Drug-free childbirth without medical intervention is a topic that spawns vitriolic debate. My own simple question ‘what do you all think of natural childbirth?’ on a social networking site fielded a series of comments – many of them from indignant mothers – within minutes. Check out any web forums on the topic and you will find it generates intense polarisation.
Regardless of whether you believe childbirth should be natural or not, there is a worrying trend in many countries in the developed world towards what practitioners in favour of natural childbirth describe as a ‘medicalization’ of
childbirth. As an increasing number of births take place in hospitals, mothers-to-be are often processed in the easiest, and sadly in some cases the most lucrative, way for medical staff.
While some industrialised countries buck this trend (a UK mother complained of societal pressure to have a natural birth), c-section rates, the use of epidural anaesthesia, episiotomies and delivering on the back – the least conducive position to an easy labour but the most convenient for the obstetrician – are all rising.
The American Association of Birth Centers says the rate of c-sections in the United States has increased from 21% in 1996 to 32% currently. According to the World Health Organization’s 2011 World Health Statistics, the 2000-10 rate in Belgium is just over 36%, Italy 38.9%, Australia 31.2% and in Cyprus, more than 50% of women have c-sections.
In many European countries, the predominant and in some cases the only pain relief offered is epidural, an anaesthesia injected into the lower back. More than 90% of women in Belgium have epidurals and hospitals offer them as a matter of course. The delivery rooms at larger hospitals have bathtubs to be used to ease labour pain but water births are almost unheard of and the use of TENS machines (see box) is permitted but you must learn how to use it yourself.
Over in the States, 98.8% of births take place in a hospital and increasing fears by doctors of legal repercussions if they do not perform c-sections at the first sign of trouble has led to certain hospitals being dubbed chop shops. Around 92% of women deliver on their backs rather than in gravity assisted positions like squatting or on all fours, according to the Association.
Aside from the risks associateed with medical interventions – let us not forget that c-sections are major abdominal surgery – the last thing a woman in labour wants is to be ordered around and encouraged to take meds to make life easier, and perhaps more lucrative financially, for the doctors rather than because it is necessary for the safety of mother and baby.
Many mothers also say they felt empowered and in control because they managed the pain without intervention. That is not to say, however, that medical intervention cannot in many circumstances be the best for mother and baby. Jo Everatt, midwife and owner of Antenatal and Baby in Brussels (www.antenatalandbaby.org), says: “There are parameters. Natural childbirth is not for all cases. The health and safety of the mother and baby must come first.” There are also mothers who are, quite naturally, terrified of child birth and convinced from the outset that the best way for them to manage the pain will be with intervention. “They should do what feels natural for them,” says Everatt.
“Some women just don’t want a natural childbirth. Childbirth should be about the mother’s satisfaction based on her expectations being met and, of course, the best way for mother and baby,” says Everatt. “One of the risks for post-natal depression is a traumatic birth where the mother is unprepared or they have to deal with the unexpected.”
The good news is that globalisation is resulting in the adoption by hospitals around the world of different techniques. “The international community is changing the system,” says Everatt, adding that in Brussels, where there is a large expatriate population, hospitals are becoming gradually more open to alternative pain management.
Certainly, a woman who gives birth without meds should not be flaunting this as a badge of honour in front of a peer who wanted an epidural. The point is that women should be encouraged to examine all the options to have the best experience possible rather than being bossed by busy obstetricians into more convenient forms of childbirth.
Empowerment through choice
Emma recounts her own natural birthing experience
Shortly before the birth of my first child a seasoned mother gave me three pieces of advice: leave your dignity at the hospital entrance, scream as much as you like, and make sure you know how to ask for the drugs. She guffawed when I said I hoped, all being safe with the baby, for a natural childbirth. Before I get lambasted for advocating natural childbirth (clearly, this is a very touchy topic among Mums), I was basically scared of the only medical pain relief on offer here in Belgium ie. an epidural. Having a needle poked into my lower back and losing the sensation in my legs scared me more than the prospect of labour pains and I wanted to feel in control of what was happening.
The day I went into labour was just the start of many examples of how children throw you a curve ball. After waddling around shopping and lunching with a friend, labour started out of the blue with fierce contractions only seconds apart. They were breathtaking and wiped away all notions of a relaxed labour with soft music and perhaps a soothing massage from my husband.
During the frantic car ride to the hospital (watch for those speed cameras) if I could have spoken, I would have told my husband to forget everything I said about natural childbirth if I could have mustered up the energy to speak. As I was wheeled in to the delivery suite I was greeted with the rather unwelcome news that I was anyway far too advanced for an epidural. Some greater force took over as I realized the natural childbirth I had in a pre- labour stage wanted was now the only option. I recalled the breathing techniques from my pre-natal classes and single-mindedly focused on these. I managed not to scream or swear although my husband, desperate to put into practice something from class, was given short shrift when he attempted a back rub.
I got mildly irritated when the obstetrician made her first appearance and started blabbering on about my birth plan mid-contraction. And when she told me to lay on my back on the delivery table and motioned towards the leg supports, I flat out refused and persuaded them to allow me to deliver laying on my side, a better if not optimal delivery position.
Just three hours after the first sign of labour, our son entered the world and I became oblivious to everything except our now family of three and stared dreamily at my offspring while the doctor started the process of stitching up tears. I announced, however, to my husband that I was sore enough not to claim, as a friend had done, that I could do it all over again in the very near future.
I cannot deny that it felt good to have managed without the drugs. Certainly when birthing experts describe this as empowering for women, I would have to agree. I just cannot quite put my hand on my heart and say I would have refused the epidural if I had had the chance. But I know that in the throes of labour, the most important thing for me was to decide how to cope for myself.