Following my post on breastfeeding a few days ago, I entered into conversation with Valerie, the lovely lady behind Atlantamonofthree. She has a wonderful page on breastfeeding. She’s also a great proponent of natural childbirth, which you can also read about on her blog.
It is a topic that greatly interests me as well. There seem to be two approaches to childbirth. One is to see it as a natural process, that should be allowed to proceed with as little intervention as possible. The other is to see at as a medical affair, and the mother as a patient.
The Netherlands, where I’m from, seems unique in the developed world in that natural childbirth is still very much the norm. As many as 30% of births are planned home births. Most births, even in hospital, are attended by midwifes; you get to see a doctor only when things go wrong. Epidurals might or might not be available, even in hospital – though I believe recently guidelines have changed to make their more accessible.
In most other countries in the world, childbirth is more medicalised in varying gradations, with the United States perhaps being one of the most extreme. My new home country, Ireland, is somewhere in the middle. Births generally take place in (maternity) hospitals, though midwifes take care of much, if not all, of the woman while in labour. Prenatal appointments are often with doctors, though for low risk cases, there’s the option of attending a midwife led clinic as well. Epidurals and other pain medication are routinely available.
Which is best, natural or medical, is a topic that people tend to feel very strongly about one way or the other. It’s difficult to take a truly objective view on the matter. I would recommend the film ‘The business of being born’ as it gives an interesting insight on childbirth in the United States. However, while it presents some interesting facts, it is very much a propaganda piece pushing natural labour and indeed home births. Good arguments for medicalised childbirth can also be presented. One the one hand, yes, our bodies are designed to carry and birth babies. On the other, why not make use of modern medicine. Why suffer through the worst pain you’ll ever go through when an epidural is readily available?
Being Dutch, my approach to childbirth was always that it was a natural process. When I became pregnant I was determined to have as few interventions as possible. Part of this is because I dislike medication, doctors and so on at the best of times. More important, however, is because it is clear that one intervention tends to lead to another. For example, epidurals, while they obviously take away the pain, do also tend to slow down labour. In response, a drug called pitocin is often administered. Pitocin does speed up labour, but it also makes contractions far more intense, which might well necessitate a top-up in the epidural, which might slow labour down again. And so you enter into a vicious circle, which might end in an assisted delivery, or even an emergency c-section, that might not have been necessary had nature been allowed to take its course.
This vicious circle can also be entered by starting a labouring woman off on pitocin. Modern doctors and hospitals often practice something called ‘active management of labour’ (pioneered in Ireland), which pretty much means you’re contracting towards a deadline. If you fail to progress according to their schedule, interventions, including pitocin, are carried out to speed things up.
Ultimately, I believe women should be allowed to labour in the manner that they want. There are plenty of mothers who want to have epidurals, pitocin and elective c-sections. In addition, you never know how you actually feel when you’re in labour and despite your previous decision to ‘go natural’ you might well change your mind, especially if labour is very long, or, for example, back to back. Conversely, if your labour is very quick or if you’re coping well, you might never have that epidural you planned on. The problem arises when doctors propose such interventions when there’s no real medical reason to a mother who would prefer not to have them. It’s difficult, if not impossible, to give informed consent whilst in labour. This is particularly true if the doctors play the ‘for the best of your baby’ card, when in reality it’s nothing other than active management of labour.
In the end, I had the natural birth that I had hoped for. The two midwifes on duty that delivered my daughter were wonderful and supportive in this choice. Though baby was back-to-back (making for very intensive contractions), I felt my body was taking over and just making it happen. My labour was very short though, kicking off with my waters braking and baby being born ten hours later; had it gone on for days I may well have changed my mind!
Of course, I do think it’s a blessing that we have the medical knowledge now to save lives where they might have been lost in the past. However, in my opinion, childbirth is mostly not a medical affair. Use the medicine only when needed