A positive birth experience can mean very different things to different couples. Each person views “favourable outcome” and “risk management” differently, and this will impact how they approach the birth experience: where they choose to give birth, who they choose as their primary caregiver, how active they choose to be in the decision-making process, etc. It is important for you to have a clear understanding of the many choices that can and will need to be made during your labour and birth, and that your caregiver(s) be informed of your values and choices so that they may be respected. This is the primary goal of preparing a birth plan.

Natural birth requires a true commitment and continuous, skilled support. This is especially true in our current health care system where natural birth is the exception rather than the norm. Consider that most physicians and nurses practicing in a hospital setting have no training or experience in continuous labour support and may never have witnessed a truly natural (undisturbed) birth. If your desire is to birth naturally, preparing a birth plan can be an invaluable tool towards fulfilling it.

It has been demonstrated that these four factors make the greatest contribution to women's satisfaction in childbirth:

· having good support from caregivers

· having a high-quality relationship with caregivers

· being involved in decision-making about care

· having better-than-expected experiences, or having high expectations.

Pain relief only becomes important for satisfaction in childbirth when expectations are not met.

The mere continuous presence of a woman who has given birth and who shares your values has a beneficial effect on the mother‘s confidence and the birth outcome. There are additional benefits when the person is specifically trained to support mothers in labour and childbirth, as is the case of a doula. The special relationship, trust and continuity of care that exist between a mother, her partner and their doula have an important positive impact on the experiences of pregnancy, labour, birth and breastfeeding. Some of the proven benefits of having a doula include:

Birth outcomes:

· 25% shorter labour

· 50% fewer cesareans

· 40% reduction in oxytocin use to speed up labour

· less use of forceps and vacuum extraction

· 30-60% fewer requests for pain medication/epidurals

· fewer complications

For Mom:

· less fever and infection; reduced bleeding after birth

· more positive birth experience; more secure, confident

· less anxiety and postpartum depression

· enhanced bonding with baby

For Baby:

· shorter hospital stay

· fewer admissions to special care nurseries

· less breastfeeding difficulties

For healthcare system:

· dramatically reduced costs of obstetrical care

If you have chosen to hire a professional labour support person (doula), having a birth plan can help her advocate for your choices at times when you may not be able to speak for yourself. Before labour begins, you should discuss with your doula under which circumstances, if any, you wish her to speak on your behalf.

Please remember that informed choice means knowledge of alternatives along with the benefits and risks of each available option, including doing nothing. A choice, by definition, implies more than one option. Parents as well as their caregivers share responsibilities in the process of informed consent.

The following is a non-exhaustive list of points for you to become informed about and include in your birth plan. You may omit or add items depending on your personal priorities. Depending on your choice of birth location, primary caregiver, and previous experience (if any) your birth plan may be more or less detailed.

Mother’s name

Father’s name

Primary caregiver (midwife / family physician / obstetrician)

Doula’s name (if applicable)

If you wish, you may include an introduction to your birth plan. Here is one example to get you started:

As parents, we acknowledge that we are ultimately responsible for our own health and that of our baby. We know that birth is a normal process that a mother and her baby are capable of carrying out without intervention, in the vast majority of cases. We know that discomfort and pain are part of this process, and we expect to be allowed and encouraged to labour in a way that is most beneficial to us, even if this is in conflict with routines or protocols. We have made efforts to seek out the knowledge, resources and support to make informed decisions. After careful consideration of this knowledge, and in accordance with our values and priorities, we have put together this birth plan to help you care for us in a way that will not only ensure the safety of both mother and baby, but honour and respect our values and needs regarding this birth.

...

Who would you like to have present during labour and birth? Do you want to place a limit on the number of people caring for you? If you are giving birth in a teaching hospital or birth center, are you comfortable having interns present? If you have older children, would you like them to be present during part or all of the birth process?

· Clinical experience is crucial to interns. While this is true, their learning process can have a great impact on your birth outcome. This also adds to the number of unfamiliar people present at your birth. Consider accepting the presence of interns as long as you are assured that supervision is adequate.

· Birth can be an amazing experience for older siblings to witness. In many cultures, children of all ages witness labour and birth. This experience can be very positive and even facilitate adaptation to and bonding with the new sibling. The child should be prepared for the events, sounds and atmosphere of birth and cared for by a person familiar to them (ideally whose sole responsibility during the birth is to care for the child). The child should know that he/she is free to be present (or not) according to his/her own comfort level.

What is your top priority during labour?

How would you like decisions regarding your care to be made? Particularly with respect to routine interventions, do you want your caregiver to make decisions unreservedly on your behalf, or do you want to be kept fully informed and share in any discussions and decisions made?

· Protocols and routines are guidelines that you are not obliged to follow. Studies show that routine interventions have little or no benefit, and can hinder the normal birth process. Being aware of what they entail, along with their possible drawbacks and benefits, will allow you to understand what is being proposed and choose accordingly. To ensure no decisions are made hastily, consider requesting a few minutes in private to regroup and discuss with your support person when anything is proposed to you during labour. There is always time to take a few minutes to make an informed decision, and you should never feel rushed to make a decision on the spot, in front of nurses, doctors, or interns. True emergencies are rare.

What is your preferred approach to pain management during labour? Do you want to be offered alternative measures only, pharmacological measures only, or both? Do you want to be offered medications, or do you prefer that this option be reserved for a moment of your choosing? Become informed on the different methods that are available in your place of birth, and on their respective benefits and risks. Any medication has potential risks for you, your baby, and the birth process, and you must understand these before labour begins in order to make an informed choice.

Examples of effective alternative (non-interventive) measures to cope with pain: hydrotherapy, upright positions, remaining mobile, exercise ball, pelvic rocking, intradermal injections of sterile water (may not be available everywhere), acupuncture, acupressure, transcutaneous nerve stimulation (TENS), massage, hypnosis, music, relaxation, visualisation, vocalisation. Pharmacologic measures include narcotics, gas anesthetics, local anesthetics, epidural analgesia.

Common routine procedures used during labour:

Unless you express a clear desire otherwise, many procedures will most likely be routinely carried out if you give birth in a hospital setting. It is wise to know what they entail and understand their benefits/drawbacks before labour begins so you will not be subject to procedures that you do not want. The following is a list of the most common routine interventions carried out during labour, a short explanation, as well as a summary of the pros and cons according to the most recently available medical research. As you will notice, hospital routines and protocols are not always evidence-based.

1st stage labour (effacement and dilation of cervix to 10 cm)

“Nothing by mouth”

The tradition of withholding food and drink from labouring mothers dates back from the time when women were “delivered” from their babies under general anesthesia. Although obviously this is no longer how women give birth today, many hospitals still have a policy that forbids labouring women to eat or drink anything but water or ice chips. The principal arguments for fasting are to prevent aspiration if emergency cesarean should be required, and to prevent nausea and vomiting during labour. These arguments are outdated. We know that the risks of fasting are far more likely to occur than the need for emergency cesarean. Furthermore, nowadays, even emergency cesareans are done under spinal anesthesia. General anesthesia is very rare in modern obstetrics; aspiration is extremely rare in modern anesthesia, so aspiration is not an issue (even if it was, fasting during labour does not guarantee an empty stomach, and the most dangerous fluid to the lungs is undiluted stomach acid!). As for nausea and vomiting, fasting does not prevent these.

Pros: None. There is no evidence to justify withholding food from the mother, at any stage of labour. Birth is the most demanding physical workout a woman’s body will ever go through, and her body requires food and drink to enable it to work efficiently.

Cons: Medical research does not support this practice. Hunger and thirst cause significant discomfort; associated with longer labour; increased use of synthetic hormones to stimulate labour; increased forceps/vacuum assisted delivery; dehydration may cause fever.

Routine IVs

Most hospital protocols include the routine use of IV fluids during labour, in part to compensate the “nothing by mouth” rule discussed earlier. However, IV fluids are not the solution to this since they do not provide the nutrition or energy offered by food and fluids, do not prevent the feeling of hunger or thirst, and may negatively disrupt the normal physiology of both mother and baby. Other than replacing fluids, another reason for routine IVs is to have a vein open “just in case” an emergency should occur. However, life-threatening emergencies are rare in low-risk labouring women (over 90% of pregnant women). Nevertheless, if you feel this is truly necessary, you may wish to consider a heparin/saline lock instead of an IV. A heparin/saline lock is an IV that is attached to a little chamber on your hand filled with either saline or heparin, which keeps your vein open and provides quick access to your venous system. It allows more freedom of movement than a conventional IV, which is attached to a tube that leads to a solution bag hanging on a pole.

Pros: None

Cons: Medical research does not support this practice. Discomfort; inflammation; bruising; inhibit mobility; fluid overload is common; abnormal blood sugar levels in baby; may exaggerate baby’s birth weight and initial weight loss following birth, which causes unnecessary stress and may prompt interventions which can interfere with breastfeeding; may cause severe breast engorgement.

Fetal monitoring

Intermittent fetal monitoring enables the caregiver to assess the baby’s well-being in a non-interventive manner by listening to the baby’s heartbeat with a hand-held device during and after a few contractions, which is sufficient to ensure a safe journey through birth for both mother and baby.

Continuous electronic fetal monitoring is often part of routine protocol in hospitals. It enables limited nursing staff to monitor several labouring mothers at a time, yet without requiring their presence. However, convenience for the staff is where the benefits begin and end. Continuous electronic fetal monitoring does not result in better outcomes. In fact, it does quite the opposite: it significantly increases the risk of cesarean section without any benefits to the baby. It has a profound effect on the way the mother experiences labour, limiting her freedom to move around, and her choice of measures to cope with pain (exposing her to the potential cascade of interventions that can ensue), and increasing the mother’s anxiety (which also has an impact on pain). Medical research does not support this practice, unless there is a specific medical reason (use of pitocin, suspected problem in the baby, or VBAC).

Internal fetal monitoring is accomplished using an internal sensor with a needle that is fixed on your baby’s scalp and another sensor introduced into the uterus to monitor the contractions. The membranes (bag of waters) must be ruptured and the cervix dilated at least 2 cm for internal monitoring to be possible. It is more accurate than external monitoring, however it is invasive and increases the risk of infection significantly. It should not be used unless there is a good medical reason.

Cervical checks

The cervical check is the most used method to evaluate the progress of labour. It provides information on effacement and dilation of the cervix, as well as the baby’s station and presentation relative to the mother’s pelvis. Although it is rarely essential, in the hospital setting, it is performed regularly and frequently throughout labour. There are several good reasons, however to limit these exams to a strict minimum. First, most of the time, it requires that the mother lie flat on her back, which is disruptive and uncomfortable, even painful. Second, this constant monitoring creates expectations of “regular progress”, according to “standards”, even though we know that the physiological process of labour does not follow any established parameters. Even if all is going well, “results” may be discouraging or disappointing for the mother and this can negatively influence the evolution of her labour. Finally, cervical checks significantly increase the risk of infection (especially when the membranes are ruptured), which can lead to further intervention and have negative consequences on the health of the mother and baby. It is also important to remember that cervical checks are a subjective assessment; therefore, the same person should perform all exams, to ensure the most consistent interpretation possible.

Restricting positions/movements

Freedom of movement is crucial to the normal birthing process. It permits gravity to help your baby come down and engage correctly as well as increase the size and shape of your pelvis. It allows you to actively manage the pain of contractions, and may help relax tense muscles, making birth easier. Last but not least, it can actually speed up labour, or stimulate a slow progressing labour. Although most birth settings will not specifically restrict your movements during labour, many routine interventions directly result in limited movement (eg. IVs, continuous fetal monitoring, rupture of membranes, epidural analgesia, etc). This, in turn, can make birth more difficult and lead to yet more intervention. Labouring while lying down on your back can be more painful and increase the likelihood of the baby entering your pelvis in an unfavourable position, making the baby’s descent into the birth canal longer and more difficult.

When the time comes for you to push your baby out into the world, you should be encouraged to adopt the position that is most comfortable to you and most facilitates the birthing process. In most cases, this is not the “typical”, on your back position with legs lifted up high and spread widely apart. Side-lying or gravity assisted positions are most often instinctively adopted when women are allowed to chose, and a woman can give also birth squatting, on all fours, kneeling, or even move between different positions as the birthing progresses. This facilitates the mother’s pushing efforts, and may help reduce perineal trauma.

Artificial rupture of membranes (AROM or breaking the bag of waters)

Although it was thought that breaking the bag of waters shortens labour and prevents/corrects poor progress, scientific evidence does not support these reasons. Another reason some practitioners perform this procedure is to assess fetal well-being by the presence or absence of meconium in the amniotic fluid. Meconium in the amniotic fluid is a sign of fetal distress. However, this is another instance where the risks far outweigh the benefits.

Pros: None

Cons: Medical research does not support this practice in early labour. This seemingly benign procedure can significantly affect the mother and baby’s well-being by:

· May precipitate umbilical cord prolapse, which is an indication for emergency cesarean

· increasing the intensity of the contractions (thereby increasing pain)

· may cause distress in the baby

· may open the door to infection

· leads to more interventions (such as medication to deal with increased pain and use of synthetic hormones (pitocin) to speed labour for fear of infection, antibiotics, forceps/vacuum assisted delivery)

· increases the risk of cesarean section

Labour induction (artificially starting labour)

Due dates are estimates that serve to guide. They are imprecise, and fewer than 5% of women will actually give birth on their due date. The average length of a first pregnancy is 41 weeks from the last menstrual period. The decision to artificially start labour should be made on a case-by-case basis, evaluating medical considerations, such as signs that the baby is no longer growing adequately or his/her well-being in the womb is deteriorating. It should not be made for convenience reasons or simply because a given date has come and gone. Interventions to start labour include stripping the membranes (manually pushing the membranes away from the cervix while leaving them intact), various methods of ripening the cervix (hormones that will make the cervix ready for labour), AROM, and synthetic IV oxytocin. As with any other intervention, induction of labour carries some risks, such as increased medication use, increased forceps/vacuum assisted delivery, and increased cesarean. There are several alternative methods which have been proven effective in some cases and do not carry with them the increased risks mentioned above.

Labour augmentation (speeding up labour and/or shortening the 2nd stage)

Giving birth is a process that cannot be measured by the clock. The accepted “standards” for the length of labour are based on faulty assumptions or arbitrary guidelines. This means many women are subjected to unnecessary interventions to correct a problem that is not a problem to begin with, and all these interventions can increase risks to mothers and babies. Procedures which can be used to speed up labour or shorten the 2nd stage (pushing the baby out) include AROM, IV synthetic oxytocin, vacuum/forceps extraction and cesarean section. Here again, if there is a need to stimulate or speed up the labour progress, there are several alternative methods which have been proven effective in some cases and do not carry with them any risks.

2nd stage labour (pushing the baby out)

Protecting the perineum

Your perineum is designed to fan out and stretch considerably to allow for the passage of your baby’s head, which is the biggest part to accommodate. An intact perineum is one that does not require suturing; a first-degree tear involves the skin of the perineum and vaginal mucosa; a second-degree tear involves deeper layers of perineal muscle; a third-degree tear involves the anus; and a fourth-degree tear involves the anus and rectal mucosa. You can prevent or reduce the likelihood of perineal tearing in several ways: instinctive/physiologic pushing (as opposed to “block and push” as described above); hands-and-knees and side-lying (gravity neutral) positions to birth the baby; slow, controlled birth of the head (most often this will require you NOT to push when the baby’s head crowns, and breathe while your uterus does the job); as well as gentle counter pressure with a warm compress during the pushing phase (this can be done by your doctor or midwife). Perineal massage during the last trimester of pregnancy may also help prevent tearing and reduce the risk of 3rd degree tears, especially in first-time mothers.

Episiotomy (a surgical incision to widen the vaginal opening) does not prevent tearing. On the contrary, it often makes tearing much worse, significantly increasing the risk of 3rd and 4th degree tears. Another outdated belief is that an episiotomy is less painful and easier to heal than a tear. Medical research has shown consistently the opposite: episiotomies are more painful, take longer to heal, and are more prone to infection than a natural tear, should it occur. Medical evidence shows there is no benefit to episiotomy. The only medical indication to perform an episiotomy is when there is severe fetal distress requiring a quick delivery, while the birth is not imminent (in the next few minutes).

Instinctive as opposed to directed pushing

The uterus is a powerful muscle and its coordinated efforts do the majority of the pushing work, with no assistance or voluntary effort from the mother. In fact, most of the time, no additional, voluntary force is needed for the baby to be born. However, the dominant approach to birth in our culture is for the woman to contribute with deliberate pushing efforts. When a woman pushes instinctively in response to her natural urge to push, she rarely holds her breath for more than five or six seconds. There is usually grunting, groaning or exhaling to decrease the strain on her heart and circulation. The mother may breathe deeply several times between pushes. This naturally provides continued oxygenation to the baby as well as to her uterus and perineum. This allows the perineum to stretch and fan out gradually for a slow, controlled birth of the baby’s head and shoulders, thereby preventing tears.

In contrast, when a woman is directed to push, as is often done, especially when the mother is under epidural or other pain medication, she is instructed to push on cue, to hold her breath for at least ten seconds and to not make noise or exhale during pushing. She must then quickly take another breath and push again, often 3 or more times within one contraction. This decreases oxygen supply to the baby, the uterus and the perineum, which can lead to dizziness, exhaustion, fetal distress and perineal trauma (tearing) and hemorrhoids. Signs of distress in the baby will prompt physicians to intervene to speed up the birth of the baby with forceps, vacuum and/or episiotomy. In addition, directed pushing may increase the incidence of postpartum urinary incontinence.

How would like the baby to be born? Would you like to have a mirror so you can see the baby be born? Would you like to lift the baby out yourself, or for the father to catch the baby and place him/her on you (with help)? Do you prefer the doctor /midwife to be the one to catch the baby?

3rd stage labour (placenta or afterbirth)

Clamping and cutting the umbilical cord

When your baby is born he or she still has a lifeline in the umbilical cord still attached to the placenta which allows him or her to gradually begin breathing on his/her own, without emergency. Between 25-60% of the baby’s total blood volume is in the placenta, and this rich placental blood contains stores of iron (among other important elements) that can be transferred from the placenta to the baby if the cord is left unclamped until it stops pulsating (usually a few minutes). This results in improved iron stores, and a reduced risk of anemia extending into the first year of life. Under usual circumstances, there is no rush to clamp and cut the cord. On the other hand, clamping the cord immediately after the baby is born increases the risk of a retained placenta and hemorrhage.

Active management with pitocin, kneading and/or controlled cord traction

Once the baby is born, there is a natural rush of oxytocin. This causes the uterus to keep contracting to separate the placenta from its wall, so that you can push it out. This may take from a few minutes to an hour or so. There is no reason to hasten this process, except for convenience. Again, unless you clearly indicate otherwise, active management of the 3rd stage of labour with synthetic oxytocin (pitocin), uterine kneading and controlled cord traction (physician gently pulling on the umbilical cord to separate it from the wall of the uterus) is done routinely.

· Unless there is an emergency, there is no medical indication to speed up the process of the delivery of the placenta. On the contrary, unnecessarily interfering with the physiological process can increase the likelihood of placental retention and hemorrhage.

Welcoming baby

Do you have any special requests about the hour or so following birth? For example, keeping baby skin-to-skin, being left alone with your partner and baby, postponing routine interventions such as cleaning, weighing, administration of antibiotic ointment in the eyes, Vitamin K injection. Would you like Apgar scores and pediatrician examinations to be done in your presence, with your baby in your arms (or your partner’s) as much as possible?

· Immediately after birth, if both mother and baby are doing well, baby should be placed skin to skin on his/her mother and they should not be separated.

Routine interventions for the baby

As long as both you and your baby are doing well, most interventions for your baby can and should be postponed until at least a few hours after birth. This is because during the first hours of life, you and your baby will be alert and primed to bond and imprint to each other, and go to the breast for the first time. For all this to happen, you must not be separated and left undisturbed, preferably skin to skin. Only absolutely essential medical care should be given at this time. After the first few hours, your baby will most likely sleep for a longer period, and this will not be conducive to a first contact if the opportunity was missed or disturbed by unnecessary routine interventions.

Apgar scores

Immediately after the birth, at one minute, five minutes, and 10 minutes, your doctor or midwife will assess your baby’s vitality according to the Apgar scale. This is done by observing your baby’s breathing, skin color, muscle tone, heart rate and reflexes. Unless there is a problem, there is no need to take the baby away to do this, and this should be done while you hold your baby.

Evaluation by a pediatrician; weight/length measurement; washing

This is usually done shortly after birth, but can be postponed for a while so that you are not disturbed. It can and should be done in your presence, and the physician can assess your baby while you hold him/her.

Prophylactic antibiotic eye ointment and Vitamin K injection

Unless you clearly state otherwise, these are routinely done immediately after birth.

Prophylactic antibiotic eye ointment is given to all newborns to prevent congenital conjunctivitis caused by sexually transmitted bacteria such as chlamydia and/or gonorrhea. However, not all newborns are at risk for this, depending on the parents’ sexual history. Also, the ointment itself can cause a chemical conjunctivitis in your newborn, which some studies suggest is far more likely than the conjunctivitis the ointment is intended to prevent. Bacterial conjunctivitis, when it occurs, is obvious and easily treated today, and is no longer considered to be significant risk. Discuss with your caregiver whether this prophylactic treatment is necessary or appropriate for your baby. If you choose to give the ointment, because it will blur your baby’s vision, it is preferable to postpone it to a time when your baby will be less alert, so it does not impede on your first contact with each other.

Vitamin K injections are also given routinely to increase clotting factors in the baby in order to prevent hemorrhagic disease of the newborn (HDN). HDN is very serious but very rare (2 per 100,000 babies per year), and not all forms of the disease are prevented by Vitamin K prophylaxis. If there were absolutely no risks or costs associated with vitamin K administration, nobody would argue against it, but in fact this is not the case. There are known risks of giving Vitamin K, and some possible risks which we do not yet know about. For example, we do not know the impact of giving babies up to 10,000 times the dose that naturally occurs in their bodies (which is what they receive with a 1 mg intramuscular injection). On the other hand, we know that colostrum contains large amounts of Vitamin K - nature’s own Vitamin K shot. Colostrum, and allowing the baby to receive as much blood from the placenta as possible offer many more benefits to the baby than Vitamin K injections do. In some cases, there are medical indications to give Vitamin K to your baby, such as increased risk of bleeding from vacuum/forceps delivery or birth trauma such as hematoma. Vitamin K prophylaxis is a complex and controversial issue. Talk to your doctor or midwife about the potential benefits and risks of this intervention and whether it is appropriate and necessary for your baby. If so, like the antibiotic eye prophylaxis, Vitamin K injection can be postponed to when your baby is less alert, to allow unimpeded bonding immediately after birth.

Glucose monitoring

An abnormal blood sugar level is more than a single arbitrary value: it is a continuum of abnormal levels associated with specific symptoms. There is no medical indication to routinely test all babies’ blood sugar during the days following birth. The procedure (heal prick) is invasive and painful, and only babies exhibiting symptoms of abnormal blood sugar levels should be subject to it. Most hospitals no longer do this routinely, but you should nevertheless be aware of this possibility (especially if you had gestational diabetes, you are diabetic or you or your baby have other risk factors). Incidentally, the first treatment for a baby who exhibits signs of hypoglycemia (low blood sugar) is to breastfeed more frequently, so by breastfeeding on demand (which for most babies is frequently...) you will be naturally preventing and/or treating this problem.

Early Supplementation for Breastfed Babies

Newborn babies should receive only colostrum and breastmilk for the first 6 months of life. However, in spite of this widely-accepted recommendation, a large percentage of newborns are given supplements of artificial baby milk during their hospital stay, for reasons other than medical necessity. Early supplementation interferes with the establishment of breastfeeding by causing problems such as the baby refusing the breast, nipple soreness, and decreased milk production. It directly impacts infant health by reducing the intake of protective antibodies from breastmilk as well as exposing babies to the risks of formula itself, and is associated with early weaning. Early, skilled support is key to a smooth start to the breastfeeding relationship. Unfortunately, advice and assistance with breastfeeding is still inconsistent in most birth settings in Quebec, with basic, effective training only recently becoming widespread among maternity staff. This can be frustrating and confusing for new parents. This is yet another aspect of life with your new baby which you will benefit from being well informed about. Peer breastfeeding support groups are known to greatly improve breastfeeding success, and when specific issues arise, access to a Certified Lactation Consultant can make the difference between an issue that is simply resolved and one that progressively becomes more complicated, potentially jeopardising the breastfeeding relationship.

References / Further reading / Useful Web Sites:

Attachment Parenting International www.attachmentparenting.org

Une naissance heureuse (Isabelle Brabant)

Coalition for Improvement of Maternity Services (Mother-Friendly Childbirth Initiative) www.motherfriendly.org

A Guide to Effective Care in Pregnancy and Childbirth (Murray Enkin et al.)

Ina May’s Guide to Childbirth (Ina May Gaskin)

Spiritual Midwifery (Ina May Gaskin)

Obstetrical Myths versus Research Realities: A Guide to the Medical Literature (Henci Goer)

The Thinking Woman’s Guide to a Better Birth (Henci Goer)

Gentle Birth Choices (Barbara Harper)

Birth Your Way (Sheila Kitzinger)

The Complete Book of Pregnancy and Childbirth (Sheila Kitzinger)

The Doula Book: How a Trained Labour Companion can help you have a Shorter, Easier and Healthier Birth (Marshall H. Klaus, John H. Kennell, and Phyllis H. Klaus)

Lamaze International: Care Practices that Support Normal Birth. www.lamaze.org

The Continuum Concept (Jean Liedloff www.continuum-concept.org)

Sleeping with your Baby: A Parent’s Guide (James McKenna) also visit www.naturalchild.com

Birth and Breastfeeding (Michel Odent)

Maternity Center Association’s Maternity Wise (Maternity Quality Matters Initiative) www.childbirthconnection.org

Vitamin K and the Newborn (Association for Improvements in the Maternity Services) www.aims.org.uk

Creating your Birth Plan (Marsden Wagner, MD)

Dr Jack Newman, Canadian Pediatrician www.drjacknewman.com

Dr Jay Gordon, American Pediatrician www.drjaygordon.com