Prior to getting pregnant, whenever I thought about giving birth, I thought it’s something you do in the hospital, with an epidural, and definitely with a doctor/OB-GYN. I just assumed that’s what you do because that’s what everyone I knew did. How we do anything we haven’t done before is often and largely determined by the way those in our culture and community did it. I wanted to write this post to encourage women to get knowledgeable on the decisions they make surrounding birth (and understand that there are many options!). There is no right or wrong way to birth, and how you plan to birth (because not everything goes according to plan) is a personal choice. What I’m hoping is that instead of just following the status quo without thought, you consider all the factors involved and decide how you want to birth such that you can make an informed decision and hopefully look back on it as a positive experience. This is going to be a lengthy post because there’s a lot to consider, but I will lay out the format so you can skip around if you’d like.
Format: I’ll start with how I came upon this route, then a background on birth culture in the US, followed by the section on the reasons I chose to pursue a natural birth. I will start that section with a tl;dr list of bullet points, followed by more elaboration on each point. Finally, I will include a list of informational resources and some concluding thoughts.
I love talking about birth and babies so please feel free to reach out to me if you want to talk about anything on this post or anything surrounding these topics. Thanks for reading!
How I came upon this route
It started with a simple curiosity of what it would be like to birth unmedicated. I thought, “Everyone in the old days used to do it, so it could be done…” but little did I know of all the benefits that come with natural birth. I was maybe 10-12 weeks pregnant when Peter and I met up with our then-new friend Elizabeth for coffee. She started the conversation by saying she would have more kids “just to go through labor again.” Wait, what? Who says that?! She then talked about how she had both of her boys at home – both were planned water births, though the second came so fast that there was no time to fill the pool. :p
It was the first time I’d heard someone talk about labor/birth with a SMILE on their face and with excitement. Peter and I were both shocked. Elizabeth then went on to share her experiences in detail and talked about the reasons she loved her labors. For her, they were spiritual and empowering. She then shared an amazing book with us – Ina May’s Guide to Childbirth. That was all I needed to get started on my journey. (I recommend this to anyone and everyone who’s having a baby!) The book opened my eyes to a whole new way of viewing birth, as something that is beautiful, positive, not to be feared, empowering, and natural (not medical or pathological).
Following my reading of the book, Peter and I enrolled in a Bradley Method course, and there, we got an even more in-depth education on birth methods and grew more and more confident with our decision to plan for a natural birth. If I had a large place and didn’t live at the top of a 5th floor walk-up, I might have even planned a home birth, but I didn’t want to startle my neighbors and there’s a great birthing center super close to us, so we decided to go there. It’s about as close to a home birth experience you can get, but it is in a hospital, so if circumstances were to require medical intervention (quite rare with home births), we’d only need to go up one floor on the elevator.
Birth culture in the US
Today in the US, most women give birth in hospitals (with a OB-GYN physician). In fact, less than 1% of people gave birth at home in 2004 (though this number grew to 1.5% by 2014 as people are getting more interested in natural birth today). Prior to the 1950s however, nearly everyone gave birth at home, and with a midwife at that (no doctor). It was only when hospitals realized what a huge money maker it could be to monopolize obstetric care that they began a huge smear campaign against midwives and home births and told everyone to instead come give birth in a sterilized, clean facility with doctors with medical degrees. They painted midwives as “dangerously uneducated” and birth as a “pathologic” process requiring scientific knowledge and hospital equipment. (See more about this here and also in the documentary The Business of Being Born.)
Thus began a shift in American culture where women stopped giving birth at home and started moving to the hospitals. Birth via midwives became much rarer, such that in the present day (well, 2014 is the latest data I found), only 8.3% of total US births were attended by a midwife. Compare this to Great Britain and Japan, for example, where midwives deliver half of all babies, and Sweden, Norway, and France, where the majority of births are attended by midwives. You would think that, with how medically advanced the US is, we’d have better birth outcomes, right? Yet, the US has one of the worst infant and maternal mortality rates in the world (all the aforementioned countries have done significantly better than us). In the US, severe maternal complications have more than doubled in the past 20 years. When medicine is getting more and more advanced, why are we getting worse and worse at giving birth?
The data speaks for itself that the US has over-medicalized birth. The US cesarean section rate is over 33% of all births. The World Health Organization has suggested that the rate should not exceed 10-15%. In Ina May’s practice (which only consist of planned natural births), their c-section rate is below 2%. How can there be this big of a difference in rates? Even comparing US rates over time, the c-section rate went from 20% of births in 1980 to 32.8% in 2011. These numbers suggest that doctors may be performing them based more out of habit, training, expediency or worry about lawsuits than out of medical necessity.
And the majority of women also prefer an epidural for labor, which can easily and often does open the door to more medical interventions. The number of instrument-assisted deliveries (i.e. use of vacuums or forceps to extract babies) is also quite high, at 3% in 2011, compared to 0.8% in Ina May’s practice through the same time period. Finally, inductions are a regular practice in US hospitals, which very often lead to a cascade of interventions and is correlated with c-sections as well (read reason #4 down below!).
Now, it’s a godsend that we have all this technology for the cases where the tech is really, truly needed. Yet, it was shocking to learn the comparative rates across different cultures, countries, etc. and of facts like c-sections being most commonly performed around 4pm and 10pm (the first set for doctors who want to make it home for dinner, the second set for those that don’t want to wait overnight in the hospital for their patients to get through labor and delivery). The data overwhelmingly suggests that hospitals and OB’s over-utilize many of these practices that should only be reserved for cases that really need them. They are also quite risk-averse and so often opt for using interventions because they feel safer to them.
Finally, there’s something to be said about the FEAR CULTURE built around birth in the US. In movies and on TV, birth is always portrayed as an excruciating experience with the mother screaming and crying and gritting her teeth. But did you know that some women find birthing so pleasurable that they describe having had an orgasm during it?! (That certainly was not the case for me, but I do look back on my experience as a really pleasant one.) The reason the media portrays birth this way is because UNBEARABLE BIRTHING PAIN is intriguing, it’s dramatic, and it sells. And, often, the stories you hear from friends and friends of friends are all the scary, dramatic birth stories. The others may have felt non-eventful (i.e. “I went to the hospital, got the epidural, pushed, and the baby came out”) and thus are not really shared. And the positive ones? You don’t hear too many, but if you seek them out, they are out there. A ton of them are from natural births!
Because there is a culture of fear around birth, it is self-perpetuating. Your attitude towards birth matters. If you fear it and think it will be painful, it will be. Take the simple analogy of getting a shot. If you get nervous and tense up, the needle is much more painful when it enters your skin vs. if you were relaxed and your muscles were loose. Scientific studies have found that people who fear pain are more likely to suffer it. In the book Childbirth Without Fear, Grantly Dick-Read pointed out that “unbearable labor pain was almost always associated with fear; fear and lack of good preparation during pregnancy, and perhaps lack of understanding care during labor.”
The point is, if you seek out the scary stories, you’ll find them and they will scare you. But if you seek out the positive stories, you can also be encouraged and find new bravery (and mentally prepare for your labor!). The latter is what I decided to do, and it was a game-changer. Let’s all share more positive stories and diminish this fear culture around what is a completely natural thing that only women have been able to do for all of mankind’s history.
The reasons I chose a natural birth
Here’s a quick summary of the reasons, followed by more in-depth explanations. Some of them overlap and blend into eachother (b/c a lot of these things are correlated) but I tried my best to make discrete bullet points.
NOTE: The comparative facts listed below are obviously not guaranteed in every natural birth and are not exclusive to natural births either, but they are general correlations that have been scientifically found compared with a medicated or medicalized birth. For many of the facts I wrote, I tried to link a study supporting each, but note that the links are not meant to be comprehensive. There is a LOT of research out there supporting these facts and I encourage you to look further into the ones that pique your interest.
- It’s a normal biological process that my body has been equipped to handle
- More efficient labor, including from the freedom to move during labor, ability to receive my body’s instructions, and birth in the most optimal position for me
- Ability to eat and drink during labor
- Less drugs –> less medical interventions (this one bleeds into so many of the others)
- Better breastfeeding outcomes
- Avoid side effects of and risks entailed by epidurals to both myself and the baby // not exposing the baby to drugs
- Quicker recovery
- FEMALE EMPOWERMENT & happiness with birth experience
1. Normal Biological Process
Women have been giving birth since the beginning of time (except maybe after Adam & Eve ;)). Whether you believe in God or just mother nature, we were made for this (not only for this, but with this for sure in mind). The female body is a frigging crazy glorious machine, that knows, without instructions, how to expand the uterus from pear to watermelon size to accommodate a baby, grow its fingers, toes, organs, and brain, then knows when the baby is good to come out, contracts on its own to help push it out, then afterwards, starts producing FREE FOOD for your baby; need I say more?
Contractions, while painful, are a good type of pain. We always think that pain is a negative thing and something that has to be resolved / diminished. However, labor pains are natural and in this case a good thing; they are a sign that things are progressing and are the body’s way of pushing out the baby. (Watch this ping pong balloon video to see how contractions work in labor!) As my contractions grew stronger with the passage of time, I knew my body was doing the work it needed to help me see Taylor.
2. More Efficient Labor
Epidurals usually numb the lower half of your body. This means a number of things. First, you don’t really walk around or move much at all, but labor is meant to be an active thing. Moving around helps progress labor, moves the baby further down, is a way to deal with labor pain, and is what all mammals do naturally during labor (including humans when unmedicated). Secondly, if you stay numb through the pushing stage, you don’t know when to push. Doctors/nurses usually have to coach you. When unmedicated, you feel each contraction and, when the time is right, the urge to push, so you can work with your body and push more efficiently and effectively.
Also, when under epidural anesthesia, women are laid on their backs to birth. This is actually the most inefficient position for birthing. If you look at natural birthing positions across time and space, they are almost always in some sort of squatting or bearing down position (I gave birth on my arms and knees too.) These are not instructed positions, they are what comes naturally to each individual woman. It makes common sense too, as you need to push a baby down out of your body. Gravity will help if you’re upright, not on your back. But at the end of the day, your body will tell you what’s the best position for you, if you are unmedicated and can feel it.
Finally, epidurals often slow down your labor. It can be from your inactivity and laying on your back, or from the dilution of blood causing a slowdown in the body’s natural contraction-causing hormones (oxytocin).
Whether the above reasons are to cite or not, studies have found longer labors by as much as 2 hours for those with epidurals vs. unmedicated (though some studies where the sample size was in the low 100s didn’t find any difference, the studies with participants in the tens of thousands found such a correlation; granted, research methods were different in any given study).
3. Eat and Drink During Labor
Labor is physical activity. As with any intense exercise, a woman who’s well-hydrated and nourished will have more power and endurance. Also, have you ever been hangry? Imagine if your entire labor is 17 hours (the average for first-time moms) and you can’t eat or possibly even drink for that time. Many hospitals don’t allow laboring women to eat and/or drink. It’s an antiquated practice that in short, was put in place because mid-20th century women who were put under general anesthesia had an increased risk for aspiration (food/liquid inhaled into lungs), so just in case a labor would turn into a c-section requiring general anesthesia, they didn’t let any laboring women eat or drink.
A lot of hospitals are changing their policies to allow women to eat/drink certain or all foods/liquids, but each hospital is different. Our hospital didn’t allow eating on the L&D floor, but in the birthing center, I was free to eat and drink as I pleased. I knew I would need lots of energy to get through birth so this was important to me. My friends that gave birth on the L&D floor all talked about how they were starving and how they had the best meal ever after birth cuz they hadn’t eaten for basically a day. Haha.
4. *Less Medical Interventions*
This was one of the most important reasons for me, especially because it blends into so many of the other ones.
First off (and this goes into why I chose a midwife over OB as well), doctors/hospitals are incentivized financially to push more interventions on you. It means more line items on the bill / more things to charge for. My friend recently just found that her epidural cost her an extra $1600 on her hospital bill. It’s also kind of disgusting to find that the hospitals with the highest c-section rates are those that are financially distressed.
But it’s not just financial; many doctors also push interventions out of their own risk aversion and/or convenience. Why wait around for a woman to naturally labor for 18 hours, when they can do a c-section, be in and out in 20 minutes, and make it home in time for dinner? Also, if any sign is not optimal, such as a drop in mom’s blood pressure (which is a common occurrence after injection of the epidural), the doctor doesn’t want to risk anything with a vaginal birth so they will recommend c-section (because that’s what they’re good at). Recovery for the mom is also longer with a major surgery obvs, so the hospital can bill for the extra nights you stay in the hospital. These incentives all stack up and the numbers/data show it. (Highly recommend The Business of Being Born and simple Google searches if you are interested in learning more about this.)
Many women report having felt pressured during their labor to opt for any given intervention. When a doctor says, “I think the best option for the baby would be X,” with all the craziness going on and just wanting a healthy baby, no mom would want to go against what a doctor says they think is best “for the baby.” I wanted to avoid any mental pressuring and questioning of motives, which is why I opted for a midwife who I knew valued natural birth and would be more conservative in recommending interventions.
Next, let’s talk about pitocin & oxytocin. Pitocin (aka “pit”) is a drug that is the synthetic version of the hormone oxytocin. Your body naturally releases oxytocin during labor to make contractions happen and get the baby out. (It’s also the hormone that’s released during sex/orgasm, and your body is flooded with it when your baby is born naturally and during breastfeeding.) It’s the hormone that creates feelings of love and bondedness, and once a mother, very strong protective feelings over your baby; the mama bear hormones.
Pit is used so regularly in hospitals today. It’s used to induce labor (i.e. when you’re nearing or past your due date) and speed up labor (i.e. when a doctor finds your labor is moving too slowly / taking too long). Note that epidurals often slow down labor, so they frequently lead to the use of pit. BUT, pit is pretty intense as it creates super strong contractions, so many women need their epidurals upped (or request/are recommended one after getting pit if they hadn’t had one before). These steps sometimes repeat (more pit, more epi, more pit, more epi). Pit also distresses the baby because the contractions are so suddenly strong and frequent (instead of the natural progression in labor). In fact, a link has been found between use of pit and lower Apgar scores of the baby and higher rates of admission to the NICU. Another study found that babies whose mothers had pit were twice as likely to have A.D.D. and a third study found a 30% increase in morbidity (all discussed here).
The use of epidurals and pit each inhibit the body’s natural release of oxytocin in both labor and lactation. This produces effects beyond just labor/birth. It can affect your feeling of bondedness, maternal mood, mothering behaviors, stress reactivity, breastfeeding relationship, milk production, and more. Please look at the research on this.
Finally, use of pit and epi make c-section more likely, whether it’s due to maternal or fetal distress, simple exhaustion on the part of the mother, or other (check out the studies). And having an OB makes c-section much more likely. And which hospital you go to will affect your likelihood of getting a c-section. C-section is major surgery. It has all the risks that come with surgery such as infection and hemorrhaging, and entails longer recovery time than a vaginal birth. It also has higher maternal mortality rates. C-sections also increase baby’s risk of having breathing problems, allergies, and autoimmune diseases such as diabetes and MS, and c-sectioned babies have higher NICU admission rates. Mother-infant attachment and breastfeeding can also be delayed.
With natural birth, you are much more likely to avoid this cascade of interventions and their effects on you and your baby.
5. Better Breastfeeding Outcomes
Natural births have been found to be linked with better breastfeeding outcomes. Breastfeeding was something I really wanted to do so this was also an important factor for me. As mentioned above in #4, oxytocin release is strongest in natural birth, while it is often hindered or inhibited by interventions. Breastfeeding takes a lot of work and both a physical and mental toll on your body (especially in the beginning), so you need all the oxytocin you can get. How much oxytocin you release also affects the length of your breastfeeding journey.
Breastfeeding success has been found to be negatively associated with epidural use (as well as pit use). There are multiple reasons for this, but one that I was surprised to learn about was the fact that the epidural affects your baby, as the drug crosses your placenta. Babies whose mothers have had epidurals are slower to suckle / find the breast than their naturally birthed counterparts because they are drugged too (not just you). They are less alert and oriented and their tiny livers must work hard to process the drugs.
The mothers are less likely to initiate breastfeeding within the first few hours of the baby’s life as well, and the start of breastfeeding is delayed, including due to delayed milk production (with both epi and pit). Also, studies have found that the larger the dosage of pit a mother received during labor, the less natural oxytocin she had thereafter, the less she released during breastfeeding thereafter, and the shorter the breastfeeding duration, Check out this read on oxytocin, bonding, and breastfeeding for more.
If you’re still reading, you’ll start to notice a trend – all these things are linked. More interventions lead to less oxytocin, which affects bonding, breastfeeding, baby’s future health, mom’s postpartum journey, and the list goes on.
6. Risks of Epidurals
I’ll try to be quick and use bullet points. See this American Pregnancy source for more.
- Can cause sudden drop in blood pressure, leading to more interventions, including c-section
- You don’t feel your body’s instructions, so your labor can be inefficient and the pushing stage may be more difficult to complete. Both can lead to interventions (i.e. pit, instruments like vacuum/forceps, c-section, episiotomies)
- You’re usually immobile which also slows down labor
- Doubled risk of severe tears (not crying tears, though yes, those too; I’m talkin tears in your perineum – YOUR DOWN THERE RIPPING), in part b/c you are numb and can’t work/feel with your body’s timing, and less oxytocin (and prob a dose of pit) leads to less effective contractions
- Effectiveness of blocking pain varies with each woman; some women feel everything even with an epi. Epidurals do not always work
- Poorer breastfeeding outcomes both initially and down the road, including supply and length of BF journey
- Baby is drugged and thus can be sluggish, less alert and oriented, slow to latch and suckle on breast, and its liver needs to work harder to process and clear the drugs out of its system
- Reduced oxytocin levels
- Can cause maternal fever during labor, which, the higher the fever, the increased risk to baby of likelihood of having poor tone, low Apgar scores, being weak, requiring resuscitation, and having seizures in the newborn period
- Postpartum: shivering, backaches (some chronic), soreness where the needle was inserted, difficulty urinating, nausea, ringing of the ears
- Rare risks: infection, severe headache, bleeding, permanent nerve damage
7. Quicker Recovery
Natural birth is linked with quicker recovery. Perhaps it’s due to avoiding medical interventions, having more oxytocin and endorphins, or from having simply birthed as your body was made to. Most people at our hospital stay a minimum of 2 nights on L&D (and 4 for a c-section), but in the birthing center, they let you get discharged as early as 12 hours from giving birth (a mom I follow on IG was home 4 hours after pushing at her birthing center!). And if you give birth at home, well, you’re already home with no hospital stay at all. 🙂
Taylor was born at 10:29 p.m. The next morning, our midwife cleared us for discharge at 8 a.m. The only reason we stayed til that evening was because the hospital required at least one bowel movement and one pee from the baby, and Taylor look a while to pee, haha. We still got home less than 24 hours after birth. For the first 36 hours or so postpartum, I felt pretty winded every time I stood up and walked, but felt totally normal while stationary. And after that? I felt back to normal pretty quickly. I also stopped needing those maxi pads after about 2 weeks postpartum, and completely stopped bleeding by about 4 weeks. I was really shocked at how quickly I felt unpregnant and back to me! (Granted I also did not tear or require any stitches so that’s also part of my short recovery.)
8. Satisfaction and Empowerment
You’ve heard the phrase, “No pain, no gain.” Although lack of pain may contribute to some women’s satisfaction with the birth experience, it does not guarantee a quality birth experience, and several studies show that women who used no pain medication actually report the most satisfaction with their birth experience. There’s really something to be said for this! Most people fear birth because of the pain (which is also why they get epidurals), but the people who experienced the most pain actually thought back most fondly on their experiences! (Quick note: increased satisfaction with birth experience is also linked with less likelihood of experiencing postpartum depression (PPD).)
Read the stories of women who birthed naturally. There is a kind of shared magic in all of them. This feeling of being part of something larger than yourself. As you’re going through the experience, you realize these pains/sensations/feelings have been shared by women all throughout history, from your ancestors all the way down to you. And the EMPOWERMENT. The feeling of accomplishment and pride and the confidence to handle anything in life. And in particular, female empowerment, showing the world that we women can do the hard work that only we can do! We don’t need drugs, we don’t need to lie down passively or to be coached by a doctor; we can do it on our own with our own God-given bodies. (This is not to discredit Jesus though cuz boy did I need him. HAHA)
I find the words from this post on indigenous birth particularly insightful: “So much of how women experience birth today has to do with how we are socialized,” says Blackowl, 36, whose first five children were born at home with the aid of certified and traditional Indigenous midwives. “We are told that you have to be hospitalized, that doctors know best, and that you can trust them with your life.” // “A lot of the time in hospitals, people don’t approach women in a way that says to them that they are the center of the birth, or in a way that gives the woman control,” says Nicolle Gonzales, 36, a Navajo nurse midwife from New Mexico. “When a woman is birthing, it’s her space, and we have to honor that space. But nobody tells you that.”
This is just to illustrate that we have choices. We don’t have to do what everyone we know does or did. And no, doctors don’t always know best when it comes to birth. They know what they learned in med school, which are all the medical ways to deliver a baby, and the overly cautious and impatient ways at that. I hope women can return to the center of birth and be in charge of their experiences.
And finally, going back to the shared magic — the love, the overwhelming love, for your baby. INSTANT attachment and bondedness the moment they come out of your body and straight into your arms. Oxytocin oozing out of everywhere! Endorphins, the body’s natural painkillers, skyrocketing as you forget the pain you just endured for the sake of your baby. ❤
- Ina May’s Guide to Childbirth
- 2 other books commonly discussed in this community (but I haven’t read): Spiritual Midwifery and Childbirth Without Fear
- The Business of Being Born, produced by Ricki Lake
- Ina May’s TED Talk
- Read up on the rates of successful birthing outcomes of births attended by midwives and/or doulas
- Look up birthing culture in Japan. It’s the total opposite of ours. And they have much better outcomes statistically
- READ AND WATCH as many natural birth stories and videos you can; they’re so inspiring and magical!
Whatever birth methods you plan on employing, I think the importance is in making educated decisions. Understand the risks and rewards with each choice – from the type of care provider, to the number and type of interventions, to the place of giving birth, etc. Understand that you have choices, even in the hospital. At the very least, you can make yourself comfortable, and say no to certain things if you want to.
That way, even if things don’t go as planned, you did your best to get knowledgeable and you planned for the route that made the most sense for you. How birth actually goes is out of our control, but we can do our homework and best preparation and work with whatever comes our way.
THANKS FOR READING!!! HAPPY BIRTHING!