What Is Informed Consent?

What is Informed Consent?

Informed consent is a process of communication between you and your midwife. This conversation usually leads to an agreement or permission for care, treatment, or services during pregnancy and while giving birth.

While there are known risks to all births and multiple factors that will affect those risks, the journey of pregnancy and childbirth is yours and you have the right to approve or deny care in low risk environments. This is why, at Nightingale Birth Center we spend more time establishing relationships with our clients to discuss your choices.

The informed consent process makes sure that your midwife has given you all of the necessary information about your pregnancy, along with any and all testing and treatment options before you decide what to do. In the past, women have made decisions during labor when they are stressed and not in the best state of mind, only to wish something had gone differently afterwards. 

Why Is Informed Consent Such An Important Part Of The Pregnancy & Birth Journey? 

Informed consent is so important because you have choices and as your midwifery team we want you to know what those choices are. Meaningful conversations with you about those choices are just as important to us as they are to you. While forms and documentations on your consent to care are a part of the process, you can change your mind at any time, even if you have already started treatment.

Informed consent ensures that you know what all of your options are and the risks, and that you are happy and satisfied with your entire journey into motherhood, whether it’s your first or fifth baby.

The midwives at Nightingale Birth Center will educate you on your choices so that the consent you give always comes from an educated point of view and a place of feeling safe and cared for.

Birth Story: The Birth of Olivia Victoria

This birth story was shared with us by our dear and wonderful client, Valerie, about the birth of her baby girl Olivia, at the birth center on October 5, 2018. Olivia was the very first baby to be born at Nightingale Birth Center, which makes it even more special!

I chose a natural labor with little to no medical intervention. Instead of drugs, I used breathing and relaxation techniques that I learned from yoga and hypnobirth (self-hypnosis) and my experience connecting my body, mind, and breath. My husband and I felt very comfortable with the decision. I also chose a provider that supported us, was patient, and gave us the best chance of having the birth experience we wanted. I had a healthy and low risk pregnancy and the baby was full term so I felt comfortable going this route. I also had a birth doula who gave me evidenced-based information and helped me during labor so that my husband could focus on loving me and being present on her daughter's birthing day.

On Thu Oct/4 at around 7am I woke up and had liquid running down my leg. It wasn’t a big gush but more like a small leak. After using a pH test strip, it turned out that my bag of waters broke. I immediately woke up my husband to tell him the news. Contractions hadn’t even started, but I knew the baby was going to make an appearance soon. Looking back, my body had been trying to tell me something since the night before when I had a discharge that looked very similar to what they call the “mucus plug”.

Later that Thursday morning, my husband and I went to visit our midwife who recommended some herbal supplements in order to get labor going and minimize the risk of an infection. We followed the instructions all afternoon and evening. I ate yummy and healthy food and took a walk to try to get things moving. I could feel very mild uterine waves (contractions) without a pattern. At around 10pm we had a call with our midwife and agreed that we were going to go to the birth center at 1am in order to start a first round of antibiotics (these are recommended after a certain number of hours since the bag of waters breaks). My husband and I grabbed our birth bag and took a 2-hour nap before heading to the birth center (1 min away from our house). Things were going to get interesting once we were there….

Friday 10/5 1am: Active Labor

I stayed at home until Fri 10/5 at 1 am when my husband and I went to the birth center and got the first round of antibiotics going.  Even with the IV in place, I was able to move and walk to the bathroom. The birth center had a queen size bed so my husband and I were able to rest for a little while. At around 2:15am I went to the restroom and noticed some bleeding, which is what they call the “bloody show”. Almost immediately after, I started feeling stronger uterine waves with more pressure moving things down. The only way I can describe the feeling is that of an icing dispenser bag being squeezed :)

In between uterine waves, I was able to rest while listening to the hypnobirthing relaxation audios. During each uterine wave, I practiced calm belly breathing (inhaling deeply through my nose expanding my belly and exhaling through my nose contracting my belly). My husband monitored the uterine waves using an app and by 3:30am they were 3 minutes apart for 1 minute for about 1 hour.  I did my best to remain relaxed throughout to avoid stress, which causes the fight, flight or freeze response. (Note from husband: “Valerie and I were lying down next to each other on the bed. She would fall asleep for a few minutes and then would tell me ‘there’s one coming’. I immediately would hug her from the back and start singing the song we had agreed on, that talks about peace and faith, to her ear. I could hear Valerie practice the belling breathing to “ride” the wave and mitigate the discomfort.  After a minute or so Valerie would tell me that the wave was over and in a matter of seconds she would fall back asleep to the point of snoring.”)

Every five or so waves I would stand and walk to the restroom while waiting for the next one to arrive. At about 4:30 am our doula arrived and started helping with massaging my back and legs during uterine waves for the next hour.

At around 5 am, I felt my breath changing from calm belly breathing to a strong ujjai breath (ocean breath inhaling and exhaling through my nose) and I also had the urge to push and a thought of escaping went quickly through my mind so at around 5:30 am I asked the midwife if she thought it was worth checking how many centimeters of dilation I had and she agreed to check. (Note from husband: “About 30 minutes before this I had asked the midwife how far along did she think the process was. She told me that it was hard to tell because Valerie didn’t seem to be in that much pain or she was managing it extremely well with her breaths.”) When the midwife checked she just said: “I feel no cervix, you are fully dilated!”. At this point I was super happy that things seemed to be progressing well so I decided that it was time to move from the bed to the water tub. I went in by myself and went through about 10 uterine waves while the doula was massaging my back and my husband was singing to my ear. After a few minutes I asked my husband to join me in the tub. I was hoping things would progress as quickly as they had so far...

Friday 10/5 at 5 am: Birthing Phase

As soon as I got into the birthing water tub the water felt great. My husband was in the tub with me and the doula was massaging my back. The midwife was instructing me to push with each uterine wave, which we tried for various waves using different positions. I didn't make much progress there and the waves seemed to be spacing out so the midwife suggested trying something different. As second option, I tried using a squat stool for several minutes, but it never felt 100% right for me so I wasn’t relaxed enough to make it work. Because initially I was seeing a lot of progress on the bed, I decided to try side-lying on the bed. The uterine waves continued to slow down so we started using a breast pump to stimulate milk production and keep the waves going at a good rate. During each wave, the midwife could see a glimpse of the baby’s head with remainder of the bag of waters in front. The midwife suggested removing the of bag of waters that was blocking the baby's head from coming out. We consented and a bit more of amniotic fluid came out and now they started seeing more of the baby’s hairy head :)

Still the side-lying position wasn’t being effective.

Friday 10/5 at 12 noon: Baby emerges

In between one of the uterine waves I went to the bathroom. I told my husband that for some reason the sitting position felt better and that I wanted to try something like that. The second midwife suggested trying a hands and knees position, but I had the needle of the IV close to my wrist so I couldn't bend it. We got creative and placed a birthing ball on top of the bed where I rested my arms and head while my knees were on the bed. I told my husband “I am going to breathe our baby down” and I tuned into my body and sent my ujjai breath down. My husband just said: “listen to your body” as he re-started playing the hypnobirth affirmation audios in the background. I tuned everything else out and went deeply within, trusting my body and baby to know what to do. (Note from the husband: “this is when things seemed to get back on track. It was like we had lost focus for a few hours trying to follow instructions as opposed to listening to what the baby and Valerie’s body wanted to do. It would be impossible for me to describe the determination on Valerie’s eyes as she started to breathe the baby down”.)

During every uterine wave, I kept sending my ujjai breath down. Instinctively, I started moving my hips down to my heels with every exhale, thus expanding my pelvis and allowing gravity to help. With each inhale my hips would move back up and I would try to rest while my husband, who was standing next to me, wiped the sweat from my forehead. The midwife told my husband that this was the most progress she had seen so far and gave me space to listen to my body. After about 10 uterine waves, the midwife asked me to reach down to feel the baby’s head. I was able to feel the crown of her head and her hair too! This alone gave me so much strength and confidence to keep going knowing I was so close to finally meeting her. As I kept breathing her down, I felt what’s known as the “ring of fire” (look it up) while my doula reminded me to just keep breathing. After that everything happened super fast! I let go and just let my instinct and inner power take over. I had the impression that I was screaming throughout the process but my husband says it was a deep exhale and moan. (Note from husband: “at this point the midwife told me to look down as the baby was about to come out. I started seeing her head come out with her little hand resting next to her face. As soon as her head and hand came out, her whole body quickly followed (usually it’s head first and then shoulders). The midwife quickly gave the baby to Valerie. At this point I was crying, laughing and everything in between”.)

My baby emerged so fast! I looked down and there she was on the bed in front of me. The midwife put her on my chest, skin-to-skin, my husband was crying. I was relieved, thankful, and full of emotions and love for both. At that moment, the room was full of life and we could suddenly feel her presence. Olivia was born on Friday Oct/5 at 12:24 pm. It was such a beautiful and magical experience.

Olivia’s precious little hand up by her face had delayed the birthing phase, although in my mind it felt much less because of the time distortion created by the hypnobirthing techniques.

Valerie Wong.jpg

Nitrous oxide... is it worthy of all the hype?

nitrous oxide birth center

Nitrous oxide is becoming increasingly more popular in the United States as an alternative to the epidural. And for good reason! Nitrous oxide is a very safe, relatively cheap, and effective pain reliever, and we have a lot of evidence on its use. It has been popular for decades in countries that have very good maternal and neonatal health outcomes, such as Canada, Sweden, Finland, and the United Kingdom, and is an important component of quality maternity care.

Nitrous oxide is a gas that is inhaled by mask and is self-administered by the mother. Women who use nitrous oxide during labor may still have an awareness of labor pain. However, many women find it helps them relax and decreases their perception of labor pain. It is a great anxiety-reliever.

Nitrous oxide does not affect the production of oxytocin or the natural progression of labor. It does not increase the probability of other interventions. It also does not affect the baby, and does not increase the need for resuscitation after the birth.

The main side effects caused by nitrous oxide may be slight dizziness, nausea, and sometimes vomiting. But because it is self-administered, a woman may discontinue use of nitrous oxide at any time, and the effects of the gas dissipate within about 5 minutes. 

The Birth of the Water Baby

The cover of Midwifery Today magazine from Autum 2015

The cover of Midwifery Today magazine from Autum 2015


“In 1977, a state hospital near Paris began quietly changing the way women gave birth.

Obstetrician Dr Michel Odent believed that childbirth had become too medicalised and he wanted a more natural approach.

So he introduced a pool to ease the pain of labour and eventually some babies were even born in the pool.

Witness speaks to Dr Odent about the innovation that has become a revolution using the power of water.”

This intriguing 4 minute BBC Witness video documents the introduction of the birth pool to labor and delivery. Watch it here.