48: Are You Natural Birth Curious?

Today I want to welcome back Dawn Herring. We spoke with Dawn in episode 34: Empowered Births,  about the Doula’s role in birth and gained great insight and the importance of quality birth education. Today Dawn is back to answer our questions all about ‘natural birth’; what it is, and what are the outcomes for those choosing it. Just a reminder, that on this show- we do not choose or judge your plans. We are here to provide support and quality information so you can feel confident is what is right for you. There are a lot of questions and fears surrounding birth, including natural birth. So today we are going to dive into this intriguing topic for those who want to know more, regardless of their birth plan.

What are the different birth settings a mother can choose (generally in this country)?

So I think it's important to note that in this country, the overarching approach to birth is that people have their babies in the hospital. What's interesting about that, is that hospital birth (typically the OB or physician led model of care) is more appropriate for high-risk pregnancies. Which is the smallest percentage of pregnancies in this country. 

Then there is what would be called the community model of care, or birthing outside of the hospital. I like to say community because that means you're either choosing to birth in your home or at a freestanding birth center. By the way, the midwifery model at a community birth center is not associated with a hospital who happens to also have ‘midwives’. A community birth center would be a freestanding birth center where births are attended by midwives. You may hear hospitals calling their labor and delivery wings “birth centers”, but that's not truly a community model birth center. 

Common birth settings in the United States

Is there a difference between the community midwives and the midwives that typically work in the OB (obstetrics) office? 

Yes, but it's each state regulates who can attend births at certain locations.  Typically in a birth center setting, you'll see certified nurse midwives (sometimes you'll see licensed or certified professional midwives at a home birth). The belief system and approach from midwives here is typically that birth is a natural normal occurrence. It's physiological. It's to be witnessed and supported.

In the medical model of care (such as a hospital birth), you will also see certified nurse midwives, but the distinction that I like to make when I'm speaking to families about birthing in that model is that every practice is different.  So you will often see certified nurse midwives, but they are essentially under the leadership or guidance of the OB doctors. So even though they're trained as midwives, in the medical model birth is typically viewed as something to manage. 

And so if you're looking for the kind of care where birth is viewed as a natural normal occurrence but you're still choosing to give birth in a hospital; finding a practice that has midwives on staff is supportive, however, you're still birthing in a model that views that birth is something to be managed.

What is a “natural birth”?

As people talk about birth, oftentimes you'll hear natural birth synonymous with vaginal birth. However, some folks will look at it from the perspective that medicine could still be involved even though your baby is coming out of your vagina.

Here’s the way I like to explain natural birth: Birth is physiological (it is of the organism and the natural normal process that something goes through). So a physiological birth is a birth that happens on its own with no intervention, no medicines. It is mama and baby making things happen. It starts on its own, progresses on its own, and it ends in a vaginal birth (technically with a baby head down). 

Sometimes babies get a little frisky, and decide they want to come out differently. But in the true definition of physiological birth, it is a “head down, baby born with no interventions”. 

What is the data on outcomes for natural childbirth?

I recently heard this quote from a local midwife:

“When left alone, birth is simply an emergence and rarely an emergency.” 

There are many benefits to a mom and baby who decide that they're going to experience a physiological birth (a natural birth). The first one is that there is a reduced risk of complications. 

There are also so many benefits of not interrupting the natural hormones of birth. When those hormones are doing their thing, there's a reduced need for intervention. Interventions are kept at bay when the process itself is unfolding naturally. The body knows with its natural organic hormones when to send more oxytocin and it knows when to send more endorphins. That's a huge part of what helps women cope with an unmedicated birth.

Consider that interventions themselves pose risks and complications. Anytime a medicine is brought in, there's an increased risk of overstimulation of the uterus or distress to the baby. 

The hormones that happen in a natural birth also support breastfeeding because that oxytocin is there. And oxytocin helps with the breast milk coming in. So interventions can introduce challenges to breastfeeding (many not mentioned here). 

If there is an intervention (medications, et cetera) it changes the system. And, even small interventions can result in sequela (added on consequences). 

It is research-driven that many women who choose an unmedicated or natural birth have higher rates of maternal satisfaction. There's a sense of autonomy. There's a sense of control in the sensations. There's a sense of power in trusting the body and meeting the body where it's at. And all of the other things we talked about kind of contribute to that overarching benefit of that natural unfolding.

Another benefit to natural childbirth is a faster recovery. Women who experience a natural vaginal birth often will heal faster than someone who goes through additional interventions (including epidural usage). 

But, you know, we can set ourselves up for the most ideal scenario and sometimes they do go left when we intend to go right. So possible interventions to labor are really important to talk about. 

What are some other birth types?

Of course there’s cesarean birth, where I like to say baby comes out the sunroof. Which is a major surgical procedure to bring a baby into the world.

And then there is vaginal birth which is exactly what it sounds like, where baby enters the world through the vagina. Vaginal birth doesn't always mean that it's with no medication. Vaginal births can sometimes be with medication, sometimes not, depending on the path and direction that mom chooses.

What is the top concern or question that you get from mothers who want a natural birth?

It’s “how do you cope with the pain or intensity of labor?”. That's typically the overarching concern. Even for women who are clear that they want an unmedicated “natural” birth, they still want to know what it looks like to be supported through the process.

The most popular question for women who are choosing to try a natural birth in the hospital, is how do they do it in that medical model environment? Because it is very different to choose a natural and unmedicated birth in the hospital setting than it is to choose a natural a unmedicated birth in a birth center or at home.

What do you think are some of the barriers to having a natural birth for someone who does want it? 

Well, first of all, there's an overarching conversation out there that birth is scary, and painful, and awful. People like to tell a lot of horror stories and share traumas that aren’t theirs. And, it's like anything, the negative reviews get the hype and the positive reviews don't always as much attention. 

Because birth in this country is very medicalized, it makes a lot of women feel like they don't have control or if they do choose to give birth in a hospital that they are going to be bullied or coerced or told what to do. 

Some of the biggest things I hear are that mothers want to be able to know that she can make the decisions that work for her. They say, “I want to be able to know that I can do what feels right to me, and not be forced or pushed in another direction.” Unfortunately the medical model often strips us from believing that and knowing our internal power. 

Part of why I love being a birth educator is that when we give ourselves the opportunity to explore what is possible in birth and what our options are, no matter what conclusion we come to for ourselves, that journey of exploration helps to quiet that outside noise. And, to discover our own belief systems or our own truths. Doing that work ahead of time helps build the muscle which allows us to see we are capable in birth.

Can you give us a few tools on how to advocate for a natural birth?

Advocacy is rooted in standing up for yourself and believing in yourself first and foremost, right? We hear so much about the need for advocacy in the hospital space. The more you deepen your trust and belief in yourself, the more un-messable with you are. I say you're bringing the body, the baby, the belly, the beliefs, and the badassery when you're rooted in a place of strength.

There are some practical tools for creating this and it's by creating space in your life daily to tune into yourself and speak to yourself. So whatever your beliefs are, whatever your affirmations, you need to have those be front and center during your pregnancy. And when your fears or other people’s opinions come in, you catch yourself in the moment and breath and come back to what you know is true for you. I call those like life contractions 😂. 

And those are all the things, by the way, that I talk about in labor. Breath, movement, mindset. Those are also your three key coping tools for building your strength and your resilience. In my view, practicing this ahead of time, is one of the most powerful and potent ways that you can prepare for your birth experience.

What about if your family, partner, or other people whom you are close with are not supportive of a natural birth? 

Let's just put your partner on a shelf for a second and start with anybody outside your immediate relationship.  Perhaps a mom or sister, literally anybody else.  Let’s say  you are acutely aware that they differ in their belief systems and you're seeing that there isn't a willingness to hop on board with your birth plan. My hot take is they don't belong in the birth room with you.

It is research driven that people in the room that pull energy versus give energy can impact a person's experience. Even the transition from home to a hospital can change the nervous system from the change in setting. And it's abrupt. So when you've got people around you that don't support you, that's a nervous system hit. When we're laboring we're so open and vulnerable, that has a direct impact on our nervous system. So yeah hot take, they don't belong in the room. I often coach my families to discuss this up front like, “Hey, these are our birth goals and preferences.”

I recognize that those are not easy conversations. I remember crying and sharing that someone could not be in the room with me because I just knew that it was not going to be supportive, but I had to stand up for myself and my experience. 

Now from a partner perspective, in my experience partners are scared too. I find that birth classes are equally as impactful as they are for a mom. And often it's about knowing what to expect and how to support that helps them to get on board and get into a good headspace. 

If someone wanted to take a birth class, how do they know that it's a quality class?

First of all, intuition is queen. So we'll just start right there.

Then there are benefits of being taught by a certified childbirth educator and/or a doula. Hopefully someone teaching outside of a hospital system is going to be teaching in a way that teaches the whole landscape of birth. But, we know everybody's got opinions and biases (and that's not short of people in this field too). So I think it's really important to understand the intention of the course that you're looking at. 

Remember that, not all doulas will be certified childbirth educators which means they may be crafting their own curriculum. Typically someone who is a certified childbirth educator is going to have a curriculum that they've adapted through their training. It should be more comprehensive to include all kinds of scenarios which is what I really recommend because birth can go a multitude of directions. So having a sense for what is normal and how to support that is one part. And then the other part is learning about interventions should something go differently than planned. 

Knowing the whole landscape helps you reduce anxiety and determine what feels right and gives you that space to think and make informed decisions should any issues arise.

To get in touch with Dawn or to see her birth education resources check out her website at www.empoweredbirthsandbeginnings.com. She also has a free “let’s chat” button if you have any questions about what resources best support your birth questions and plans.