Originally posted August 2010
I was recently interviewed by a graduate student for a project in a women’s health class. She was very bright and asked a lot of great questions; some I answered quickly and some I am still thinking about. One of these questions was, “what does it mean to have a ‘natural’ birth”?
What is “natural birth”?
I am inclined to say that it will be defined differently by different people. A basic definition would be to say that if a woman gives birth with no pain medications, she has had a natural birth.
It’s possible to have a drug free birth while hooked up to continuous fetal monitoring, IV fluids, artificial breaking of the waters, and even episiotomy. It’s even possible (though very difficult) to experience a birth with no pain medication that begins with a medical induction. . . but some would argue that these examples are not very natural.
I like the term “physiologically normal birth” better than the more commonly used “natural”. To me, it suggests not only avoiding pain medication, but allowing the woman’s body to perform the functions it was intended to without interference. Interrupting this natural process results in many issues that require further interventions and can contribute to the cycle of complications we consistently see in the U.S. maternity system today.
Is a “natural” birth the goal?
As a childbirth educator, the question of defining a natural birth led me to ask myself if my goal is for women I teach to have a “natural” birth. Of course I consider myself a strong advocate for physiologically normal birth, but my ultimate goal is for women to be able to weigh benefits and risks and make their own informed choices. It is not my job to judge women for their choices. I had one student who told me guiltily that she had “wussed out and got the epidural”. I felt that she thought I was disappointed in her, which made me sad. My intention was to support her to achieve the best birth experience possible. I have no idea what she was dealing with in terms of her coping skills, emotional state, available support, whether she had slept all week, etc. It was her choice to make and I think she was well-informed and did not take the decision lightly.
The current U.S. c-section rate is 33%, yet research indicates that when birth is approached from a preventative care/expectant management perspective (where interventions are performed as needed, rather than routinely on each woman), cesarean birth occurs less than 5% of the time. That says to me that there are a lot of women experiencing major surgery unnecessarily (in fact, the majority of those who have cesareans). Unnecessary may not be the best term, since a woman who has labored many hours, had her water broken, is immobile, and “not making progress” may “need” a cesarean. A better term would be “preventable”. Had several of the interventions not occurred, a vaginal birth would very likely have been possible.
Some of these women come to realize that their birth outcome was a result of decisions made during their care by them or their providers. Some are very angry. Many don’t realize this and believe that their bodies were simply unable to give birth. Knowing what I know, I seek to help women overcome the emotional and physical barriers leading to these unnecessary (or preventable) complications and learn to advocate for themselves.
Is “natural birth” for everyone?
Do I advocate for natural birth in every situation? Certainly not. Just because interventions are widely abused does not mean that they do not have legitimate uses. There are situations where an IV or epidural can help a dehydrated or exhausted mother. For the few women who require surgery, a c-section can be life-saving and essential. To retrospectively determine which cesareans were necessary and which could have been prevented is impossible, but it is easy to speculate when a first time mom experiences a failed induction prior to cesarean at 39 weeks.
A recent study revealed that first time mothers who were induced increased their odds of having a c-section by 2.67 times. Mothers were induced in 43.6% of cases, 39.9% of which were elective. That means that only 3.7% of the mothers had medically necessary inductions and the remainder were placing themselves and their babies at increased risk for other reasons, most likely without even realizing it. Given this information, I’m sure that some would have made a different choice. Others may have felt that the emotional or other benefits outweighed that increased risk of cesarean and still chosen the elective induction, but it is my feeling that most if not all of these women did not understand the risks of induction. This example illustrates how difficult it is to achieve true informed consent when making health care decisions. It is vital that women are diligent in researching risks and benefits as they make their choices.
One of my childbirth trainers taught that I was not responsible for the outcomes of my students’ births. I have come to embrace this sentiment. These women are responsible. These are their choices. They are the ones who live with them. I am here to teach, support, and encourage them to do their best, not to make decisions for them or judge them for their choices. Along those lines, I cannot take credit for the accomplishments of my clients. I have been thanked profusely by clients who had difficult and wonderful ‘natural’ births. I can only say that it is their achievement. I stand amazed at THEIR choices and THEIR strength . . . but I KNEW they could do it.
So the question “what is a natural birth?” is not so important (except that it sparked this discussion!) Whether they choose no intervention, taking an IV, an epidural, or a cesarean, the question is whether women embrace these choices and make them wisely. As a “side effect”, I have seen that this approach results in much higher rates of physiologically normal or “natural” birth, and certainly higher rates of maternal satisfaction as women learn to take an active role in their care.
Ehrenthal, Deborah B. MD; Jiang, Xiaozhang MD, MS; Strobino, Donna M. PhD. “Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term.” Obstetrics & Gynecology: July 2010 – Volume 116 – Issue 1 – pp 35-42
Gaskin, I. M. (2003). Ina May’s Guide to Childbirth. Bantam.
Johnson, K. C. & Daviss, B. “Outcomes of planned home births with certified professional midwives: large prospective study in North America” BMJ 2005; 330: 1416.