Senior Project 1

DECISIONS AFFILIATED WITH CHILDBIRTH 1
Location, Method, And Pain Relief Option Chosen During The Delivery
Of One’s Baby And The Effects Of The Decision Made
Instructor: Gregory Falls
Brianna Kimes
December 5th, 2017
Abstract
This paper explores a variety of articles dealing with maternity and birthing practices in relation to
culture, religion, and access to medical technology. The resources used to write this paper range from
2005 until 2017. Throughout the paper, there are many different topics discussed with varying
perspectives from different groups of people and one’s options in relation to method, pain relief option,
and location chosen for the child birthing experience. The factors listed above can greatly affect the health
of the mother and baby in some cases. For that reason, it is important that one researches the risks and
benefits for each option in the three different categories. This paper will go over in great detail vaginal
birth, cesarean section, water birth, breathing techniques for pain relief, epidural analgesia, position
changes, and delivering in different locations including one’s home, hospital, and a birthing center.
Table of Contents
Abstract……………………………………………………………………………………………2
Introduction………………………………………………………………………………………..4
Limitations of Study………………………………………………………………………………6
Literature Review…………………………………………………………………………………8
Discussion……………………………………………………………………………………….11
Location………………………………………………………………………………….11
Method…………………………………………………………………………………...14
Pain relief option…………………………………………………………………………19
Culture……………………………………………………………………………………23
Religion…………………………………………………………………………………..24
Access to medical technology……………………………………………………………25
Conclusion………………………………………………………………………………………26
References……………………………………………………………………………………….28
Appendix A………………………………………………………………………………………35
Introduction
Throughout life, there are many incredible opportunities that one may encounter.
Childbirth is considered one of those. Although it can be so incredible, it can also be daunting.
When it comes to giving birth to a child, there are many decisions to be made. These may
include choosing the method and location for the delivery of one’s baby. It might also include
decisions dealing with medication or lack thereof. One has to take into consideration the pro’s
and con’s of all of these choices which create an enormous workload that involves a large
amount of research. Decisions including location, pain relief, and delivery method chosen affect
the health of the mother and baby and decisions are made in response to different cultures,
religions, and access to medical technology.
Different religions and cultures have varying ideas on treatment options for mothers and
babies during childbirth. Each religion and culture may have sets of rules that are not to be
broken. Some rules may keep a mother from choosing a certain medication, place, or way to
deliver one’s baby. For these reasons, there are many different options for those specific
decisions that allow for mothers to try and follow they rules as closely as they can. In some
cases, emergencies make it impossible or unsafe for one to stick with the status quo of religions
or cultures. Unfortunately, the birthing methods addressed in this paper are not accessible to all
women due to the varying access to medical technology.
People all across the world have different ways to bring into this world. Delivery
methods can include vaginal delivery without epidural, vaginal deliveries with epidural, cesarean
sections, lotus birth, vacuum extraction, and forceps deliveries. The method chosen by the
mother is a reflection of her background and environment. Pain relief options can include spinal
analgesia, immersion in water, IV narcotics, position changes, and breathing techniques.
Locations may include home, birthing center, and hospitals. Viewpoints vary worldwide,
leading to differing ideas for the perfect child birthing experience.

Limitations
Personal bias: The author herself feels that it is unsafe to deliver a child anywhere
besides the hospital with medical professionals, including doctors, present. The author seeks to
back that opinion up with facts from several different sources and hopes to develop an
understanding of why one would not want to experience childbirth in the hospital.
Resource limitations: Due to the fact that this research paper is associated with the
medical field, textbooks and most books are considered to be outdated resources. This is due to
the ongoing research done by medical professionals every day in regards which inherently causes
the evolution of technological innovations, changing protocols, social norms, and taboos.
Method limitations: Due to the gargantuan amount of research on the topics of delivery
methods, the researcher chose to research cesarean birth, vaginal birth, and water birth,
specifically. Lotus birth was chosen by the researcher because of the interest in the subject
matter and the controversy of the method. The author also chose cesarean birth due to the
complications and scenarios where they are necessary for the child and mother to survive.
Location limitations: With response to the research question and the broadness of the
topic, in order for the author to get into detail about location, method, and pain relief option it is
important that each topic gets its own proportion of the paper. For that reason, the researcher is
limiting the paper to home births, birthing centers, and hospitals.
Pain relief option limitations: Worldwide there are many different pain relief options
and they may have to correlate with the location chosen. For this reason, the researcher is
choosing to research on spinal analgesia, immersion in water, position changes, and breathing
techniques. These are many options that include taking medication and not taking medication. It
is important that the reader take into consideration that not every pain relief option involves the
use of medication.
Despite these limitations, this research paper will successfully determine the explanations
for decisions being made by certain cultures and religions. The author intends to find the
disadvantages and advantages of certain decisions made during the birth of a child. Some
decisions will include medication, location, and method chosen for delivery.
Literature Review
The author of this research paper used a multitude of resources in order to ensure the
accurateness of this paper. The resources used to research the author’s topic all have to do with
the choices made by parents before or during the child birthing process. These may include
method chosen, pain relief option chosen, and the location chosen. The author will be separating
many resources into different sections regarding what the information was about and what it will
be used for throughout the paper. The author then will be separating those within the categories
in regards to how much good information the resource gave the researcher.
“A Child is Born” has devoted a page on cesarean births and the reasons for them along
with the possible disadvantages of having one in comparison to a normal, vaginal delivery.
Although cesarean births aren’t necessarily chosen, it is a method for child birth that is offered.
Statistics show that in the recent years, the proportion of cesarean births have increased
immensely. In the United States alone it has grown between twenty and twenty five percent.
The decision to have a cesarian birth is usually made by the physician who is caring for the
mother and baby. Cesarean births typically correlate to labor complications which can include
the baby showing bad signs while still in the womb. Cesarean births are also planned when the
baby is large in relation to the birth canal or if the baby is in an unsafe position to enter the birth
canal and deliver vaginally.
“Your Pregnancy and Birth” highlights that it is the most common to deliver one’s baby
vaginally while laying back with feet rested on designated foot rests. It mentions that there are
many different positions that one can use while birthing. These can include lying on one’s side,
only if the doctor approves of the specific position. Doctors strive to use techniques that make
one’s birthing experience comfortable. Vaginal deliveries vary in the length of time that it may
take. Sometimes, one may feel a stinging feeling while the baby appears at the opening of one’s
vagina. Once the baby’s head and shoulders are out of the vagina, the rest of the body follows
quickly. After vaginal deliveries, the physician will deliver the placenta. In some circumstances,
the doctor may have to use forceps or vacuum extraction to help push the delivery along.
Forceps are used to guide the baby out of the birth canal. Whereas the vacuum extraction assists
the baby through the birth canal while the mother is still pushing. There are some risks with
come with having to use forceps or vacuum extraction during child delivery.
The “Pregnancy Childbirth and the Newborn Complete Guide” has an enormous amount
of information in regards to medication. The section starts out by highlighting the fact that the
location chosen for childbirth does affect the availability of medications during childbirth. The
section of information about different options in regards to medication includes a graph about the
many different pain relief options which include spinal analgesia, also called an epidural,
immersion in water, position changes, breathing techniques, and many more. The vast majority
of people choose the option of spinal analgesia and most say that the option was very helpful.
This section also talks about the lack of knowledge in regards to the non-medicinal pain relief
options even though they are surveyed to be very helpful for pain management.
“Your Pregnancy and Birth” highlights that during a vaginal delivery, if one is not dilated
enough to start pushing, it is important to be using breathing methods to let the urge to push go
away. This is because if one pushes, with the cervix not fully dilated, it can damage one’s cervix
and can exhaust the mother during labor.
An excerpt from the book “A Child is Born” gives an immense amount of information
about different methods of pain relief. It gives a short description of the different options and the
potential risks that it may have on the baby. It goes into details in regards to epidural anesthesia,
cervical anesthesia, nitrous oxide, analgesics, pelvic anesthesia, acupuncture and hypnosis, saline
solution and TNS, massage and heat treatment, and confidence in the care provided.
The “Pregnancy Childbirth and the Newborn Complete Guide” has an entire section
devoted to the location chosen for childbirth. It refers to whether or not one’s pregnancy is high
risk or low risk and suggests that if one has a high risk pregnancy, to go ahead and birth at a
hospital with high technological advances, several medical professionals, and provides tertiary
care. Whereas it suggests that if one has a low risk pregnancy, there isn’t a drastic difference
between hospital births and birthing center/home births. But it does suggest that if one chooses
to birth at home or at a birthing center that they keep into consideration the time it would take to
travel from there to a hospital if one needed to get further medical treatment.
Discussion
Location
A mother must take many things into consideration when making a decision as to the
location for one to deliver. Jonathan Snowden, Ph.D, said “Women explore the evidence related
to their options and make choices about which risks they prefer to accept and which they prefer
to avoid.” (Husaini, 2017) The different options for locations limit the methods and pain relief
options throughout the delivery. The availability of certain resources decreases from location to
location and for that reason it is essential that one weighs each option and chooses those that are
safest for the mother and baby. Throughout this research paper, the author specifically is
weighing the options for home births, delivering in a birthing center, and the hospital birthing
experience. Each option has its own advantages and disadvantages.
Home
The home birthing experience has many advantages but should not be considered if one
has a high risk pregnancy. Before deciding whether or not a home birth is a good decision, one
should speak to a healthcare professional that is familiar with the specifics of the pregnancy to
discuss the risks of the delivery at home. One important aspect that should be taken into
consideration before going through with the home birth options is a plan on getting the mother
and/or baby to a hospital if either one needs immediate medical attention. “The National
Birthday Trust study in the United Kingdom in 1994 found that 16% of all mothers of all who
had booked home births transferred to the hospital.” (Horn)
Mothers transfer to hospitals from home births for many reasons. These can include
exhaustion, high blood pressure, labor stops progressing, and hemorrhaging. The benefits of
delivering in one’s home includes affordability, immediate bonding and breastfeeding, and no
visiting limitations. The immediate breastfeeding helps the mother’s bleeding stop and also
transfers disease-fighting antibodies from the mother to the baby. Home births usually have
trained healthcare professionals. Nurse-midwives and midwives are the normal healthcare
providers for in-home deliveries. “A midwife is a healthcare professional who provides health
care services for women including gynecological examinations, contraceptive counselling,
prescriptions, and labor and delivery care.” (Mona, 2016) Midwives have a specialty in low risk
or “normal” pregnancies.
Not being in a hospital with doctors poses several risks. The biggest risks are that one is
not in a hospital with the difference resources that the hospital offers. Those risks include
needing labor induction, needing a cesarean section, delivery requiring the use of forceps or
vacuum extraction, several bleeding, and severe vaginal tearing. In a hospital with medical
professionals, all of these circumstances could easily be addressed and taken care of. For that
reason, again, it is very important for one to have a plan in case of a need for an emergency
transfer to the nearest hospital.
Birthing center
A birthing center is a medical facility that offers a more homelike, comfortable setting
than a hospital and offers more natural options for mothers delivering their babies. Birthing
centers have many benefits such as granting an immense amount of family and loved one to
witness connections throughout one’s pregnancy and delivery. Another benefit is that it allows
for one to make healthcare decisions based upon one’s values and beliefs. This pretty much
means that the healthcare professionals leave more room for the patient to make decisions about
one’s care throughout their pregnancy and delivery.
Birthing centers usually partner with hospitals just in case a patient needs immediate
medical attention. This allows for the mother and baby to get seen quickly if one needs special
medical attention. Licensed nurses and midwives work for birthing centers and assist with the
deliveries. Although they are trained professionals, they cannot perform emergency procedures
if needed. Birthing centers, unlike most home births, offer fetal monitoring which allows for the
licensed health care professionals to find signs of problems early on so the mother can be
transported to the hospital for care if needed. It is crucial that one looking into delivering in a
birthing center looks at the nearest hospital and makes sure that the pregnancy is not high risk.
High risk pregnancies shouldn’t consider delivering in anywhere but the hospital.
Dr. Robert Atlas said “Women who decide to birth in a birthing center are at an increased
risk of delayed medical treatment should a major complication like a haemorrhage or eclampsia
occur.” (McCoy, 2014 ) This supports the research done by the researcher because of the risks
of not having access to doctors and treatments that are available in hospitals.
Hospitals
Hospitals are healthcare institutions providing patient treatment with specialized medical
and nursing staff and medical equipment. A huge benefit of hospital deliveries is that hospitals
are controlled and sterile. There are many advantages and few disadvantages to delivering in the
hospital. Most hospitals offer many different types of pain relief for patients and physicians to
choose for the specific case. According to the Pregnancy Childbirth & Newborn Complete
Guide, only 3% of hospitals in the United States do not offer epidurals.
The benefits include safety, close to an operating room, offers most advanced technology,
and access to varying pain relief options. Hospitals are safe because of the other benefits that
come with delivering in the hospital. When it comes to delivering one’s child, it is very
important that one has access to the option of a cesarean section and a hospital is the location for
that to happen. There are many different circumstances that would require a cesarean section
especially when the healthcare providers monitor the baby and mother very closely.
The strict protocols and privacies make it extremely hard for women to make decisions
based on their own healthcare. With constantly revolving healthcare professionals in and out of
the room it does not really allow for privacy for one in their room. With the amount of patients
constantly being treated in the hospital, patients can get the feeling that the care in the hospital is
impersonal and intimidating. The fact that access to operating rooms is available in the hospital
setting allows for more likely chances of having a cesarean section. Physicians would rather go
for the cesarean than risk the health of the mother or baby. Cesarean sections have long term and
short term effects. The long term effects are in regards to future pregnancies. The short term
effects are risk for infection from the surgical procedure.
Method
Cesarean section
The method of a cesarean section is not usually chosen by a patient but it still correlates
to the research in that one may not allow for a cesarean birth due to religion and culture and may
not have the option due to lack of medical resources and technology. One in four babies are born
by cesarean sections. Cesarean sections are methods used in many different circumstances.
These circumstances would include a previous cesarean birth, certain medical conditions,
multiple pregnancy, large baby or small pelvis, breech position, umbilical cord problem, placenta
problems, labor fails to progress, and labor is too stressful for the baby. Some cesarean sections
are planned ahead of time.
If one has already had a cesarean section usually one would have another cesarean even
though some women attempt to have a vaginal birth after a previous cesarean. This is commonly
called a VBAC. Certain medical conditions make it more safe for the mother and baby to just
have a cesarean birth. This would be the case if the mother had an active genital herpes
infection. Cesarean births are very common with multiples because of the strain it can have on
the mother and the babies. For that reason, with triplets and so forth, cesarean sections are
planned beforehand.
Cephalus disproportion is when the baby is too large to pass through the pelvis safely.
When this occurs, the safest option for the mother and baby is to have a cesarean section. They
also occur when the baby is in certain positions. If the baby is breech or transverse, a cesarean
section is used to deliver the baby. Breech is when the buttocks or feet of the baby are closest to
the vagina. Transverse is when the baby is lying sideways in the uterus. If the health care
professional assigned to the delivery finds an umbilical cord problem, a cesarean operation needs
to occur. Umbilical cords can get pinched or compressed and that has a negative effect on the
baby. It can cause the baby to not get the oxygen that is needed. Usually when this happens the
baby is delivered by an emergency cesarean section. Another reason for a cesarean would be if
there are placenta problems. One of the many placenta problems is placenta previa. Placenta
previa is when the placenta is below the baby and covers the cervix. This blocks the birth canal
and can cause heavy bleeding.
Certain circumstances during labor allows for one to need a cesarean section. These
include when labor fails to progress and when labor is too stressful for the baby. 1 in 3 cesarean
sections occur due to labor slowing down or stopping. (Your Pregnancy & Childbirth, 2005)
When one is in a hospital delivering there are many different monitors on the mother and baby.
If fetal monitoring detects signs of problems, healthcare professionals usually make a decision to
deliver the baby using a cesarean section.
Water birth
The concept of water births are fairly new and is still being researched heavily. Sources
have varying risks for the water birthing experience. Water birthing is a process of giving birth
in a tub of warm water. The American Pregnancy Association states that “The theory behind
water birth is that since the baby has already been in the amniotic fluid sac for nine months,
birthing in a similar environment is gentler for the baby and less stressful for the mother.”
(americanpregnancy.org, 2017) Some sources agree that reducing the stress of the labor and
delivery will reduce fetal complications. It is common to have a healthcare professional there at
time of birth. Healthcare professionals include doctors, nurse-midwives, and midwives.
There are many benefits to delivering in a tub of warm water. Many of the benefits are
for the mother but there is one for the baby. However, the many benefits also come with many
risks. There are also situations where one shouldn’t consider a water birth. Throughout a water
birth there are situations that need to stay constant and controlled by the healthcare provider.
Before deciding if one should deliver in a tub, one should check with a healthcare provider to
make sure it is a good option and should also figure out a location that best fits the needs of the
specific delivery and emergency route to the hospital in case of an emergency.
The warm water from the tub allows for an immense amount of comfort for the woman
who is in labor. The water also increases the woman’s energy throughout her delivery. The lack
of medication permits the woman to move freely and to position oneself in different positions to
help with pain. The water birthing experience helps lower high blood pressure and also helps
reduce the amount of vaginal tearing. The benefit for the baby is that the water is similar to the
amniotic fluid which allows for a similar environment.
The risks that come with the water birthing experience are water embolism, water
aspiration, and the snapping of the umbilical cord. A Safe Birth Project highlights that water
embolism is a theoretical risk of a water birth. Water embolism would be defined as water
entering the mother’s blood stream. This would only be a theoretical risk if one delivers the
placenta in the birthing tub. The umbilical cord snapping ties in with the risk of water aspiration.
Due to the fact that babies take their first breath once the umbilical cord is cut, it poses a serious
risk for the umbilical cord snapping. If the umbilical cord were to snap, the baby would then
take a gasp for air while still in the birthing tub and that would allow for water aspiration for the
baby. Water births are very high risk for infection and can cause irregularity of the baby’s blood
temperature.
A water birth should not even be considered for a mother with herpes, excessive
bleeding, maternal infection, breech, multiples, preterm, or pre eclampsia. The chosen health
care provider assisting with the delivery of one’s child throughout the water birth should keep a
close eye on the temperature of the water. If the water gets to a temperature that is too high, it
can cause dehydration and overheating for the mother and baby.
Vaginal
According to the statistics from the Center for Disease Control and Prevention, vaginal
deliveries more than doubled in the United States compared to the amount of cesarean sections in
the year of 2015. (CDC, 2017) A vaginal delivery is considered to be when the baby is
completely delivered through one’s birth canal. There are three stages to a vaginal delivery and
those consist of dilation and effacement of cervix, pushing and birth, and the delivery of the
placenta. Some consider postpartum to be the fourth stage of delivery.
Although vaginal deliveries are attempted before cesarean, there are still many risks to
vaginal deliveries that aren’t necessarily risks for cesarean sections. Vaginal deliveries have
different benefits than those of cesarean sections. In regards to vaginal deliveries there are many
benefits for the mother and different benefits for the baby. Babies getting delivered vaginally
have the ability to get earlier contact with the mother rather than one delivered by a cesarean
section. The pressure from the birth canal of the mother allows fluid from the baby’s lungs to be
squeezed out. This makes babies less likely to suffer from breathing problems at birth. With
cesarean sections being so sterile, it does not allow for babies to be exposed to good bacteria that
they would be exposed to through the birth canal. This good bacteria helps boost the immune
systems and protect the intestinal tracts of the baby. (Nierenberg, 2015)
With the average weight of a newborn being 7.5 pounds, there can be many
complications when coming through the birth canal. (emedicinehealth) The stretching of the
vagina during the delivery of one’s child in the birth canal can do serious damage to the skin and
tissues around the vagina. The skin and tissues around the vagina can tear, making a need to get
stitches. The pelvic muscles used throughout vaginal deliveries allows for weaknesses and/or
injuries to the pelvic muscles. The pelvic muscles are the muscles that control urine and bowel
functions. For this reason, one may experience the leaking of urine when coughing, sneezing, or
laughing shortly after delivering a baby vaginally. One can also experience an immense amount
of pain after delivering vaginally in the vaginal area.
With the many risks of vaginal deliveries there are also benefits. Those benefits can
include short hospital stays and shorter postpartum recoveries. If one delivers vaginally, major
surgery was avoided. The time between delivery and being able to breastfeed for a vaginal
delivery is much shorter than that of a cesarean section due to the amount of recovery the mother
may need and the restitching of the several layers of the stomach. It is said to create a stronger
bond between the mother and baby the sooner after delivery that the child attempts to breastfeed
for the first time.
Pain relief option
During the delivery of one’s baby there are many different pain relief options. Pain relief
options are chosen based on varying circumstances. The location and method chosen for the
delivery can affect which pain relief option is best. With today’s technology, doctors and other
healthcare professionals are able to use a multitude of options at different times and stages of
delivery. Healthcare professionals are also aware that pain varies for every woman. There are
three main factors for pain during childbirth. The three factors are size and position of the baby,
along with strength of contractions.
Pain relief options are not always medicinal. Breathing techniques and position changes
are very commonly used during childbirth. Many classes are offered to teach breathing and
relaxation techniques that way woman know how to cope with the pain that comes with
delivering a baby. Many woman use a combination of non-medicinal options and medicinal
options. Specifically, breathing and relaxation techniques are helpful to use alongside pain
medications.
Spinal analgesia
There are two overlying categories in relation to medicinal pain relief options. The two
categories consist of analgesics and anesthetics. Analgesics offer relief of pain without total loss
of feeling or muscle movement. This pain relief option does not always stop pain but it does
lessen it. Usually analgesics are offered to women in labor or after the delivery. Anesthetics
block all feelings. This blocks the pain and muscle movement. Certain types of anesthetics
cause loss of consciousness. General anesthesia is an anesthetic that causes loss of
consciousness. Another type of anesthetic is regional anesthesia.
Regional anesthesia removes all feeling of pain in specific parts of the body but keeps the
user conscious. This is used quite often during and right after a surgical procedure, also called
the cesarean section. Whereas regional analgesia tends to be the most effective method of pain
relief during labor and causes few side effects. Epidural analgesia, spinal blocks, and combined
spinal-epidural blocks are types of regional analgesia that are used to decrease the pain that labor
inflicts onto a woman. Each of the three popular types of regional analgesia pain relief options
are used for specific purposes.
The epidural analgesia causes some loss of feeling in the lower area of a woman’s body
but the woman remains awake and alert under this method of pain relief. This is given by an
anesthesiologist or a nurse anesthetist in the lower back. One using this method is not allowed to
walk around after the needle is inserted into the lower back. If one is treated using a “walking
epidural,” walking is permitted. Low doses of this treatment are used to prevent side effects for
the mother and baby. Too much of the medication can have a negative effect on the mother’s
health, this can include the mother’s breathing. Some side effects of this treatment are decreased
blood pressure and headaches for the mother and variations in baby’s heart rate. However, the
side effects can both be prevented. Healthcare professionals use IV fluids to prevent decreased
blood pressure. One’s stillness while the needle is placed affects the likeliness of a long term
headache for days after one’s delivery. Based on the Pregnancy Childbirth and the Newborn
Complete Guide, 81% of women who used spinal analgesia said the options was very helpful and
10% said that the option was somewhat helpful. (Simkin, 2016)
Position changes
Positions changes throughout the laboring of one’s child allows for movement.
Movement has many benefits for one who is in labor. There are varying positions that each have
their own set of pros and cons. Position changes also can be supplemented and enhanced by
elements which can include yoga balls and peanut balls. Positioning affects many different
factors of a woman’s delivery. Changes of position should be made by one delivering their child
and should be made in response to one’s body.

Movement enhances comfort by stimulating the receptors in the brain that decrease pain
perception, facilitates labor, and helps the baby move through the pelvis. In a study, there was a
50% reduction in time for mother's progressing from 3 to 10 centimeters dilation. Some
positions even enlarge pelvic diameters which gives the baby more room to go through the birth
canal. Positions play a critical role in the mother’s comfort level. Some popular positions
include standing, supported squat, semi-sitting, sitting (on and off the table), squatting, side-
lying, walking, standing, leaning or kneeling forward with support, knee-chest, and on back with
legs raised.
Changing positions can do more than helping physically with pain and labor. With the
power to move freely and change positions as needed one can get the feeling of control. The
mother should attempt different positions until she feels comfortable. Certain positions also
allow one’s labor partner to help. When one is in labor, being helped by someone else can give
them a feeling of support. Pain medications can restrict the mother from certain positions. If she
has position preferences, she should discuss certain positions with the healthcare provider for the
delivery. Position changes is an option for pain relief that one delivering at any location can use.
Breathing techniques
Breathing techniques can be used anywhere and anytime while one delivers as long as
one is conscious. Some call breathing techniques throughout labor patterned breathing due to the
possible patterns that one can use. Different breathing techniques can be used for varying
purposes. There are many benefits to using breathing techniques during labor and they can
easily be used as a supplement to medicine or other non medicinal pain relief options.
Each woman, with varying amount of pain is going to have their own preferences in
regards to which type of breathing helps them feel comfortable in specific points of one’s
delivery. The common goal of patterned breathing is to lessen the amount of pain of one in
labor. Breathing should give one a sense of control and calmness. There are many benefits to
the varying breathing patterns that one can obtain during the delivery of one’s baby.
After some time, breathing patterns become a natural response to pain. For this reason,
the American Pregnancy Association suggests that one should practice certain breathing
techniques before one goes into labor. Breathing allows for contractions to become more
productive. As contractions become more productive, labor progresses. In a time where strength
and energy is very low, patterned breathing can produce more strength and energy for the mother
and baby. With whichever breathing pattern one chooses it is very important that one focuses on
one’s breathing. A huge benefit of using breathing techniques as a pain relief option is that
breathing maximizes the amount of oxygen available to the mother and the baby. (Baby centre
UK) It is crucial that one does not hold one’s breath during either stage of labor. One’s body
gives one a sign to change breathing patterns when the breathing pattern no longer works to
comfort one’s pain.
Culture
The variation of cultures affects immensely the process of birthing one’s child. “The role
of culture is critical in terms of birth and prenatal care for immigrant mothers.” (Kang, 2014)
Each culture has it’s own sets of trends and taboos in regards to the birth of one’s child. Many
tend to categorize the culture from the ethical point of view. For this reason, researchers are able
to observe the norms of a culture by how one in the culture may go through with certain events.
For the sake of this research paper, the certain event is childbirth.
Filipinos are those who are native to the Philippine Islands. (Merriam-Webster) The
culture practiced by Filipinos tend to dislike the use of pain medication. The reasoning for this is
that pain medication is said to be scarce; therefore, people use less in hopes that it will be used
for someone else who may need it more. There is also a very popular fear of becoming addicted
to narcotics. “Suffering is an opportunity to demonstrate virtue.” (Galanti, 2000) With this
example, the culture practices of Filipinos would affect which pain relief option one would
choose for the delivery of one’s baby.
Haitians, meaning the inhabitants or natives of the country of Haiti, have specific trends
in relation to childbirth as well. Haitians and Haitian Americans as a whole tend to choose more
natural deliveries than a woman in the United States. This is so when it comes to pain relief
options. Haitians have a tendency to deny analgesics and to use non medicinal pain relief
options. Vaginal delivery is more common due to the common fear of the cesarean section.
Woman from Haiti fear cesarean sections due to the fact that it is abdominal surgery. (Cultural
and clinical care for Haitians)
These were just two of the many examples of how culture affects one’s decisions
throughout the childbirthing experience. In some cultures, there is even more things dependent
on the decisions made by a mother during her child’s delivery. For example, “In parts of Asia,
how a woman handles labor pains reflects upon her family’s honor.” (Collin) This would push
one to show no signs of pain and to not ask for any medicinal pain relief options which would in
turn affect the health of the mother and baby.
Religion
Not everyone considers themselves to be religious, but there are many religions
throughout the world. Certain practices and beliefs of a religion can affect one’s childbirth. The
intensity or importance of one’s religion will affect the likeliness of specific religious practices
throughout one’s delivery. Depending on the healthcare provider and the intimacy of a delivery,
it can be hard to implement religious practices due to the seriousness and possible risks to
childbirth. For this reason, one attempting to follow many religious practices tend to use a
midwife. Midwives tend to use spirituality an important factor during the birth of a child.
(Aziato, 2016)
A religion in which they call themselves the “disciples of the new dawn” have very strict
norms and taboos when it comes to the delivery of one’s baby. This group makes many posts
and memes in regards to the usage of medications and cesarean sections in childbirth. Their
memes tend to have a lot of information. “Epidurals and anesthetics contain neurotoxins that are
harmful to your baby.” and “Good mothers use experienced Doulas and midwives because they
do not want to ruin their child with pharmaceutical poison.” The group also has strong views that
women who don’t deliver vaginally and naturally should be punished and should get CPS called
on them. This religious group’s ideas affect the location, pain relief option, and method of one’s
child birthing experience. (Schwartz, 2017)
There are many misconceptions in regards to cesarean sections throughout the Islamic
religion. Some scholars say that cesarean sections are strictly forbidden amongst Muslims. This
is not a historical belief according to the website of Muslim Heritage. Islamic scholars were in
fact the first to write about and illustrate the cesarean section operation. Poems that talk about
the operation also identify and describe the usage of anaesthesia during the cesarean section.
This shows that the Islamic religion is okay with or at least tolerates the practice of cesarean
sections alongside the use of pain medications with the operation. (muslimheritage)
Access to medical technology
Inhabitants of developing countries suffer from a lack of many different resources.
Developing countries are considered to be countries that are not highly industrialized. The
resources they lack can include the basic necessities to live which include clothing, shelter,
water, and food. On top of those things, it is important that one has healthcare. “A large body of
evidence confirms that many people in the developing world go without health care.”
(O’Donnell) A large reason for people not getting health care is that the hospitals do not have
access to enough supplies to run a hospital. “There is an urgent need to establish mechanisms
that can increase the availability and improve the quality of healthcare in the developing world.”
(O’Donnell)
If one does not have access to healthcare, one would not be seen for prenatal care or for
the delivery of one’s baby. This has many risks because of the fact that only the rich people of
developing countries get seen by midwives or doctors throughout their pregnancy or during their
childbirth. Without being seen by a doctor or a midwife one probably also would not have access
to any medicinal pain relief options. With lack of resources, one probably would not have access
to fetal monitoring. This allows for one to be unsure of what is going one with one’s baby and
this poses many risks. If one encounters one of the many circumstances where a cesarean
section is needed, one without health care would not have access to a sterile operation. This
would greatly affect the health of the mother and baby and could possibly be fatal.
Conclusion
Religion, culture, and access to medical technology affects the health of the mother and
baby throughout the process of labor and delivery. Those three factors affect the location,
method, and pain relief option chosen for the birth of the baby. None of the topics researched by
the author of this paper were clearly unsafe compared to others. Yet, there are options available
with small amounts of risk. It is important that one understands and knows, after reading this
paper, that the method, location, and pain relief option planned could not go as planned due to
many different circumstances that could arise.
With the unknowns that can arise throughout the labor and delivery process, the author of
this paper has come to the conclusion that it is safest and is in the best interest of the health of the
mother and baby to deliver in a hospital where healthcare professionals are in case of a medical
emergency where either the mother or baby need immediate medical attention. Research has
also suggested that vaginal deliveries without any medicinal pain relief is safer for the mother
and baby than the different medicinal options. This is due to the side effects and the possible
risks if someone were to go wrong with the doses. Cesarean sections put mothers in a much
higher risk than a vaginal delivery but it is needed in some cases to keep the baby alive.
Nonmedicinal pain relief options can still be used and do not have obvious risks relating to them
specifically.
In conclusion, it is crucial that one researches an immense amount and speaks to a
healthcare provider before making any of the decisions listed in the above research. These
decisions are very important and one should weigh out the risks of each option before making a
decision that could be detrimental to one having a child. There are long term and short term
consequences to each of these options and the decisions should not be made in the spur of the
moment.
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Appendix A
Questions:
1) Did your culture affect the location, method, or pain relief option chosen for the delivery
of your children?
2) Did your religion affect the location, method, or pain relief option chosen for the delivery
of your children?
3) Did your access to medical technology affect the location, method, or pain relief option
chosen for the delivery of your children?
4) How/where/with what medication did you deliver your oldest child?
5) What was considered to be a “normal” delivery when you delivered your oldest child?
6) How/where/with what medication did you deliver your middle child?
7) What was considered to be a “normal” delivery when you delivered your middle child?
8) How/where/with what medication did you deliver your youngest child?
9) What was considered to be a “normal” delivery when you delivered your youngest child?
10) With either delivery was there an emergency situation?
11) With either delivery did you consider birthing at home or at a birthing center? Why or
why not?
12) With either delivery did you consider the water birthing method? Why or why not?
13) With either delivery did you consider delivering without medicinal pain relief? Why or
why not?
14) What years did you deliver your children?

Answers:
Interview 1
Kathryn Matney
1) No, I don’t feel that my culture affected the location, method, or pain relief option chosen
for the delivery of either of my children.
2) No, I don’t feel that my religion affected the location, method, or pain relief option
chosen for the delivery of either of my children.
3) Yes, I do feel that my access to medical technology affected the location, method, or pain
relief option chosen for the delivery of both of my children.
4) My oldest child, Will, was born by a vaginal delivery in a hospital with an epidural.
5) I considered a “normal” delivery, at the time, as no vaginal tearing and no major
complications. Ending with a healthy mother and baby.
6) Does not apply to me.
7) Does not apply to me.
8) My youngest child, JT, was also born by a vaginal delivery in a hospital with an epidural.
9) With my youngest child, I considered the same circumstances as normal.
10) For my oldest son, the umbilical cord was wrapped around his neck. The health care
providers were concerned for the heart rate of the baby. For that reason, there was
careful monitoring for the baby. There was also a possibility for a cesarean section. At
that point, I was very glad that I delivered my child in the hospital rather than delivering
in my home or at a birthing facility.

11) With neither of the deliveries, I didn’t even consider the delivering of my children in
anywhere else but the hospital. I felt that common sense was telling me that the best and
safest options was to be in the hospital just in case. I also wasn’t aware of the birthing
center option until years after I delivered my second child.
12) No, I did not consider the water birthing method. At the time, I wasn’t aware of the
option of the water birthing experience but I for sure wouldn’t have done it unless it were
in the hospital.
13) No, I did not consider delivering my children without pain medication. I felt that way
because I really don’t like to be in pain. I thought to myself “Why be in pain when I
could get an epidural and not feel pain?”
14) I delivered my children in 1998 and 2001.
Deenna Schunk
1) Yes, my culture greatly affected the location, method, or pain relief option chosen for the
delivery of my children.
2) No, I do not feel that my religion affected the location, method, or pain relief option
chosen for the delivery of my children.
3) Yes, I do feel that my access to medical technology affected the location, method, or pain
relief option chosen for the delivery option of my children.
4) For the birth of my oldest child, I delivered vaginally with an epidural in the hospital.
5) During the delivery of my oldest child, I considered a “normal” delivery to be a vaginal
delivery where the baby was born 24-48 hours after active labor was initiated.
6) Does not apply.
7) Does not apply.

8) For the delivery of my youngest child, I delivered vaginally with no pain medication in
the hospital.
9) I had the same thoughts about what a “normal” delivery was.
10) There was not an emergency situation for either of the deliveries.
11) I did not consider delivering my children at home or at a birthing center. I thought that it
would be better to deliver in a facility with full staff of knowledgeable medical
professionals.
12) I did not consider delivering using the water birthing method because that option was not
available to me.
13) I did deliver without medicinal pain relief for my second child and if I were to go back I
would have gotten an epidural. I feel that my first delivery was more relaxing because I
had the medications. I was able to enjoy the birth of my child with the medications given
to me.
14) I delivered my children in 1977 and 1981.
Jennifer Bogart
1) No, I do not feel that my culture affected the location, method, or pain relief option
chosen for the deliveries of my children.
2) No, I do not feel that my religion affected the location, method, or pain relief option
chosen for the deliveries of my children.
3) No, I do not feel that my access to medical technology affected the location, method, or
pain relief option chosen for the deliveries of my children.

4) I had a cesarean section for my oldest child. I had had a previous epidural before they
figured out that I needed to be delivered by a cesarean section. I, of course, was in the
hospital.
5) I considered a “normal” delivery as a vaginal delivery with an epidural and a healthy
baby being born.
6) I had a cesarean section for my middle child. I had had a previous epidural before they
hospital.
7) Considered the same criteria for a “normal” delivery.
8) I had a cesarean section for my youngest child. I had had a previous epidural before they
hospital.
9) Considered the same criteria for a “normal” delivery.
10) With my oldest child I had an emergency situation which was resolved by an emergency
cesarean section. Also, my middle child was breached.
11) I couldn’t deliver at home or at a birthing center.
12) I couldn’t deliver using the water birthing method.
13) I couldn’t get 3 cesareans without any medicinal pain relief option.
14) I delivered my children in 1999, 2003, and 2004.
Carolyn Kimes
1) Yes, my culture promoted pain relief methods and where I had my children. I was
encouraged to have my children within the hospital setting and with pain control I could
use IV medication or an epidural.

2) No, my religion did not affect any of those aspects.
3) No, my access to medical technology did not affect any of those aspects.
4) I had my first child in a hospital, vaginally with the use of an epidural.
5) A “normal” delivery when I was pregnant with my oldest child was to push when you
were 10 centimeters dilated with the nurse and doctor with me throughout the delivery.
6) Does not apply.
7) Does not apply.
8) I had my youngest child in a hospital, vaginally with the use of an epidural.
9) A “normal” delivery was considered in my brain to be the same thing as my youngest
child.
10) There were no emergency situations with either of the deliveries of my children.
11) No, I did not consider birthing at home because I knew I wanted all of the pain options
and the safety of the hospital.
12) No, I did not consider the water birthing method because I don’t feel that it is sanitary.
13) No, I was aware that I needed pain medication.
14) I delivered in 2000 and 2002.
Krista Daldrup
1) No, my culture did not affect those aspects of my delivery.
2) No, my religion did not affect those aspects of my delivery.
3) Yes, my doctor advised me to deliver at a hospital where there was a level one NICU just
in case because of my high risk pregnancy.
4) I delivered vaginally; however, forceps were used due to the umbilical cord being
wrapped around the baby’s neck. I actually had to get 2 different epidurals because the
first one didn’t work. They ended up taking my spinal fluid out so I was completely
paralyzed from the waist down.
5) I am not sure what I considered to be “normal”, I just know that mine was special.
6) Does not apply.
7) Does not apply.
8) Does not apply.
9) Does not apply.
10) Due to the fact that the baby came 5 weeks early, the NICU team had to be present and
the umbilical cord was around the neck.
11) No, I wasn’t offered that option because I needed the NICU present.
12) The water birthing method also wasn’t offered to me.
13) No, I didn’t want to feel any pain at all. Contractions hurt enough.
14) I delivered my child in 2014.
Kelsey Warren
1) Yes, being American I expected to deliver in a sanitary hospital environment with trained
medical staff. I understand that in other cultures it is expected to deliver in the home
without as much medical intervention.
2) No, I do not believe this impacted my decision.
3) Yes, I preferred to deliver in a hospital where the highest level of medical technology was
available. I wanted this technology to be close by in the event emergency medical
intervention was needed. I used some of these interventions, like cervidil and pitocin, to
induce labor at my doctor's recommendation. I ended up having a cesarean section and
utilized that technology as well.

4) Via cesarean section at Sentara Princess Anne hospital. I used cervidil and pitocin to
attempt to induce labor. Since my son's heart rate did not respond well to the induction I
had a cesarean section surgery with the associated numbing and pain medication. I was
on Percocet, Tylenol, stool softener, and an antibiotic after the surgery.
5) “Normal” to me is a vaginal delivery in a hospital. I was informed that 1 out of 3 women
will have a cesarean section and knew this was a possibility, but it was not my plan going
into the delivery of my child.
6) Does not apply.
7) Does not apply.
8) Does not apply.
9) Does not apply.
10) While it was not an emergency situation, my doctor stopped my induction and scheduled
the cesarean section for several hours later.
11) I did not consider that option, I wanted the medical intervention available at a hospital if
an emergency situation arose. I also did not know if my health insurance would cover
those other options.
12) Yes, I did consider a water birth as I find water relaxing and thought it may be a more
peaceful way to labor. I did not move forward with that method because the hospital I
wanted to deliver at didn’t offer that option.
13) Yes, I was hoping to have a natural labor and see how long I could last without pain
medication. I wanted to see what I was physically capable of since I had maintained a
very active and fit lifestyle throughout my pregnancy. My mother also had very quick
labors and I was hoping mine would be the same.

Deanna Mozingo
1) No, I do not feel that my culture affected those.
2) No, I do not feel that my religion affected those.
3) No, I do not feel that my access to medical technology affected those.
4) I had a vaginal delivery in a hospital with intrathecal medication.
5) I considered a “normal” delivery a vaginal delivery.
6) Does not apply.
7) Does not apply.
8) With the twins, I had a vaginal delivery in the hospital with no medication.
9) I considered a “normal” delivery a vaginal delivery.
10) No, I did not have any emergency situations with either of the deliveries.
11) No way, I feel that the hospital is always the safest just in case of an emergency.
12) The water birthing method seems to unsanitary to me.
13) No, I did not consider delivering without medicine but the epidural was done wrong and
by the time the doctors had realized that it was too late to readminister the epidural so I
really had no choice.
14) I delivered my children in 1999 and in 2004.
Melanie Huss
1) No, I don’t feel that my culture affected any of those aspects.
2) No, I don’t feel that my religion affected any of those aspects.
3) No, I don’t feel that my access to technology affected any of those aspects.
4) I delivered my oldest child vaginally in the hospital with no medication.

5) A “normal” delivery at the time would be vaginal delivery in the hospital with
medication.
6) I delivered my middle child vaginally in the hospital with an epidural.
7) I still felt the same way about a “normal” delivery.
8) I delivered my youngest child vaginally in the hospital with an epidural.
9) I still felt the same way about a “normal” delivery.
10) Middle child was a “blue” baby. She wasn’t breathing when she was born. The doctors
and nurses had to resuscitate her. She had the cord around her neck.
11) No, because I wanted a doctor if there was an emergency.
12) I would have considered a water birth but none of the hospitals offered it.
13) After the first baby with no medication, I wanted the medication and it was worth it.
14) I delivered my children in 2004, 2010, and 2013.
Ingrid Martin
1) I feel that my culture has a norm of getting an epidural when you are done with the pain.
I tried to go as long as I could but I finally had to give in and get the epidural done.
2) No, even though I was highly encouraged by fellow people in my church to do a home
birth, I knew that I should use the resources of the hospital due to prior birth
complications.
3) I don’t think so.
4) Pitocin, epidural, and something inserted into the cervix to help with dilation were the
medications used for my delivery due to the induction of my labor. I delivered at Sentara
Princess Anne hospital. I delivered vaginally.

5) A “normal” delivery to me was one where everyone went well.
6) Does not apply.
7) Does not apply.
8) Does not apply.
9) Does not apply.
10) No, there were no emergency situations throughout the delivery.
11) I briefly considered the option of delivering at home but due to the immense amount of
sickness and complications throughout my pregnancy, the doctors and I were scared that
the delivery would be filled with complications as well.
12) No I didn’t consider the water birthing method. Being in and out of the hospital
throughout my pregnancy made me 100% sure that I wanted to deliver my son in the
hospital and it was not an option at the hospital.
13) Yes, I did consider and I tried to go through with it but the pain got too much for me to
handle. I had a metal piece put into my body and the contractions really made that hurt.
Although, the epidural didn’t take away the pain, I am glad I did it to at least take away
the pain from the contraction itself.
Sherry Kososkie
1) No, my culture didn’t affect any of those aspects.
2) No, my religion didn’t affect any of those aspects.
3) No, my access to medical technology didn’t affect any of those aspects.
4) With my oldest child I delivered vaginally in a hospital with an epidural, induction
medications, and magnesium sulfate.

5) I considered a “normal” delivery to be a vaginal delivery with no complications resulting
with a healthy mother and baby.
6) My second child was born at a women’s center, vaginally, with epidural and induction
meds. My third child was also born under those same conditions.
7) I still considered the same circumstances as “normal.”
8) My youngest child was born by a cesarean section at the women’s center under spinal
and magnesium sulfate.
9) For me, after 3 somewhat normal deliveries, I just knew my fourth delivery wasn’t
normal due to the pregnancy and delivery being very high risk.
10) I had many complications with my third and fourth children. My third child was born at
32 weeks and was in the NICU for 6 weeks after the birth due to the riskiness of the birth.
Medical condition was preeclampsia. My entire body shut down, starting with my
kidneys and slowly everything else followed. This made it to where I needed a nurse
bedside at all times. My child then had to be moved to a level three nursery where she
could be cared for her condition, which was respiratory failure. She was given surfactant
therapy and came home under the conditions of having oxygen all the time for the first
six months of her being at home. My fourth baby also was born early and had to go into
the NICU for three weeks before being able to go home. Both my third and fourth
children were life threatening. The baby had to be delivered or I would have died. After
I delivered my third child, I had to spend three weeks myself in the ICU for my
immensely high blood pressure. After the delivery of my fourth child, I was in the
hospital for 9 short days before my liver completely failed.

11) I did not consider delivering at home because my insurance wouldn’t cover it. I also
knew that I was going to need special medical attention for the youngest two and knew
that I could really only get that at the hospital.
12) For the same reason, I didn’t consider the water birthing method.
13) I didn’t even consider delivering any of my four children without medicine because I
didn’t want to feel any pain.
14) I delivered my children in 1996, 2000, 2005, and 2009.
Sherry Zurlinden
1) No, I do not feel my culture affected my child birthing experience.
2) No, I do not feel that my religion affected my child birthing experience.
3) Yes, I do feel that my access to medical technology affected my child birthing
experience. If it weren’t for me living where I did, with so many resources near me, I
would have had to deliver at home, especially with my second child coming so quick
after my water breaking. I am so glad that I have access to the hospitals because I never,
at the time, would have thought about delivering anywhere else unless the other options
offered an epidural. I saw so many different side effects to the other medications that I
only wanted an epidural.
4) I delivered my oldest child vaginally at the hospital with an epidural.
5) I considered a “normal” delivery to be one at the hospital with or without medicine.
6) Does not apply
7) Does not apply
8) I delivered my youngest child vaginally at the hospital with no medicine.
9) I still considered the same thing as a “normal” delivery.

10) There were no emergencies.
11) I never considered home birth because my only option was the hospital. I wanted to have
pain medicine and I didn’t see a reason not to have a control of the pain and have medical
help if there was a problem with the birth or the baby.
12) I never heard about water birthing. If I would’ve had a third child, I definitely would
have delivered that child using the water birthing method. I think it would be more
normal for the baby to go from water to water. I feel that it would have decreased the
amount of stress for me and the baby and it may have prevented me from getting pain
medicine. I just feel that water is so relaxing and that it can do so much for one’s pain and
from what I know about water birth it seems awesome.
13) I didn’t want to go without pain medication but I ended up doing it because I didn’t get to
the hospital quick enough. By the time I had gotten to the hospital, I had to start pushing
right then. I didn’t have time to get the epidural done.
14) I delivered my daughters in 1981 and 1985.

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DECISIONS AFFILIATED WITH CHILDBIRTH 1

Of One’s Baby And The Effects Of The Decision Made

Instructor: Gregory Falls

December 5th, 2017

Pain relief option…………………………………………………………………………19

Access to medical technology……………………………………………………………25

religions, and access to medical technology.

women due to the varying access to medical technology.

analgesia, immersion in water, IV narcotics, position changes, and breathing techniques.

leading to differing ideas for the perfect child birthing experience.

limiting the paper to home births, birthing centers, and hospitals.

canal and deliver vaginally.

and can exhaust the mother during labor.

experience. Each option has its own advantages and disadvantages.

had booked home births transferred to the hospital.” (Horn)

care services for women including gynecological examinations, contraceptive counselling,

transfer to the nearest hospital.

one’s care throughout their pregnancy and delivery.

Guide, only 3% of hospitals in the United States do not offer epidurals.

effects are risk for infection from the surgical procedure.

are planned ahead of time.

and can cause heavy bleeding.

deliver the baby using a cesarean section.

time of birth. Healthcare professionals include doctors, nurse-midwives, and midwives.

specific delivery and emergency route to the hospital in case of an emergency.

amniotic fluid which allows for a similar environment.

placenta. Some consider postpartum to be the fourth stage of delivery.

of pain after delivering vaginally in the vaginal area.

for the first time.

Pain relief option

along with strength of contractions.

cause loss of consciousness. General anesthesia is an anesthetic that causes loss of

consciousness. Another type of anesthetic is regional anesthesia.

are used for specific purposes.

and should be made in response to one’s body.

comfort one’s pain.

to narcotics. “Suffering is an opportunity to demonstrate virtue.” (Galanti, 2000) With this

choose for the delivery of one’s baby.

and clinical care for Haitians)

turn affect the health of the mother and baby.

child birthing experience. (Schwartz, 2017)

Access to medical technology

Inhabitants of developing countries suffer from a lack of many different resources.

many different circumstances that could arise.

In conclusion, it is crucial that one researches an immense amount and speaks to a

2017, from http://www.kybeleworldwide.org/041013-the-pain-of-childbirth---differing-cultural-

Retrieved November 27, 2017, from https://www.babycentre.co.uk/a544499/breathing-

Retrieved December 01, 2017, from

Hospital. Retrieved November 02, 2017, from

Developing country. (n.d.). Retrieved December 01, 2017, from

Filipino. (n.d.). Retrieved December 01, 2017, from https://www.merriam-

care. Retrieved November 27, 2017, from

December 01, 2017, from http://adc.bmj.com/content/89/12/1094

Haitian. (n.d.). Retrieved December 01, 2017, from https://www.merriam-

November 26, 2017, from https://www.fitpregnancy.com/pregnancy/labor-delivery/home-birth-

Huss, M. (2017, December 07). Child birth [Telephone interview].

of Immigrant Women: Doulas’ Perspective. Retrieved November 27, 2017, from

Kimes, C. (2017, December 07). Child birth [Telephone interview].

Kososkie, S. (2017, December 07). Child birth [Telephone interview].

Technique for a Natural Birth. Retrieved November 27, 2017, from

Martin, I. (2017, December 07). Child birth [Telephone interview].

Matney, K. (2017, December 01). Child Birth [Personal interview].

November 27, 2017, from http://www.parents.com/pregnancy/giving-birth/labor-and-