Tell people you’re interested in a natural birth, and they just might look at you like you’ve lost your mind.
“Why in the world would you do that?” is the usual response. Women are called crazy, reminded that “you don’t get a medal at the end,” and scolded that they “don’t have to be a hero.” Worse yet, they’re sometimes insulted by those who assure them, “Oh, you’ll get the epidural.”
As a doula and natural childbirth instructor, I meet these pregnant women all the time. They have some instinct that they’d like to allow their body to work the way nature intended, but friends, family, even strangers seem to think their goals are unrealistic, even foolish. As a mother of two boys, I was in their shoes not so long ago—wanting to birth without drugs, but not so sure I could really do it when everyone was telling me how completely unbearable childbirth really was.
Good news: for the vast majority of women, natural birth is far from unbearable. It’s work, it’s effort, and for most it does involve pain. But with the right support and space for a woman to tune into her body, it’s very doable and ultimately rewarding.
Assuming natural childbirth is achievable, why would anyone want to do it? We have drugs, why not use them?
It sounds cliché, but our bodies were made to birth. No, you wouldn’t have a tooth pulled without anesthesia. Of course not! But the pain of birth is not at all like that pain—at least not under the right circumstances. Childbirth is one of the few positive pains we experience in our lives. It’s pain with a purpose, to bring a child into the world. The pain of childbirth is not an indicator that a woman is hurt or sick, or that there is anything wrong at all—it is normal.
Just as you don’t need drugs to run a marathon (wouldn’t that defeat the purpose?), the majority of women do not need drugs to birth. Sure, during a marathon, there’s a small chance you could encounter complications that need medical attention. At some point, you’ll probably feel that you can’t go on. But, by and large, those who start the journey fit and well-centered do finish the marathon—exhausted, but triumphant.
The pain of birth can also be transformative. It is our passage from woman to mother, from mother of one to mother of two, and so on. If women are supported and loved on their journey, this kind of pain has the incredible power to bring them out on the other side feeling invincible. If you can triumph over the birth journey, and come out on the other side of that fire, you can do anything. That’s an amazing way to start our journeys as mothers: feeling powerful, strong and wise.
I’ve felt that incredible transformation in my own body, and, as a doula and teacher, I’ve witnessed it in many other women. This power is the core of why I love natural birth.
But not everybody understands that perspective. It’s a little too “out there” for some folks. So if people don’t buy into the natural birth empowerment bit, surely they will understand that natural birth, when there are no medical complications, is safest for moms and babies. “Healthy mom, healthy baby” is at the top of every parent’s list of priorities, and unmedicated birth is generally the surest way to achieve those goals. Take for example the epidural, the so-called “Cadillac of anesthesia.” It can be quite effective at abolishing pain, true. However, a systemic research review undertaken by the maternity advocacy organization Childbirth Connection found that epidurals also:1
- increase the length of the pushing phase of labor;
- increase the likelihood of birth with vacuum extraction or forceps;
- reduce the likelihood of “spontaneous vaginal birth,” that is, birth with neither vacuum extraction, nor forceps, nor cesarean section;
- increase the likelihood of maternal fever, which in turn increases the chance that the baby will have blood drawn to check for infection and will be given antibiotics through an IV (intravenous) line as a precaution;
- increase the likelihood of serious tearing of perineal tissue—probably due to the increased use of vacuum extraction or forceps;
- can adversely affect newborn behavior compared with unmedicated infants;
- increase the likelihood of newborn jaundice.
There is also some evidence that epidurals increase the length of labor, increase the likelihood of cesarean section, increase the incidence of postpartum hemorrhage, adversely affect breastfeeding success, increase the likelihood of stress incontinence, and increase the risk of side effects during labor such as low blood pressure and allergic reactions.2
That’s a lot of data, but there are a lot of risks to consider. Narcotics like Demerol and Stadol carry their own risks, including nausea and depressed respiration in the mother, and they readily cross the placenta and can depress newborn breathing and affect behavior in a way that appears to interfere with parent-baby interaction and breastfeeding. Worse yet in some women’s eyes, the research also suggests that narcotics are not particularly effective at relieving labor pain.3
I suggest that my students leave pain medication on the table as an option for their births. I have myself seen a few situations in which an epidural was just the right choice to help a laboring mom go on to have a vaginal birth. Occasionally a medical indication warrants such intervention, or a woman’s pain crosses over into unacceptable suffering. But medication for childbirth is stunningly overused in the United States.
I’ll say it again: the vast majority of low-risk women do not need drugs to birth their babies. All drugs carry risks, and there is a huge toolbox of comfort measures that carry no risks at all to mom or baby. All I’m suggesting is that women try those tools first, and if they are well-trained and supported, the majority never even ask for medication. A midwife or physician who understands natural birth and is supportive of those goals can serve as a guardian for low-risk birthing women, alerting them to true complications and recommending intervention only when it is medically necessary.
Beyond the choice for narcotics, an epidural or other pharmaceutical pain relief in labor, cesarean birth is a huge issue in our country. According to the Centers for Disease Control, more than 31 percent of U.S. women gave birth by c-section in 2006 (the most recent year for which data is available).4 Really? Almost a third of women are unable to birth their babies vaginally? I am certain that we are not so poorly designed.
The World Health Organization has said for more than 20 years that no country in the world is justified in having a c-section rate of more than 15 percent.5 In 2000, the U.S. government set that 15 percent rate as a national goal for the United States by 2010, a goal that now not only seems unreachable, but almost laughable.6
Having a cesarean section increases risk to mother and baby of a host of problems, ranging from accidental surgical cuts and infection to infertility and stillbirth with future pregnancies. In their research review, Childbirth Connection found 33 areas where cesarean section was found to involve more risk for moms and babies than vaginal birth, and just four areas where vaginal birth was found to involve more risk than c-section. Clearly, we need to reach some kind of equilibrium where cesarean birth remains an option for the relatively small percentage of women for whom it is safest way to deliver, but reduce the outrageously spiraling number of so-called “unnecesareans.”
So my charge to you?
If you are pregnant, do some research on natural birth. Your worldview might change a bit, and something wonderful could evolve for you and your baby. Beyond empowerment, every mother certainly wants to do what’s healthiest for her baby. For low-risk women, when there are no complications, that usually means a prepared, natural birth.
If you are a woman who has birthed naturally, share your story! In my class I connect all my students with mentors who have birthed without drugs. We need more positive stories to counteract all the manufactured horror that surrounds birth in this country.
And finally, if you meet someone who says she wants a natural birth, support her in that goal. Don’t tell her she’s crazy, and please don’t tell her your horror stories. Expectation can create reality, and she is more likely to have a positive birth experience if she goes in expecting and prepared to have one.
Here’s to a world filled with much more normal, natural birth.
This article is not intended as medical advice. Women should, of course, consult their health care provider in weighing pros and cons and making decisions about their own births. Each situation is unique.
Tips to Prepare for a Natural Birth
- Take an independent, out-of-hospital childbirth course. Look for one that lasts at least eight weeks, and ask your instructor what percentage of her students birth naturally.
- Surround yourself with positive stories! Connect with others who have birthed naturally.
- Find the right provider. One of my students told her doctor that she wanted a natural birth. The doctor asked if that meant she wanted to have her baby in the woods. Message: not a good match. There are providers who support and encourage natural birth, and the women who see them generally have better outcomes, with less intervention.
- Consider a doula. Doulas are like your tour-guide through birth—a non-medical support person who helps to ease and normalize the experience for the entire family. The research is incredibly clear: women attended by doulas are significantly less likely to request medication, less likely to have a c-section, and more likely to be satisfied with their birth. Doula care also improves breastfeeding success and decreases the incidence of post-partum depression.
- Trust your body! Our bodies have incredible wisdom. Structure a birth team that shares that trust and will help you create the space you need to tune in to the natural process.