What’s the big deal about natural childbirth?

by Réka Morvay on December 23, 2008

These days, natural childbirth seems to be becoming more popular again, which gives it a kind of crunchy trendiness like doing yoga or being vegetarian. (Both worthy and healthy endeavors – just like aiming for natural childbirth – under the right circumstances.)

Fact of the matter is that there have been trends in childbirth, and in western societies, this trend has been leading towards more medicalized births actively managed by doctors, to the point where now fully one third of births in the United States are surgical births (C-sections), and it’s hard to spot any birth in a hospital that hasn’t been meddled with in some way.

So what’s wrong with that, you rightly wonder. What’s wrong with “meddling” if it means that the birth is safer, faster, or the mother feels less pain?

The problem is, it means none of those things. It just means that medical interventions are introduced as a matter of routine (as opposed to necessity) into a well-oiled process, and in the majority of cases, these interventions increase the number of complications, not decrease them, and even introduce new ones. Interventions interfere in the natural process, which then necessitates more interventions. It’s like the first intervention just starts the slide down a slippery slope, at the end of which is a C-section.

What’s wrong with a C-section, you ask.

It’s major surgery, with all the associated risks. At base, it’s a lot more risky to both mom and baby than a vaginal birth. For mom, there are all the post-surgery complications, potential infections, and so on. It also means that the number of children a woman can have is instantly numbered, and the frequency at which she can have them, already determined for her. Because after a C-section, it is recommended that a woman wait at least 3 years before giving birth again, and the second birth after a C-section is likely to also be a C-section, and I believe few doctors will be willing to administer more than 4 C-sections on anyone.

The baby is also at risk for infections , and for respiratory difficulties after a surgical delivery. C-sections tend to make breastfeeding more difficult (though primarily only because moms tend to receive babies later, and thus attempt to nurse them later). And not lastly, it deprives both mother and child of going through a rite of passage, psychologically and spiritually. All fine and well, if the child’s life is in danger, because obviously, a living baby is far more important than being able to go through a rite of passage. But C-sections are used far more “liberally” than just in life-threatening situations, and most often, they are the last intervention in a line of interventions in what otherwise could have been a natural birth.

Physicians these days routinely use interventions for three primary purposes: to trigger labor, to speed up labor, and to reduce pain.

Each of these interventions carries a risk (=increased probability of C-section), and each of them can produce situations that necessitate further interventions.

Take, for example, the topic of episiotomies. Episotomy is the cut performed on the woman’s perineum (the tissue between the vagina and the anus) to allow the baby’s head to emergy more quickly during pushing. If you know your anatomy, you also know that a baby whose head is already pushing on the mother’s soft tissues on the perineum has cleared the bony pelvic passage, and is thus minutes away from being born.

According to the WHO (World Health Organization), there is not need to routinely administer this cut, which severs skin, nerves and muscles in this sensitive area, and is the equivalent of a third-degree tear. The prevalence of third-degree tears in home births or birth centers with minimalized medical intervention is 0.3%. That’s 3 women in 1000. By contrast, in Hungary, 70% of first-time mothers receive this cut. The rationale: to prevent fourth-degree tears (despite the fact that scientific studies have shown that routine administration of an episiotomy actually increases, rather than decreases, the incidence of fourth-degree tears.)

So why does a woman receive an episiotomy? Because by the time she is pushing, the baby’s heartbeat is uneven, or too low, and because she is lying on her back, with the diameter of her pelvis at its narrowest. She is trying to push against gravity, and push with her pelvis locked in a narrow configuration due to her prostrate position, and her tissues appear on the verge of tearing, especially as the doctor bears down on the laboring woman’s belly with each contraction to help the uterus push the baby out. The doctor decides to speed things up, and makes the cut, both to make sure the baby is all right and to prevent the fourth-degree tear that the aggressive external pushing can cause. Had she been laboring in an upright position at her own speed, her tissues would have had an opportunity to adjust to the pressure of the baby’s head, she would have felt when her tissues stretched too far, and paused to give them a chance to adjust, and would probably have gotten away with no tears, or a first-degree tear (the equivalent of a bruise). And had she not been lying on her back and receiving both pain medication and artificial oxytocin, the baby would probably have been under much less strain, removing the pressure for a speedy exit.

So how did she end up pushing in this position? She ended up in this position because she was receiving an epidural and artificial oxytocin, the former to decrease her pain, the latter to keep her contractions strong (because the epidural tends to slow down labor). Because she had IVs in her arms, hospital protocol required her to be on her back, even though moving around during labor and an upright position during pushing are associated with best outcomes. Also, doctors prefer women to be on their backs and presenting their vaginas at eye level so the entire crotch area is clearly visible and accessible for the doctor.

Why was she receiving an epidural and artificial oxytocin? Because her physician decided to induce labor after she passed her due date, even though the average length of pregnancy is 38-42 weeks, even though the baby’s heart rate, as indicated by an NST, was fine, and flowmetrics as seen on an ultrasound of the placenta and the umbilical cord, indicated that the placenta was still functioning perfectly. He decided to induce because maybe the weekend was coming up, or maybe because he truly believed (despite all evidence to the contrary) that babies should leave the uterus when the doctor decides. So the doctor attempted to induce labor by mechanically dilating her cervix and breaking her water, neither of which succeeded in triggering her labor within the allotted time, thus she ended up receiving oxytocin in an IV, which produces far more painful contractions than ones driven by a woman’s own natural oxytocin, so to help her endure the pain of these artificial contractions, and of having to labor on her back (the most uncomfortable position for enduring labor pains), she was given an epidural.

So the woman ended up with several interventions during her labor that could have most likely been avoided had she been allowed to go into labor on her own, been allowed to labor at her own speed, and been allowed to choose her own position for pushing.

Now, she may be glad that she escaped the specter of having a C-section, has a surgical cut between her vagina and her anus that will take a week or so to heal (though it can leave a scar that lasts a lifetime), is convinced the doctor saved her baby’s life, and simultaneously convinced that she could not have birthed a child without medical intervention.

When in truth, the first intervention, the act of attempting to trigger her labor when her body was clearly not yet ready for it, resulted in a cascade of interventions ending with the baby’s faltering heartbeat and her episiotomy. And had she been actually encouraged to trust her body’s signals and follow her instincts during birth, she would have had an empowering experience that carried far fewer risks for either her or her baby.

More information:

What accounts for the rising rates of C-sections in the States?

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