Natural Childbirth

Early in the third trimester I explore with women their thoughts and feelings about their upcoming labor and birth. Many will say, “I want to birth naturally, but I am open to an epidural.” Based on my many years of being with women in labor, and what the statistics show us (Osterman, 2011), my response is something like, “Without some significant preparation and a strong support team, that outlook will likely lead to an epidural.”

This response comes from seeing that if a woman is having her first labor, in the hospital setting and takes the general hospital based childbirth classes, she is more likely than not, to have an epidural as part of her experience. So, when I hear a mama say she wants a natural childbirth, I encourage her to explore how much she wants a natural childbirth. Because, if she is birthing in a hospital setting in the United States, where epidural rates can be as high as 90% (Osterman, 2011), she is going against the cultural norms – and hence it is very difficult (but not impossible) to achieve, especially for a first time mama.

To discuss this further requires some definitions – for this article, natural childbirth means more than vaginal birth, it means vaginal birth with minimal interventions in the normal, or natural, labor process. Epidurals are a BIG intervention in the process and are a very common intervention in most parts of the country.

Don’t get me wrong, I support women to make decisions that match their values and beliefs. Some women are clear that they want anesthesia during their labor and birth – and our hospitals are well equipped to provide this approach. My focus here is to help women who want natural childbirth by providing some information about things they can to do to help them achieve that. It’s generally not easy to do something different than the cultural norm.

So… if you want natural childbirth, the first, and likely most important decision, is where you will be birthing and with whom. Evidence shows that when recommended guidelines are followed, home birth and free standing birth centers provide excellent outcomes for mamas and babies with very low intervention rates (Stapleton, 2013). In these settings, the epidural rate hovers around 10% – you have to transfer to the hospital for this intervention.

BUT, I am a realist, and what I see is that for now anyhow, the majority of women in the US choose to birth in a hospital setting. It will be a huge culture shift for this to change in a significant way. I also know that many women birthing in the hospital setting would like a natural childbirth. What things can she do to increase the likelihood of this happening?

  1. Select your providers with care. Find out what their intervention rates are – not just c/section, but epidural, and induction too. Look into care provided by midwives (Vedam, 2018).
  2. Select your hospital with care. Even if your providers have low intervention rates, the overall rates at the hospital give you information about the way nurses care for patients. Does the hospital offer low intervention rooms staffed with nurses experienced with, and excited about, natural childbirth?
  3. Hire a doula – evidence is conclusive that doulas make a difference in decreasing interventions (Bohren, 2017).
  4. Educate yourself and develop a birth plan. Explore community based classes.

And then, once you have done this ground work – please, be open. Because the bottom line is that success isn’t natural childbirth, success is staying connected and present to what unfolds. I have absolutely seen where an epidural makes the difference between a traumatic birth verses a growing, learning and strengthening experience. Just not 80, or 50 or even 30 percent of the time.

Be open to where your path leads.

References

  1. Osterman, M. and Martin, J. (2011). “Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area”. National Vital Statistics Reports. 59(5).
  2. Stapleton, S., Osborne, C. and Illuzzi, J. (2013). “Outcomes of Care in Birth Centers: Demonstration of a Durable Model.” Journal of Midwifery and Women’s Health. 58(1); 3-14
  3. Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, et al. (2018) “Mapping integration of midwives across the United States: Impact on access, equity, and outcomes”. PLOS ONE 13(2): e0192523.
  4. Bohren, M.A., Hofmeyr, G., Sakala, C., et al. (2017). “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766.

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