Why a Pro-Modern-Medicine Non-Hippie Might Consider a "Natural" Birth

My husband and I recently visited the only certified birthing center in our area, and barring any emergent complications in what has so far been a low-risk easy pregnancy, I am definitely considering giving birth there. The other main contender is Saddleback, a local hospital with a low c-section rate in comparison to other hospitals in my area. In any case, given that everything is going well, I am hoping to be able to give birth naturally - no c-section and no pain control meds. (We'll see how it goes, though - obviously, I'm new to this childbirth thing!)

You may ask, why would anyone even consider attempting this? Some women do because they are anti-technology or anti-medicine, and others simply think that all things "natural" are just better; I fall into neither of these categories. I am no fan of pain (though I have endured it as part of various athletic endeavors) and I also do not think that giving birth naturally should be held up as sort of test of one's womanhood or rite of passage as a mom or anything like that. For all these reasons, I wouldn't at all have expected to want a natural birth before I started researching pregnancy and birth options. So what other reasons are there for wanting a natural birth?

In short, while I think that such a birth may be somewhat more painful in the short run, it is less likely to cause actual damage - less damage to my body and less risk to the baby.

Let's consider c-sections versus vaginal birth fist. While c-sections are much easier to recover from than they used to be, they are still major abdominal surgery, and the recovery typically takes longer than with vaginal births. Women are advised not to lift anything over a few pounds for a couple of months after their c-section surgery. That means no lifting your baby. Also, no lifting the car seat, doing any laundry, etc. (You are even advised not to take the stairs for several weeks, though from talking to women who have had c-sections, I think many simply have to take the stairs slowly and ignore this restriction - what else can you do if you don't live in a 1st floor apartment, or if your home has stairs?) I recently spoke to one woman about why she opted for a vaginal birth with her second child after having to have a c-section the first time around, and she said that being disabled for so long after the birth was something she had really wanted to avoid. Given the quicker and easier recovery with her second child, she was glad that she hadn't needed a c-section again.

But even if you grant that trying to avoid a c-section may be a good idea, why would a woman try to minimize pain meds in the case of vaginal birth? The epidural is the most commonly used means of pain relief in childbirth in the States, and it is very effective in controlling or eliminating pain for most women who get one. So what's not to love? In short, the other possible consequences of an epidural: more short-term pain control may lead to more stress on the baby as well as more damage to the woman's body and thus, a longer and difficult/painful recovery for her. Given that this form of pain control may lead to more damage to parts I am frankly very fond of, this is a real concern to me, and any short-term pain seems to pale in comparison, especially if I find other non-pharmaceutical methods of pain control effective (more on that in a future post).

So what are some possible side-effects or consequences of epidurals? First, especially if they are given early in labor, epidurals tend to slow labor for various reasons, not the least of which is the woman's inability to move around - walking around during the first stage of labor helps keep things moving along and prevent stalled labor. Given that most hospitals want a woman to deliver within 24 hours or so of being admitted (even if neither baby nor mom are showing signs of distress), this slowing of labor increases the likelihood of the woman having a c-section, which is no fun for the reasons described above.

Second, epidurals also make it either very difficult or impossible to labor or push in certain positions, such as on all fours, squatting, standing, etc. Why does this matter? First, these positions are often very effective in getting the baby into a proper birthing position (rear-facing, head down), which leads to more effective and possibly less painful and less physically traumatic labor and pushing. Second, even if the baby is positioned just right at the start of labor, since gravity helps the laboring woman in these positions more than when she is lying flat or reclining, this is another reason such positions can help bring about more effective labor. Some experienced midwives say that in their experience, these positions, by opening the pelvis more, actually reduce the risk of vaginal and perineal trauma. (See Ina May Gaskin's Guide to Natural Childbirth for more information on this point of view. Yes, she's a crunchy-granola hippie, and that may not inspire confidence in her expertise. However, the fact that she is also a very experienced midwife, with amazing healthy baby/mom stats that would make most obstetricians jealous, does earn her views on such matters respect and serious consideration, in my estimate. She has a great deal of experience, has written interesting pieces on the body-mind connection in childbirth and how psychological stress can impede the normal physical progress of birth, and has done thoughtful and intelligent analysis based on her experience and on medical literature.) In any case, the use of such positions is definitely associated with fewer episiotomies.

In addition, since the woman often can't feel when to push or cannot push as effectively, epidurals also tend to lead to more prolonged labor, and more interventions like forceps (more commonly used in the past) or vacuum (more commonly used today) deliveries - both of which tend to cause perineal trauma, or even necessitate episiotomies. (Ouch and ouch! Thankfully the latter are no longer as commonplace as they once were.) Spontaneous pushing, where the woman pushes as and when she feels the need to, seems to be the most effective sort of pushing in terms of protecting the woman's body, and this often simply isn't possible with an epidural, since the woman often does not feel the urge to push and must be coached to push by medical providers. (This varies depending on the woman and the sort of epidural given, however; I do know women who had epidurals and still pushed spontaneously and effectively, without any perineal trauma.)

Finally, and on a closely related point, many midwives argue that if a woman can feel what is happening, she is more likely to be able to control the pace of her pushing (during the second stage of labor) and to slow down to give her body time to stretch and adjust as the baby is crowning. This may be part of the reason that spontaneous pushing tends to give rise to less damage to the woman's body. Unfortunately, there are not really any medical studies specifically on this, but the general principle does make sense to me. If you can't feel what's going on with your body, it seems like it would be harder to protect yourself by controlling the pace as needed. And the low rates of vaginal and perineal trauma among the patients of experienced home or birthing center midwives (where anesthetic is generally not available) seems to offer some support for this claim.

As to stress on the baby, epidurals are often used in conjunction with drugs like cervical softeners and Pitocin to speed up labor - either the epidural is necessary because such means of inducing labor tend to make contractions more intense than naturally-generated contractions (and thus difficult to bear without an epidural) or the epidural necessitates the use of measures like Pitocin because of its tendency to slow labor. These other drugs can cause fetal stress to such a significant extent that a c-section becomes necessary to get the baby out quickly, which is a less-than-ideal situation for mom and baby.

However, from what I can tell from my research, careful and gradual use of such drugs, judiciously tailored to the response of mother and baby, seems to obviate these possible risks, at least, to a large extent. Why can these drugs bring about fetal stress? The greater intensity of medically-induced contractions as compared to naturally-induced contractions is one problem. In addition, higher doses of Pitocin may not allow the uterine muscle to fully relax and rest between contractions, which means the baby cannot recover as fully between contractions - the longer the contractions, the more time the baby spends getting less oxygen and the less time it has to recover in between. Obviously, this is not good for the baby, and such problems are why a c-section may become necessary to prevent fetal stress. There are a few ways to reduce the risk of such problems. Cervical softeners like Cervidil (instead of Cytotec) offer less risk of this kind of downward spiral of fetal distress. Similarly, lower doses of Pitocin reduce such risks, as does adjusting the dose of it only gradually and as needed, instead of increasing it quickly, and/or by a set protocol (a set amount over a set period of time, without regard to how the individual mother and baby are responding).

I have not seen definitive evidence that epidurals directly cause any other ill effects to the baby - other than the effects caused by the various meds to induce or accelerate labor often used in conjunction with epidurals. Some claim, from anecdotal evidence, that babies born to moms with epidurals are less alert and active, but I haven't seen medical evidence to support such claims. The use of narcotic medicines, if timed too close to delivery, can definitely have such an effect on the baby, however, and can even cause the baby to have a difficult time breathing. Some commonly-used narcotics, though, if used early in labor and at proper doses, seem to have no ill-effects on the baby and may also help the mom rest a little to maintain her strength for the work that lies ahead. I'll see how things go - if this seems like a good option early in labor, I'll definitely consider it. (But then again, it seems like I'd be most likely to want pharmaceutical pain relief later in labor, so narcotic pain medicines seem to be of only limited usefulness.)

To summarize, I am leaning toward a natural birth because I think that birth, unlike just about any other situation that may cause a person to go to a hospital, requires work on the part of the "patient" (hence the English name "labor" for the state leading to birth). In fact, except in medically complicated births, it seems that most of the work is done by the woman, with the medical staff primarily/ideally standing by to help if complications should arise. Given this, I think it is important that my body is not prevented from being able to do the work it must do to give birth. This means I have to be able to pay attention to and control my body, which is difficult or impossible with the use of many pharmaceutical methods of pain control. Given how useful pain is in preventing damage in other situations, it is not surprising that it should be useful in the same way in childbirth as well.

For my next posts:
- possible natural means of controlling pain during birth (Why think they'd be effective?)
- why a birthing center may be worth considering (even for non-granola types)

Good news!

We got back blood work and ultrasound results this week, and they confirmed that baby and I are both doing fine. No gestational diabetes for me, so I think I've now officially dodged all of the most common third-trimester health woes for pregnant women. Also, we had the ultrasound today, and it confirmed 1) that the baby is head-down 2) that the baby is a boy and 3) that he's measuring only about a week bigger than expected. The typical margin of error for ultrasound measurements, from what the ultrasound technician said, is +/- 2 weeks, so that basically means he's measuring normal for his gestational age (for what that's worth, given the general accuracy of such measurements).

Unfortunately, the ultrasound tech only had access to a rather low-quality printer, so I don't have any awesome photos of the little guy to post. The low quality of the photos along with the fact that only parts of him can be seen on screen at one time now that he's so big means that the photos I got are almost indecipherable. The screen at the doctor's office showed him in much better detail, though, and it was cool to get a look at him again now that he's basically formed!

The Apocalypse is Nigh...Like, Really Nigh

Just saw this story about some doomsday Christian group predicting that the world will end on the baby's birthday-to-be, May 21.

In case anyone was wondering, as persuasive as their arguments for the upcoming Rapture are, I'm still planning to set up the nursery, figure out how to care for a newborn, etc. Also, the baby shower is still on. :-)

Pregnancy + Furniture Assembly Marathon = Bad Idea

Hubby and I spent much of last weekend putting together furniture - we're still getting set up in our new place. That meant I spent many hours of the weekend hunched over partially-assembled Ikea bookshelves resting on the floor.

Bad. Idea.

I have a pretty strong back - I like to lift weights and was doing stiff-legged deadlifts as well as core exercises like the plank until recently, when I haven't had much workout time. Nonetheless, by Monday morning, my back was painfully objecting to me having spent so much time hunched over while hauling around almost 30 extra pounds of belly. It was pretty excruciating and rather comically disabling. I've just now recovered enough such that I can twist slightly to look over my shoulder while merging into traffic without my back muscles twinging violently. The takeaway tip from all of this, which is perhaps obvious to most sane people: don't take up furniture assembly as a hobby come third trimester. (Or if you must, at least make sure you don't have crappy furniture assembly posture like I did.) I'll definitely keep this in mind when some of our nursery furniture arrives this week!

Who Knows How Big This Baby Is?

This week, hubby and I met with obstetrician #2, who thought I was measuring completely normal for this stage of the pregnancy - within a centimeter of normal. Obstetrician #1 had thought the baby seemed quite large - so large that she ordered an ultrasound to have a look at the baby - but this second doctor thought the baby was right on track and seemed normal-sized. This is weird, since both were measuring fundal height!

From what I've read, this kind of mixed message about a baby-to-be's size isn't unusual. Strangely, predicting the size of a baby before it's born is something the modern medical establishment can't yet do very accurately. According to Marjorie Greenfield, the obstetrician who wrote The Working Woman's Pregnancy Book, the most accurate way to predict the baby's size is for the mother to predict the size by comparison to her previous pregnancies. If she hasn't had any previous pregnancies, though, this method is obviously out. The next most accurate way is for an experienced medical practitioner to examine the woman, and the least accurate way is by ultrasound measurements. But none of these methods are particularly accurate. So...who knows how big this baby is?

I do know that he's pretty active, though - he's kicking and punching and moving around all the time lately, which is exciting! (I wish there was some way to communicate to him that he could stand to do a little less kicking of the underside of my diaphragm, though, since that seems to be a favorite activity of his lately.) I'm going to start keeping a kick count chart soon, since it's good to have a baseline record of his activity.