What Makes a "Good" Birth?

As a Childbirth Educator, I strive to employ what I call the Three Es. If I’m doing my job correctly, my students leave class feeling educated, empowered, and entertained. At the closing of every course, I ask my students to share what they have found to be most and least helpful. I also have an open dialogue with many of our local Midwifes and OBs and ask them how my clients respond to labor and birth. Often times, I hear that the Moms are unafraid, bold, and ask lots of questions. This makes me happy, and here’s why.
Anne Lyerly wrote a book titled "A Good Birth", and I was fortunate enough to attend her lecture a few years ago. She interviewed hundreds of Mothers and asked them to share their birth stories and how they felt about the experience. Dr. Lyerly identified five themes – agency, personal security, connectedness, respect, and knowledge— common across women's stories. What may surprise many is that a woman's perception and overall satisfaction of her birth, had less to do with how she brought her child into the world, and more to do with if she felt heard.
I approach birth as a “Choose Your Own Adventure” experience. Remember those books as a kid where you chose to flip to various chapters to shape your story? It starts with who you choose as your Health Care Provider. Whether it is a General Practitioner, Obstetrician or Midwife, it is essential that Mothers feel listened to, safe, and on the same page with their provider. Before interviewing a potential provider, a Mother should think about what is most important to her. Knowing that flexibility is essential, what would be the ideal birth experience? Thinking about what is desired and then finding that fit in a provider is more empowering than hiring and fitting into an HPC’s philosophy. Baby Center has a list of thought provoking questions to ask, which can be found here: http://assets.babycenter.com/ims/Content/ob_gyn_interview_May_2010.pdf
Choosing where you give birth goes hand in hand with whom you choose as a provider. Most providers have privileges at only one location. Check both provider and hospital VBAC and Cesarean rates. Hospital rates can be found here: http://www.vbacfinder.com/2015/01/north-carolina-hospital-vbac-rates.html. Visiting the hospitals and taking a tour can also be insightful. If you are choosing a birth center, or are having a homebirth, being familiar with back up care is important.
Choosing the right childbirth class is critical to advocating effectively. Parents are paying a lot of money for the experience of giving birth- good service should be expected. Parents have chosen the care team because they respect how they practice, but Mom and Partner should always feel free to ask questions, and in fact, be encouraged to do so. A good childbirth class will help you understand what questions to ask.
Whether you are considered high risk, planning to use pain medications, or choosing to birth naturally, it is important that you understand interventions. Remember, this is an adventure, and birth is fluid. When plans change, it’s important to have familiarity with procedures. Using your “BRAIN” is helpful.
Benefits- What is the benefit of the proposed intervention?
Risks- What are the potential risks to proceeding?
Alternatives- What are our other options?
Intuition- What do our guts tell us?
Necessary- Is it necessary at this moment, or can we have some time?
For brevity’s sake, as I could spend pages discussing what is important to include in class content, I encourage Moms and Partners to ask the following questions to potential instructors
  • What are the instructor’s goals for the class?
  • What is the instructor’s philosophy on pregnancy, birth and breastfeeding?
  • What is their curriculum based on? What evidence-based information do they use?
  • How long is the class? What does it cover?
  • Will the class include hands on practice?
  • What interventions are covered?
Bottom line, birth is sacred. A laboring Mother deserves respect, support and has the right to expect collaboration with her providers. Setting one's self up for success is a personal responsibility and can easily be achieved with a little due diligence.


Below are a few questions about breastfeeding that I frequently field during my Breastfeeding Basics Class. Teaching this course affords me the unique opportunity to work with Pregnant Women and their Partners so that they can prepare for breastfeeding well before birth.

I have small breasts, can I still breastfeed? Yes! Your cup size has nothing to do with the amount of milk you will produce. In fact fat cells, not milk making cells, are what determine your size. Women produce about the same amount of milk per 24 hour period; however, storage capacity can vary from person to person. A baby whose mother has a large storage capacity, and who can therefore eat more in one session, may nurse less frequently than a babe whose mother has a smaller capacity.

What do I do when the baby wants to be on me ALL THE TIME?  I wish I could prepare pregnant woman for the amount of time they will spend nursing their babies. It's always a surprise. In a society where we revere multitasking, it can be a hard notion to accept when I suggest mom simply nurse, eat and rest. A baby is transitioning from womb to the world, and her Mother is her constant. She seeks comfort in mom, and breasts not only nourish, but they regulate breathing, heart rate, temperature, assist in the myelination of nerves and literally protect with the antibodies that are produced in breastmilk. You cannot spoil a baby. A local Doula, Kim, recently shared a wonderful story of a Russian neighbor who said she was puzzled by the statement "spoiling a baby". Spoiling is ugly and rancid. It is what happens when something is neglected and allowed to deteriorate . Holding ones baby is anything but spoiling.

Why does breastfeeding hurt so bad? Breastfeeding should NOT hurt. It's hard to believe when all we hear are horror stories about cracked bleeding nipples, but it's true, nursing should be a comfortable venture. If you are experiencing pain, break the latch by inserting a clean finger in the corner of baby's mouth. Be sure that she latches widely with a generous portion of your breast tissue in his/her mouth. If pain persists, please seek counsel from a successful breastfeeder, community organizations such as La Leche League or Nursing Mother of Raleigh, or a Lactation Professional.

How do I know my baby is eating enough? We live in a bottle feeding society, and since we dont have milliliter ticks on the sides of our breasts, many of us often wonder if we are producing enough for baby. When baby is first born, you will have colostrum, a thick sticky substance to nourish her. What colostrum lacks in quantity, it more than makes up for in antibodies and nutrients. In fact, on the first day of life, your baby eat less than a teaspoon of colostrum per feed! Babies are not born hungry. Their bellies are tiny and they have the stores to sustain themselves for the first days.  As your baby learns coordinate sucking and swallowing, your breasts will produce transitional and then mature milk. Look for the following signs of a well fed breastfed baby:
  • What goes in comes out. Is baby urinating frequently? Is it light in color?
  • Poop tells a story. At first it is dark meconium and then transitions  to green and eventually to yellow stool after a few days.
  • Does baby look satiated? Does baby come off the breast themselves and does he or she look relaxed after the feed? Is baby nursing 8 or more times per day?
  • Hydration is Key. Is Baby's mouth moist? And if you gently pinch the skin, does it bounce back? If so, these are good signs of hydration.

What kinds of foods should I avoid? What about java and vino?  You do not need to avoid any foods. In fact, some babies prefer the taste of their mother's breastmillk after she has consumed garlic and certain spices! Breastfed babies typically have a more adventurous palate and tend to be less picky eaters than their formula fed counterparts. Drinking caffeinated beverages in moderation is also okay.  Alcohol leaves your breastmilk much like it does your bloodstream, so a glass of wine is perfectly acceptable. The best advice is to watch your baby. If there seems to be a correlation between a certain meal and fussiness, you can always consider decreasing the amount of said food. Though some babies may have allergies to food that mom has consumed, it is atypical. If you find that your baby arches her back in pain or stools are discolored, blood or mucous tinged, discuss with your trusted LC or Health Care provider. Certain herbs are said to lower milk supply in some Mothers- these include parsley, mint, sage, oregano and thyme.