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Organized Labor : High Rate of Cesareans and Impersonal Care Prompt More Pregnant Women to Turn to Birthing Assistants


As the contraction swept over her body, Lisa Maloney closed her eyes, put her arms around Sherri Alden and clung to her for dear life.

"You're doing great, sweetie," Alden whispered, holding Maloney tightly. The two women rhythmically swayed back and forth, breathing together, riding out the wave of pain.

It was about one o'clock in the afternoon, March 15. Maloney, had been in labor for 19 hours. Exhausted, but still able to smile between contractions, she asked, "So how long is it going to be till we have this baby?"

Little did she know, she had 11 more grueling hours to go.

But she wouldn't be going it alone. On one side was her husband, Patrick. On her other side was Alden, a registered nurse hired independently by the San Clemente couple to guide them through the birth of their first child.

When Maloney was weary and in pain, it was Alden she most often turned to for comfort.

"I can trust her," explained Maloney. "And when the contractions come, I can fall into her arms and welcome them."

Alden, who calls herself a labor support professional, is part of an emerging trend in the childbirth arena. Concern over the high rate of Cesarean births and frustration over doctors and hospital staff whose care is often perceived as impersonal or insensitive, are leading some pregnant women to turn to labor companions like Alden.

For flat fees ranging from $250 to $600, these labor room companions may do everything from massage your back to stand up to your doctor.

Some doctors see labor assistants playing a positive role, particularly as coaches to expectant mothers; others believe they can end up creating problems if they interfere with the patient-doctor relationship. Women such as Maloney, who are determined to avoid a Cesarean section and give birth "naturally" with the help of little or no medication, see these labor assistants as their guardians against so-called intrusive medical care during childbirth.

In fact, many of the clients of labor assistants include women who believe they had unnecessary C-sections or had a previous unpleasant birthing experience. Some want an advocate in the labor room to help them feel they have control over how they give birth.

Most doctors have had limited experience working with private labor assistants. Although their presence in the labor room is growing, the overall number of women employing them is small.

Maloney's obstetrician, Henry Pollak, had worked with Alden before and was comfortable with having her help coach Maloney through labor. Pollak is chief of obstetrics and gynecology at Samaritan Medical Center in San Clemente as well as medical director of its family birthing center.

Alden, a strong backer of limited medical intervention in the birthing process, had worked as a labor and delivery nurse before becoming a private labor assistant. She has assisted with about 60 births in that role.

Maloney got in touch with Alden after hearing her speak on the radio about the benefits of having a labor assistant. Their association began in mid-pregnancy and, by the time the delivery date was at hand, they felt they knew each other well. Alden explained to Maloney the kinds of choices that might be open to her--from refusing medication to opting to use a Jacuzzi in the labor room. Maloney drew up a written birth plan that detailed how she wanted her baby to be born. Among other things, she wanted to be able to reach down and touch the baby's head just before delivery and her husband wanted to cut the umbilical cord.

A primary goal, though, was to avoid a Cesarean delivery.


The rate of Cesarean births in Southern California is between 15% and 25%, according to Pollak.

In the late 1980s the Cesarean birth rate at Samaritan was as high as 37%, he said. The hospital made a conscious decision to lower that rate, which is now at 24%--close to the national average. Much of the decline has been achieved because women who have had one delivery by Cesarean are not automatically considered candidates for another. Each Cesarean at the hospital undergoes a peer review process to determine if it was medically necessary.

Some labor assistants, such as Anne Sommers of Corona, state in their literature that they can actually prevent or reduce the chance of Cesareans. While doctors may be skeptical of those claims, Sommers and others contend they can achieve a lower Cesarean rate by assisting their clients in coping with labor, suggesting alternative labor techniques and by negotiating with doctors in an attempt to dissuade them from administering drugs to the women or performing hasty C-sections.

Even if having a labor assistant lessens the odds of having a C-section, it certainly doesn't guarantee a woman won't have one.

Maloney and her husband discovered that the hard way. After 30 hours of labor, Maloney delivered her baby--an 8-pound, 6-ounce girl--by Cesarean. The position and size of the baby prevented Maloney from delivering vaginally.

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