What the *Bleep* is “Natural Childbirth” Anyhow?

Title of this post shamelessly stolen from a comment by another local birth professional.

You hear this quite often in the childbirth world. “I want a ‘natural childbirth'”, “She’s trying for a ‘natural childbirth’. In general, they mean that a woman wants to give birth without pain medication, especially an epidural. They are laying a claim to “Birth the way nature intended!”.

But is supported birth, that is: Birth where outside interventions are used to support & influence the health and well-being of the mother and/or baby really “unnatural”? I don’t think so, at all.

To be clear, I am talking here about needed and necessary interventions. Certainly there’s much to be said about the over use of interventions, and the increased pressure women feel to utilize interventions when in a hospital setting; that is a major issue that needs addressed, but not here and now.

When an intervention is used thoughtfully, with clear intention, to address a particular need happening in a woman’s labor, then that intervention is an asset that shouldn’t be discounted. Nor are interventions limited to the hospital or birth center setting- midwives also have interventions they use regularly during labor. Some count those as less ‘invasive’ or ‘unnatural’ because many are not Western Medicine based- that doesn’t make them any less of an introduced intervention. They are still an outside influence on the physiologic process of birth.

Natural Birth as this mythic ideal of the perfect birth is a dangerous precedent. Do hands off, unmedicated, perfect births happen? Absolutely, they can and do happen. But by promoting an idealized image as natural, we default label women who don’t meet that ideal as unnatural. We set them up for feeling shame, guilt and failure over not being able to “go natural”. We open up the door for them to doubt their own feelings, choices and experiences.

Imagine a woman having a ‘natural’ childbirth- she’s labored without significant medical supports (aside from intermittent EFM, and a vaginal exam or two) for hours, and has just reached Transition. The intensity and pain is overwhelming for her, and for her partner and they find that the comfort measures they know aren’t effective anymore. The nurse offers a dose of IV narcotic and she accepts, feeling this is the best next step for her to take. The relaxing impact of the narcotic is so effective, she births a 8+lb baby less than an hour later, with only a small episiotomy.

Did taking that narcotic (and having a small episiotomy on a primapara with an 8lb baby) magically cause her childbirth to become unnatural? Baby still came out, her body was still working hard for hours, the physiologic process of birth still occured- Nature still Happened. But some around her console her for not “being able to go natural”, as if, by her choice, she’d done something wrong, and failed at having a natural birth. She’s led to doubt herself, and her birth experience. Should she have toughed it out? Was she a wimp? Did the nurse pressure her into drugs she didn’t really want? Where did she go wrong?

There’s a dozen “But ifs…”, that could have happend: But if she’d had more support in transition. But if she’d changed positions. But if she’d had more childbirth preparation so she knew Transition was coming…butifbutifbutif… she may not have felt she needed a medical-based intervention. Speculation doesn’t help us, and it certainly doesn’t help her. Coping and responding to a need is using the resources available too you in that moment.

The focus then, shouldn’t be on promoting a Natural Childbirth ideal, but on what I call “Baby Steps” childbirth:

When a need arises in childbirth, apply the appropriate resources; starting with the least invasive possible, and then working up from there.

The idea is to fuss with the physiological process of birth as little as possible, and take baby steps when increasing the amount of fussing being done.

Care providers & support people who utilize & encourage the use of smaller tools before getting out the big guns, send a message to the laboring woman that they believe in physiologic birth as a functioning, well-designed process, and that supporting that process doesn’t automatically require lots of bells and whistles and medications and monitors, but they are willing to draw on their tools as appropriate. Women who are given supportive access to a wide range of tools, can be more confident and secure in the choices they make during labor and birth, because they know they are making appropriate decisions in each moment.

By going for the least-interventive tools in the birth toolbag first, we can know that everything has been tried if and when the big tools need to be used. A woman who has been supported in non-pharmocological means of pain-coping, can know that she is making a compassionate and appropriate choice for herself if she moves to an epidural, or other medical means of pain reduction. When her care provider has been supportive, and has been noticeably using the least-invasive tools through labor, then if they do recommend something more invasive, there’s a sense of trust that it is the most appropriate step to take.

It’s like if you know your IT person has done everything possible to pull a virus from your computer, and then tells you they’re going to have to reformat the hard drive- you’re still going to be upset that the drive needs formatting, but you’ll likely be less angry and upset over it than if the IT whiz had just waltzed in and said “Oh, that’ll need formatted”, without ever trying anything else.

The bottom line is that the path of labor and birth is going to be different for every single woman, and every single woman is going to need something different- we shouldn’t be setting up any type of birth as the ideal.

We can still make the effort to improve maternity care, and push for changes where interventions and invasive procedures have become routine and the norm, rather than applied appropriately to individual cases, but that is very different from setting a birth up on a pedestal and calling it perfect.

But what about induction? Induction is a very specific intervention, that is ideally only used when nature isn’t working- it artificially kickstarts the physiologic process, and sometimes artificial oxytocin flow is needed to maintain the entire process until birth. Like other interventions, the over-use of induction is an entirely different discussion.

Isn’t Cesarean Section unnatural? Technically, yes, a surgical birth is ‘unnatural’, because the physiologic process of birth is bypassed to bring the baby out of the uterus directly through the abdominal wall. However, it is still a birth, and the whole motivation behind this post was that I find the implication of labeling someone’s birth as ‘unnatural’ to be pretty darn offensive.