Down with “natural” childbirth

As I’ve mulled over my birth recent experience, I think I’ve arrived at the conclusion that I dislike the expression “natural childbirth.” Here’s why.

I see natural childbirth blogs and Web sites with descriptions such as the following, from Natural Childbirth Stories: “Births the way nature intended. No pitocin. No epidural. Just the beauty (and intensity!) of the human body at work.” Hmm.

“Natural childbirth” is what I was shooting for when I started this journey, and I fought tooth and nail for it. In the end, I wound up with interventions which would not be considered “natural” by most NCB advocates, namely, Pitocin and the vacuum extraction. I think these interventions were medically indicated and absolutely necessary. Still, they probably disqualify me from the natural childbirth club.

But what is “natural childbirth” anyways? “Giving birth the way nature intended.” As someone with Rh-negative blood who pair-bonded with someone with Rh-positive blood, if I “gave birth the way nature intended,” I’d probably only be able to have one healthy pregnancy. Nature apparently intends for about 15% of women to have limited childbearing abilities. Modern-day obstetrical intervention has corrected that. Yet most NCB advocates would probably not discourage Rh-negative women from obtaining the recommended Rhogam injections, and would not say that your childbirth was no longer “natural” on that account.

Here is the list of actual obstetrical interventions and procedures that were used on me during my prenatal care, labor, and delivery:

  • Rhogam injection at 15.5 weeks (due to amniocentesis)
  • Rhogam injection at 28 weeks (standard)
  • Rhogam injection within two hours of giving birth (because newborn son has Rh-positive blood)
  • Membrane sweep (in an attempt to start labor without more formal induction or at least prepare the cervix for induction)
  • Hep-lock installed
  • Low dose of intravenous Pitocin to induce labor (due to risk of pre-eclampsia), shut off after the first 5 hours of labor
  • Intravenous antibiotics to counter Group B strep, first dose at start of induction, second dose 4 hours later
  • Continuous external fetal monitoring (to see how baby was handling the Pitocin)
  • Continuous external contraction monitoring (to accompany external fetal monitor)
  • Vacuum extraction because baby was large (9 lbs 5 oz) and in occiput posterior position
  • Routine injection of Pitocin to prevent third stage hemorrhaging

I have seen natural childbirth advocates argue against the use of all of these, with the exception of Rhogam. Everyone seems to agree that Rhogam is a good idea for Rh-negative women.

The following interventions were discussed, offered, or possible given the circumstances, but not used:

  • Mechanical dilation via a Cook’s catheter (cervical ripening balloons) to dilate my cervix and prepare for Pitocin induction (not used because my cervix was already a stretchy 2 and 60% effaced, so we opted to go straight to Pitocin)
  • A regular IV (nurse was about to place it when I requested the Hep-lock instead)
  • An epidural (my doctor admitted that most women are unable to cope with being on Pitocin without an epidural)
  • Use of magnesium sulfate to counter high blood pressure (doctors decided I did not need it)
  • Internal fetal monitoring (not used because I declined)
  • Intrauterine pressure catheter (not discussed, but I assume this would have accompanied the internal monitor)
  • Amniotomy (would have been necessary to place the internal monitor and pressure catheter)
  • A c-section (the nurse who attended to me for my son’s delivery says that she has seen her share of women wind up with a c-section due to posterior position; the hospital I delivered at has a 31.4% overall c-section rate)

In the end, I turned down or avoided quite a few interventions. However, I still had a number of them, most of them either minor or routine for treating the conditions in question.

So, how many and which interventions can a woman have and still get this?

Achievement Unlocked

The thing is, I feel that all of my interventions, from the most minor to the most serious, were appropriate. I had the minimal number of interventions that I could have had and still delivered with good outcomes for both myself and my son. And while I was overall very happy with the birth, the fact that I did not make it into the “natural childbirth” club did give me some remorse and threatened to make me feel inadequate for having failed to deliver my son without help. “Natural childbirth” may not be the healthiest goal to shoot for.

Next time I deliver (if there is a next time), I do not believe I will be pursuing a “natural childbirth.” Instead, I think I will tell my provider that I expect:

  • Minimal interventions
  • Informed consent
  • Patient autonomy
  • Respect for the patient

I’d like to see a name for a movement that stresses those four things, because I feel like that is what is presently lacking in the birthing world, and I don’t believe the goal of “natural childbirth” lends itself easily to pursuit of those things. But every woman should have the right to only submit to necessary interventions, to be fully informed of the risks and benefits of proposed procedures, and to have ultimate control in accepting or rejecting procedures. Furthermore, every woman should be treated with dignity and respect, and not have her choices or her reactions to what’s happening to her belittled or undermined by the medical staff.

I continue to admire and respect the natural childbirth movement, and I feel that I’ve learned a lot from them, but I think I will be seeking a more integrated attitude towards birth in the future.

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Categories: Interventions, Labor & Delivery | 2 Comments

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2 thoughts on “Down with “natural” childbirth

  1. I’m with you! I know the title of my book doesn’t sound like I”m with you, but I’m really, really with you on this one. I believe that the best birth is the birth where the woman in in charge. Some women want a lot of medical interventions from the get-go and I support them (even, sometimes, as a doula). Other women want to give birth as naturally as possible. You start off with a birth vision (my dream birth included dolphins and beaches), but you also have to deal with reality. There are many things outside of your (complete) control, like your baby’s or your placenta’s position. One of my babies tilted his head in such a way that it was impossible to birth him vaginally and he was born by cesarean. But I was in charge of that birth just as much as I was in charge of my two vaginal births. Interventions are not evil. They are just overused in America. But each and every intervention has its place when used for the right reason and when mothers are not shut out of the decision-making process.

  2. I’m so happy you came and commented, Cynthia! When I read Natural Hospital Birth, I was curious why you had a c-section with your first. Was he a brow presentation or an anterior face presentation?

    I’ve been doing a bit of reading around since I made this post, and I think Improving Birth may be working towards the kind of goals that I described in my post. I might look to get more involved.

    I agree though, feeling like you are in control and part of the process is the most important thing, and one of the things that I hated about having an epidural with my first. I felt like I had lost control and was no longer part of the birth experience. Other women seem to feel like being in pain takes away their control, and for them an epidural restores control. I’m a-okay with that.

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