Jessica Anderson knew what she wanted when bringing her children into the world.
The South Portland mother of three – with a fourth on the way in February – opted for un-medicated births, in the water, in a birthing center. And as her babies (now 8, 7 and 51?2) grew, she chose breastfeeding over formula and bottles.
They were all very personal decisions, she noted – and ones that every pregnant woman has to make for herself and her family.
Ultimately, “all labors are different,” she said.
Indeed, “Do I or don’t I?” is the perplexing question often posed by mothers-to-be when it comes to some of the most crucial aspects of pregnancy, delivery, and early child-rearing.
Here, we offer up the pros and cons of three of the most important decisions you’ll make: where to deliver; whether to use pain medication; and whether to breast or bottle feed.
Home, hospital ?or elsewhere?
Ultimately, it comes down to your comfort and the conditions of your pregnancy.
The traditional route is the hospital, particularly if you’ve been under the care of an obstetrician or family practitioner for the past nine months. This is an appealing option for families who want access to the most up-to-date technology in case of an emergency, according to the American Pregnancy Association (APA), and it is typically recommended for mothers who are at high risk due to past birth complications, certain existing medical conditions, and other factors.
However, some hospitals tend to impose more restrictions on labor, birth and techniques, according to the APA – such as who can be present, how much mothers can move around and what they can do while in labor – so it’s important to check policies and procedures before making a decision, the association suggests.
On the other end of the spectrum is the home-birth method, which today is often overseen by a midwife. This option is most suitable for low-risk pregnancies, the APA suggests, and is typically chosen by women looking to avoid interventions such as epidurals and C-sections, who want to be surrounded by as many family and friends as they like, and who want the ability to move around freely during labor (and eat, drink, even take a shower). Overseeing midwives typically come equipped with oxygen and IVs, as well as sterilized instruments, stethoscopes, drop cloths, and medications to stop hemorrhaging, according to the APA.
Families going this route, though, need to be well-educated about the issues that can arise, the APA warns, and also have to be open to the option of going to a hospital in the event of an emergency or complication.
An in-between option, meanwhile, is a birthing center, which can be a free-standing institution, inside a hospital, or on hospital grounds, and which offers a natural birth experience in a slightly more structured setting.
This was Anderson’s choice: She delivered her three children – 8-year-old Norah, 7-year-old Thomas, and 51?2 year-old Timothy – at the Ballard House in Portland.
Although she did consider the other options, the hospital felt “invasive,” with “too many strangers, interruptions, distractions and pressures of society,” she explained, while a home birth felt a little “too close to home.”
“We were afraid that if something did go wrong, we would have to live in that house forever with that memory,” she explained.
Typically, according to the APA, birthing centers are equipped only with oxygen and catheters, and don’t make use of drugs for pain relief, electronic fetal monitoring, induction or operative deliveries. They are more suitable for women with some existing conditions, such as diabetes and pre-eclampsia, those who are expecting multiples, or couples looking for more of a middle ground between the home and the hospital (as with Anderson).
In the end, though, Anderson urged, make your decision based on your own comfort. “If you want a hands-off experience, chose home birth,” she said. “If you want a more assisted birth, go with a hospital.”
Drugs or not?
Several different types of drugs – ranging in duration and intensity – are available for laboring mothers.
The most prominent is epidural anesthesia – according to the APA, more than 50 percent of women giving birth in hospitals opt for an epidural, which regionally blocks pain in the lower half of the body. In some cases, in addition to providing pain relief, epidurals can help provide rest for exhausted or agitated mothers, especially those suffering through a long labor period.
A similar, but less long-lasting option is a spinal block – for this, an anesthetic or narcotic is injected directly into the spinal fluid and provides relief for roughly two hours, according to the APA.
However, there are potential side effects to both, the association cautions: most severely decreased blood pressure, permanent nerve damage, and difficulty breastfeeding just after birth. Pushing during labor can also be made more difficult, thus leading to mothers requiring additional assistance in the way of forceps, vacuum extraction or even C-sections.
Opiates are another option that are typically given in smaller doses through spinal column injections, IVs, or a patient-controlled pump, according to the APA. But these, too, come with side effects for both mom and baby: the most common for the former are sedation, nausea, vomiting, dizziness, and decreased gastric mobility, while the latter can experience central nervous system or respiratory depression, altered neurological behavior, and decreased ability to regulate body temperature, according to the APA.
All told, mothers who prefer not to use drugs note these various side effects, as well as an unwanted sedation that dulls the birth experience. Natural and alternative pain-reducing options include breathing techniques, massage and water birth.
Anderson, for her part, chose the latter – delivering in a tub – without pain medication.
“I am a young, healthy woman who trusts my body to know how to birth a child,” she said, noting that drugs would have limited her options. “I wanted it to be a special bond between who I choose to be present, the baby and me. I wanted my body to be free to move around and relieve pain my way.”
Still, she said, “if you want (or) need medication, use it.”
Breast or bottle?
At times, it’s been one of the most contentious issues surrounding early childhood care – although these days, the general feeling is that breastfeeding is the best option.
Typically, it’s thought to provide the best balance of nutrients; it passes on certain immunities from the mother; it’s more easily digested and absorbed and is always the perfect temperature; and it takes no preparation time, according to the APA. Also, its contents change during various milk production stages, thus meeting the changing needs of the growing baby.
And an extra perk in this economy? It’s free.
Anderson has breastfed all her children, and plans to with her fourth, Kenneth, due in February.
However, it was “way harder” than she anticipated, and she also noted a “learning curve” for her whole family (and along the way, she occasionally pumped and used formula).
The APA also stresses that certain medications can interrupt breastfeeding, early breastfeeding may be uncomfortable for the mother, and the mother must be available to feed when needed, or otherwise provide pumped milk – which can be a struggle for those merging back into the working world after childbirth.
On the other hand, some mothers, due to a lack of time, issues or discomfort with breastfeeding, prefer to use formula – which has the added benefit of anyone being able to feed the baby when it’s hungry, whether or not mom’s around.
But its drawbacks: It requires a longer preparation time, as well as perfecting a warming process, and cost can be expensive. Also, not all babies tolerate formula, according to the APA, and there have been recent, high-profile cases involving tainted formula.
Ultimately, though, Anderson noted, nutrition shouldn’t just be about food. “Love and attention is the way you should feed your child,” she said.
In the end, pregnancy is a period of many crucial and very personal decisions – and making the best ones comes down to what you feel is right for both you and your baby.
As Anderson advised, “Trust your body, listen to it and go with what makes you and your partner feel comfortable.”