Jaime Lewis (Host): Welcoming a new baby is one of life's most profound experiences, and many families are exploring natural childbirth as an empowering path. Today we're discussing the natural childbirth journey with Dr. John Alton, an Obstetrician and Gynecologist. And Amanda Alton, a Registered Nurse and Childbirth Educator, both with Southwest General Health Center.

 Welcome to Southwest General Health Talk, a podcast from the specialists at Southwest General Health Center. I'm Jaime Lewis. Dr. Alton, Amanda Alton, thanks so much for being here.

John Alton, MD: Welcome. You can call me John.

Host: And speaking of names, you have the same last name. Is that a coincidence?

Amanda Alton, RN: No, it's not. We are married and, yeah. So.

John Alton, MD: Yeah, have, uh, eight kids all together, two of our own and three from previous lives and, worked together at Southwest. Met there, got engaged at Southwest, got married and Amanda, took care of kids. And then she came back and now she's the educator, which is super exciting.

Host: That's wonderful. That's the dream team right there. Well, let's start some basics. What does it actually mean to have natural childbirth? What defines this approach for families who are considering it?

Amanda Alton, RN: A lot of people when they think about natural childbirth, they think of not using pain medication, intermittent monitoring, moving around freely throughout the course of their labor.

John Alton, MD: And this is, you know, we want this to be educational for people. It's certainly not medical advice. And you Cosgrove Maternity Center is an awesome place for physiologic births, but we have a lot of safety and a lot of reassurance for our patients here.

Host: Well, what are some of the biggest benefits for moms and babies when families choose natural childbirth?

Amanda Alton, RN: Some of the big benefits are that moms can just, again, stay mobile and active throughout their labor process. The data shows that moving around is the biggest thing that you can do to keep your labor progressing. So a lot of moms really like having that ability to not make this a confined to bed experience. And then, you know, our goal is to get mom and baby bonding right away as soon as baby is born. So, we want to get baby right on mom's chest and start skin to skin.

Skin to skin will help with baby's bonding. Start with that first feeding. Temperature regulation, blood sugar regulation, so really great benefits.

John Alton, MD: Yeah. And here at Southwest there's a skilled team of nurses and doctors, so we'll talk more about that later, but I think that's the safety part of natural childbirth here at Cosgrove.

Jaime Lewis (Host): Can you walk us through what natural childbirth usually looks like from those first signs of labor through delivery? What are the different stages that families should be aware of?

Amanda Alton, RN: So labor's broken into a few different stages. So the first stage is what we call early labor. So this is typically where mom's moods are very happy. They're excited. They typically can still walk and talk through contractions. So this is a great time to utilize your home environment if you haven't been told to come in early or you don't have other health concerns.

So staying at home, getting a shower, napping if you can, eating some light snacks, maybe playing some games, going for a walk during this time. And then, as labor progresses and, it's time to come into the hospital, we're looking at more of like an active phase of labor. So this is usually where mom's mood gets a little bit more focused, a little bit more serious to work through those tough contractions.

And this is where mom really wants to utilize those labor positions that hopefully, she's been practicing or she's aware of before she comes into the unit. And then also using breathing exercises that have been practiced before coming up here. As well as support partners who have helped to practice those labor positions and breathing exercises with mom. So it's really going to be, a team partnership throughout that process up here.

John Alton, MD: And you know, Amanda's idea of the being at home as long as you can is really important. Obviously, you're going to call your doctor or come in if you start having fevers or heavy bleeding or, the baby's not moving as much.

You know, if your water breaks and you have a group B strep positive, which your provider will talk to you about, you need to come in for that part. That part of the safety is really important for the patient and their support person to know when is it important to come to the hospital.

Host: Well, I know for my own part, I have two children, 13 and 15 now, but back when I was having them, I was definitely curious, concerned about having natural childbirth, no medication. What kinds of techniques or strategies can really help with pain and stress during the birthing process?

Amanda Alton, RN: I Teach the Prepared Childbirth class here at Southwest and through that class we focus on a number of non-medical coping techniques. Some of those obviously would be the breathing exercises and labor positions, but we also go through some visualization and guided imagery exercises. Having something to focus on other than the clock in your labor room is really key.

You really want to put yourself in a positive bubble, positive support, positive mindset, typically will create a positive experience of creating that positive bubble. You can also do that by way of, if you are want to still be touched in labor. Some moms get to a place where they're just touched out and that's okay too.

 But massage can help too. There's a theory that pleasure sensations will reach our brain faster than pain sensations. So that's where massage can be helpful. And I'm, I won't lie and say massage will take away all labor pain, but it will trick the brain a little bit so that it will decrease your perception of pain.

 And then also using some water therapy. You know, the data shows how water therapy can help lower pain scores and kind of do that same decreasing the perception of pain within the brain. And also the tub allows moms to kind of go a little bit weightless and take some of that weight that is kind of just hanging with their belly because they can use the water, to just kind of rock back and forth.

Music therapy. So I always tell anybody who takes my class or my tours to bring in a Bluetooth speaker. Again, having something in your room to focus on other than the hospital noise or watching monitors. So whether it's music, or something from home, like a favorite picture of a vacation or something from baby's room that you can set inside your labor room that you can just focus on, will really help with that too.

So those are just some of the key things that we work on in my class.

John Alton, MD: Yeah. And one example of this patient just delivered last year and she played country music and they named their baby Laney. That was really, so I mean, things like that, you know, that help bring everything together.

Laney Wilson obviously, but, you know, those are the type of natural things that help and, the prepared childbirth class, getting ready for those things. Like if, if a patient were to come in and they, they just decided to have a baby natural, it's going to be really tough. Those tools have to be preloaded.

Really important for that. That's probably the biggest part. And the staff here and they do a great job of supporting those positions, they help dads and the support person as much as anyone else does say, Hey, this is a, a good way of managing this. The nurses are excellent at saying, Hey, let's go ahead and, try this.

They have a very great experience with it too.

Host: Well, as I mentioned, I had kids and I was able to do both natural and I would say that the number one thing that helped me was the people that were around me. They were supportive. And it sounds like you have exactly the same kind approach. I'm curious how much does the environment matter during labor? You've mentioned the ability to walk around as something that's considered a benefit. Are things like that and lighting and having supportive people around, as important as I experienced them to be?

Amanda Alton, RN: A hundred percent. So walking around, we have a couple different options for monitoring, which I think we're going to get to, um, a little later on in the podcast. But no matter which one of our monitoring systems is being utilized; there's ability for movement. All of our labor rooms have dimmer switches so you can dim the lighting.

All of the rooms have windows, but they have darkening shades that you can roll down too. I know people have brought in like battery powered, it has to be battery powered flicker candles or like battery powered, like kind of little fairy lights, like twinkling lights. You know, you do have the ability to kind of make this space your own when you're in here.

Also sound, music or you can shut the door if it's too loud to the hallway or if you want to hear what's going on, you can obviously leave the door open. There's a lot of abilities to kind of make the labor room your own and comfortable for when you're here.

John Alton, MD: In 2022, we redid the labor and delivery suites. They're huge. They're very big. Amanda mentioned support persons. The rooms are big enough that if you want more than one person in the room, you can have that. It's not just restricted just to one support person. You can have two or three if you want, you know, where some people just want to have just one.

So, you know, that ability to choose how you want your environment's really important.

Host: John, you mentioned earlier, front loading that discussion, preparing ahead of time. For expectant parents who are interested in this path, what are some of the best ways to prepare physically and emotionally? Are there classes, you mentioned tours, resources, what would give somebody confidence for the big day?

John Alton, MD: I'm a doctor, so I get the doctor side of it. Amanda gets the fun side of this. The doctor side is I, will emphasize prenatal care. You know, getting the diabetes testing, making sure your blood pressures are okay, those are the things that are out of your control as a patient.

But those are the things that can be prepared for as a physician. So getting ready in my world is the medical obstetrician side of it, which is great prenatal care. All the doctors and providers at Southwest General do a wonderful job. We do support natural childbirth. We also prepare patients, say, okay, this is what epidurals are during the time when you're not in labor, to have an idea of what you're getting into.

Host: Well, what about partners and support people? How can they best help during labor and delivery? I think a lot of people are confused about how to support somebody who's in labor.

Amanda Alton, RN: First thing, and it's maybe sounds kind of funny, but it's really serious. The support partner is going to have the ability to see when contractions are happening if a mom is on one of our monitoring systems. I would encourage all support people to never say, here comes another one. Mom's going to know, so you don't have to tell her.

She's going to know. When you see the contraction start to fade and taper off, at that point, I would encourage support people to say, you did it. You did a great job. But don't say, here comes another one. And all kidding aside, for support people, practicing those labor positions and those breathing exercises with her at home before she gets here, so that when she's in the middle of these contractions, you know what to do and she's going to look to you as her visual resource to say, okay, help me through this one.

And if you've practiced this with her, you're going to know what to do. In addition to that, when you are offering a comfort technique or you're offering some sort of help, just keep it one option at a time. If you start throwing out, like, do you want a Popsicle, do you want a washcloth, do you want to a slow dance?

Like what do I, it kind of will feel like spam, like sensory overload for her. So just one option at a time is key.

John Alton, MD: And then, you know, you reassess. Amanda went natural and I was obviously her support person. And I will also give the advice sometimes don't talk. Sometimes just keeping your mouth quiet might be the best move to make sometimes and, and be able to, to support that person.

Because sometimes when you talk they might not want to hear it. So, you know, Amanda brings out the best point. You take the cues, you, you throw a little bit out there, you don't try to unload at all. I think setting boundaries up is really good before you show up. Like the mom might not want to ever hear you say you're doing great.

Like, they might never want to hear that. So they'll say, Hey, don't say that, and then you don't. So I think kind of getting ready in that position of what type of, and labor changes personalities. The most sweetest, wonderful person can just not be that person when they're in labor, and that is a hundred percent okay. A hundred percent.

Amanda Alton, RN: That's a really good point. That's another thing to stress to any of the support people out here watching is, there does usually, not always come a point in labor where mom might become a little bit more irritable. We call this the bity phase. This is the phase to not take anything personal.

So these contractions are tough work. During that minute that that contraction lasts, she needs to be really, really focused on just getting through that.

Host: Yeah, we're here to do a job and only one person can do it.

Amanda Alton, RN: Right. Exactly. That's so true.

Host: So respect the job. Yes, exactly. Well, tell me more, you, I know that you have so many cool things there at Southwest General Cosgrove Maternity Center. Tell us about some of the cool perks that you've got there for like personalized birthing plans, special spaces, that sort of thing.

Amanda Alton, RN: So we have what's called a birthing journey service. And I think we're going to link the QR code to the podcast later on. But what this service does is it puts our patients right in direct contact with our nurse educator on our floor. And then there's an email exchange back and forth where there's basically a blank PDF of a birth plan template with preferences and choices and some write-in

abilities too. And parents can fill this out. They can email this back, and then this would be attached to their chart on admission. So it would serve as a communication tool between them and the nursing staff and the doctor who's there taking care of them.

John Alton, MD: But it's not a contract. So anything put in that can be changed later at another time. And, you know, this was done to allow the expectations of the patient and what we can provide to, to kind of get on the same page. It's a great service.

Amanda Alton, RN: So yeah, that, and then obviously our classes and then taking the maternity unit tour, the tours are free. Some of the classes do have a cost associated with them. They're not very much. And I know that some insurance companies will offer reimbursement, but I know that's also plan specific. So, but tours are free.

John Alton, MD: Yeah. And you know, when Amanda does the tour, the room she shows, the rooms are hotel style. You know, when they redid it, they did not want to make it a sterile environment like the old school, you know, two beds in a room. Two, you know, it is, it walks the fine line between clinical and home. The tubs in the room are great for patient who and there's showers. The handheld showers with a place to sit in case the patient can't get in the tub. The facility has a lot here that when you take your tour, you get to see it.

There's the waiting room outside is great. The maturity side after they have the baby across the bridge is wonderful. Walking around outside, there's lots of space for if they do want to walk and get, want to get outta the room.

Host: Fantastic. Well, what would you say to parents who like the idea of natural childbirth, but they're just not sure they can handle it?

Amanda Alton, RN: I would say that's totally fine. You know, you are allowed to change your mind. We have, some moms that will come in that are, you know, really firm in their decisions and this is what they're going to do. And then as things start changing, they want to also change their mind. And you're allowed to, nobody's going to hold you to what you initially say and say, well, this is where you started, so we're going to stick to this.

But that being said, you know, we have some moms that will come in and say, I'm not sure about pain medication. Please don't offer it unless I ask it. And our nurses will respect that too. So really just open communication, will really help the back and forth and you know, we want to do everything we can to honor a mom's desires and wishes as long as we're staying, you know, within the safety guidelines.

And mom is safe and baby's safe.

John Alton, MD: A hundred percent.

Host: Well, if labor does take an unexpected turn, which sometimes it does, and medical intervention is necessary, how do you help parents still feel empowered in that experience?

John Alton, MD: In those situations, it's never, never expected. We are prepared for it, but it's not expected. So, you know, the nursing staff here, you know, when you look at our Press Ganey ratings and our ratings, it's always through the roof. The nurses here get a bond with patients to the point that the next day after they've had their baby, they'll go visit them on their postpartum side to visit.

So there's a relationship between the nurses here that, somehow these nurses have the ability to get that bond right away. Now, they might not have ever met the patient, but they get that bond right away, and that's a great resource. So when things start to go some way, the nurse has their crystal ball and they say, Hey, we're looking at this.

I'm going to check in with the doctor. The medical staff here and the obstetricians here, do think they do a wonderful job of presenting those options. There's not one way. They empower patients to make decisions. They give patients time to ask questions about what's going on. This situation's hard if things go south really fast, and it's up to seconds and minutes to make that decision,

we understand the psychological trauma that happens with that. We know that even though it's our every day, it's that patient's one and only. So if, God forbid, we have to wheel them down the hallway for an emergency c-section, during that time, that support team is doing everything they can to make sure the patient is as comfortable and is in tune with the environment and informed of what's going on.

We also do a post afterwards to have a discussion with them of, Hey, this is what happened. This is why we went this way. The satisfaction after those is going to be low. We know that. That's not what they wanted. That's not what they came for. But at the end, we have a healthy mom and a healthy baby. That's what we're here for.

Host: Well, thank you Alton's so much for all of your work in the field and also for sharing your expertise with us today.

Amanda Alton, RN: Thank you for having us. Yeah. A lot of fun and a lot of fun. We look forward to meeting you, whoever's watching this and your baby very soon here at Southwest.

John Alton, MD: Right, right. And you know, Cosgrove maturity really appreciates the time you gave us.

Host: Absolutely. Well, that was Dr. John Alton, Obstetrician and Gynecologist, and Amanda Alton, Registered Nurse and Childbirth Educator with Southwest General Medical Group. To request an appointment with Dr. Alton, you can visit swgeneral.com. And if you found this episode to be helpful, consider sharing us on your social channels and check out the full podcast library for topics of interest to you.

Thank you so much for listening to Southwest General Health Talk.