Natural childbirth

Natural childbirth
Intervention
MeSH	D009321

Natural Childbirth is a philosophy of childbirth that is based on the notion that women who are adequately prepared are innately able to give birth without routine medical interventions. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. The term "natural childbirth" was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in the 1930s, which was followed by the 1942 Childbirth Without Fear.

History

Historically, most women gave birth at home without emergency medical care available. The "natural" rate of maternal mortality - where nothing is done to prevent maternal death - has been estimated at 1500 per 100,000 births. In the United States circa 1900, before the introduction and improvement of modern medical technologies, there were about 700 maternal deaths per 100,000 births (.7%). ^[1] (However, natural childbirth advocates recognize the importance of emergency medical intervention, which can avert maternal or neonatal death.)

At the onset of the Industrial Revolution in the 19th century, giving birth at home became more difficult due to congested living spaces and dirty living conditions. This drove urban and lower class women to newly available hospitals, while wealthy and middle-class women continued to labor at home.^[2] In the early 1900s there was an increasing availability of hospitals, and more women began going into the hospital for labor and delivery. In the United States, the middle classes were especially receptive to the medicalization of childbirth, which seemed to promise a safer and less painful labor.^[3] In fact, the ability to labor without pain was part of the early feminist movement^[1]. With this change from primarily homebirth to primarily hospital birth came changes in the care women received during labor: although no longer the case, in the 1940s it was common for women to be routinely sedated and for babies to be delivered from their unconscious mothers with forceps (termed by Dr. Robert A. Bradley as "knock-em-out, drag-em-out obstetrics"). Other routine obstetric interventions have similarly come and gone: shaving of the mother's pubic region; mandatory intravenous drips; enemas; hand strapping of the laboring women; and the 12 hour monitoring of newborns in a nursery away from the mother.^{[citation needed]}

Beginning in the 1940s, childbirth professionals and mothers began to challenge the conventional assumptions about the safety of medicalized births. Physicians Michel Odent and Frederick Leboyer and midwives such as Ina May Gaskin promoted birthing centers, water birth, and homebirth as alternatives to the hospital model. Some research has shown that low-tech midwifery provides labor outcomes as good as or better than those found in hospital settings with fewer interventions, except for a small percentage of high-risk cases.^[4]

Psychological aspects

Many women consider natural birth empowering.^[5] A woman who is supported to labor as she instinctively wants to, is a woman who will likely feel positive about her birth experience and future parenting skills. Her baby is more able to be alert and placed on her skin (promoting maternal bonding) and breastfeeding is more likely to be enjoyable and successful.^[6]

Alternatives to intervention

Research has estimated that up to ninety-five percent of women can safely give birth without medical interventions (including, but not limited to, epidurals, caesarian sections, vacuum extraction, and forceps). Therefore, the midwifery model of care, which usually holds a more holistic approach to labor and delivery, tends to avoid such routine interventions (which can lead to complications for both mother and infant) when used for the sake of convenience, and rely on medical tools when only they are deemed absolutely necessary to ensure safety ^[7] .

Instead of interventions, a variety of non-invasive methods are employed during natural childbirth to aid the mother, since they do not to carry the inherent risk of medical procedures. Many of these stress the importance of "a mind-body connection," which the techno-medical model of birth tends to ignore. Pain management techniques other than medication include hydrotherapy, massage, relaxation therapy, hypnosis, breathing exercises, acupressure for labour, TENS, vocalization, visualization, mindfulness and water birth. Other approaches include movement and different positions (i.e. using a birthing ball), hot and cold therapy (i.e. using hot compresses and/or cold packs), and receiving one-on-one labor support like that provided by a midwife or doula. However, natural childbirth proponents maintain that pain is a natural and necessary part of the labor process, and should not automatically be regarded as entirely negative. In contrast to the pain of injury and disease, they believe that the pain of childbirth is a sign that the female body is functioning as it is meant to.

Some methods used to augment labor without medication require that the woman is an active participant in the birthing process. They include frequently changing positions and walking. Birth positions favored in natural childbirth - including squatting, hands and knees, or suspension in water - contrast with the popular lithotomy position of a medicalized birth (woman in hospital bed on her back with legs in stirrups), which has consistently been shown to slow and complicate labor ^[8] . Methods to reduce tearing (instead of an episiotomy) include managing the perineum with counter-pressure,^[9] hot compresses, and pushing the baby out slowly.

Preparation

Some women take birth education classes (such as Lamaze, the Bradley Method, Brio Birth, CAPPA, ICEA, Hypnobabies.) to prepare for a natural childbirth. Several books are also available with information to help women prepare. A midwife or doula may include preparation for a natural birth as part of the prenatal care services. However, a study published in 2009 suggests that preparation alone is not enough to ensure an intervention free outcome ^[10]

Prevalence of medical intervention in the U.S.

A recent study revealed the rates of medical intervention in childbirth in the U.S. found that 93% of mothers used electronic fetal monitoring; 63% used epidurals; 55% had their membranes ruptured; 53% received Pitocin to stimulate labor progress; and 52% received episiotomies.^[11]

Additional reading

• Simkin, P. (1992) "Just another day in a woman's life? Nature and consistency of women's long term memories of their first birth experience." Birth 19:64-81.
• Sakala, C., M. Corry, and H. Goer. (2004) Vaginal Birth and Cesarean Birth: How Do the Risks Compare? New York: Maternity Center Association. Full report available at http://www.maternitywise.org
• Thompson, Craig. (2005) Consumer Risk Perceptions in a Community of Reflexive Doubt Journal of Consumer Research Full Paper Available at: http://gatton.uky.edu/courseweb/99/JCR%202005-09%20Thompson.pdf
• Durand, Mark A. (1992) The Safety of Home Birth: The Farm Study American Journal of Public Health Full Paper Available at: ://www.thefarm.org/charities/mid.html

See also

• Childbirth positions
• Early postnatal hospital discharge
• Hypnotherapy in childbirth
• Squatting position

References

1. ^ Van Lerberghe W, De Brouwere V. Of blind alleys and things that have worked: history’s lessons on reducing maternal mortality. In: De Brouwere V, Van Lerberghe W, eds. Safe motherhood strategies: a review of the evidence. Antwerp, ITG Press, 2001 (Studies in Health Services Organisation and Policy, 17:7–33). "Where nothing effective is done to avert maternal death, “natural” mortality is probably of the order of magnitude of 1,500/100,000...In the USA of 1900, for example, there were about 700 maternal deaths for 100,000 births"
2. ^ Cassidy, Tina (2006). Birth. New York: Atlantic Monthly Press. pp. 54–55. ISBN 0-87113-938-3. 
3. ^ Thompson, C.J. (2005). "Consumer Risk Perceptions in a Community of Reflexive Doubt". Journal of Consumer Research 32 (2): 235–248. doi:10.1086/432233. 
4. ^ Durand, Mark A. (1992). "The Safety of Home Birth: The Farm Study". American Journal of Public Health 82 (3): 450–452. doi:10.2105/AJPH.82.3.450. 
5. ^ Having a Great Birth in Australia, David Vernon, Australian College of Midwives, 2005
6. ^ The Womanly Art of Breastfeeding. La Leche League International. 2004. 
7. ^ Gaskin, Ina May (2003). Ina May's Guide to Childbirth. New York, New York: Bantam Dell, a Division of Random House. pp. 184-203. 
8. ^ Davis-Floyd, Robbie (2004). Birth as an American Rite of Passage. University of California Press. ISBN 0520229320. 
9. ^ World Health Organization (1997). "Care in normal birth: A practical guide". http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_chapter4.en.html. 
10. ^ http://www3.interscience.wiley.com/cgi-bin/fulltext/122394587/HTMLSTART?CRETRY=1&SRETRY=0
11. ^ "What Women Aren’t Told about Childbirth". 2007. http://www.alternet.org/story/65608.