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Safe, safer, safest… As we learn more and more about all the scary things that “might” happen during childbirth, we can become desperate to “do something” — anything — to lower that risk. Even if the risk we’re preventing is 1 in 100,000, and the “something” we do to avoid it causes a whole new set of risks.

The majority of Americans accept the superior safety of medicalized hospital birth without question. And yet even the National Institute of Health finds that babies are often safer out of the hospital, and when doctors offer fewer interventions. As parents, we would do anything to keep our babies protected from unnecessary hazards — from too much TV to preservatives and toxic paints on their toys and art supplies — but when approaching the birth process, we may not know all our options.

The home-birth movement is gaining broader acceptance as a safe and empowering choice for those who feel comfortable keeping a bit of distance from the hospital’s technology. Natural-childbirth-oriented “birth centers” give women who don’t want to birth at home a new option for a professional, yet warm and home-like atmosphere. A new generation of midwives undergo rigorous medical training as well as learning a spectrum of childbirth techniques.

Natural childbirth has been perceived in recent decades as a rejection of modern science — now science has recognized that more needles, tubes, and beeping machines may not be the answer. For both mother and baby, choosing “less is more” may make both feel better and make more research-based sense. After weighing the options, a pregnant woman may opt to switch from a conventional obstetrician to a midwife — not to reject science, but because the midwife is more supportive of choices well-backed by research.

Even births considered “high risk” have better outcomes when the process is simplified and the body’s natural processes are given priority. So why do we continue to treat childbirth as if it were a heart attack, in urgent need of fixing?

Here are five solid reasons to ask questions and be prepared when your doctor offers a medical intervention during your birthing experience. Each step can have multiple consequences, and they’re not always what you expect. By educating yourself in advance, you can make informed choices about what feels right for you.

1. Avoiding the "Cascade of Interventions"

Frequently, the first intervention is the mother’s choice — though “choice” can be a misleading term. She is often strongly influenced by medical providers, and may not be offered an unbiased summary of risks and benefits. In many cases, it starts with a voluntary epidural. What she might not be told: an epidural increases the length of labor, makes fetal distress more likely, often leads to other drugs such as Pitocin, and decreases the ability to push effectively, leading to the need for more “help” in getting the baby out, such as forceps, episiotomy or surgery. It’s the classic slippery slope. Many women end up feeling they lost all control of their labor and delivery. They describe feeling shaken and even violated, as they struggle to focus on their baby and put the difficult memory behind them.

During my first pregnancy, I was grateful for midwives who asked about my preferences in advance. I told them I wanted to avoid pain-medication if possible. Knowing this, they didn’t offer it to me (though I knew it was available if I changed my mind). If I hadn’t felt confident in my ability to birth without medication, and if I hadn’t researched the benefits of avoiding drugs and anesthesia, of course I would have been tempted by well-meaning offers of pain-reduction. It was not an easy labor — it was the hardest thing I have ever done. I was lucky to be surrounded by family and friends who supported my choice. Many women are pressured to accept medication or an epidural by well-meaning loved ones who are themselves uncomfortable witnessing the intensity of normal labor.

Inducing labor — generally through use of the drug Pitocin — is another mossy rock on the slippery slope. The rate of inductions has more than doubled in the past 25 years, many scheduled simply for convenience. There are times when induction is crucial for urgent health concerns. But if it’s just to avoid being stuck in the hospital over a holiday weekend, or because someone (perhaps the doctor) is tired of waiting, take a second look. By agreeing to induction, you agree to getting hooked up to an IV and constant fetal monitoring devices, and set yourself up for a host of additional risks. Artificially inducing labor doubles your chances of a C-section (because the induction, while painful, is often not effective), and causes longer, more intense contractions which can dangerously restrict your baby’s oxygen supply. Induced babies have more complications after birth, probably due to the stress of the over-strong contractions. The mother is also at greater risk for excessive bleeding or uterine rupture. All of these possibilities, needless to say, lead to longer hospital stays, more medications, and loss of family control.

The current US caesarean section rate is about 33%. The vast majority of these surgical births involve normal, “low-risk” pregnancies: single babies poised in the favorable “head down” position, at full term (at least 37 weeks gestation). Some of this can be explained by cultural reinforcement: first-time mothers may increasingly perceive a C-section as safer and easier, because so many of their friends have given birth this way and natural childbirth has gotten a reputation as frightening and brutal. Unfortunately, they may realize too late that a C-section is in fact a major surgery involving numerous risks and potential complications. Infection (for both mother and baby), bowel obstruction, organ damage, and blood clots are a few of the risks — yet even when a vaginal delivery is planned, the probability of a C-section increases with many of the routine procedures offered to “make it easier”.

2. Freedom and awareness during labor - and after

It’s the first day of your baby’s life as an independent being — it’s a blessing to be as clear-headed as possible. Babies, too, can experience drug “hangovers” or loss of coordination after medicated births. Epidurals do appear to be better for babies than opiates: babies born to mothers who use opiates for pain management during delivery often need another drug to help them “withdraw” from the opiates they have received through the placenta.

Mothers saying yes to the epidural may not anticipate the discomfort of urinary catheter insertion, the constant tether of the spinal tube, and the reduced mobility at a time when walking and freedom of movement can be a tremendous relief. When you can’t feel your contractions, you lose the natural instincts which help you sense just how your body needs to move to help labor progress.

Keep in mind that even a long labor is only the blink of an eye in the span of your life. It will end, and you will be left with a new amazement of what you and your body are capable of. That’s another thing many women don’t realize until later: when they allow themselves to be persuaded into medication or surgery, they may regret having missed out on that once-in-a-lifetime (or twice, or three times…) chance to experience the “rite of passage” which women have passed through for millennia.

3. A strong start with breastfeeding

Most research suggests that babies born to women under the influence of epidural anesthesia are significantly more likely to experience difficulty “latching on”, the crucial first step in successful breastfeeding. Although it is certainly possible to persevere through this initial difficulty (especially with support from an experienced lactation consultant), the frustration can prove so discouraging and anxiety-provoking that some women give up, despite breastfeeding’s well-known benefits. If the mother is recovering from surgery, or the baby is receiving intensive treatment for complications, the nursing process can be sabotaged by the administration of formula and the passing of the ideal time window for initiating the breastfeeding relationship (though if this happens to you, get help instead of giving up!).

The natural endorphins your body produces in response to intense sensations are more powerful than morphine, yet leave you (and baby) alert and ready to bond. I was amazed by how much energy and joy I felt holding this tiny body, despite 40 hours of sleepless labor. Breastfeeding wasn’t easy at first: it took many tries (and some good coaching from the midwife) to get my daughter to open wide enough and suck effectively. My baby and I both needed all the alertness we could muster after our long ordeal.

4. "Good" bacteria: your baby's first defense

What’s the first thing that happens when a baby comes out? Generally, she is scooped up and cleaned off before being presented to the happy parents. But it turns out that slippery coating may be crucial to her future health. Born vaginally to a healthy mother without the use of antibiotics, the baby is inoculated with immune-boosting microbes which protect them from a variety of infections. These same microbes colonize the intestines, giving babies a good start in healthy digestion, and possibly even contributing to the lower risk of obesity among vaginally-birthed children — scientists now speculate that the obesity epidemic is strongly influenced by intestinal flora. In addition, these bacteria may explain reduced rates of asthma and allergies among vaginally-birthed children. The world outside the womb is crawling with microbes of all varieties, and the baby who emerges “naked” of maternal bacteria may be more vulnerable to the wrong ones.

Researchers are beginning to experiment with swabbing newborn C-section babies with their mother’s birth canal bacteria, in an attempt to give them the same advantage as vaginal-born babies. Initial results are promising: it does appear to help. But the exposure during a vaginal birth is much greater, and the colonization of the infant’s body by the helpful microbes is proportionately more robust. Microbiome investigation is still in its exciting early days — we’ll look forward to more fascinating discoveries of how bacteria can make us healthier throughout our lives!

5. Faster recovery, greater satisfaction

Women who choose natural childbirth generally express more positive feelings about their birth experience afterward. They recover more quickly, develop more confidence in themselves, and seem to almost forget about the pain — this may be nature’s way of encouraging us to have more babies! Women reporting lower satisfaction after choosing pain medication may have found that the drugs did not block the pain as completely as they expected, their labor was longer, and in some cases they felt uneasy about the drug’s effect on the baby.

Non-drug pain management options include relaxation techniques, water therapy (baths and showers), and massage. Consider choosing a provider who seems knowledgeable and supporting of these options, and who is aligned with your personal preferences around childbirth.

Plans change. We can never truly plan our birth experience — each birth is full of surprises, new sensations, and unpredictable twists. Flexibility is key. Find a doctor or midwife you trust, who will support your choices and also keep you fully informed if unexpected problems interfere with the plan. We are fortunate to have options, and in an emergency the most committed home-birther may be grateful for a speedy ambulance and compassionate surgeons.

But some medical choices aren’t made to save lives. They are often made to increase comfort, or to address an ambiguous risk which may be quite remote. During active labor, in the heat of the moment, who can evaluate the pros and cons, and calmly wonder “how will I feel about this choice in retrospect?” The time to discuss and decide is well in advance, during a routine prenatal visit. If you need more information beyond what your provider can give, look for objective, peer-reviewed research studies, rather than subjective internet opinions and anecdotes. What else has been scientifically proven to reduce risk of complications? Hiring a doula — a birthing “coach” whose role is simply to support, inform, and advocate for the mother.

Many interventions, and particularly C-sections, may be driven by doctors’ increasing fear of liability. “No one gets sued for doing a C-section”, obstetricians are known to say — but they do get sued for passing up a chance for an intervention, if the outcome is bad. This is true despite the many complications of C-sections, both for the recovering mother and for her future children, who in a surgically-scarred uterus are at greater risk for placenta previa (in which the placenta blocks the cervical opening); placenta abruption (in which the placenta separates from the uterine wall); and other potentially life-threatening conditions. In general, both the compensation system and the legal system reward doctors for doing “something” rather than “nothing”, even if “nothing” is actually the scientifically safer thing to do.

There are two sides to every story, even “routine” medications for both mother and baby. The best providers can give you both sides of the story, offer their own recommendation, and ask for your thoughts and feelings. If you ever feel discouraged from asking questions about an offered procedure, it may be a sign that your provider is not a good fit for an involved parent who wants to be part of the decision-making process.

No one can truly prepare for the mind-blowing, terrifying and joyful mystery of childbirth. Hundreds of books and scientific papers will not tell you how you are going to feel at the peak of contractions. What you can do is have frank discussions with everyone expected to be at the birth, making sure you’re all on the same team. If, as in the great majority of births, everything is within the range of “normal”: know that your body can handle it, even when your mind isn’t so sure. Toward the end, when I felt I could not go on, my midwife kept repeating “you’re going to meet your baby soon!” Those words kept me going.

Ultimately, I wasn’t a purist. I said yes to the midwife manually rupturing the amniotic sac, which was successful in stimulating my stalled labor. This was a departure from my “natural” plan — I had assumed my body would determine the right time for my water to break. Saying yes involved a risk, the midwife explained. I understood: once the membranes are ruptured, the uterus becomes more vulnerable to infection if labor is prolonged. I made an informed choice, and I’m thankful it worked out.

I wish the same for every birthing woman: a caregiver who presents all options clearly, a supportive family who advocates for her wishes, and the confidence in her own ability to birth a healthy baby in her own unique way.