Natural childbirth

Last updated September 20, 2024

Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. Natural childbirth attempts to minimize medical intervention, particularly the use of anesthetic medications and surgical interventions such as episiotomies, forceps and ventouse deliveries and caesarean sections. Natural childbirth may occur during a physician or midwife attended hospital birth, a midwife attended homebirth, or an unassisted birth. 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—meaning without surgical or pharmaceutical intervention—has been estimated at 1,500 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 (0.7%).^[1]

At the onset of the Industrial Revolution, 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 promised a safer and less painful labor.^[3] The use of childbirth drugs began in 1847 when Scottish obstetrician James Young Simpson introduced chloroform as an anesthetic during labor, but only the richest and most powerful women (such as Queen Victoria) had access.

The term "natural childbirth" was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in 1933. In the book, Dick-Read defined the term as the absence of any intervention that would otherwise disturb the sequence of labor. The book argued that because of "civilized" British women fear birth the birthrate was dropping, and if women were not to fear birth, birthing would be easier since fear creates tension which, in turn, causes pain. In 1942, Dick-Read published Revelation of Childbirth (which was later retitled Childbirth without Fear), advocating natural childbirth, which became an international bestseller. In the late 1940s, he brought his ideas to America, but saw similar ideas with differing names – "pain-free birth" and "prepared childbirth" – were already gaining traction.^[4] The appeal of natural childbirth rested in the idea that merging physiological, psychological, social, and spiritual aspects of reproduction would create the best comprehensive care.^[5]

The Lamaze method gained popularity in the United States after Marjorie Karmel wrote about her experiences in her 1959 book Thank You, Dr. Lamaze, and with the formation of the American Society for Psychoprophylaxis in Obstetrics (currently Lamaze International) by Karmel and Elisabeth Bing. The Bradley method of natural childbirth (also known as "husband-coached childbirth"), a method of natural childbirth developed in 1947 by Robert A. Bradley, M.D., was popularized by his book Husband-Coached Childbirth, first published in 1965.^{[ citation needed ]}

In the 1970s, natural childbirth became a movement associated with feminism and consumerism, stressing obstetrics' lack of concern for the whole person and technology a method for controlling women's bodies.^[5] Michel Odent and midwives such as Ina May Gaskin promoted birthing centers, water birth, and homebirth as alternatives to the hospital model. Frédérick Leboyer is often mistakenly believed to have advocated for water births, but he actually rejected the alternative as he felt it was not beneficial to the health of the baby.^[6] In 1976, Gaskin wrote the book Spiritual Midwifery, which described the beauty and power of unmedicated home births.^[4]

Psychological aspects

Many women consider natural birth empowering and giving women more control in the birth process, pushing against the paternalistic medical establishment.^[7]^[4] They prepare for the delivery of their children by accepting that they will have contractions, finding solace when needed, and feeling confidence in their capacity to give birth.^[8] Studies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves mother-infant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with the mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life.^[9]

Alternatives to intervention

Instead of medical interventions, a variety of non-invasive methods are employed during natural childbirth to ease the mother's pain. Many of these techniques stress the importance of "a mind-body connection," which the techno-medical model of birth does not. These techniques include hydrotherapy, massage, relaxation therapy, hypnosis, breathing exercises, acupressure for labor, transcutaneous electrical nerve stimulation (TENS), vocalization, visualization, mindfulness and water birth. Other approaches include movement, walking, and different positions (for example, using a birthing ball), hot and cold therapy (for example, 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.

Birth positions favored in natural childbirth—including squatting, hands and knees, or suspension in water—contrast with the lithotomy position (woman in hospital bed on her back with legs in stirrups), which has consistently been shown to slow and complicate labor.^[10]

Methods to reduce tearing during natural childbirth (instead of an episiotomy) include managing the perineum with counter-pressure,^[11] hot compresses, and pushing the baby out slowly.

Preparation

Some women take birth education classes 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.^[12]

Women who choose to do home births appear to take more measures in preparation for their birth compared to women who choose to do hospital births. According to a study of 19 women looking at home and hospital births in Australia, the women who participated in home births had more preparation and expectations compared to those who had hospital births. A mother in this study who had a home birth went to two different antenatal classes, read Spiritual Midwifery (Gaskin, 2002) three times, and knew about home birth and its qualities very well. In contrast, another mother in the study who had a hospital birth did not know what a contraction was. Many of the mothers who had home births reported taking pain management classes, and yoga classes to go into the birth having a positive mindset. They also participated in more antenatal classes than women who went through hospital births. This implies a higher sense of responsibility and control for women who go through with home births. ^[13]

Prevalence of medical intervention in the U.S.

In the U.S in 2007: 93% of mothers used electronic fetal monitoring; 63% used epidurals; 55% had their membranes ruptured; 53% received oxytocin to stimulate labor progress; and 52% received episiotomies.^[14]

Criticisms

Some people argue that the push towards 'natural childbirth' in Western countries is exaggerated, and can harm women.^[15] Some women also express shame when not able to have a "natural birth," feeling that their bodies may be defective or lessen the experiences of individuals using assisted reproductive technologies, or who are adoptive parents and parents who use surrogates.^[4]

Related Research Articles

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

A birthing center is a healthcare facility, staffed by nurse midwives, midwives and/or obstetricians, for mothers in labor, who may be assisted by doulas and coaches. The midwives monitor the labor, and well-being of the mother and the baby during birth. Doulas can assist the midwives and make the birth easier. Should additional medical assistance be required, the mother can be transferred to a hospital. This transfer is more likely if an epidural is needed, there is meconium staining, it is a prolonged labor, or the newborn needs intensive care. Some hospitals have birth centers as an alternative to the usual high tech maternity wards.

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

The Lamaze technique, also known as the psychoprophylactic method or simply Lamaze, began as a prepared childbirth technique. As an alternative to medical intervention during childbirth, it was popularized in the 1950s by French obstetrician Fernand Lamaze and based on his observations in the Soviet Union. The goal of Lamaze is to build a mother's confidence in her ability to give birth, through classes that help pregnant women understand how to cope with pain in ways that both facilitate labor and promote comfort, including relaxation techniques, movement, and massage.

The postpartum period begins after childbirth and is typically considered to last for six weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the subacute phase, lasting six weeks; and the delayed phase, lasting up to six months. During the delayed phase, some changes to the genitourinary system take much longer to resolve and may result in conditions such as urinary incontinence. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during this period.

A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medicine, the de facto method of delivery. The term was coined in the middle of the 19th century as births began to take place in hospitals.

Ina May Gaskin is an American midwife who has been described as "the mother of authentic midwifery." She helped found the self-sustaining community, The Farm, with her husband Stephen Gaskin in 1971 where she markedly launched her career in midwifery. She is known for the Gaskin Maneuver, has written several books on midwifery and childbirth, and continues to educate society through lectures and conferences and spread her message of natural, old-age inspired, fearless childbirth.

<span class="mw-page-title-main">Unassisted childbirth</span>

Unassisted childbirth (UC) refers to the process of intentionally giving birth without the assistance of a medical birth attendant. It may also be known as freebirth, DIY (do-it-yourself) birth, unhindered birth, and unassisted home birth. Unassisted childbirth is by definition a planned process, and is thus distinct from unassisted birth due to reasons of emergency, lack of access to a skilled birth attendant, or other. It is also different from homebirth, although most UCs also happen within the home.

The role of men in childbirth in the Western world has become more participatory than it was in the past. More Western women want their male partners to give active assistance during pregnancy and childbirth.

Grantly Dick-Read was a British obstetrician and a leading advocate of natural childbirth.

Frédérick Leboyer was a French obstetrician and author. He is best known for his 1975 book, Birth Without Violence, which popularized gentle birthing techniques, in particular, the practice of immersing newborn infants in a small tub of warm water — known as a "Leboyer bath" — to help ease the transition from the womb to the outside world. He also advocated low lighting and quiet in a warm room to limit the supposed shock of birth,[Reynolds, Concise Encyclopedia of Special Education, 138] and that a newborn be laid on its mother's stomach and allowed to bond, instead of being taken away for tests.

<i>The Business of Being Born</i> 2008 American film

The Business of Being Born is a 2008 documentary film that explores the contemporary experience of childbirth in the United States. Directed by Abby Epstein and produced by Ricki Lake, it compares various childbirth methods, including midwives, natural births, epidurals, and Cesarean sections.

Childbirth and obstetrics in classical antiquity were studied by the physicians of ancient Greece and Rome. Their ideas and practices during this time endured in Western medicine for centuries and many themes are seen in modern women's health. Classical gynecology and obstetrics were originally studied and taught mainly by midwives in the ancient world, but eventually scholarly physicians of both sexes became involved as well. Obstetrics is traditionally defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (recovery). Gynecology involves the medical practices dealing with the health of women's reproductive organs and breasts.

The following outline is provided as an overview of and topical guide to obstetrics:

<span class="mw-page-title-main">Joseph DeLee</span> American physician

Joseph Bolivar DeLee was an American physician who became known as the father of modern obstetrics. DeLee founded the Chicago Lying-in Hospital, where he introduced the first portable infant incubator. Early in his career, he was associated with the medical school at Northwestern University. After 1929, he was employed by the medical school at the University of Chicago.

Elisabeth Dorothea Bing was a German physical therapist, co-founder of Lamaze International, and proponent of natural childbirth. She trained as a physical therapist in England after fleeing Nazi Germany due to her Jewish ancestry. Her hospital work there made her interested in natural childbirth, and she taught it to parents in the United States after she moved there in 1949. To promote natural childbirth methods, she co-founded the American Society for Psychoprophylaxis in Obstetrics, made several TV appearances and radio broadcasts, and wrote several books on the subject. She became known as the "mother" of the Lamaze method in the United States.

In its early history, Mexico was occupied by a large number of indigenous tribes such as the Mayans and Aztecs. In the 16th century, Spain colonized New Spain and took over the land from the indigenous peoples. Though it is now an independent nation, Mexico retains much of the cultural influence of Spain, including its official religion of Catholicism, the Spanish language, and the importance of machismo - the belief that men are superior to women. Mexico also retains much of the traditional beliefs of the indigenous peoples who first occupied the country. Besides Spanish, there are over one hundred different languages spoken in the country today. As a result, the current medical system involves a mix of traditional and Western medicinal techniques.

Pain management during childbirth is the partial treatment and a way of reducing any pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Tension increases pain during labor. Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.

Birthing classes are classes to help parents to prepare for the birth of a baby and the first cares of a newborn, and a birth plan is a document created by a pregnant woman detailing her decisions and expectations regarding her labor and childbirth.

References

↑ 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"
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↑ Having a Great Birth in Australia, David Vernon, Australian College of Midwives, 2005
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↑ Davis-Floyd, Robbie (2004). Birth as an American Rite of Passage. University of California Press. ISBN 0-520-22932-0.
↑ World Health Organization (1997). "Care in normal birth: A practical guide".
↑ Wiley Interscience
↑ Dahlen, H. G.; Barclay, L. M.; Homer, C. (2008). "Preparing for the First Birth: Mothers' Experiences at Home and in Hospital in Australia". The Journal of Perinatal Education. 17 (4): 21–32. doi:10.1624/105812408X364143. PMC 2582407 . PMID 19436436.
↑ Gissespie, M., Strauss, M (2007). "What Women Aren't Told about Childbirth".{{cite web}}: CS1 maint: multiple names: authors list (link)
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Articles:
- Glaser, Elaine (5 March 2015). "The cult of natural childbirth has gone too far". The Guardian | Opinion. Retrieved 2 October 2017.
- Freeman, Hadley (29 May 2015). "The obsession with 'natural' birth is just another way to judge a woman". The Guardian | Comment is free. Retrieved 2 October 2017.
- Phipps, Alison (9 May 2014). "The drive for 'natural motherhood'". Scrubbing Up. BBC . Retrieved 2 October 2017.