A Roadmap to a Safe Natural Birth
Many great researchers and writers have shown that people generally think that medical technology equals safety, especially when it comes to childbirth. The reality is, however, that birth is safe and intervention is risky – and all of those high-tech machines are not making birth safer1.
In some situations, medical technology is lifesaving. Nobody is going to argue that, certainly not me. But pregnancy, labor, and childbirth are complex and intricately designed to work – and to result in a healthy baby and a healthy mama when all is said and done. Far from being some sort of fad, natural childbirth is a way to ensure the intricate safety mechanisms built into birth work properly – and to save the technology for when it's truly needed. As Carla Hartley says, “birth is safe, intervention is risky.”
Natural Birth is Not a Movement
It truly irritates me that those who are against recommending natural birth (which in itself is a ridiculous notion) like to say “the natural birth movement.” Last time I checked, natural birth was the norm for humanity and technological, medico-legal birth was the latest fad.
But really that's just my opinion and it's based on a pet peeve – opponents (again, why it seems valid to oppose natural birth is beyond me) try to dismiss natural birth as some sort of fad among fanatical women who lack common sense.
The true problem with their perspective is that it's completely skewed. Not only is natural birth the norm, but as I've mentioned several times, it's incredibly complex. That complexity doesn't create danger. It creates safety.
The medical model of birth treats a woman and her baby as enemies. The baby must be saved from the mother, and the mother must be saved from pregnancy and birth. The medical model of birth also views pregnancy and especially labor and birth in very mechanical terms. A mother's body cranks open and then she forcefully expels the baby through an “unyielding maternal pelvis” (that quote is actually in an obstetrics textbook!2).
That may be a simple way to explain childbirth to novice students eager to get their hands on a surgical knife, but it is not the reality of birth. Birth is far more complex and it's not just a simple mechanical process. Treating a mother and a baby like a car coming into the shop is just not going to work in anybody's favor.
Birth is Not a Mechanic's Shop
The Misunderstood Cervix
It is true that your cervix opens during birth. But it's not true that that happens in a smooth, linear fashion that can be easily predicted by a doctor, nurse, midwife, or machine. Research assigning a set length to “normal” labor and a set rate to “normal” dilation has been proven by recent research to be wrong. The early research prescribed a length of labor that was unrealistic for many women, and a rate of dilation that was much too fast3. Recent research has also acknowledged that women don't dilate at the same rates and not necessarily in a smooth, even fashion.
In other words, you may dilate at 1/2cm an hour for a few hours, then go from 6cm to “done” in 30 minutes. Or your labor may just take awhile, especially if you're a first-time mama. Mama and baby generally remain stable through short or long labors – when mama is well-nourished (both during pregnancy and while she's laboring – you can't expect a starving women to have what she needs to work with her body and her baby. Restricting access to food for laboring women should be considered an international crime).
Labor Means More Than a Cervix
The “mechanical birth” mentality gets even more flawed. Most of us know that dilation doesn't happen in a “textbook” way due to the recent research becoming more and more mainstream. But the notion that dilation is the whole purpose of labor remains. The problem?
Dilation is not the only purpose of labor. In fact, effacement (shortening length and eventual complete merging into the lower uterine segment) and dilation (opening to the average of 10cm) of the cervix are almost a side effect of the work of the upper uterine segment.
During labor, the upper part of the uterus, called the fundus, gets thicker. The uterus is a muscular organ. During labor the muscles of the top portion of the uterus retract – as a contraction happens, they contract down. When the contraction ends, the muscles relax, but not completely back to where they were before. The muscle bands are actually shorter. This happens over and over again during your birthing time, and results in the top portion of the uterus (the fundus) becoming thicker than the lower portion.
It creates a thick bed of muscle that can then push down and assist baby's efforts to be born. We'll come back to this in a minute. First, lets talk about baby.
Mama and Baby Are Partners – Not Enemies
It's sad that many in the medical world view mama and baby's bodies as vying against each other throughout pregnancy. The truth is mama and baby are completely intertwined, and that a woman's body makes remarkable adaptations to nourish her baby. Problems occur when those changes aren't supported. It's no wonder so many moms get sick during pregnancy, or babies fail to grow, when surveys show that most people still believe that a baby “take whatever it needs from the mother's body.” But the physical, physiologic, and metabolic changes (just to name a few) of pregnancy are the subject of another article!
It's enough to say that if mothers are well-supported during pregnancies, babies and mothers thrive.
Labor doesn't suddenly create a battle ground between a mama and her baby. It's not a race against the clock to get a baby through the harsh gauntlet of a mother's body. And the baby is not a passive blob just waiting for the mother to suffer through popping it out.
Babies work throughout labor. Doctors actually understand this to an extent, because the “mechanisms” or “cardinal movements” of labor can be described in very mechanical-medical terms. The baby is moving all throughout labor, and I'm not talking about wiggling fingers or toes. Baby actually moves and rotates all through the birth canal, working actively to move through your body. I talk about this in depth in Baby's Experience of Childbirth.
And your body is not an “unyielding maternal pelvis” (can you tell that really irritates me?). Your pelvis actually becomes quite flexible during pregnancy thanks to hormones (primarily relaxin and progesterone). You may have experienced pain or tenderness at your pubic bone as cartilage softens. Your entire pelvis is made of connected parts and there is some movement in those parts. Baby's rotation and flexing along with your pelvis adjusting to baby make it so he or she can navigate through the pelvis to the birth canal. The fundus takes over there and helps push baby out.
Oh, one point I should make. Sitting in a bed, strapped to a fetal monitor with your tailbone being pushed up into your baby's face? Not really conducive to a mobile pelvis. Of course I haven't run any gold-standard, double-blind trials on this, but I have a hunch that could be one of the reasons doctors see so many babies with “arrested descent.” I'd find it hard to slide past a bone being shoved into my face, too.
(NOTE: Want a Perfect Birth Plan Template? Use this template and step-by-step videos to write a birth plan that gets your birth team on your side for a beautiful birth experience! Get the kit here.)
The Hormones of Labor
So far everything I've covered about how birth really works has been fairly “mechanical.” But what actually facilitates all of these changes? Honestly we're not completely sure. Doctors and medical researchers don't truly understand what triggers labor or even what works throughout labor to keep everything moving – and anybody who tells you we've discovered it all is lying. Just pick up the current edition of any obstetrics textbook and that will become clear. We may know how to manipulate labor into “jump starting” or “overclocking” (speeding up) – but we really don't understand. Truly it's playing with fire – and that's why so many mamas and babies get burned.
We do, however, have a basic understanding that hormones play a large part in the birthing process. Humans have actually known this for a really long time. At least, farmers and breeders have. Anyone raising livestock or breeding dogs/cats knows that when it's time for a mama to go into labor, it's time for darkness, quiet, and waiting. Occasionally an animal mother needs help, but farmers and breeders understand that their hands, lights, and loud sounds usually just mess things up.
Why is that the case? Birthing is a hormonal orchestra, and outside forces can seriously interfere with the normal flow of hormones.
Yes, we're really intelligent, we're the top species on the planet. We're the pinnacle and we can overcome many limitations.
But, to be crass, when somebody is staring at you in the bathroom, you still have a hard time pooping. When there's an audience at intimate times, it makes it tough to perform. Think about how challenging it would be to make love with lights, doctors, and monitors. Hormones get interrupted and it's a little hard to get in the groove.
It doesn't matter that we're humans and we're superior beings. Going to the bathroom, making love, and seeing toddler and teenage temper tantrums are enough to make us realize that hormones and the environment make a big impact on us.
This is more than true during labor, when certain hormone levels skyrocket, and certain hormone levels take a back seat. As labor progresses, hormonal roles shift and different players move to center stage. As I said, it is truly a complex (and beautiful orchestra).
Interrupting that flow of hormones has major impacts for mothers and babies. It has incredible implications for the safety of labor. Circumventing natural hormones can literally create deadly complications. Induction or augmentation with Pitocin is one example – it essentially cuts off the body's own oxytocin levels, putting a mother in danger of postpartum hemorrhage. You've probably heard that nurses are ordered to “turn the Pit wide open” as a baby is being born – doctors know they've short-circuited a mother's safety mechanism and they're praying the drugs will be enough to substitute and keep a mother from hemorrhaging (more on this in Will the Real Oxytocin Please Stand Up).
Messing with labor is dangerous. Period.
Birth Changes the Minute You Walk Out the Door
“The first intervention in birth that a healthy woman takes is when she walks out the front door of her home in labor.”
~Michael Rosenthal, OB/GYN
As Dr. Rosenthal stated so well, even walking out your front door in labor has a major impact. Not only does being in the car create physical discomfort (and compression of the pelvis), it really changes the hormonal landscape of labor.
I'm not telling you that you need to have a home birth to have a good birth – many of my . students have beautiful natural hospital births. Those students are aware of how much birthing in the hospital can change things. And it's not just from the standpoint of having to advocate for yourself/your baby and navigate through hospital procedure. “Fleeing” somewhere else during labor changes hormonal and physiological processes, so it's important to get grounded when you get to the hospital.
My hospital-birthing students have generally advocated for themselves well before labor begins. They've talked with their doctors or midwives about what's really important for them (most ask for low lighting, a nurse that wants to work with a family choosing natural birth, intermittent fetal monitoring so they can stay mobile, and no IV pole tethered to them). They want to create an environment that's most conducive to the normal hormonal flow of labor, because they know that generally means a safe, smooth birth for them and baby.
Many of the interventions designed to create safety have been shown (repeatedly) in research trials to be of no benefit to low-risk mamas and babies. They've actually often been shown to create risk and danger. Continuous fetal monitoring is an example of this.
These interventions really change what's going on in a mother's body. They restrict movement, which has mechanical implications on how A. a mama's pelvis can open and B. a baby can adjust and rotate on his or her way through the pelvis. They interrupt the flow of vital hormones (such as oxytocin and beta-endorphin) and introduce detrimental hormones (such as adrenaline, which impedes early labor, though it's helpful during pushing).
Drugs such as narcotics and epidurals really short-circuit the body's normal responses to labor, and regardless of what glossy pregnancy and baby magazines proclaim, evidence does show that they slow labor, increase the needs for interventions, and increase the rates of cesarean surgery. Plus they completely short-circuit the body's own production of natural pain-relieving substances (beta-endorphin is a major one, and oxytocin is also very helpful, to name a couple).
I highly encourage you read Dr. Buckley's [raw]
Birth is Not a Torture Chamber
Yes. That's blunt. But again, it's an argument the natural birth “opponents” frequently use. Those of us who recommend natural birth are “not thinking of the suffering of the poor mothers and how moms who have medications actually have a ‘better perception' of childbirth”.
Except that's not true. I'm not saying that birth has to be “painless” or “orgasmic” by any means. But childbirth is a process that women can prepare for it. Preparing won't take away all the work, but it gives you the resources to work with your baby and give birth.
I despise the Hollywood stereotype of a woman screaming mindlessly through labor while occasionally hurling insults at her husband/boyfriend for “getting her into this situation.” I'm no stranger to loud labors – I'll be the first to say I screamed out at least two of my baby's heads (I felt that “ring of fire”). But I've also birthed several babies with no screaming, and I prepared well in advance for those little heads (yes, it made a difference for me). I wouldn't describe any of my births as “orgasmic” but all of them were satisfying and safe experiences.
I often give the analogy of a woman training for a marathon, or preparing to climb a mountain. Those women do not just sit back and expect things to go smoothly because running is “natural” or climbing is “natural” (both are pretty natural to humans). But a sustained run or climb is going to take some level of preparation. And there's probably going to be some discomfort during the actual process of running the marathon or climbing the mountain. She's going to have to really push herself.
That's true during birthing too. But labor doesn't last forever. In fact, when labor is left alone and a woman is prepared, it often goes more smoothly and quicker (not always, but you can still have a beautiful birthing – here's how to handle a long labor).
The fact of the matter is, massive amounts of pain in birth are usually due to bad positioning, tension, fear, etc. Preparing for labor and having a strong support system in place means you can focus on working with your baby – and when the going gets tough, you can overcome those and get back on track (see What to Do When You Lose It During Labor).
Birth is Not a Solo Gig
I've already mentioned it several times, but the purpose of labor and birth is to work with your baby's efforts to be born. You are not in this alone. And I'm not even talking about working with your husband or doula or midwife.
I'm talking about your baby. The whole process of pregnancy and childbirth is to bring this new little person into the world, and this little person is working really hard during labor, too. And that's good for your baby.
Evidence shows that the stresses of vaginal birth are beneficial to our babies, perhaps even “switching on” positive genes. It's similar to how research has shown that ample calories (from real, nutritious foods, not junk foods) during pregnancy “switch on” genes that program our babies to be slimmer (low-calorie diets during pregnancy program your baby to hoard fat – for life).
Vaginal birth is good for babies. It's beneficial to lung and respiratory function. Vaginal birth (without antibiotics on board during labor) also primes your baby's gut with “good bacteria” – and triggers important immune system function4.
I'm not saying that babies born with antibiotic drips or born via cesarean are going to have horrible lives. I don't believe in mommy guilt. Sometimes those things are needed and as an intelligent woman you can make that decision with confidence.
But giving birth naturally has massive benefits for your baby. We know many of them, and we discover more every year (understanding of the benefits to the microbiota and the immune system is just beginning, for example).
And you're not doing all of this by yourself. Your baby is working with you, very actively, to make this happen. Birthing will be done before you know it, and you'll be holding your baby in your arms. The hormonal orchestra continues then, and the design of birthing continues then, creating safety for you and your baby. Hormones continue the previously discussed retraction of the uterus, which causes the placenta to separate from the uterus and literally twists and kinks vessels in the uterus, quickly and effectively shutting off blood flow. Your body responds to your baby's presence by adjusting temperature to warm him or her – and to regulate breathing, heart rate, and even blood sugar levels! More on this in The Case for Bonding at Birth and How to Prevent Postpartum Hemorrhage.
All of that happens because labor and birth worked as designed. And all of that can be interrupted by intervention.
Yes, sometimes interventions are life-saving, and I would never say that they should be taken away. But their value will increase phenomenally when they're not used to create traumatic births for mothers and babies who never needed them – but instead used to saved the mothers and babies who truly need them.
That happens when you understand that birth is safe and intervention is risky, and when we work to create as safe a birthing environment for mama humans as we do for mama cats. A beautiful childbirth free of drugs and interventions is safe and satisfying for mamas (even if it takes some work) and it's unquestionably the best start for healthy babies. A smooth, safe, natural birth is something worth working for.
(NOTE: Want a Perfect Birth Plan Template? Use this template and step-by-step videos to write a birth plan that gets your birth team on your side for a beautiful birth experience! Get the kit here.)
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References:
1. http://www.midwiferytoday.com/articles/technologyinbirth.asp
2. Posner, Glenn D., William R. Foote, and Harry Oxorn. Oxorn-Foote Human Labor & Birth. New York: McGraw Hill Medical, 2013. Print. (p.59)
3. Cesario, Sandra K., PhD. “Reevaluation of Friedman's Labor Curve: A Pilot Study.” Journal of Obstetric Gynecologic & Neonatal Nursing. N.p., 90 Mar. 2006. Web. 04 Jan. 2015.
4. Check out the great documentary Microbirth if you're interested in more about this: http://microbirth.com/
