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What the bleep is “natural childbirth” anyhow?

Photo: Yiada Liao/Flickr


You hear this quite often in the childbirth world. “I want a natural childbirth” or “She’s trying for a natural childbirth.” In general, what’s meant is that a woman wants to give birth without pain medication, especially an epidural. They’re laying a claim to “Birth the way nature intended!”

But is supported birth, that is, “Birth where outside interventions are used to support and influence the health and well-being of the mother and/or baby” really unnatural? I don’t think so, at all. To be clear, we’re talking about needed and necessary interventions. Certainly there’s much to be said about the overuse of interventions, and the increased pressure women feel to utilize them; that’s a major issue that needs to be addressed, but not here and now.

When an intervention is used thoughtfully with a clear intention, to address a particular need in a woman’s labor, that’s an asset that shouldn’t be discounted. Interventions aren’t limited to hospitals or birth centers — midwives also have interventions they use regularly during labor. These may seem less invasive, but that doesn’t make them any less of an introduced intervention. They’re still an outside influence on the process of birth.

Natural birth as this mythic ideal of the perfect birth is a dangerous precedent. Do hands-off, unmedicated, perfect births happen? Absolutely: they can and do. But by promoting an idealized image as natural, we label women who don’t meet that ideal as unnatural. We set them up for feeling shame, guilt and failure for not being able to “go natural.” We open up the door for them to doubt their own feelings, choices and experiences.

Imagine a woman having a natural childbirth; she’s labored without significant medical supports for hours and has just reached transition. The intensity and pain are overwhelming; she and her partner find the comfort measures they know simply aren’t effective anymore. The nurse offers a dose of IV narcotic and she accepts, feeling this is the best next step for her to take. The relaxing impact of the narcotic is so effective, she gives birth to an 8-plus-pound baby less than an hour later, with only a small episiotomy.

Did taking that narcotic magically cause her childbirth to become unnatural? The baby still came out, her body was still working hard for hours, the physiologic process of birth still occurred — nature still happened. Some will console her for not “being able to go natural” as if, by her choice, she’d done something wrong and failed to have a natural birth. She’s led to doubt herself and her birth experience. Should she have toughed it out? Was she a wimp? Did the nurse pressure her into drugs she didn’t really want? Where’d she go wrong?

There’s a dozen “but ifs”: But if she’d had more support in transition. But if she’d changed positions. But if she’d had more preparation so she knew transition was coming.  But if, but if, but if. She may not have felt she needed a medical-based intervention. Speculation doesn’t help us, and it certainly doesn’t help her. Coping and responding to a need is using the resources available to you in that moment.

The focus then, shouldn’t be on promoting a natural childbirth ideal, but on what I call the “Baby Steps” of childbirth: When a need arises in childbirth, apply the appropriate resources, starting with the least invasive possible, and then working up from there.

The idea is to fuss with the physiological process of birth as little as possible, and take baby steps when increasing the amount of fussing being done.

Care providers and support people who utilize and encourage the use of smaller tools before getting out the big guns send a message to the laboring woman that they believe in physiologic birth as a functioning, well-designed process, and that supporting that process doesn’t automatically require lots of bells and whistles and medications and monitors; they’re willing to draw on their tools as appropriate. Women who are given supportive access to a wide range of tools can be more confident and secure in the choices they make during labor and birth; they know they are making appropriate decisions in each moment.

A woman who has been supported in non-pharmacological means of coping with pain can know that she’s making a compassionate and appropriate choice for herself if she moves to an epidural, or other medical means of pain reduction. When her care provider has been supportive, and has noticeably been using the least invasive tools through labor, then there’ll be a sense of trust if something more invasive is recommended.

It’s like if you know your IT person has done everything possible to remove a virus from your computer, and then tells you they’re going to have to reformat the hard drive — you’re still going to be upset that the drive needs formatting, but you’ll likely be less angry and upset over it than if the IT whiz had just waltzed in and said, “Oh, that’ll need to be formatted” without ever trying anything else.

But what about induction? Induction is a very specific intervention that is ideally only used when nature isn’t working — it artificially kick-starts the physiologic process, and sometimes artificial oxytocin flow is needed to maintain the entire process until birth. Like other interventions, the overuse of induction is an entirely different discussion.

Isn’t a Caesarean section unnatural? Technically, yes, a surgical birth is unnatural because the physiologic process of birth is bypassed to bring the baby out of the uterus directly through the abdominal wall. However, it is still a birth.

We can still make the effort to improve maternity care, and push for changes where interventions and invasive procedures have become routine and the norm, rather than applied appropriately to individual cases, but that is very different from setting a birth up on a pedestal and calling it perfect. The bottom line is that the path of labor and birth is going to be different for every single woman, and every single woman is going to need something different — we shouldn’t be romanticizing any type of birth as the “ideal.”

Charlene Hamilton has been a Birthing From Within Mentor since 2002, after having been a DONA-trained doula for several years. When she's not doing birth work she reads (a lot), does arts & crafts (many), and designs games. She lives in Mountlake Terrace with her husband, cats, birds and eldest of her three children. This first appeared as a blog post on heartofbirth.net

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