Natural birth 101
Just as the name suggests, natural childbirth is the most primitive method of delivering a baby, a feeling as natural as taking a breath to stay alive. Just as our senses make us do and feel certain things, a natural birthing process is an integral part of the human reproductive activity.
Natural childbirth can be very simply stated as “how the childbirth is naturally intended”. Christine Isaacs, MD, director of the General Obstetrics & Gynecology Division at Virginia Commonwealth University Medical Center and director of Midwifery Services for the VCU Health System mentions childbirth as "In general, it implies a non-medicated birth where you're letting the natural process of labor and birth take place without any interventions”.
In natural birth, childbirth is treated as a natural biological event. The goal is to avoid any medical interventions and medical pain relief options. Natural methods like massage and warm water bath are encouraged. Caesarian sections (C-sections) evolved from the need of reducing maternal and child mortality rates at childbirth and is still recommended as a life-saving procedure, but there is an alarming increase in rate of C-sections all over the world. World Health Organization (WHO) states that C-section rates should be between 10% and 15%. At these levels, they are associated with lower maternal and child mortality rates. Anything above 15% is associated with higher deaths at childbirth. The global rate of C-sections stands at 18.6%, while India’s overall rate is at 20.6%. This data is based on the National Family Health Survey (NFHS) conducted in 2017. The true colours emerge when pare this data into rural-urban, rich-poor, and public-private. C-section rates in urban areas are as high as 28.3%. In some states such as Telangana, C-section rates can be as high as 58% according to NFHS. Surgical and non-surgical interventions are inevitable in high-risk cases but should not become the norm.
With this context, we at the nestery try to share with you all the information you need to arms yourself with for getting that natural birth.
Benefits of natural birth
Natural childbirth offers better outcomes for both mother and child. Medical interventions should be avoided in “delivery” unless and until it is necessary for mother or child.
- No medical side effects that are typically caused by medical/surgical interventions. Epidural for instance, stops the release of oxytocin hormones that help in aiding contractions, as a result length of labor increases, increasing chances of “failure to progress” or “vacuum or forcep delivery”. Numbing spine using epidurals may cause long term side effects including back pain
- Speedy recovery for mother, thereby aiding better breastfeeding initiation rates
- Autonomy, and a sense of control over the birthing process. Birth can be an empowering situation than one one where there is no control
- Freedom to choose laboring positions. The mother can labor in any position and is not constrained by wires and tubes. It reduces labor pain too. Being in one position (lying down) during labor can decrease the chances of contractions. Labor enabling positions like squatting take the help of gravity to reduce pressure on the birthing mother
- Allowed to eat and drink freely during labor. This increases energy levels and helps sustain mother during labor. This is not possible in C-section. C-section is a major abdominal surgery and all surgeries are performed on an empty stomach to prevent aspiration of food contents into the lungs during the anesthetized state
- Natural birth kicks off breastfeeding immediately. Medications or intervention in natural birth can disrupt early establishment of breastfeeding
- Natural childbirth keeps the child healthier. Passing of baby through the birth canal during natural birth ensures the contact of baby with healthy bacteria (microbiome) which in turn helps develop a strong immune system
- Vaginal birth helps improves and helps regulate infants breathing process too
- Your partner and family is involved in labor process and it makes your bond deeper
What are the options in Natural Birth?
Natural birth is a normal, biological process. The medical model of care is not woman centric but is numbers-centric. It targets safe delivery using medical methods available which include pain relief, surgery, and other medical interventions. It reduces a complex interplay between body and it’s progress into numbers like “1 cm per hour”. For a healthy pregnant woman, all that is needed is:
- education, counselling and sound prenatal care
- freedom of movement during labor and control over environment
- minimal medical and surgical interventions
- someone to aid and coach you through pregnancy and labour and the postpartum phase
- a medically trained professional who can identify risk factors and refer you to a doctor in case of emergency
We have broken this down into three key elements:
Think of this as a spectrum. On the one end you have doctors and birthing in a hospital set-up. On the other end you have Doulas, they are childbirth coaches, like the Dai’s of ye old, except armed with evidence based methods. Think of them as birthing companions who can help make your labor process easier through holistic pain relief and supporting you and presenting an unbiased view to the parents in case of a suggested medical intervention. Doulas are present throughout the labor process for the mother, but they cannot make any medical decisions or diagnosis on behalf of a healthcare professional. Midwives fall somewhere in the middle. They are trained healthcare providers who specifically handle child birth. Midwives are mostly present in a hospital context, but their model of care is woman centric. The advantage of a midwife handled birth is that they are certified to identify risk factors and call on a doctor in case of an emergency. There are other differences too but these are the main ones.
Birth India is a good place to start when looking for Doulas in India. Birthing centers that support natural birth are slowly coming up in India. Birthvillage in Cochin, and The Birthplace are notable to name a few.
A natural birth can occur at home or at the hospital. Home Births are overseen by midwives and/or doulas with a doctor ready on-call in case of emergency at the nearest pre-agreed upon hospital. In a homebirth there is control over environment and labor positions. It also has the added comfort of being “at home” to relax after childbirth. Hospital births are child births occurring at medical care facilities, some may be midwife units also called birth centers that encourage natural birth. Some medical care facilities have facilities like water pools for aiding water births
- Hypnobirthing: Hypnobirthing is a method that prepares a woman for childbirth while taking into account;physical and psychological well-being of mother, child and the birth partner irrespective of the context of birth (home/hospital). It is interdisciplinary and focuses on breathing techniques, relaxation, visualization, meditation, focus on nutrition and physical wellness of the birthing mother. Self hypnosis methods help the laboring mother to manage fear, anxiety and feel in control during delivery.Hypnobirthing professionals and clinics can be found listed on the Birth India website.
- Water birth: Water birth is a method where the woman labors inside a specially designed birthing pool with warm water. The logic behind this is that, babies are floating in amniotic fluid for 9 months and being born into a liquid environment is less stressful for them. Also, it allows the woman to change positions easily due to buoyancy reducing the weight pressure and provides medication-free pain-relief. Water births are sometimes known to relax the body too much and prolong labour. Slowly, hospitals in India are offering water birth as an option to pregnant mothers.
- Lamaze: A natural childbirth method developed by Dr. Ferdinand Lamaze where the laboring woman is distracted during contractions in using rhythmic breathing techniques that help manage contractions which in turn reduces labor pain. This distraction reduces the perception of pain at labor.It helps mothers manage pain without medication. Lamaze is one of the most popular birthing techniques in the world also because it involves the partner to be involved throughout the delivery process. Parents-to-be can attend Lamaze classes towards the end of the pregnancy to learn about breathing techniques, pain-coping techniques, understanding various medical interventions to make an informed decision.
How to prepare yourself for a natural vaginal birth
- Birth Plan: Prepare your birth plan and discuss it to your healthcare provider and the staff before labor and during early stages of labor
- Birth class: Attend a natural childbirth class if possible. Watch hypnobirthing and Lamaze videos to understand breathing techniques, more so to build the belief that, “you got this.”
- Physical self: Take care of physical self with appropriate exercise and good nutrition
- Psychological self: Take care of psychological self with positive affirmations and visualizing a safe and successful birth experience. Also, prepare yourself for the eventuality that things may not go according to plan
- Seek help: Get support from your partner and family members
- Learn about the natural pain relieving methods as well as medical methods. Make sound, educated decisions
- Surround yourself with positivity. Think positive always!
- Take enough rest - you definitely need it before the baby arrives
Drug-free pain relieving tips for a natural delivery
- Breathing exercises: Patterned breathing techniques can help a laboring woman relax so that she can embrace labor with loads of positivity. It increases oxygen supply to mother and child and provides an energy burst to both mother. It helps the woman to be in control of her labor. Hypnobirthing, and Lamaze methods encourage the use of patterned breathing to distract and to go into a meditative state to aid with labor.
- Massage: A gentle massage can relieve pain, increase circulation, increase muscle flexibility, release endorphins (the happy hormone), and generally promote relaxation. Shoulder and lower back massage during contractions help to cope with labor better.
- Aromatherapy: Aromatic oils of Lavender, clary sage, neroli, jasmine, chamomile and geranium can be used during labor as they boost blood circulation and act as antidepressants. Some aromatic oils have extreme soothing and refreshment properties. Always use aromatic oils only after consulting with doctors or healthcare providers.
- Hot and cold packs: Both hot & cold packs can relieve labor pain. Use a cold pack on the lower back to alleviate cramps and pain. Hot packs do wonders to relieve back pain before and after delivery.
- Hydrotherapy: A warm bath or relaxing in warm water in tub can provide physical comfort and mental relaxation. It enhances cervical dilation and helps with coping with pain
- Music: Music is a wonderful pain reliever. It relaxes the mind too. Hypnobirthing techniques suggest listening to positive affirmations in the form of chants visualizing safe birth.
- Acupressure: This method is used in many medical conditions where pressure is applied on specific points with palms, fingers or elbows. In labor acupressure helps to reduce pain and pressure off the lower back. It helps in dilating the cervix and in the baby’s descent into the birth canal.
- Movement and labor positions: Sitting or lying down in a single position may keep you uncomfortable. Lying down during labour is suboptimal because it does use the pressure-relieving effects of gravity. Moving around and walking during early labour and using labor-friendly positions like squatting, using a birthing ball and even dancing can help cope with pain of contractions better
- Environment: Lastly, enough cannot be said about the labouring environment. A dark, quiet birthing space with soothing lights, music and loved ones can release anxiety and fear. This can act as a powerful pain management tool as against being strapped to the bood with needles and tubes with harsh lights at the hospital. You can request hospital authorities to help you with this.
The entire process of having a baby is mind over body. While it is extremely important to nurture & prepare the body for the delivery and what follows after, it is equally important to train your mind to help you achieve a beautiful birthing experience.