Natural childbirth

Last updated January 18, 2025

Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth arose in opposition to the medical model of childbirth that is common in industrialized societies. Natural childbirth attempts to minimize medical intervention, particularly the use of anesthetic medications and surgical interventions such as episiotomies, forceps, 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.

Natural childbirth is seen by some as empowering and a way to push back against paternalism and lack of patient say in the medical system. Other commentators describe it as a way to judge and shame women who need medical interventions. Home births specifically are associated with increased risks compared to hospital births, including an increased risk of death for the infant in the first 28 days of life.

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 advocated for natural childbirth.^[4]

Psychological aspects

Many women consider natural birth empowering and giving women more control in the birth process, pushing against paternalism in the care given by medical providers.^[7]^[4]

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 medical model of birth does not.^{[ citation needed ]} 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 supine lithotomy position (woman in hospital bed on her back with legs in stirrups). Supine positions, on average, when compared to upright positions, have been shown in a Cochrane review to be associated with a 6.16 minute longer duration of the second stage of labor and an increased incidence of some labor complications but a decreased incidence of other complications.^[8]^[9]

Methods to reduce tearing during natural childbirth (instead of an episiotomy) include managing the perineum with counter-pressure,^[10] 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.^[11]

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.^[12]

Criticism

Some argue that the push towards natural childbirth in Western countries has transformed from a way of empowering women into a way of shaming and bullying women who need medical interventions.^[13]^[14]^[15] Some women 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]

Home birth specifically, even when attended with a midwife, is associated with risks that are not present in hospital births. A United States study of over 13 million births from 2006 to 2009 found that infants born at home have a fourfold higher chance of death in the first 28 days of life compared to infants born at a hospital, and a sevenfold chance of death for firstborns.^[16] Another study found that infants born at home have a three times higher chance of death in the first 28 days of life.^[17] Additionally, it found that up to 37% of first time mothers and 9% of non first time mothers intending home birth must be transferred to a hospital during childbirth. Home births attended by undertrained midwives are also associated with increased risks compared to those attended by midwives who are highly trained and well-integrated into the healthcare system.^[18]

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.

Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

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 developed countries, most deliveries occur in hospitals, while in 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.

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.

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> Intentionally giving birth without medical assistance

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.

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

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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

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↑ Cassidy, Tina (2006). Birth . New York: Atlantic Monthly Press. pp. 54–55. ISBN 0-87113-938-3.
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↑ Gupta, J. K.; Sood, A.; Hofmeyr, G. J.; Vogel, J. P. (2017). "Position in the second stage of labour for women without epidural anaesthesia". The Cochrane Database of Systematic Reviews. 2017 (5): CD002006. doi:10.1002/14651858.CD002006.pub4. PMC 6484432 . PMID 28539008.
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↑ Glaser, Elaine (5 March 2015). "The cult of natural childbirth has gone too far". The Guardian | Opinion. Retrieved 2 October 2017.
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↑ Wax, Joseph R.; Lucas, F. Lee; Lamont, Maryanne; Pinette, Michael G.; Cartin, Angelina; Blackstone, Jacquelyn (2010). "Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis". American Journal of Obstetrics and Gynecology. 203 (3): 243.e1–8. doi:10.1016/j.ajog.2010.05.028. ISSN 1097-6868. PMID 20598284.
↑ "Planned Home Birth". www.acog.org. Retrieved 2025-01-17.