I've recently figured out that I have become a passionate natural childbirth advocate. How do I know this? Because I literally can not shut-up about it when people ask me! So, I think it's time for a blog post about this topic.
While I was pregnant I spent a lot of time reviewing literature concerning the merits of various childbirth practices. I wrote some posts about some more flashy topics that I thought other people might find interesting, such as alcohol and marijuana use during pregnancy, treatment for vaginal group B strep, and placentophagia (see old posts). But most of what I read is technical, detaily, and in general, very boring to most other humans. What struck me as I learned more and more was the effect of standard hospital practices on babies and mothers. There are many standard obstetrical interventions that are used commonly. These include artificial induction of labor, the use of pitocin to augment contractions, manually breaking a woman's water, epidural anesthesia, an IV drip of antibiotics, and most concerningly, a sky-rocketing cesarean section rate (upwards of 35% for many hospitals). I began to find that each of these interventions increases the chance of harm to the mother and baby. And not only that, but it robs women of the experience that they were hoping for. It doesn't have to be this way. In many other countries, such as Norway, Sweden, and Finland, many women give birth at home or at specialized birthing centers with very little medical intervention. Babies born at home with minimal intervention are just as healthy (if not even a little better) and mothers are much more satisfied with their experiences, while in the USA, we continue to have some of the highest rates of infant and maternal mortality for any industrialized country (Check here for current stats).
I believe that the birth process has become medicalized partly because of the cultural attitude surrounding birth. Most Americans believe that giving birth is terrifying, horribly painful, and extermely dangerous. Furthermore, if you only watch TLC birth shows or see pregnancy and childbirth depicted in movies, you would have no reason to believe anything to the contrary! It's this attitude that leads women to expect that there is little they can do while giving birth. They must depend on drugs to take away the pain while their obstetrician "gets the baby out". I am sincerely heartbroken that this is the experience that many women get.
To illustrate this situation, here is a common scenario depicted on TLC's show, A Baby Story: A very pregnant lady is sitting in front of the camera. She is saying that she'd like to give birth as naturally as possible, but she knows that you can never control what is going to happen during childbirth. She is in early labor and the nurses have her laying in bed with an IV drip in her arm and a fetal monitor wrapped around her stomach. She is trying to breath through the contractions, but is having trouble. She just knows that is going to get much, much worse and even though she's OK now, she knows she won't be able to handle the pain coming up! The nurses bring in the anesthesiologist and she agrees to get the epidural.
(Note: from experience, I know that labor is much more painful when you are lying down. If she was standing up and moving her hips she would have felt much better. The difference is night and day. But rather than suggesting that she get up and try moving her hips in a circle, the nurses suggest she numb the bottom half of her body with powerful narcotics... go figure. Additionally, labor doesn't neccesarily get steadily worse and worse. It changes as the baby moves down and your endorphins naturally regulate your pain. I felt a lot better as I got towards the end. OK, back to the story.)
So now she's numb and completely out of control of her birth. The pain is gone, except the catheter in in her urinary tract is bothering her and the medicine is making her shiver uncontrollably. The medicine also begins to slow down her labor, so the nurses give her some pitocin in her IV to increase the speed and intensity of her contractions. The contractions start coming more powerfully now, so the nurses increase her epidural to take the pain away. But the increased epidural slows down the contractions again, so they bump up the pitocin a bit too. Now the contractions are coming very strong, much stronger than her body would be producing naturally, but for some reason her cervix has stopped dilating and she is stuck at 5 cm. The obstetrician uses a hook to break her water in the hope that it will make her labor begin progressing again. Now the baby has no cushioning and is being subjected to very strong contractions, the baby's heartrate becomes a bit erratic, this is called fetal distress. The obstetrician tells the women that she is not progressing and now it seems like the baby is not tolerating labor well (as if it is her fault), the Ob recommends a C-section. The women tearfully asks why this is happening and the Ob explains that, "The baby's head may just be too big to fit out of your pelvis. Oh well, you can't control childbirth!" (This statement is especially ironic, because given all the intereventions that were performed, it seems like "controlling childbirth" was exactly what they were trying to do.) At the end the woman is left holding a perfectly healthy, normal sized baby and everyone is nodding their heads saying, "all that matters is that the baby and mother are healthy."
Someone watching this show might think, "That person needed to have an emergency C-section. If she hadn't been in the hospital the baby would have been in great danger!". The truth is that each intervention performed increases the chance that the baby will have to be removed from the mother's womb by C-section. Although many women think that a C-section seems "easier", it's not. It's major abdominal surgery with substantial risks and a much tougher recovery. And this happens all too often just because of a misconception that labor is dangerous and unbearably painful.
Of course there are risks involved with birth. C-sections can save lives in situations where the baby is mal-positioned and cannot be delivered easily. Pitocin can help when a women is exhausted and needs help pushing the baby out. Pain medications can help with very difficult labors. The problems begin when these interventions are used routinely, rather than sparingly and according to medical need.
Let's imagine a different story. One where the woman mentally prepared to give birth. Where she followed her body's cues during labor to make herself as comfortable as possible and help the baby move down. Where she was able to feel how to move and know when it was time to push. Avoiding interventions doesn't guarantee a problem-free birth, but it does make it much less likely.
I think the world would be a better place if people thought about childbirth like this, as an intensely amazing experience that usually will go very smoothly. And let's not focus on the pain so much. Anxiety and fear are a great way to take a manageable situation and turn it into something excruciating. Pain is involved with childbirth, but it's not the wall of insurmountable, unbearable pain that people assume. You probably won't get a lot of help with natural childbirth if you ask your Ob about it. So read as much as you can and get support in your community or from friends who have gone through it before. Here is a good blog that really helped me- Birth Sense. Good luck!
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