Anesthesia was first used for birth in 1847, 170 years, or roughly seven generations ago. In response to this, Grantly Dick Read coined the term natural childbirth in the 1940’s. Before that it was just called birth, like organic food was just called food before Lord Northbourne coined the term organic around the same time. Natural birth, normal birth, physiological birth, Michel Odent’s term undisturbed birth, are all essentially words for the same thing. Some use the term un-medicated birth, but I believe that defining something by what it is not inadvertently reinforces the other. Sometimes I ask my natural childbirth students what they think natural birth means and the answers range from no medications or interventions, to an epidural-free birth that may include analgesia or nitrous oxide, to any birth that is vaginal.
In the course of human history, seven generations is a short time. Even if each generation of grandmothers in your family chose anesthesia, you come from an unbroken line before that of women who gave birth naturally. If you can, go up your family tree as far as you can, and see how the women in each generation birthed. Natural birth isn’t unusual or complicated, like folk dance it is something that all the folk can do. But since the majority of people in the United States give birth with epidurals, normal birth is not the norm here.
Women choose natural birth for many reasons. They want to experience the birth process, the physical sensations, and the accompanying hormones. They want to avoid the other interventions that often accompany pain meds. And they don’t want to expose their babies or themselves to the effects of the narcotics in epidurals and analgesia. Ani DiFranco said, “I believe the act of giving birth to be the single most miraculous thing a human being can do and it is surely the moment when a lot of women finally understand the depth of their power. You think it can’t possibly be done, you think you can’t possibly take the pain, and then you do – and afterward you look at yourself… in a whole new way. If you can do that, you can do anything.” We carry our birth experiences, good or bad, with us through the rest of our lives.
Hospital natural childbirth is possible, but there are more challenges then you would find at home. We protect our babies during labor by keeping them inside when we feel unsafe. This means little or no dilation when adrenalin levels are high, and it is a functional response to fear. (The process is different during pushing when increased adrenalin helps the baby come more quickly; at this point we are committed and the best strategy is to birth the baby, then get up and run.) Fear is what keeps us alive, and what enabled all of your ancestors to live long enough to reproduce. But for us to open to the process of birth we need oxytocin levels to soar, an impossibility when adrenalin levels are high. So natural childbirth in the hospital depends on feeling safe.
Obstacles in the hospital include being asked to rate your pain (a practice ACOG now discourages), staff including anesthesiologists asking if you want an epidural (many parents ask in there in birth plans that this not happen), monitors and IVs which inhibit movement, thereby increasing pain and slowing down labor, and restricting oral intake (a practice not supported by evidence). One study found that even the presence of a hospital bed in the center of the room increased the risk of pain medication. Additionally, in many hospitals, women are not able to access tubs in labor, although we know that being in water decreases pain in labor. Another issue is the overuse of cervical exams, which can be encouraging or discouraging, and often interrupt how a laboring woman is coping and result in her being in bed, a difficult place to labor.
More monitoring in labor doesn’t improve outcome, but it increases the risk of interventions including pain medication for the increased pain caused by not moving, and Pitocin to speed up the labor slowed by lack of movement. Oxytocin driven contractions, the kind we make ourselves, come in a package with endorphins, which help us with pain. Pitocin driven contractions, by contrast, do not come with endorphins, so we make them in response to experiencing the contractions, a more painful process. Thus we see increased use of epidurals with Pitocin. If a mom must be monitored, she may still be able to labor near the bed instead of in it, or get a telemetry monitor which allows her to move within and outside her labor room. If continual monitoring is being done out of concern over a baby’s flat heartbeat, cold and sweet foods will often wake the baby up and create a more reassuring heartbeat.
If you are planning to give birth without pain meds in the hospital, ask yourself how you generally cope with stress. Do you like to exercise after a hard day? Do you prefer a warm bath? A massage? Meditation? Listening to music? Develop a plan for how to use your coping skills in labor both at home and in the hospital. Bring along things that will help you relax: music, aromatherapy, snacks, etc. Choose a practice with a lower epidural rate and labor tubs if you can. Consider hiring a doula; doulas lower the rate of interventions, in part by helping to keep adrenalin levels low. Take a quality, independent natural childbirth class to learn tools for labor and labor support, and practice those techniques.
Natural childbirth is worthwhile. As Polly Perez said, “When a woman births without drugs…she learns that she is strong and powerful…She learns to trust herself, even in the face of powerful authority figures. Once she realizes her own strength and power, she will have a different attitude for the rest of her life, about pain, illness, disease, fatigue, and difficult situations.” At the end of a physiological labor, you and your baby will have endorphin levels higher than if you’d just run a marathon. That is the feeling of bliss that we remember, that make us want to have another baby. Natural childbirth allows you to see what your body is capable of. Joyce Maynard said, “Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead . . . that I’d finally found my sport.”
Julie Brill, CCCE, CLD has taught childbirth education to thousands of families over the last twenty-five years and has mentored hundreds of doulas and childbirth educators since 2003. She is the mother of two daughters, a La Leche League Leader, and the author of the doula anthology Round the Circle: Doulas Share Their Experiences.