Green, Organic and Healthy Living Articles

Allin, Nancy Valley Medical Center Sandra Coan Photography Seattle Postpartum Doula Services Birthing Inn, The

Birthing Naturally - Is It For Me?  By Anna Matsunaga 

You have made major changes in how you take care of yourself and your family, you shop and eat organic, you use homeopathic medicine far more often than drugs and you consider yourself a convert to the "natural" way of doing things. However, you are now planning a pregnancy or are already expecting a new arrival. Is "natural" the way to go for pregnancy and birth as well?

Natural birth is free of medication, surgery or any other intervention that prevents spontaneous labor with the mother delivering under her own power. Let's look at just a few of the benefits a natural birth holds for your family.

Safety - Hopefully your first goal is a safe and healthy mother and baby. Study after study proves that a natural birth, in an overwhelming majority of cases, is the best way to achieve this. Infant and maternal mortality figures are lower in natural births.(1,2,3)

Prevention as a Model of Care - Most caregivers who are supportive of and trained in assisting with natural birth work with you in advance of and during the labor and birth to help you prevent problems before they arise. Caregivers who lean towards a more interventive model of care tend to wait until there is a problem and then use modern technology to hopefully cure the problem.

Earlier and More Complete Family Bonding - Families that experience a natural birth are more likely to bond with the baby earlier. In fact, a mother who has a natural birth is more likely to be successful at breastfeeding.(4,9) Any intervention may interfere with this, even one as simple and routine as breaking the bag of water during labor has been shown to significantly alter attachment to the baby after the birth. And yet, this procedure is so routine that some obstetricians fail to even mention that they are going to do it.

Empowerment - Couples that have worked together and achieved a natural birth find that they both have confidence in themselves and each other that they had never experienced before. It is their birth and they gave birthÉa birth that was a true gift to each other and to their babyÉthey were not simply delivered of a baby. They often find themselves much closer and much more confident as parents and in life.

Less Costly - A natural birth does not include the costs of an anesthesiologist, or a surgeon. Generally, it also does not include a long hospital stay or complications with the child or the mom as the result of routine interventions. Just a quick comparison in our area of estimated costs for total maternity care, delivery and newborn care reveals significant savings by having a natural birth. Comparing costs of a natural uncomplicated birth with the costs of an uncomplicated birth with an epidural and episotomy reveals a potential savings of between 35-75%, depending upon where you choose to birth. The most savings is realized with a home birth and the least with a hospital birth. Birth at a freestanding birth center comes in at a little less than that at the hospital in costs. This is without considering the fact that medications alone make it more likely to have complications including, but certainly not limited to, a C-section. An uncomplicated C?section will cost, by conservative estimates, more than seven times an uncomplicated natural home birth. And serious complications are 400% more likely to happen for mother or baby after a C-section than after a natural delivery.(18)

Shorter Labor - Unmedicated labors tend to be shorter than medicated ones.(6,7)

Faster Recovery - What many families fail to realize is that by attempting to avoid pain during labor, they simply delay it until later, when the mom is attempting to adjust to caring for the new baby and recover as well. A drugged mom is more likely to tear, hemhorage, have postpartum infections, and suffer other complications after giving birth.(1) Natural childbirth moms tend to feel little or no pain once the baby is born.(8)

Alert and Responsive Newborns - Babies who come into the world undrugged are more likely to be ready and willing to be nursed and interact with their parents right away.(8) Conversely, about a quarter of babies whose moms have an epidural have to be resuscitated.(1,3)

Decreased Likelihood of Future Drug Addiction for your baby later in life. Babies who have been born without drugs are less likely to abuse them later in life.(9,10,11)

These are just a few of the reasons to have a natural birth. Are there any drawbacks to a natural birth? Ask anyone who has worked hard to accomplish it, and they will likely tell you that what might seem like drawbacks in the short-run end up being benefits in the long- run. You will have to work harder and take responsibility for your pregnancy and birth than someone who just lets her caregiver take care of everything. You will likely find a need to get more educated and take an active role in staying low-risk. You may find it necessary to change caregivers to someone more supportive of your plans. You will have to work together and communicate more closely with your spouse and/or others who will be supporting you at the birth. You as a mom will likely experience pain during the labor, which you will want to be prepared for in advance. Dads and other support people will have to handle watching someone they care for be in pain and help them deal with it. Most naturally birthing mothers later say that they saw the pain as productive and it was experienced more as a rite of passage rather than something to be avoided. This is especially common with the families that have been well trained to experience a natural birth.

Also, what if you plan for a beautiful, natural birth and end up with necessary interventions you had not planned on? Many people who advocate a more medical approach to birth will mention this as a reason not to plan for a natural birth. This is much like planning for a divorce with the person you love, instead of marriage and life together, "in case something goes wrong." When all is done to insure a natural birth and it is not possible, the family will find that they still benefit from planning on a natural birth. Their baby will be better nourished and also will receive less medication than if a natural birth had not been planned at all. The mom will be healthier and better able to recover. Most of all you will know that the interventions were needed, not just routine.

So, you want a natural birth. How do you make it more likely that you get to have one?

Support - Women who want to have a natural birth have a much greater chance in doing so with support. The ideal person is of course the baby's father. Working together also helps the baby come into a closer family with an involved dad for the baby from the very start.(8) In addition, a professional labor support, or a "doula", to support the couple physically and emotionally increases the odds of a natural birth.(3) A doula may also be hired as support in situations where the dad is not involved.

Education - It is essential that you know all you can to make good decisions and stay low-risk. Where would you look for education?

Attend a La Leche League Meeting and check out their library. Ask for information on breastfeeding preparation and birthing.

Choose your method of childbirth instruction and your instructor with great care. Questions to ask your prospective teacher:
1. Are you independent? Be sure that she does not work for and is not dependent on an institution (hospital or other) in order to practice. You want someone who works for YOU and has you as first priority.
2. Where did you receive your training and what method do you teach? Don't choose someone who tells you she teaches a combination of methods since you will have trouble using any of them well if you are not able to learn them thoroughly. Make sure your instructor is certified.
3. Have you had any children using this natural birth method? You want to learn from someone who has done it before and believes that you can, too.
4. What percentage of your students had completely unmedicated births without intervention? Look for an instructor who has 80%-90% or better.
5. What is covered in your classes? The best classes will cover nutrition, exercise, how to avoid unnecessary pain, relaxation, physiology, 1st and 2nd stage labor, communication skills, birth planning, variations of labor, possible complications, workable alternatives to common procedures, consumerism, postpartum, breastfeeding, and care of your newborn and more.
6. How many weeks of class are there? (How many hours?) A weekend course or one of just a few weeks may not give you enough. To truly master relaxation you need 12 weeks of consistent practice, and that many exercises also need to be done for at least this long to be effective.
7. How many couples will be in our class? Smaller classes mean more personal attention and more interaction. Ideal is between 3-8 couples.
8. Are you available outside of class for questions?(17)

Care Provider -
1. Find out what percentage of their patients (especially first timers) have natural births. Be sure that by natural they do not just mean vaginal, but that they mean unmedicated, spontaneous labor with the mother delivering under her own power. Look for a provider who does mostly natural births.
2. Trust your gut instinct: if you feel uncomfortable with a provider, do not stay. Labor is a process that works best with good levels of trust and emotional relaxation.
3. Do not settle for vague answers; insist on respectful and specific answers and information.
4. Consider choosing a midwife, who will be an expert in normal birth, over an obstetrician who is an expert in surgery and labor complications. Another option is a family physician; statistics show less likelihood of a C- section with a family doctor than with an obstetrician. Obstetricians are needed for complications; choose one with a good reputation to be your backup doctor in case you need them. Midwives generally spend far more time with clients and really get to know you. They tend to practice preventive care and know pregnancy, labor and you well enough to know well in advance if there is a problem, and often are able to fix it with non-invasive and natural means.
5. Get recommendations from other women who have had a good experience with a natural birth, and check with doulas and childbirth educators as well.

HELPFUL RECOMMENDATIONS

Water - Consider using water for labor and for birth. Every woman I have spoken with who has used water for labor and birthing agrees that it eliminates much of the pain. Some sources say it is at least as effective as narcotics for pain.

Birthplace - Plan to birth at home, or at a freestanding birth center. Studies indicate reduced rate of medication and intervention, even for moms who have the need to transfer to an institution.(1,3,12,13,14)

Doula - Hire professional labor support. Extensive research shows that doing so reduces the likelihood of a C-section, reduces the perception of pain and shortens labor.(3)

Chiropractic - See a chiropractor during your pregnancy to optimize alignment and positioning of baby for birth and to help you deal with the discomforts of pregnancy drug-free. Similarly, consider massage and acupuncture to help deal with pregnancy pain instead of medication.

Nutrition - Eat a balanced diet free of junk food, pesticides, additives and refined food and with at least 80 grams of protein daily. This is perhaps the most important thing you can do to stay low-risk and healthy.(16,17)

Birthplan - Plan your birth ahead of time. Research your options and put decisions in writing. Do so in a manner that invites your caregivers to help you rather than putting them on the defensive, and discuss your plan with everyone who will be or may be involved with your care (i.e.: your doctor or midwife, their backups, the head nurse and nursing staff, labor support and anyone else who will attend the birth).

IN LABOR

1. Plan to stay home until labor is very well established. Go back home if you are less than 4-5 cm dilated and not showing emotional signposts of late labor.(3,17,18) You'll learn about these things in a comprehensive childbirth class.
2. Avoid allowing your bag of waters to be artificially ruptured.(3,18)
3. Urinate at least one time per hour.(3,8,18)
4. Walk and change positions regularly, avoid being on your back and use a squat or other position that feels right to you, not one that is chosen for your caregiver's convenience.(18)
5. Use water for your labor in the form of the shower, a birth tub or bath tub.(18)
6. Work with your body, respond to what it tells you. Relax if you feel tense, focus on making your breathing slower, do not use altered breathing patterns. In second stage, bear down as your body feels like it and avoid prolonged straining and breath-holding. (8)
7. If labor slows down use non-medical options like change of position, nipple stimulation, a shower, thumb sucking, walking, kissing, sitting on the toilet and getting some privacy. Commit to using drugs or intervention only if there is a medical reason and other alternatives do not work.(3,18)
8. Avoid routine use of electronic fetal monitoring unless there is a specific medical indication for one.(18)
9. Do not be rushed.(18)

Does preparing for a natural birth sound like work? It is, just like every other truly worthwhile thing you've done in the past. Will it be worth it? Yes, and your baby will thank you too.

References

1. David Stewart PhD & Lee Stewart AAHCC, "Safe Alternatives in Childbirth," 4th ed., NAPSAC International, 1994.
2. K. H. Nicolaides MD, "Labor: an immunologically beneficial process for the neonate", Harris Birthright Research Center for Fetal Medicine, May 25, 1995.
3. Henci Goer, "The Thinking Woman's Guide to a Better Birth," The Berkley Publisher's Group, 1999.
4. "The Womanly Art of Breastfeeding," 6th ed., La Leche League International, 1996.
5. Althabe' & Carldeyro-Barcia,"Influence of rupture of membranes on compression of fetal head and dips in fetal heart rate."
6. "Randomized trial of ambulation vs. oxytocin for labor enhancement: a preliminary report," American Journal of Obstetrics and Gynecology, 1981, pp 669-672.
7. L. L. Albers, "The relationship of ambulation in labor to operative delivery," Journal of Nurse Midwifery, 1997, 42 (1): pp 4-8.
8. Robert Bradley MD, "Husband Coached Childbirth."
9. Ob-Gyn News Vol 23 #7.
10. Ob-Gyn News Vol 26 #4.
11. "Socio-economic vs obstetric risk factors for drug addiction in offspring," British Journal of Addiction, 1992, pp87, 1669Ñ1676.
12. "Maternal medication during labor may affect offspring's drug dependency," Epidemiology, 2000, 11:715-716,
13. "Outcomes of elective home births: a series of 1,146 cases," Journal of reproductive Medicine, Vol. 19: pp 281-291.
14. "Safer Childbirth? A critical history of maternity care," Tew M. Chapman & Hall, Publishers London, 1990.
15. "Freestanding birth centers in CA. Program and medical outcome," Journal of Reproductive Medicine, pp 960-970, 1989.
16. Gail Sforza-Brewer & Tom Brewer MD, "What Every Pregnant Woman Should Know," Penguin Books USA Inc., 1985.
17. Susan McCutcheo AAHCC, "Natural Childbirth the Bradley Way," Penguin-Plume publishing, 1996.
18. Diony Young and Charles Mahan ICEA, "Unnecessary Caesareans, Ways to Avoid Them ," 1989.

The resources and studies listed here are only a very small sample of published data supporting natural birth, and non-interventive care. For a more complete survey and discussion & bibliography see the book, The Five standards for Safe Childbearing by David Stewart, Ph.D.