What's the big deal about natural childbirth?

These days, natural childbirth seems to be becoming more popular again, which gives it a kind of crunchy trendiness like doing yoga or being vegetarian. (Both worthy and healthy endeavors – just like aiming for natural childbirth – under the right circumstances.)

Fact of the matter is that there have been trends in childbirth, and in western societies, this trend has been leading towards more medicalized births actively managed by doctors, to the point where now fully one third of births in the United States are surgical births (C-sections), and it’s hard to spot any woman giving birth in a hospital whose birth hasn’t been meddled with in some way.

So what’s wrong with that, you rightly wonder.

Why would anyone prefer natural childbirth if it takes longer and is more painful?

What’s wrong with “meddling” if it means that the birth is safer, faster, or the mother feels less pain?

The problem is, it means none of those things. It just means that in a hospital birth medical interventions are introduced as a matter of routine (as opposed to necessity) into the well-oiled process of natural childbirth, and in the majority of cases, these interventions increase the number of complications, not decrease them. Each intervention may even introduce new interventions. Interventions interfere in the normal process of natural childbirth, which then necessitates more interventions. It’s like the first intervention just starts the slide down a slippery slope, at the end of which is a C-section. Click here to see a wonderful explanatory video about how interventions pave the way from natural childbirth to a C-section. What’s wrong with a C-section, you ask?

It’s major surgery, with all the associated risks. At base, it’s a lot more risky to both mom and baby than a vaginal birth. For mom, there are all the post-surgery complications, potential infections, and so on. It also means that the number of children a woman can have is instantly limited, and the frequency at which she can have them already determined for her. After a C-section, it is recommended that a woman wait at least 3 years before giving birth again, and the second birth after a C-section is likely to also be a C-section, and with each repeated C-section, the risk to both mom and baby increases.

The baby is also at risk for infections and for respiratory difficulties after a surgical delivery. C-sections tend to make breastfeeding more difficult (though primarily only because moms tend to receive babies later, and thus attempt to nurse them later).

And not lastly, a c-section hijacks both mother and child's experience of birth as a rite of passage, physically, psychologically and spiritually. After a natural birth, both mothers and babies are in a unique hormonal and emotional state. This is nature's way of encouraging bonding and parenting behavior from the mother, and survival behavior from the baby. And not insignificantly, this unique hormonal state feels good - it is the motherbaby pair's reward for the hard work they both did during labor.

C-sections are also a rite of passage, but a vastly different one than a natural birth. Seldom was there a mother who was floating on a hormone-driven cloud of bliss after having abdominal surgery.

Giving up the visceral good feeling and triumph of a natural birth is all fine and well if the child’s life is in danger, because obviously, a living baby is far more important than being able to go through a rite of passage. It's also fine and well if the mother chooses to forgo the experience, because that is her choice to make.

But C-sections are used far more “liberally” than just in life-threatening situations, and actually, very few women request a C-section, despite what doctors sometimes claim. Most often, a C-section is the last intervention in a line of interventions used routinely or for convenience.

In hospital births, interventions are used for three primary purposes: to trigger labor, to speed up labor, and to reduce pain.

Each of these interventions carries a risk (=increased probability of C-section or complications), and each of them can produce situations that necessitate further interventions.

How the cascade of interventions leads to one seemingly small and innocent decision cascading down to an undesired outcome.

Take, for example, episiotomies, which is a particular soapbox of mine, since they are so prevalent in Hungary, where I live and work. An episiotomy is the cut performed on the woman’s perineum (the tissue between the vagina and the anus) to allow the baby’s head to emerge more quickly during pushing. It means the difference of about 5 minutes.

According to the WHO (World Health Organization), there is no need to routinely administer this cut, which severs skin, nerves and muscles in this sensitive area, and is the equivalent of a second-degree tear. The prevalence of second-degree tears in home births or birth centers with minimalized medical intervention is very low. According to Ina May Gaskin's statistics, nearly 70% of the women who gave birth at The Farm birth center had an intact perineum - no tears at all.

By contrast, in Hungary (where I live and attend births), 70-90% of first-time mothers receive this cut. The rationale: to prevent third- and fourth-degree tears (despite the fact that scientific studies have shown that routine administration of an episiotomy actually increases, rather than decreases, the incidence of more severe tearing.)

Here is where the cascade starts...

So why does a woman receive an episiotomy? Because by the time she is pushing, the baby’s heartbeat is uneven, or too low, and because she is lying on her back, with the diameter of her pelvis at its narrowest, and the baby's head pulled by gravity to put pressure on the tissues of her perineum. She is trying to push upwards, against gravity, and push with her pelvis locked in a narrow configuration because she is lying flat on her back, and her tissues appear on the verge of tearing, especially as the doctor bears down on the laboring woman’s belly with each contraction to help the uterus push the baby out. The doctor decides to speed things up, and makes the cut, both to make sure the baby is all right and to prevent a more serious tear that the aggressive external pushing can cause.

Compare with a natural childbirth...

Had she been laboring in an upright position, pushing at her own speed, her tissues would have had an opportunity to adjust to the pressure of the baby’s head, she would have felt when her tissues stretched too far, and paused to give them a chance to adjust, and would probably have gotten away with no tears, or a first-degree tear (the equivalent of a scrape or a nick). And had she not been lying on her back and receiving both pain medication and artificial oxytocin (pitocin, syntocinon), the baby would probably have been under much less strain, removing the pressure for a speedy exit. If she was having a natural childbirth, she would not have been on her back, and she would not have needed an episiotomy, which will take longer to heal.

So how did she end up pushing in this position? She ended up in this position because she was receiving an epidural and artificial oxytocin, the former to decrease her pain, the latter to keep her contractions strong because the epidural tends to slow down labor. Because she had IVs in her arms, hospital protocol required her to be on her back, even though moving around during labor is a major natural pain management technique, and an upright position during pushing is more effective. Also, doctors prefer women to be on their backs and presenting their vaginas at eye level so the entire crotch area is clearly visible and accessible for the doctor. So had she been having a natural childbirth, she would not have been receiving an epidural or artificial oxytocin.

Why was she receiving an epidural and artificial oxytocin? Because her physician decided to induce labor after she passed her due date, even though the average length of pregnancy is 38-42 weeks, even though the baby’s heart rate, as indicated by an NST, was fine, and flowmetrics as seen on an ultrasound of the placenta and the umbilical cord, indicated that the placenta was still functioning perfectly. He decided to induce because maybe the weekend was coming up, or maybe because he truly believed (despite all evidence to the contrary) that babies should leave the uterus when the doctor decides. So the doctor attempted to induce labor by dilating her cervix and breaking her water, neither of which succeeded in triggering her labor within the allotted time, thus she ended up receiving oxytocin in an IV, which produces far more painful contractions than ones driven by a woman’s own natural oxytocin, so to help her endure the pain of these artificial contractions, and of having to labor on her back (the most uncomfortable position for enduring labor pains), she was given an epidural. So had she been having a natural childbirth, her doctor would have waited for her labor to begin spontaneously, her contractions would have built gradually, allowing her body time to respond to the pain levels with increasing natural painkillers (endorphins), and she would not have required the epidural to cope with the pain of labor. So this hypothetical mother ended up with several interventions during her labor that could have most likely been avoided had she been allowed have a natural childbirth: to go into labor on her own, labor at her own speed, and choose her own position for pushing.

Though she may be glad that she escaped the specter of having a C-section, now she has a surgical cut between her vagina and her anus that will take a while to heal (though it can leave a scar that lasts a lifetime), is convinced the doctor saved her baby’s life, and simultaneously convinced that she could not have birthed a child without medical intervention. Do you think she will ever try for natural childbirth with these experiences? Do you think she has faith in her body's ability to birth a child?

In truth, the first intervention, the act of attempting to trigger her labor when her body was clearly not yet ready for it, resulted in a cascade of interventions ending with the baby’s faltering heartbeat and her episiotomy.

Had she been actually encouraged to trust her body’s signals and follow her instincts for a natural childbirth, she would have had an empowering experience that carried far fewer risks for either her or her baby.

---

Go back to the Budapest Doula homepage