Birth Questions & Answers with Doctors Mussalli & Worth

Unmedicated birth is an amazing achievement. Ask any mom who has done it. Almost without exception, when our patients climb this steep mountain and reach the pinnacle, they tell us they are changed forever and proud. But remember — it isn’t easy and sometimes not possible on the first try. For example, think about how many Olympic gold medalists failed to medal or even qualify in previous events before winning gold. Their past experiences, determination, great coaching, and a little luck helped them succeed. So it is with unmedicated birth; very hard accomplishments take practice and patience!


Our triple D winning recipe is Determination, Doula, and Doctor.

If you want it, give yourself time, and we promise you can (baring an unexpected complication with the baby or placenta- that’s the luck factor). If you don’t get there for your first delivery, then you will for your second.

Why would anyone want unmedicated birth when pain-free birth is available. This question is complex. The answer is personal and different for every mom, but these are answers we have heard:


“My breastfeeding goes better, I am closer to my baby, I am proud of myself, I bond better with my baby, I recover faster, My husband or partner is proud of me, I am more present at my child’s birth, It is the moment in my life so far that I am most proud of”.


Yet, there are some labor situations where you need an epidural to help achieve a vaginal birth. For example, a baby that is occipital posterior (facing the ceiling instead of the floor). An epidural helps rotate the baby before it’s too deep in the pelvis. Once it’s deep in the pelvis, either the baby delivers in that position (5%), or the baby doesn’t descend more, and you need a c-section (95%).


What’s hard is if your plan is for unmediated birth and you get an epidural you didn’t want, then don’t have a vaginal delivery. In these situations, we have found some moms who feel they didn’t have birth their way. The alternative may be a c-section, but the mom got to call the shots. Think through what would be best for you. Above all, we want you proud of your birth experience.

Epidural anesthesia for labor pain is a solution that almost immediately removes all labor pain. We support this for our patients whenever wanted. Ask for an epidural, and the pain will be gone shortly. 


Yet, remember that old saying, “There’s no such thing as a free lunch.” Epidurals come with a cost, especially for the first vaginal birth. In our experience delivering over 10,000 babies, we have seen epidurals that sometimes led to unneeded c-sections. Epidurals do alter the strength and frequency of contractions. Often, as the labor is getting into a good pattern, many ask for an epidural. Natural labor has now been interfered with, the contractions often too weak, too far apart, and not coordinated with the fetal status. Often, the epidural hinders the natural rotation of the baby, leaving the head in a transverse or occipital posterior position. (A frequent position that prevents the baby from fitting through the birth canal.) Once the epidural is in, and with the pain gone, it’s tempting for many to want to go back to the plan of non-interventional natural birth. Yet generally, the worst thing to do is break the momentum of labor with an epidural and then not get back on track.


We counsel patients on the importance of the correct timing of epidural anesthesia. Try not to get an epidural too early. Use your doula and other supports to help push a little further past your “I’m done” point. Then, when you get the epidural, allow us to help restore the labor you were having before and keep the momentum. That hard work of early labor is helpful to your success for a vaginal birth. Knowing how labor feels, and that you did everything possible is satisfying. Oh yeah, if the baby’s head is already out, it’s too late for an epidural. But, almost up to that point, it’s never too late for your epidural.

“First do no harm” is part of the Hippocratic oath that doctors swear to. Safety, safety, safety. That’s our #1 job as doctors. Safety for mom and baby is the key difference between hospital birth and birth centers or home birth. Safety means being able to rapidly help you, your fetus, or your newborn baby if there is a problem. A timely cesarean section, or immediate expert pediatric resuscitation if your baby is in distress is a real challenge if not in a hospital. The most traumatic stories heard are from couples who endured the chaotic transfer from home or birth center to the hospital when something went wrong.


Birth centers separate patients based on predetermined risk factors. They accept only “low-risk” patients. Epidural, C-section, and pediatric staff are not available on-site at birth centers. Birth centers also need to discharge home 18 hours after birth which might be difficult if you’ve had a long labor. 


Some worry that increased fetal monitoring in a hospital creates unnecessary cesarean sections. We disagree. It’s not the information that is bad, but what a doctor does with it that is the key. Village Obstetrics enjoys a low cesarean section rate because fetal monitoring gives the information needed in labor to know it’s safe to continue. When labor is active, monitoring the baby is important. Information is critical to making the best decision. Think about going to buy a new home. Would you not get an appraisal or engineer’s report. We all seek information in everything we do to help make the best decisions. And so too in managing pregnancy and birth.


We don’t practice at a birth center because we disagree with the current birth center approach. Information is our friend, the more, the better.

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