A Guide to Natural Childbirth
If you’re pregnant, you’ve probably been doing research about different birth options. A traditional western birth occurs in a hospital and includes an epidural to ease pain and often Pitocin to speed contractions and keep labor from stalling. Some feel, however, that these medical interventions are not beneficial for the baby or the mother. Let’s explore the world of natural childbirth. Perhaps you’ll find something in it that appeals to you.
Why Natural Birth?
The idea behind natural childbirth is that birth is a natural process that has been unnecessarily medicalized by Western society, and that a return to natural methods will result in a happier and healthier mother and baby. Common elements of various natural birth methods include: education about what the body does during pregnancy, labor and birth, foregoing as many medications and medical interventions as possible, and alternative methods for dealing with pain, including birth affirmations, breathing techniques, visualizations, massage, acupressure, and use of a TENS unit, to name a few. It’s important to note that while natural childbirth can be safe and even rewarding for many women, it can be dangerous to forego medical intervention in some cases. For those with low-risk pregnancies, many of these ideas may be options you can pursue. If you have a high-risk pregnancy, consult with your doctor about which, if any, of these options will be safe for you.
Born naturally. Photo Credit
A medical intervention is anything a doctor or nurse may do to you or for you. Proponents of natural childbirth believe that many of the common medical interventions used during birth today are unnecessary and can in fact be harmful. Some of these interventions include Pitocin to induce or speed up labor, epidural or spinal block for pain management, cesarean surgery to remove the baby from the uterus, and vacuum extraction or use of forceps during vaginal birth. Many who want a natural birth feel that the best way to achieve a birth free of medical intervention is to birth at home with a doula or midwife. Others opt to birth in a hospital, but to avoid use of as many medications as possible. A word to the wise, as someone who chose the latter option: it is difficult to avoid medicines and interventions in a place specifically designed for medicines and interventions, especially if you are in pain and no one is advocating for you. If natural birth appeals to you, know that you can do it in a hospital setting, but you’ll need to be firm in your decisions, and having a supportive husband, partner or friend will help you achieve your birth plan goals.
The Deal with Epidurals
Look, childbirth hurts. There’s no getting around it. This is why, according to The American Pregnancy Association, over 50% of women giving birth in a hospital request an epidural to help with pain. As with all medical procedures, however, there are both benefits and risks. An epidural is a mix of anesthetics and narcotics. These can effectively relieve pain, but they can also affect both you and the baby during and after birth. Epidurals can cause a drop in blood pressure and severe headaches. You may have difficulty walking and urinating afterwards, and in rare cases you may have permanent nerve damage. Perhaps the most alarming thing for naturopaths is that “epidural makes pushing more difficult and additional medications or interventions may be needed, such as forceps or cesarean.”
Having the lower half of your body numbed does indeed make pushing more difficult. And since a core goal of natural birth is to avoid medical intervention when possible, an epidural’s tendency to increase the number of medical interventions necessary make it unpopular with the natural birthing crowd. Some studies estimate that having an epidural will double your likelihood of having an instrument-assisted birth. Having delivered a baby with an epidural and without, I can tell you that pushing with an epidural is nothing like the powerful experience of feeling and working with pushing contractions. My first birth was an epidural birth, my next three were not, so that should tell you which I preferred.
The effects of an epidural are not limited to the mother. Your baby will also get some of that solution, and he may have a few issues from it. The American Pregnancy Association tells us that when a woman gets an epidural, “studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.” So again, starting with one medical intervention, an epidural for pain relief, leads to many other medical interventions that may be much less pleasant. (Are you familiar with episiotomies?) Further, “most studies suggest that some babies will have trouble “latching on” [after epidural] causing breastfeeding difficulties.” Breastfeeding is hard enough without a side effect from a medication making it more difficult!
None of this is to say that you can’t get an epidural. Many women find the benefits to be worth the risks. A baby delivered by forceps, vacuum or cesarean is still a wonderful, joyous thing. But if your birth could be a little more gentle and natural and less distressing and potentially dangerous, wouldn’t that be nice?
One thing most natural childbirth courses agree on is that you shouldn’t go to the hospital too early in your labor, and the main reason is so that you can avoid being given Pitocin. Pitocin is artificial oxytocin, the hormone that causes your uterus to contract. Some hospitals will send you home if you show up too early, but others will admit you, then give you a deadline. For example, when my labor started with my first child, my first sign of labor was my water breaking. I had no contractions whatsoever. I went to the hospital around 5 pm and was admitted, then told that if my contractions didn’t start naturally by midnight, I would be put on Pitocin. Well, all the walking I could do didn’t start things moving, and I was given Pitocin to start contractions. Many of you may have had similar experiences, and maybe you had no problem with it. But since I was hoping for a natural birth, I already felt like I had failed when I was given medication. Additionally, Pitocin can cause very strong contractions, making it more difficult to go without an epidural. Sure enough, I got an epidural, and instead of feeling only joy at my child’s birth, I felt a joy tinged with guilt that I hadn’t achieved the birth I wanted.
Since then, I have had 3 more births. And all three of them made use of Pitocin. Why, you may ask, did I agree to Pitocin again if it was so terrible? Because in each case, it was determined that Pitocin was what was needed to help me deliver a healthy baby, and that’s what matters in the end. (I have decided that I would likely have died in childbirth if I had been born before Pitocin was invented.) In my last 3 births, I was able to achieve a birth free of epidural or other medical intervention, even with Pitocin. So again, natural birth is not about foregoing medication no matter what the doctor says. It’s about doing things as naturally as possible while still prioritizing the health of the baby. For me, that meant Pitocin. And that’s okay.
Feeling What You Feel
The main reason I am a proponent for natural childbirth is the powerful feelings that an epidural blocked out for me. With the epidural, I felt a slight pressure with each contraction, but I had to be told when to push and when to stop. I pushed for 2 ½ hours, which really felt like a lifetime. I felt little accomplishment in what I had done, I was just glad it was over. And to top it off, I still felt the infamous “ring of fire,” the burning sensation you feel as your vaginal tissues stretch when your baby crowns. Fast forward to my next birth, when I was determined to have an epidural-free birth experience. It was so different! I felt the power of my body as my muscles performed as they should (with the help of Pitocin!). When it was time to push, no one had to tell me. I KNEW. The urge I felt to push sticks with me as one of the most overwhelming sensations I’ve ever felt. And then, 20 minutes later, I had a beautiful baby and I was beaming with pride at what I had done. I had never felt so empowered by my own body before. Others who have had a natural birth describe similar feelings. And we go on to recommend it to women whenever we can!
Natural Childbirth Philosophies
There are several major proponents of natural childbirth, but I will focus on those who offer classes you can attend and books that you can read on your own.
The Bradley Method
The Bradley Method is a style of natural childbirth developed by Dr. Robert Bradley in 1947 as a reaction to traditional labor and delivery methods of the day. At the time it was common for women to be heavily drugged during labor, which often necessitated the use of forceps or cesarean for removal of the baby as the mother was too dazed and unconnected with her body to participate in the birthing process. The husband, meanwhile, was told to wait in the hospital lobby until the baby was delivered, where he learned about the status of his wife and child along with whoever else happened to be sitting there at the time.
The Bradley method focuses on relaxing and trusting your body. It encourages you to close your eyes and turn inward, searching for places of tension in your body, and to actively relax those tensed muscles, letting the muscles of the uterus and the cervix do their work without interference. When you clench muscles in response to pain, it makes it harder for the work of labor to progress. Therefore, the best thing you can do to help move labor along is to relax and let your body do its thing (during contractions. Pushing is another story).
The Bradley Method comes in the form of a series of books, the best of which is Natural Childbirth The Bradley ® Way by Susan McCutcheon, as well 12 in-person and/or online classes that include a student workbook. The content focuses on giving information about what your body does during pregnancy, labor, and birth, as well as after birth, and what you can do to best assist your body with its work. The goal of the Bradley Method is an unmedicated, natural and even enjoyable birth. This is achieved through relaxation, through visualizing what the body is doing during contractions, and through natural breathing patterns, all supported by your birth coach, who ideally would be your husband (or partner).
I can personally attest to the fact that you can do this method even without a husband who wants to be your personal coach. Mine asked to be in charge of handling updating family members and taking occasional pictures; he did not want an active role in labor and delivery. Nevertheless, with the help of nurses, doctors, friends, and my Bradley book, I made it through, without even taking the class! Now, I would have loved to take the class, so don’t decide to skip it on my account. But Natural Childbirth the Bradley Way is such a good book that it guided me through three unmedicated births. It is full of pictures, exercises and real-life examples. I can’t recommend it highly enough.
One of the best parts of this book is the beginning portion, which is purely educational. It details what happens in the body during pregnancy and gives information that I didn’t know, despite reading the book AFTER I’d had a baby! Then labor is broken down in a step-by-step manor, from the position of the baby’s head as it enters the birth canal to what each muscle is doing during a contraction, once again giving me information I didn’t have despite having gone through the experience myself. Whether you want a natural birth or not, do yourself a favor and read this book. You’ll be happy you did!
If you’re interested in hearing more about the Bradley Method, try reading some birth stories from women who used it for their births. You’ll be amazed at what this method does for women who want a natural birth experience.
HypnoBirthing is a natural birth method based on the concept of creating relaxation during birth through visualization, birth affirmations and self-hypnosis. The term was coined by Marie Mongan, a hypnotherapist who developed the method in the 50’s and 60’s when she birthed her 4 children naturally. The first edition of her book was published in 1989, and the latest edition, Hypnobirthing: A Natural Approach To A Safe, Easier, More Comfortable Birthing is available on Amazon (note that a CD or MP3 file is required to fully learn this technique).
The goal of hypnobirthing is to change the way you view labor and birth and to shift away from the idea that it has to be painful. This is achieved in part by using alternate words for parts of labor, such as calling contractions “surges” and using the word “pressure” and never the word “pain.” The classes last 5 weeks, and include education and time for practicing the techniques of breathing and visualization used to induce self-hypnosis.
My husband and I took HypnoBirthing classes during my first pregnancy. While the idea of having a natural birth and avoiding an epidural appealed to me, this method did not work for me. I was never able to buy into the premise that it wouldn’t hurt if I just convinced myself that it wouldn’t. Even with practicing during class and at home, I was never able to achieve self-hypnosis. However, that doesn’t mean this method couldn’t work for you! And while I was unable to take advantage of the full curriculum, several of the visualizations, including Marie Mongan’s Rainbow Relaxation, helped me nevertheless. It’s worth checking out if you think this method could be for you.
Lamaze is focused on education and integrating scientific findings with their assertions. Their mission is to help women “make informed decisions about pregnancy, birth, breastfeeding and parenting.” Lamaze espouses 6 Healthy Birth Practices, including avoiding medical intervention when necessary and keeping mother and baby together after birth. They also proclaim that “birth can safely take place in homes, birth centers and hospitals.” Their online classes are available in eleven languages. Local classes are also available in many areas. If you’d like more information, check out the Lamaze website, or get the book Six Practical Lessons for an Easier Childbirth by Elisabeth Bing.
Apart from organized classes, there are many books and groups you can use to learn about natural childbirth. If you can handle a blast from the past (along with the outdated views on women that go with it) you can try Childbirth Without Fear, a book written by a British man in 1942. He is considered to be one of the fathers of the natural childbirth movement. Or, if waterbirth interests you, check out The Waterbirth Book by Janet Balaskas. Waterbirth can mean giving birth in a tub of warm water, but it can also mean utilizing warm water in any part of your labor, not necessarily only for delivery. If you’re considering a homebirth, please research carefully. We want everyone to stay safe!
Natural Pain Management
Because a goal of natural birth is to avoid medications, there are various techniques to handle the pain of childbirth.
Birth affirmationsBirth affirmations are mantras you can repeat to yourself such as “I trust my instincts” and “I relax and my baby relaxes with me.” You can find many online and practice them beforehand so they’ll be easy to remember during active labor.
Breathing techniques vary with the method you choose, and can be measured or natural. The Bradley Method encourages you to breathe naturally, while some relaxation techniques depend on breathing in time with a certain count.
Visualizations are a key component of Hypnobirthing. Popular images include imagining your contractions as the waves of the ocean, and you afloat on top of them, or picturing the muscles in your uterus as ribbons that are slowly opening the way for your baby to emerge.
Massage during labor is often a love it or hate it type situation, so if you decide to try it make sure whoever is administering the massage is prepared to back off if you decide you don’t want to be touched after all. I had a doula massage my calves, which I found very helpful as they kept cramping up.
Acupressure has been shown to reduce pain in labor. If you plan to try it, the person who is going to administer it needs to study beforehand. Be wary of practicing, however, as some acupressure points are thought to help induce labor.
A TENS unit
A TENS unit is a small machine that delivers electrical stimulation via sticky electrodes. Many doulas use them to help alleviate pain during labor, usually applying them to the back or legs. You get to control the intensity of the shocking sensation, as well as choose the pattern it is applied in. I found it a helpful distraction during contractions. It is believed that the TENS unit works by either interrupting pain signals or by increasing the production of endorphins, which can relieve pain.
When Natural Goes Too Far
There are some natural birth ideas that take the concept too far. Remember that modern medicine is what has allowed us to lower the mortality rate among mothers and new babies, and that there is a difference between seeking to reduce medical intervention when possible and ignoring what science has discovered in recent decades. One over-the-top method is lotus birth, the practice of leaving the placenta attached to the baby until it falls off naturally. Many natural birth proponents advocate for delayed cord clamping, in which the umbilical cord is not clamped or cut until it has stopped pulsing, indicating that the blood flow from the placenta has stopped. Lotus birth, however, advocates never cutting the cord. One article explains that once the flow of blood from the mother has stopped, “the placenta becomes dead tissue prone to infection. Because the placenta is still attached to the baby, an infected placenta can infect the infant.” You can do your own research, but that’s a no from me!
Another extreme form of natural childbirth is freebirth, an anti-medical movement that advocates birthing at home without any medical assistance, from either doctors, nurses or midwives. The trouble with this idea is that, though you may have the best intentions, you can’t control what happens during labor and delivery, and a medical emergency could arise. If that happens, it would be best to be in a place where medical help is available, or at least to be attended by someone with some medical training. Click here to read the story of a woman who’s freebirth went tragically wrong.
Personalize Your Plan
Many women who choose natural childbirth prefer to give birth in a birthing center or at home. There was no birthing center near where I lived, and my husband wasn’t comfortable with a home birth, which is why I had 3 natural births in 3 different hospitals. A goal in natural birth is to avoid medications, but I had Pitocin for all 4 of my births. Another common natural birth talking point is using different positions during labor and delivery, such as walking, using birthing balls, and squatting or being on all fours. I tried moving around and using different positions for my third birth, and I found it much more stressful than staying put in a bed as I had done with my second. What I’m saying is, don’t feel limited by the tenets of any particular natural birth method. You can pick and choose techniques and interventions and find what works best for you, your body and your baby. The point isn’t to adhere to guidelines and win a “natural childbirth” medal at the end of the day. The point is to have an arsenal of options, to utilize what fits the situation and satisfies your preferences, and to let go of the rest!
Don’t Feel Guilty!
Guilt is not helpful in childbirth. If you plan to forego an epidural, then end up getting one, you may feel guilty about it later. I planned to have my first child without an epidural, but I ended up getting one almost before I had even had any contractions. The support (or lack thereof) of the people around you, how physically and mentally ready you are for birth, and medical necessity are all going to affect your plans. It’s great to have plans and goals, but we can’t let ourselves feel guilty when reality doesn’t line up with those plans. You may find that the pain is greater than you realized. Your labor may last longer than anyone could have imagined (like my sister’s did). Your baby may be in distress and you might be rushed to an OR for a c-section. If you don’t get to carry out all the parts of your birth plan, don’t let that disappointment turn into guilt. A healthy baby and mama are the only end results that really matter. So praise yourself for having high expectations, then take a deep breath, look into your baby’s eyes and let go of those expectations in favor of accepting the reality of how your birth went. I find that snuggling that baby close and smelling that delicious newborn smell helps cure a lot of woes.