Natural, or normal physiological, birth occurs when no drugs or interventions are employed while a woman labours to birth her baby vaginally. Some common interventions are induction, rupturing the membranes, inhaling nitrous oxide, pain relief such as pethidine or epidurals, and caesarean birth. For some women, considered use of some interventions is necessary and essential to their health and that of their baby. In Australia, the rate of interventions in birth is much higher than that recommended by the World Health Organisation and this has serious implications for babies and women. When we interfere needlessly in labour and birth we can upset the balance which evolution has developed to keep us safe. One intervention commonly leads to another in what has been called the “cascade of interventions” and often then leads to caesarean birth and its attendant risks.
How can women achieve natural birth?
Many women plan to achieve a natural birth for their babies. While birth, like life, has no guarantees, there are some ways we can increase the likelihood of achieving a natural birth. Here are some suggestions:
Choosing a carer
Wherever you choose to give birth, your opportunity to birth naturally depends on the skill, beliefs and history of your carers. Most hospitals and birth centres in Australia have rates of 25-35% caesarean. This means that you have a 1 in 4 or 1 in 3 chance of experiencing caesarean birth. Private hospitals and obstetricians usually have higher rates of caesarean birth. You can ask a hospital or private practitioner to provide you with their annual data. Many hospitals have this on their web sites nowadays.
Choosing a private midwife means that you will have a carer who has a very low rate of caesarean birth and even lower rates of any interventions. You can ask a midwife to provide you with their personal statistics as you would any other carer. It is common to find that midwives also have much higher rates of HBAC (Homebirth After Caesarean) or VBAC (Vaginal Birth After Caesarean) than most hospitals or obstetricians.
If you have no choice but to give birth in a hospital or birth centre, make yourself very familiar with their protocols and with as many of the staff as possible. Planning to labour mostly at home can mean you spend less time in a hospital with less potential for interventions. A midwife can support you in this.
Choosing the midwifery model of care
The World Health Organisation recommends that midwifery care is the most suitable for most women. The midwifery model is evidence-based, not protocol-based, and views pregnancy and birth as normal physiological states not medical emergencies. One to one care through pregnancy and birth gives women greater safety and confidence as they are cared for by someone who comes to know them well not someone who only meets them for one shift. While a private obstetrician can provide one to one care, it is rarely the kind of attention a midwife gives. Obstetricians are not usually present for most of labour and do not have to invest as much time getting to know their clients. Women often spend up to an hour a month at their appointments with a midwife who also visits them at home in the week after a birth. Many midwives can also provide breastfeeding support.
Understanding pregnancy and birth
While there are many books available on birth, many do not encourage a healthy consumer-type approach to choosing our health care. Many are more concerned with how to make labour pain go away than understanding its function in a healthy labour. Many also do not encourage women to be in control of their own care but to uncritically hand responsibility to medical personnel.
Professional journals, books by midwives, videos of natural births and birth stories by women are all invaluable tools for learning about labour. The more information you have, the more informed choices you can make. You are the expert on your body!
It is appropriate to question your care givers and expect straightforward answers. Ask what research an opinion is based on and let the person know you will check it out. Evidence-based practice should support you in your quest for information. A caregiver who is threatened by your need for information is probably not the best carer to support your natural birth.
There is little in our society which supports us in viewing birth as a normal and natural part of life. To help us achieve natural birth it can aid us to be around others who feel it is normal and desirable to want to birth without drugs or interventions.
When you are actually in labour, it is the kind of support you receive, and how comfortable you are in your environment, that will make your pain manageable. You can learn ways to help you manage strong labour and help those around you to be the best support possible as well.
Be aware of the approach of your carer
Hospitals support a hierarchical approach to health care. Doctors and obstetricians are the top of the power structure with women as “patients” rather than clients or consumers. Protocols are developed in hospitals to standardise care regardless of an individual’s opinion. This means that your care is governed by rules but like any workplace, it can depend who is on duty as to how sensitively those protocols are managed. The midwifery model of care is not employed in hospitals and not generally employed in birth centres either. This means that your pregnancy and birth will not be viewed as normal events but as medical events requiring constant management with drugs and interventions. Midwives view pain in labour as normal and healthy, showing the body working at its optimal level to safely bring a baby into the world. Labour is not the time to sort out issues you have with your caregivers so choosing wisely can help avoid this happening to you. Listen to your gut instinct and avoid carers who don’t meet your expectations.
After you give birth
Every birth is life changing, no matter how peaceful and empowering. It is important to spend time discussing your birth experience after your baby arrives. If your birth is a brilliantly fulfilling experience you may live on the high from it for months or years. It could also suddenly throw previous birth experiences that were not good into sharp relief. If you have planned a natural birth and then experienced interventions which have utterly changed your plans, you will need to debrief. If you experience an unwanted caesarean you may need quite a lot of support to see you through the emotional distress this can cause. Your alternative practitioners can help you with this too. You may need to see a counsellor who specialises in birth trauma to regain a sense of wellbeing. Your birth support group can put you in touch with some.