Why Natural Childbirth?
The Journal of Perinatal Education Lamaze International
Judith A. Lothian, RN, PhD, LCCE, FACCE Abstract
A reader asks for help in answering the question “Why natural childbirth?” Understanding the simple story of normal, natural birth, what helps and what sabotages nature's plan for birth, and the appropriate use of interventions are discussed and form the foundation for coming to the conclusion that nature's plan makes sense. Women are inherently capable of giving birth, have a deep, intuitive instinct about birth, and, when supported and free to find comfort, are able to give birth without interventions and without suffering.
Question: I have taught Lamaze classes for over 10 years. The epidural rate in the hospital in which I teach is over 90%. Over and over again, I am told that women no longer want natural childbirth and the statistics certainly support that opinion. I need help answering the question, “Why natural childbirth?”
Answer: The first step in finding an answer to the question, “Why natural childbirth?” is to understand the simple (not the medical) story of natural, normal birth. Strangely enough, the more we know about birth, the easier it is to lose sight of how well designed and simple birth actually is. In Lamaze class, our teaching too often focuses on the mechanics of anatomy and physiology and ways to deal with pain rather than telling and retelling the simple story of birth the way it is meant to be.
What Happens in Normal Birth?
In the last month of pregnancy, the cervix softens and ripens like a piece of fruit. Contractions of the uterus become noticeable, and the baby settles into the pelvis. The contractions become stronger, the cervix stretches and opens, and the baby moves lower and rotates, eventually moving down the birth canal. With each contraction, pain sends a signal to the brain and oxytocin is released. With the release of oxytocin, the contractions increase in intensity. As the pain of contractions increases, more oxytocin is released and the contractions become harder.
The pain of labor is what most women worry about. It is important to understand that the pain of the contractions in labor is valuable. It is an important way in which nature actually helps women find their own ways of facilitating birth. In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The positions and activities she chooses in response to what she feels actually help labor progress by increasing the strength and efficiency of the contractions and encouraging the baby to settle in and move down the birth canal. When the pain is entirely removed, the feedback system is disrupted and labor is likely to slow down and become less efficient. As labor progresses and pain increases, endorphins (much more potent than morphine) are released in increasing amounts. The result is a decrease in pain perception, quite naturally. Nature's narcotic! The rising level of endorphins also contributes to a shift from a thinking, rational mind-set to a more instinctive one. Endorphins create a dream-like state, which actually helps women manage the tasks of birthing. Inner experiences become more important than the external environment. As labor progresses and the pain of labor increases, women “go into themselves,” become much less aware and, at the same time, much more focused on the work of labor, and are able to tap into an inner wisdom.
A woman surrounded by family, friends, and health care providers who remind her of the power of labor and encourage her quietly and patiently is a woman who is not afraid. Her support team is totally present and comforts her as she does the hard work of labor. She eats and drinks and, even if labor lasts a long time, she has the energy she needs to persevere. She rests between contractions. No one looks at the clock. Everyone trusts the process of birth and believes that she has the strength and the wisdom to give birth.
In a very real sense, the pain of each contraction becomes a guide for the laboring woman. The woman moves in response to what she feels. Whether she gives birth in a hospital, birthing center, or at home, she is able to use a wide variety of comfort measures; for example, moving freely, listening to music, taking a shower or bath, and having her feet and hands massaged. She is able to create an environment that is just what she needs as she does the hard work of labor and birth. She pushes her baby down the birth canal, responding now to the pressure of contractions and the baby as he rotates through the pelvis and moves down the birth canal. She moves, changes position, and grunts, sometimes holding her breath—all in response to what she is feeling. In this way, she not only protects the muscles of the birth canal and perineum but also protects her baby as he is born. A great surge of adrenaline insures that the mother is alert, even if her labor has been long. She is totally focused on her baby, ready and eager to embrace him. Baby is eager and alert, too. The stimulation of his journey has primed him for the transition to life outside the womb.
With her baby in her arms, the mother is engrossed, excited, at peace, proud, and astounded at the miracle she has produced. No one tells her what to do. They know that she knows what to do—not because she and her baby have read the books or attended Lamaze class, but because their journey has physically and emotionally prepared them both for this moment. The weight of her baby on her belly helps her uterus contract and expel the placenta. Baby stays warm in his mother's arms. Baby knows just what to do to survive in the world he has entered. He is awake and looks around. Within seconds or minutes, he has his hands in his mouth and is smacking his lips. Unpressured, he slowly but methodically crawls to his mother's breast and self-attaches. As he nurses, his mother's uterus contracts, insuring that bleeding will not be excessive. The two greet each other unhurried, confident, and unpressured. Together, over the next hours and days, they will get to know each other and fall in love.
For all of its simplicity, nature's plan for birth actually requires a fair amount of flexibility. Each mother and each baby are different. While the anatomy and physiology are standard, how each labor and birth proceeds is fine-tuned through the active involvement of the laboring woman. All through labor, her body tells her what is happening and helps her discover what she needs to do to help. The active involvement of the laboring woman is a critical piece of nature's plan for birth, and it is the least understood. The hard work of labor is not meant to be accomplished alone. Changing position, avoiding exhaustion, and staying adequately nourished require assistance. So across the world, women giving birth are supported, encouraged, and comforted by family, friends, and professional birth attendants. Giving birth as nature intended is not “biting the bullet and letting it happen.”
The “Everyday Miracle” section of the Lamaze video, "Celebrate Birth! (2000)," is an excellent resource to use in your classes. It shares several women's experience giving birth naturally. The commentary highlights the simple story of natural birth. Women are confident, working very hard, supported, and encouraged. “I can do that!” is the exclamation I hear every time I showCelebrate Birth! In your classes, it is important for you to emphasize that natural childbirth is not about suffering. It is about having the freedom to find comfort in many different ways. Choosing to give birth naturally does not mean that interventions will not be needed or that complications will not occur. Nature's plan for birth includes pleas for help when help is needed. Choosing natural childbirth means that women prepare for the birth of their babies confident in their own ability to give birth, being willing to feel contractions, and finding comfort in response to what they are feeling. It means that they will be surrounded by family, friends, and professionals who will encourage them to trust their inner wisdom. It means that wherever they give birth—hospital, irthing center, or home—they will have the freedom they need to respond to their contractions.
The video "Born in the USA (2000)" powerfully demonstrates the differences between natural birth and births that become complicated with the cascade of interventions. The women attended by midwives give birth confidently, finding comfort in many different ways, supported and encouraged by family, friends, and their midwife. In stark contrast, the women who give birth attended by physicians in a busy hospital find it difficult to find comfort without medication and appear pressured to give birth quickly. The cascade of interventions is dramatically and realistically presented.
Women know how to give birth without machines, epidurals, and fear.
Why natural childbirth? Ultimately, women find the answer to that question themselves. What they need from us as childbirth educators is to know that nature's design works beautifully. Confident women who are supported and encouraged and who enjoy the freedom to tap into their own wisdom find deep satisfaction in giving birth naturally. The process itself prepares mother and baby perfectly in every way to continue on their journey together.
Some women choose to give birth naturally because they love the challenge. Others find great satisfaction in working hard and “getting the job done.” Many women are eager to avoid anything that might harm their babies or themselves. But the most compelling reason to choose natural childbirth is a universal one. Women know how to give birth without machines, epidurals, and fear. Why natural childbirth? The more important question might be “Why not?”
J Perinat Educ. 2000 Fall; 9(4): 44–46.
Judith A. Lothian, RN, PhD, LCCE, FACCE
Judith Lothian is a childbirth educator in Brooklyn, New York, and the Chair of the Lamaze International Certification Council.
Copyright 2000 A Lamaze International Publication
Articles from The Journal of Perinatal Education are provided here courtesy of Lamaze International
Injoy Productions. 2000. Celebrate birth! [Video]. (Available from Injoy Videos, 1435 Yarmouth, Suite 102-B, Boulder, CO 80304; also available from Lamaze International Media Center, www.lamaze.org)
Jarmel M, Schneider K., (Producers). 2000. Born in the USA. [Video]. (Available from Fanlight Productions, 4196 Washington Street, Suite 2, Boston, MA 02131)