience. Be sure to find out how the people you talk with
handle these 10 issues about caring for you and your baby. You may
want to ask the questions below to help you learn more.
1. Ask, "Who can be with me during labor and
Mother-friendly birth centers, hospitals, and home birth
services will let a birthing mother decide whom she wants to have
with her during the birth. This includes fathers, partners,
children, other family members, or friends.
They will also let a birthing mother have with her a person who
has special training in helping women cope with labor and birth.
This person is called a doula or labor support person. She never
leaves the birthing mother alone. She encourages her, comforts
her, and helps her understand what's happening to her.
They will have midwives as part of their staff so that a
birthing mother can have a midwife with her if she wants to.
2. Ask, "What happens during a normal labor and birth
in your setting?"
If they give mother-friendly care, they will tell you how they
handle every part of the birthing process. For example, how often
do they give the mother a drug to speed up the birth? Or do they
let labor and birth usually happen on its own timing?
They will also tell you how often they do certain procedures.
For example, they will have a record of the percentage of
C-sections (Cesarean births) they do every year. If the number is
too high, you'll want to consider having your baby in another
place or with another doctor or midwife.
Here are some numbers we recommend you ask about.
- They should not use oxytocin (a drug) to start labor
for more than 1 in 10 women (10%).
- They should not do an episiotomy
(ee-pee-zee-AH-tummy) on more than 1 in 5 women (20%). They
should be trying to bring that number down. (An episiotomy is
a cut in the opening to the vagina to make it larger for
birth. It is not necessary most of the time.)
- They should not do C-sections on more than 1 in 10
women (10%) if itís a community hospital. The rate should be
15% or less in hospitals which care for many high-risk mothers
- A C-section is a major operation in which a doctor cuts
through the mother's stomach into her womb and removes the
baby through the opening. Mothers who have had a C-section can
often have future babies normally. Look for a birth place in
which 6 out of 10 women (60%) or more of the mothers who have
had C-sections go on to have their other babies through the
3. Ask, "How do you allow for differences in culture
Mother-friendly birth centers, hospitals, and home birth
services are sensitive to the mother's culture. They know that
mothers and families have differing beliefs, values, and customs.
For example, you may have a custom that only women may be with
you during labor and birth. Or perhaps your beliefs include a
religious ritual to be done after birth. There are many other
examples that may be very important to you. If the place and the
people are mother-friendly, they will support you in doing what
you want to do. Before labor starts tell your doctor or midwife
special things you want.
4. Ask, "Can I walk and move around during labor? What
position do you suggest for birth?"
In mother-friendly settings, you can walk around and move about
as you choose during labor. You can choose the positions that are
most comfortable and work best for you during labor and birth.
(There may be a medical reason for you to be in a certain
position.) Mother-friendly settings almost never put a woman flat
on her back with her legs up in stirrups for the birth.
5. Ask, "How do you make sure everything goes smoothly
when my nurse, doctor, midwife, or agency need to work with each
Ask, "Can my doctor or midwife come with me if I have to
be moved to another place during labor? Can you help me find
people or agencies in my community who can help me before and
after the baby is born?"
Mother-friendly places and people will have a specific plan for
keeping in touch with the other people who are caring for you.
They will talk to others who give you birth care. They will help
you find people or agencies in your community to help you. For
example, they may put you in touch with someone who can help you
6. Ask, "What things do you normally do to a woman in
Experts say some methods of care during labor and birth are
better and healthier for mothers and babies. Medical research
shows us which methods of care are better and healthier.
Mother-friendly settings only use methods that have been proven to
be best by scientific evidence.
Sometimes birth centers, hospitals, and home birth services use
methods that are not proven to be best for the mother or the baby.
For example, research has shown it's usually not helpful to break
the bag of waters.
Here is a list of things we recommend you ask about. They do
not help and may hurt healthy mothers and babies. They are not
proven to be best for the mother or baby and are not
- They should not keep track of the baby's heart rate
all the time with a machine (called an electronic fetal
monitor). Instead it is best to have your nurse or midwife
listen to the baby's heart from time to time.
- They should not break your bag of waters early in
- They should not use an IV (a needle put into your
vein to give you fluids).
- They should not tell you that you can't eat or drink
- They should not shave you.
- They should not give you an enema.
A birth center, hospital, or home birth service that does these
things for most of the mothers is not mother-friendly. Remember,
these should not be used without a special medical reason.
7. Ask, "How do you help mothers stay as comfortable as
they can be? Besides drugs, how do you help mothers relieve the
pain of labor?"
The people who care for you should know how to help you cope
with labor. They should know about ways of dealing with your pain
that donít use drugs. They should suggest such things as
changing your position, relaxing in a warm bath, having a massage
and using music. These are called comfort measures.
Comfort measures help you handle your labor more easily and
help you feel more in control. The people who care for you will
not try to persuade you to use a drug for pain unless you need it
to take care of a special medical problem. All drugs affect the
8. Ask, "What if my baby is born early or has special
Mother-friendly places and people will encourage mothers and
families to touch, hold, breastfeed, and care for their babies as
much as they can. They will encourage this even if your baby is
born early or has a medical problem at birth. (However, there may
be a special medical reason you shouldn't hold and care for your
9. Ask, "Do you circumcise baby boys?"
Medical research does not show a need to circumcise baby boys.
It is painful and risky. Mother-friendly birth places discourage
circumcision unless it is for religious reasons.
10. Ask, "How do you help mothers who want to
The World Health Organization made this list of ways birth
services support breastfeeding.
- They tell all pregnant mothers why and how to breastfeed.
- They help you start breastfeeding within 1 hour after your
baby is born.
- They show you how to breastfeed. And they show you how to
keep your milk coming in even if you have to be away from your
baby for work or other reasons.
- Newborns should have only breast milk. (However, there may
be a medical reason they cannot have it right away.)
- They encourage you and the baby to stay together all day and
all night. This is called "rooming-in."
- They encourage you to feed your baby whenever he or she
wants to nurse, rather than at certain times.
- They should not give pacifiers ("dummies" or
"soothers") to breastfed babies.
- They encourage you to join a group of mothers who
breastfeed. They tell you how to contact a group near you.
- They have a written policy on breastfeeding. All the
employees know about and use the ideas in the policy.
- They teach employees the skills they need to carry out these
Would you like to give this information (and more) to your
doctor, midwife, or nurse? This information is a part of the
Mother-Friendly Childbirth Initiative written for health care
providers. Download a copy at MotherFriendly.org.