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by Cathy Daub, PT, CCE, CD(BWI) Factors leading to the rise in maternal mortality and morbidity at birth in the USA.   Nutrition: The Center for Disease Control (CDC) show through a series of maps of the USA , a dramatic rise in obesity and diabetes in just the last 11 years.  It is so prevalent now that it is in pandemic proportions.  This means that many women giving birth are already compromised in their bodies from what they are eating.  As a nation, we are consuming too much sugar, salt, and fat and this is not only throwing our bodies out of balance, but also increasing health risk to pregnant women and their babies.  More women are being diagnosed with gestational diabetes in pregnancy. Babies are now being born with fatty deposits in their blood vessels at birth due to their mothers’ diets high in fat.   Lack of good quality childbirth education Unfortunately many pregnant women are either not receiving any preparation for childbirth or not attending good quality classes. The end result of any childbirth education classes, should be an increase in confidence and decrease in fear of labor and birth.  This is accomplished in BirthWorks classes through a philosophy that emphasizes integration of the mind, body, and spirit and the practice of Human Values.  They need to know that having a doula or birth companion with them helps to decrease fear and allows labor to progress more easily.  They need to know optimal birthing  positions that keep their pelvis tipped forward to increase space in which the baby can move into optimal positions.  They need to understand how hormones in their body work to birth a baby and which encourage bonding and attachment.  They need to determine where they feel safe giving birth.  They need to be given an opportunity to identify beliefs they have about birth and also to express fears.  They need to hear positive stories about birth and surround themselves with people who support them.   Many pregnant women today are so fearful of the pain of labor that they plan to have an epidural so they don’t have to feel the pain. In childbirth classes they need to learn many ways to work with their labors so they don’t resort to medical procedures that have their own risks.   Lack of Patience Each woman finds her own way to give birth.  Some women will have shorter labors and some longer labors.  When women in birth move their bodies into various positions, their babies can more easily rotate and turn to be born.  So long as there are no medical reasons to interfere, they need to let time be their friend.   Hearing positive words during labor Too many times women in labor are perceived as suffering, and in a medical environment personnel are training to relieve suffering.  For women in labor this means obstetrical drugs and medical procedures such as epidurals. When contractions become stronger, they may be encouraged to have an epidural instead of suggestions about moving into the bath or shower, or changing positions.  The presence of doulas or birth companions is comforting and helps women in labor to feel safe.  Research shows that women labor better when they feel safe.  The doula also knows how to say encouraging words that are empowering, and helps her to find optimal positions to birth.