Thoughts on med-free birth

The superstitious side of me is reluctant to post this before I actually experience childbirth … so while this may appear after the event, I am sitting here writing this at just about week 36, so I’ll have it to look back on and perhaps laugh at my naïveté :).

I honestly can’t remember the exact process that brought me to this point of planning on a “natural” birth. A few distinct memories stand out in my head:

-Hearing random news stories of babies being born in cars, on airplanes, at home — it never occurred to me when I was young that childbirth could ever be anything but an emergency that required hospitalization, physicians, interventions, and a lot of agony. That a baby could be born on someone’s bathroom floor and turn out FINE was revelatory.

-A random conversation I had with my mother years ago where I said of course I would get an epidural when I give birth, why would I deny myself perfectly safe pain relief? And she chided me and said that epidurals slow the baby’s heart rate down, so how can they be “perfectly safe?” I later looked it up. Epidurals are pretty safe. That doesn’t mean they are always safe, or completely without potentially dangerous side effects.

A dear friend of mine wrote a package on natural/out-of-hospital birth for her newspaper in her previous life as a reporter. This was around the time Ricki Lake was out and about promoting her documentary and alternative birth methods were all over the news. Some of the things I learned from her research were so eye-opening. We hear so much about how childbirth can turn into an emergency situation in the blink of an eye. At the time, we rarely heard about the millions of happy stories of totally boring, routine and complication-free births. Nor did I realize how many routine situations have earned an “emergency” label for dubious reasons.

So clearly, I know that the concept of a natural birth had been rolling around in my head for a while. But when it came time for me to actually make the decision on what kind of birth I wanted to prepare for, I felt conflicted. The epidural vs. med-free birth debate seems like two flip sides of a feminist coin: claiming empowerment from the experience of a defining aspect of womanhood, vs. taking advantage of technology that allows us break free from the constraints of the “curse of Eve” that is our punishment as women. I could see both sides. And I wondered: was I really strong enough to push out a baby without pain relief?

Before I go any further, I want to make clear: I am a scientist by training and I believe in modern medicine. I feel incredibly fortunate that I live in a country (and in a region of said country) with great medical care, and, perhaps more importantly, that I have excellent insurance and access to that care (because let’s not forget that the US track record in maternal health outcomes is actually pretty dismal for the developed world). Medical interventions such as cesareans absolutely save lives and make having babies much safer when used under the right circumstances.

Furthermore, one of the first things you learn in your survey ecology course is that this myth of everything in nature being in balance and harmony is just that — a myth. Our bodies are not “perfectly evolved” machines, as though evolution has reached some kind of end point where we don’t need any more improvement, or that, under even normal circumstances, don’t dysfunction on the regular. Just try telling that to someone with type 1 diabetes, or cancer, or a congenital heart defect. Our bodies can AND WILL fail us at many opportunities! And some times, for some women, that happens during pregnancy or childbirth. So I don’t really buy into what some advocates of natural birth say about how women’s bodies were “designed” to give birth and we should just allow it to do its thing. Yes, they were, and some of the adaptations we have are pretty amazing. But things can also go awry, and for that, I am grateful for modern medicine.

But I will also say that I am the daughter of two lawyers, and married to one, and I am not always the most blindly trusting of all physicians. Its not like I think physicians are evil — but they are human and make mistakes and sometimes have additional motives beyond the exclusive, long-term interest of the patient’s well-being. So when deciding what kind of birth I was going to prepare for, there were some things I was pretty sure about:

1. I do not want to be induced. I have seen/heard about enough experiences from friends, family, colleagues and acquaintances to deduce that it has to be more than a coincidence that the people with the most textbook, easiest births are the ones who went into labor spontaneously, and those with traumatic birth experiences more often than not began in an induction.
Turns out my hunch was correct: elective inductions dramatically increase the chance that your labor will end in a c-section. Pitocin contractions are much more painful. Science has not yet quite elucidated the complex set of reactions that spur a woman to go into labor and a baby to be born. There is much we still don’t know. As mystical as it sounds…babies know when they are ready. And I don’t want to force mine out before its time.

2. I want to be able to move around. I may actually find that lying in bed the whole time is just how I want to be — but I want to be able to decide that. Walking, standing, squatting, etc can help the baby move into an optimal position or just use the force of gravity to keep things moving.

3. I want to avoid a c-section. Obviously, if I need one that’s a whole ‘nother thing. But I wanted a provider who would give me a fair shot at a vaginal birth, by not pushing induction without a medical reason (and by medical reason, I don’t mean “you’ve reached 41 weeks”), not jumping to diagnose “failure to progress,” etc.

4. I want a supportive, touchy-feely, happy environment. I didn’t want an impassionate doctor who didn’t listen to my concerns. And, not gonna lie, I wanted to deliver in a location that was convenient, comfortable, with private rooms and all the bells and whistles. I want to deliver in a hospital — home birth sounds kind of nice in theory, but, I dunno, it also sounds kind of messy. I am also more comfortable delivering somewhere with a high level NICU.

5. I want some specific postpartum protocol followed. Things like at least one hour of skin-to-skin, breastfeeding, allowing the cord to stop pulsating before being cut are important to me. Midwives are more likely to be on board with these things, and they are standard procedure at my practice. I think they are starting to catch on with a lot of OB practices, though.
It is also important to me that the baby and I not be administered prophylactic antibiotics. I really believe that the process of a vaginal birth is an important first step in colonizing a baby’s gut with beneficial bacteria — some scientists even have gone as far as inoculating their own children born by c-section with their vaginal fluids! I know that, had I tested positive for GBS or could possibly transmit any STDs, antibiotics would be non-negotiable. But luckily, that is a bridge I do not have to cross and so I want to minimize any additional situations that could result in routine administration of antibiotics. “I heard that” (sorry, very unscientific of me) epidurals can cause fevers in a significant minority of women who receive them, which in turn can cause complications for the baby that are treated with prophylactic antibiotics (on top of possible NICU stays or additional tests which cut into that important initial bonding time). I do not want that!

So when comparing the different providers available to me in my area, it ultimately came down to a group of hospital-based midwives who want their patients to be committed to natural birth — including foregoing the epidural. I was on board with their whole philosophy, but never having given birth before, really wondered if the pain of childbirth could be outweighed by my desire for a natural birth. Could I really remain strong while in the throes of labor? How can I make assumptions about what I can handle when I’ve never experienced it before?

I am not opposed to epidurals per se. But when it came down to it and I really thought about it, it made total sense to me that an epidural is an intervention. And you intervene when things don’t go according to plan. I decided that so long as my labor was progressing in a textbook manner, meaning, a well-positioned baby and a spontaneous labor lasting under 24 hours, the best choice for me was to forgo pain meds. If things veer off this course, then I knew I’d be in the hospital where I had access to any interventions I might need, but I wasn’t going to plan on them.

And in reading a lot of positive birth stories, there seemed to be a universal answer to the question: “am I strong enough to give birth without pain meds?” Yes. Every woman is (assuming a complication-free labor). That doesn’t mean it will be pretty or fun or easy. I am expecting it to be awfully hard. But so many women throughout time and throughout the world have given birth. Of course any woman (again, complications aside) physically can. Luckily, today we have the choice of how much pain we want to experience. But with some people’s rhetoric you’d think that surviving the pain of childbirth were an actual impossibility that one should not even dare contemplate. So just the understanding that natural childbirth is actually a POSSIBLE thing is reassuring to me.

**** Post-natal Thoughts ***

So, how did I end up doing?

If you read my birth story below, you’ll see that my experience truly covered the whole spectrum! I was able to give birth without any meds or interventions, but started hemorrhaging shortly after he was born which required a whole slew of them. I will say I am glad I decided to deliver in a hospital where all the necessary procedures could easily be performed. Postpartum hemorrhage is not super common but it is the leading cause of maternal death in the developing world, and it is a real possibility in even the most routine deliveries, as my experience demonstrates.

I honestly also wonder how interventions may have made my experience worse — for example, c-sections carry a greater risk of hemorrhage and I wonder if the so-called “cascade of interventions” would have contributed to a worse outcome for me.

As far as the actual labor and delivery goes, looking back on it I feel like it was nothing to be afraid of, at all. I can honestly say I’d rather give birth again than get a root canal or really any major dental work. I HATE the dentist! And while the pain of childbirth was certainly real, it was not unbearable or the worst pain I can imagine, and the breaks between contractions make all the difference. The only seriously bad part, transition, was fairly brief; the hours leading up to it were not fun but certainly manageable. Active labor for me was only about 6-7 hours, plus one hour of pushing. I can definitely say I’d attempt a med free birth again.

Ultimately, I think it is important that evidence-based practices are adopted and that women have the opportunity to give birth in whatever way makes the most medical and emotional sense for them.  I generally think it is good to question the medical care you’re receiving and make sure it is always in your best interest, and I’m glad I found a practitioner whose procedures were aligned with my views.  In spite of my complications, my experience was very empowering and I”m so grateful that I was able to experience everything my body was capable of, receive the necessary medical care when things came apart, and, most importantly, end up with a healthy baby.

-R

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