MORE IN NATURAL CHILDBIRTH

Women have been giving birth for centuries without epidurals, cesarean sections or chemical inductions, and there is a small but growing interest among modern mothers to return one of humans’ most primal acts to its roots. Proponents of natural childbirth, also known as unmedicated birth, say that without chemical or medical intervention, labor can progress more quickly and be safer for both mother and baby.

With natural childbirth, a laboring woman uses methods to manage her pain and keep her labor progressing that might include breathing techniques, hypnosis, the use of labor support such as a doula, visualization, massage, using tools like birthing stools or birth balls, and moving around and using different positions, which can help the baby’s progress down the birth canal. There are a number of schools of natural childbirth that focus on these types of techniques, including the Bradley Method, Hypnotic Childbirth, and Lamaze. Although natural childbirth can take place in a hospital, it’s a technique that is often practiced during home births or in birthing centers, often attended by a midwife.

Natural births are not common in the United States, although interest is growing. According to the Center for Disease Control, the cesarean rate in the U.S. is about 30 percent, an increase of about 40 percent in the past 10 years (The World Health Organization says that the frequency of cesarean sections should be no greater than 10 to 15 percent). And estimates show that anywhere between 50 and 70 percent of laboring women use an epidural during birth.

There are several physical benefits to choosing natural childbirth. The laboring mother is more alert if she’s undrugged, and is able to move around if she’s not hooked up to fetal monitoring equipment, a catheter or an IV. This means she can walk around, try different laboring positions or take a shower or a bath, all things that can help manage the pain. Additionally, because a labor can slow when an epidural or other chemical painkiller is used, there is more likelihood of the necessity of medical interventions such as a forceps or vacuum extraction, not to mention a cesarean section.

Natural childbirth can also have obvious benefits for the baby, as certain medical procedures can negatively affect a newborn. For instance, artificial induction can cause greater fetal distress as well as interfere with the flow of oxygen and blood to the fetus and can also cause jaundice and breathing problems in the baby. Epidurals, meanwhile, can also cause breathing problems in babies and can also result in initial breastfeeding difficulties. And cesarean sections can result in respiratory distress, since the pressure of contractions helps expel fluid from a baby’s lungs, and even the occasional fetal laceration.

Some of effects of natural childbirth are less tangible. Fans of natural childbirth claim that mothers who opt for a natural childbirth have a feeling of being in control of the situation, and that they have a sense of accomplishment and empowerment.

History

Only in the past century has childbirth been anything but natural. Before medicine, cesarean sections, and state-of-the-art hospital equipment, women gave birth at home either on their own or attended by a midwife.

By the turn of the 20th century, there was a better public acceptance of medicine due to medical breakthroughs, scientific discoveries, and better medical training, and hospitals became more easily accessible due to better roads and the advent of the automobile. While less than 5 percent of women gave birth in hospitals in 1900, the following years saw women becoming more attracted to the idea of a hospital birth because of the pain-relief options available, such as anesthesia.

In time, physicians and public health reformers began campaigning that childbirth should be the domain of a hospital and the medical community, in an effort to reduce maternal and infant mortality. The development of health insurance also made it more affordable for women to give birth in a hospital rather than at home.

In 1920, Dr. Joseph De Lee, a leading obstetrician, proposed a childbirth method that was intended to reduce complications through sedation, episiotomies, and forceps deliveries, all practices that became commonplace. Within the next 20 years, childbirth became increasingly seen as a procedure that was akin to a disease, needing a hospital visit, the care of a doctor, and the use of medical procedures. In fact, by the 1940s, 50 percent of all American women (and 75 percent of women in urban areas) were delivering their babies in hospitals.

But these practices were already beginning to be questioned in 1944, when Dr. Grantly Dick-Read published his book, Childbirth Without Fear, about natural childbirth methods. While 97 percent of births were performed in hospitals by 1960, women were beginning to realize they had a choice in their lives, spurred by feminist icons like Betty Friedan, whose book, The Feminine Mystique empowered women to take charge of their lives.

The 1970s saw a number of birthing centers open around the country, most famously The Farm in Tennessee, which was founded by one of the country’s leading midwives, Ina May Gaskin. Around the same time, women began taking charge of their bodies and arguing that childbirth is not a disease or a disorder, and does not require hospitalization or medical intervention. Other social unrest movements, such as civil rights, anti-war and back-to-nature movements, helped to foster a more skeptical, questioning consumer.

Medical-intervention births were further thrown into question when the news broke in 1979 of a study that found motor-function deficits in children whose mothers received large doses of anesthesia during birth.

Today, however, there tends to be a schism between the medical community and believers of natural childbirth, such as midwives and doulas. Choosing a midwife over a doctor is often a woman’s best chance of having a natural childbirth, but insurance coverage for Certified Nurse Midwives has rapidly declined, and the American Academy of Family Physicians has publicly opposed midwives.

Meanwhile, the cesarean section rate has increased 40 percent over the past 10 years, a progression that critics say is due to a number of factors, including doctors’ interest in making the birth process speedier and easier, avoiding possible lawsuits, and the use of epidurals, which have been known to slow labor and introduce complications that necessitate the surgery.

The Context

While natural childbirth might seem like an ideal option for some women, other women might feel like they cannot handle the pain without medication. Some women who had intended to have an unmedicated birth might change their minds when they’re actually in labor and see how intense the pain can be.

Although natural childbirth is a safe method, it can become dangerous if a woman refuses to listen to her health care provider if there are unexpected complications and a medical intervention is necessary.

And controversy continues to rage between those who believe that childbirth is historically a natural, normal function of a woman’s body that should occur with as little intervention as possible, and those who believe that it is safer for women to labor in a hospital, attended by a doctor, with equipment and drugs available should a complication or problem arise.

External Links:

Wikipedia - Natural Childbirth

The Bradley Method

Babycenter

Doulas of North America

American Association of Birth Centers

The History of Childbirth and Midwifery in America

Further Reading:

Natural Childbirth the Bradley Way by Susan McCutcheon

Husband-Coached Childbirth: The Bradley Method of Natural Childbirth by Robert A. Bradley and Ashley Montagu

Ina May’s Guide to Childbirth by Ina May Gaskin

Childbirth Without Fear: The Principles and Practice of Natural Childbirth by Grantly Dick-Read and Michel Odent