My youngest of three just had his first birthday. “This is really your day to celebrate, more than his,” my husband said. I thought back to the day my baby was born and smiled a little wryly. David was right; my babies’ birthdays always make me think about what a monumental task it was to deliver each of them, and with such an incredible reward afterwards. How to describe what it is like to go through childbirth? “Labor of love” doesn’t sound right. That is too clean and soft a term. No, childbirth is messy, humbling, and viciously painful. It takes true grit.
A large number of my friends planned during their pregnancies that they wanted to have “natural” childbirth. They wanted to avoid drugs and medical procedures during delivery. Not me. I was grateful to have an epidural.
I remember a college biology lecture about evolution, with diagrams that showed the shape of the pelvis bones and pelvic opening in animals that walked on all fours. In order to be upright, man (and woman) developed a narrower and tilted opening of the pelvis. I was told that this required human babies to be born when they were still quite small relative to the way things went for other mammals. “Other mammal babies can walk, trot, or run from the time they are born, since they are born mature,” said this teacher, “but for humans, the geometry of the birth canal is too challenging to allow for this. For humans, childbirth is not natural.”
I had a feeling of cold apprehension during that lecture. Natural…unnatural…whatever it was, childbirth wouldn’t be easy. My grandfather had been on the front lines of World War I, and later he had been an obstetrician. The pain of women in labor, he said, often seemed as bad or worse than the suffering of soldiers in the war.
These days, in the U.S. and other developed countries, epidurals are used by about 70% of women who deliver babies in hospitals that offer them. An epidural is a catheter placed through the skin of the lower back that guides narcotic or numbing medicine to flow into a space immediately outside of the spinal canal. Epidurals decrease pain while still permitting women to feel pressure and movement in their uterus and to use their legs and pelvic muscles.
Considering the pain of birthing, and considering the technology of epidurals, is it worth it for women to try to have their babies drug-free? In one Australian survey from 2004 that interviewed 496 women, 14% of women planned to avoid all pain medicines during their childbirth, and another 40% of women considered the idea of natural childbirth but planned to “wait and see.” In the United States, the numbers are probably similar. My friends who have wanted “natural” childbirth have mostly been concerned about the effect that drugs, including an epidural, might have on their babies. They also wanted to be fully aware and participating in the birth experience.
In light of those concerns, there are some interesting controversies and myths about epidurals. Some studies have suggested that epidurals might slightly weaken uterine contractions and cause a longer total time of labor. Women appropriately worry that if this is so, an epidural might slow labor to the point that a cesarean or a forceps delivery could become necessary. From early epidural studies, this was a realistic concern.
However, epidurals have changed over time. Now a much lower dose of medicine is used with most epidurals. Recent studies on epidurals are reassuring. Epidurals are still associated with a small increase in labor length—15 minutes, on average. But statisticians now agree that an epidural does not make a woman more likely to need a cesarean. It is debated whether there is any increased chance of forceps delivery, but if so, the difference is small. Epidurals don’t change breastfeeding rates, and they don’t worsen one-minute and five-minute APGAR scores (the scoring system that evaluates newborn health). One large study from 2005 showed that the newborns’ APGAR scores one minute after delivery were slightly better in a group of mothers who had epidurals placed early in labor, compared with babies whose mothers received epidurals after a delay. This difference may have come from the fact that some of the mothers with a “late” epidural needed to get narcotics through an IV, because they urgently needed pain relief.
How many women request medicines for pain relief, even if natural childbirth was their original plan? Most do—surveys show that up to 60% of women who plan to deliver naturally end up requesting medicine for pain once they are in labor. It is especially hard for women who are having a first baby—the “success rate” for following-through with natural childbirth for first deliveries is 29%. Among women who have delivered a baby previously, 68% are able to stick with a plan to have natural childbirth.
One of the most interesting studies that I have reviewed about women planning to have natural childbirth was published in 2001. This study followed 50 women who wanted natural childbirth: 23 of these women delivered naturally, 24 received an epidural to deliver vaginally, and 3 required a cesarean section. The women who received epidurals reported lower pain scores at the end of their labor, but most of them also had lower satisfaction with their delivery. This shows how strongly pre-labor expectations can affect the emotional part of the birth experience.
For my first baby, my doctor had trouble getting the epidural into place and my labor was difficult. I was so tired at the end of the delivery that I was afraid to hold my baby, fearing I might drop her. My husband gave the baby her first bath and changed her first diaper, while I slept in an exhausted stupor. For my other babies, I know the epidural allowed me to participate in childbirth with awareness and enjoyment. I had more reserve at the end of the birthing process, and I was able to participate in my baby’s first day much more fully.
Women can be quick to pass judgment on each other. We need to be careful that we don’t use decisions in childbirth as a measure of a woman’s strength. In my opinion, natural childbirth is difficult, but it is not superior. To me, natural childbirth seemed more adventurous but birth with an epidural felt more sensible. The labor and delivery experience is vastly different for different women.
I can understand the instincts of women who want childbirth to be a human event and in no way a medical event. On the other hand, one thing that makes humans special is that we are innovative about solving problems. From my perspective, childbirth is a human triumph. Lessening the pain of childbirth is also a human triumph.
What is your opinion about natural childbirth? If you’ve had a child, did you experience any pressure from family or friends to go natural or to get an epidural?
Mary Pickett, M.D., is an Associate Professor of Medicine at Oregon Health & Science University where she is a primary care doctor for adults. Her field is Internal Medicine. She is also a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.
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Comments: 28
It's like my son's dad told me, "Childbirth in itself is a courageous thing, there's no need to be a hero"
So, with that I gladly let them stick that HUGh needle in my back to relieve the gut wrenching pain. It was worth it to not be able to feel my legs for about a day!
Great article Dr. Pickett!
~Natalie Neal
The Best in the Whole Wide World
With my oldest child, my doctor did not "believe" in medication.
I see myself lucky with his birth, as it came on strong & went fast.
My second child, was premature and the same doctor stated medication would be to risky. Premature or not, I was in severe pain for hours on end.
Before my last child was born, I moved to another state.
(Another doctor...lol) I am happy to say I finally received the epidural I requested.
(Several hours into the experience)
Some of us don't have a choice it's true. I was glad to have mine.
My sibs and I all read what we refer to as the PAIN book. It has PAIN written in big letters on the front and it is only part of the title; I don't remember the author's name, but he has written several books. His Pain Book talks about how necessary pain is and how different cultures approach pain and deal with pain. We often get the experiences we have been taught to expect, especially by television. Just look at how those actresses portray childbirth and that is what two generations, at the least, are going to expect, and so that's what they will get. Same with almost any other kind of pain, the commercials tell us we can't live with it, that it ruins our day and makes us cranky. - But of course a blanket statement can't cover every situation.
Our western civiliation population doesn't handle any sort of pain very well at all - from headaches to backaches to childbirth - we have every sort of device and chemical to alleviate it.
I have lived with severe chronic pain since I was eight years old. Many people wonder how I do it and stay so up and are sometimes embarrassed to complain about their aches and pains around me knowing what I go through, but I tell them that every person's pain scale is different. Your "10" is going to be relative to whatever pain you have been through before. My "10" may be different than your "10" but it is still a "10" isn't it? After childbirth, epi or no, your "10" is going to be a lot different from what it was before you were pregnant - guaranteed.
As it was said, we are all so quick to judge each other and to expect other people to live by our standards. Pain is so relative, so social, so psychosomatic that there is no real way to compare and no reason to measure another's worthiness or bravery by it either.
If man was meant to fly he would have been born with wings, if he was meant to avoid pain he would have been born without nerves. Boy, am I glad I'm a woman. :)
- Jeanjaz
I found out 3 years later when I was pregnant with my second child that "natural" meant without medication. I should have said Vaginal Birth. I had thought that was what it meant at the time. My second child was delivered by a different doctor with a different office and hospital. I was much more informed through them than I was in my first pregnancy. Now after four children and four c-sections, I think I could do it myself! ;) But thankfully I have the best OB-Gyn anyone can ask for and I'll leave the dirty work to her. I'll simply enjoy my children and make sure they're much more informed than I was.
Lamaze preparation for labor and delivery is one of several techniques you can learn in a birthing class. The goals of Lamaze are to help you to be less fearful about pain and more distracted from pain during your labor.
Lamaze classes reduce fear by making you familiar with the way labor normally progresses. Women who have been informed in detail about labor and birth are typically less fearful about the process. Lamaze classes also teach techniques that can help you to take your mind off of pain. These techniques may include deep breathing, massage, concentrating on a focal point, imagining control over your body, and listening and responding to a labor coach.
Lamaze classes can be useful to women whether or not you choose to use medicines to relieve your pain. Many Lamaze classes today do very strongly promote drug-free childbirth, however. You may want to anticipate this bias as you enroll in a birthing class.
I only had the one child, but I tried to go it naturally. I would have too, as I just put it into my head that this wasn't going to last forever and if the labor ends - the baby is born. Right? Uh-uh. After 14 hours of induced labor, I had to have a c-section. After those 14 hours, they wanted to knock me out. Nope, I said and an epidural wasn't offered, but a spinal was and I gladly took it for the privelege of being awake and alert and also being able to hold my baby right after birth. Good article.
Natural (no medications), vaginal delivery.
C-section (with epideral)
V-BAC(Vaginal Birth After Cesarean) - with a button (delivers pain mediction on demand), I had refused the epiderual that is automatically given to previous "C-sectioners".
I gave birth in both Military and civlian hospitals, with and without pitocin. I've done it all!
I believe that a natural vaginal birth is the best option if possible. You get to fully experience the birth and have a much faster "recovery" time.
If I had been able to go "natural" for each birth I would have, and I encourage expectant mothers to seriously consider the option.
Taking advantage of modern medicine is in no way a shameful choice, please don't get me wrong. I just hate to think of a woman missing out on the most wonderful of adventures. Giving birth the "old fashioned" way!
Another thing, I also believe that the choice a woman makes depends heavily on the prior experience of family and friends. If the majority of mothers you know had a good experience with a certian type of delivery, you are much more likely to choose that method yourself. It only makes sense, we are still functioning on a tribe mentality underneath all of our civilization and individuality.
No one experience or "type" is better than another as a whole. Do what you feel is right for youself and your child, based on prior experience and input from other sources. Just don't let yourself be pushed in any one direction by any of those sources.
It's your body, your adventure, you control it:)
I notice one of the themes many respondants are sharing is that with pregnancy, you don't always have the luxury of deciding how you would prefer to deliver--at any time, a complication or unexpected event may make a cesarean the safest way.
It is wonderful to make plans, but when you are pregnant it is also important to avoid setting yourself up for disappointment. Keep your expectations flexible when you think about what will make your delivery a success. Clearly, for many of us, things don't go as we expect when we arrive at the delivery day. Isn't it interesting that we say a woman is "expecting" when she is pregnant?
My second came so fast, I literally didn't have any pain. By the time the contractions became painful, she was literally descending down my canal and was born less than 10 minutes from the first painful contraction! My second labor was 1 hour and 19 minutes, and I wound up never making it to the hospital. My recovery with my first took over 3 months before I felt like myself, and with my second, within 2 weeks I felt like myself again. I was in more agony recovering from my son's birth than I was delivering my second!
However, my primary disappointment in my deliveries definitely were with the hospital staff. The nurses didn't care about my birthing plan; they actively discouraged me from trying to stay in the shower and flat-out refused to let me in the tub because it "takes too long to start up the tub". They kept complaining that I wasn't on a monitor and kept trying to walk around; it was miserable. I know that nurses have a lot of demands put on them and having a woman in labor who is lying in bed on a monitor makes their job much easier, but I was extremely angry that they were pushing me to "decide" to get an epidural and lay in bed so their job would be easier.
If I ever have more children, I will give birth at home and refuse to go to a hospital after I give birth. I was so disgusted with the treatment I received to the point where no treatment is better!
the two natural were 28 and 29 hours respectively. With the second I was j=having back labor at 35 weeks and thought I had overdid whatever I had done the previous day. My mother told me what it was.
My last, was going to be natural. i had last done that 8 years earlier. I could handle it. When that first big Contraction hit, I was already at the hospital, and told them to give it to. This was a lot worse than I remembered. His labor lasted 7 hours altogether.
I had Lamaze classes with the first two. where we were, they were not offered except to drive forever and I was having none of that. I think they did make a difference.
I warn all women that they may not be able to get a pain free delivery, and to prepare for the worst.
With both of my last deliveries, it was different circumstances that caused me to be pain free. With the middle child, it was a lazy doctor who refused to check in on me at all until I had been there for almost 5 hours, and by then, it was only because the nurse let her know I was dialated to 8- well past the magical number. Considering how long I had been in the hospital, and that I was only at a 2 when I went in, and that there was only 1 other woman in labor that night, there was no excuse for the doctor being so inattentive.
It was satisfying to me to hear a few years later that she had been removed from the hospital and city, and had left to try and practice elsewhere.
With my youngest, it was a fast labor- I was med-free induced by having my water broken at 8am on the dot. My contractions started immediatly, but weren't starting to get painful until almost 9:30-10:00pm. By 10:30, I was in very hard labor, and by 10:58, I was holding my daughter- which the nurse delivered for lack of a doctor on hand!
I can tell you that for anyone expecting to go in and have a pain free labor & delivery (or even a minimal pain), it can be devestating and panic inducing to suddenly be faced with the most painful experiance most women will ever have.
Another thing I like to say- there's nothing natural about the pain involved in labor & delivery. ;)
I read Immaculate Deception, and there was no getting me in a hospital after that. Furthermore, the doc, even though she was female, was authoritarian. It was scary to change, but I went with a lay midwife and a naturpath, at home. I am very glad I did this. I wanted to be in control.
Yeah, it hurt, but my mother was there, so I had to keep a stiff upper lip. I would have been a mess of nerves at a hospital. He had an Apgar ten and was born looking around. He was a bit overdue. When he learned to drive, he said to me, "Mom, I don't know what you are worried about, you know I am neurotic."
People who wanted natural childbirth in those days often hopped on planes to go to Dr. Bradley in Denver, who wrote Husband-Coached Childbirth. I was lucky to live in Oregon where midwives were legal.
In a way I envy the people who just say, "Oh, give me the drugs, and it'll be fine." I'm too neurotic for that. That's why I do yoga.
Each woman deserves the right to choose how she births her baby.