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Natural Childbirth III: Why Undisturbed Birth?

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Spontaneous labor in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere [do no harm]
G.J. Kloosterman, The Universal Aspects of Childbirth

In the wild, mammals isolate themselves during labor.

A pregnant sheep, which is normally a herd dweller, will separate herself from the flock when birth becomes imminent. A rhesus monkey will move away from her group to the edge of the forest and choose a well-camoflauged hiding place in which to give birth. The rat, which is normally a nocturnal prowler, gives birth during the day to increase the chances that she’ll be unobserved. And the horse, which is normally a daytime grazer, gives birth during the night for the same reason.

Human beings are mammals

As often as we forget this, human beings are mammals. We share the same 175 million year evolutionary heritage of birth with other mammals. These similarities should be starting point when try understand the process of normal, undisturbed birth in our own species.

Like our mammalian relatives, human females are designed to give birth safely in the wild without supervision or medical intervention. It is as natural to us as eating, breathing, digestion, elimination and sleeping. It’s in our genes.

As physician and natural childbirth advocate Michel Odent reminds us:

When you consider birth as an involuntary process involving old, mammalian structures of the brain, you set aside the assumption that a woman must learn to give birth. It is implicit in the mammalian interpretation that one cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily. 1

Traditional humans also isolate themselves during labor

In a film about birth among the Eipos people of Papa New Guinea, ethologist Wulf Schniefenhovel documents mothers-to-be leaving their village and going into the bush just prior to giving birth.

Isolating oneself in this way has been the norm in traditional societies around the world, including the Kung San in Africa, the Turkomans in Central Asia and First Nations groups in Canada.

In an eighteenth-century, firsthand account of birth practices in a group of Canadian Indians found in a Paris library, J-C B. explains1:

Women usually give birth by themselves and without any difficulty, and always away from their own homes in small huts which have been built in the forest for this purpose, 40 or 50 days beforehand. Sometimes they even give birth in their fields.

It’s worth noting that in these societies where women isolate themselves during labor, deliveries are often reported as being easy, almost to the point of seeming effortless to observers.

Why would this be? How does privacy and isolation contribute to easier and less complicated labor?

What kind of environment inhibits a female in labor?

To answer those questions, we can look at studies of mammalian birth carried out by Niles Newton in Chicago during the 1960s.

Newton studied birth in several mammals, but focused on mice in particular. She analyzed the factors that made deliveries longer, more difficult, and more dangerous.

She found that labor could be slowed or even stopped completely by:

  • Placing the laboring mother in an unfamiliar environment (a place where the sights and smells are not what she’s accustomed to).
  • Moving the mother from one place to another during birth.
  • Putting the mice in a transparent cage made of glass and observing them.

Does this sound familiar? Each of these things happens in a conventional hospital birth. The mother is moved during labor from her home, which is familiar, to a hospital, which is unfamiliar, and observed by a staff of people she has little connection to or experience with.

Although we are not mice, we do share similar needs as other mammals during labor. Anything that disturbs a laboring woman’s sense of safety and privacy will disrupt the birth process.

This definition unfortunately covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant women. As Dr. Sarah Buckley observes 3:

Some of the techniques used are painful or uncomfortable, most involve some transgression of bodily or social boundaries, and almost all techniques are performed by people who are essentially strangers to the woman herself.

Underlying these procedures, Buckley says, is a fundamental distrust of women’s bodies and the natural processes of birth. This distrust has a powerful “nocebo” effect and becomes a self-fulfilling prophecy, where women are almost certain to need the interventions that the medical model provides and feel grateful for them no matter how traumatic the experience.

Because of this, many women in western culture have come to expect birth to be a medical emergency – rather than a natural, instinctual process – that requires medical management and intervention.

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The hormonal orchestration of an undisturbed birth

The hormonal orchestration of birth is an exceedingly sophisticated and complex process that is still not well understood.

In fact, we still don’t know what causes the onset of birth. We know that estrogen, progesterone, cortisol and SP-A are all implicated, but we don’t know exactly how they work together. This is another reason why it’s so important to minimize interference in the natural birth process; we are more likely to cause problems with intervention than solve them.

A perfect example of this is fetal heart monitoring with ultrasound during labor. The pretense for this type of monitoring is that it will catch a potential problem and thus make the mother and baby safer.

However, studies show just the opposite is true. A large review published in Lancet in 1987 covering tens of thousands of births in Australia, Europe and the U.S. found that the only statistically significant effect of continuous fetal heart monitoring during labor was an increase in the rate of Caesarians and forceps deliveries.

The hormones involved in orchestrating mammalian birth are secreted by brain’s most primitive structure, the limbic system. The limbic system is not in our conscious control. For birth to happen optimally, we need to give this more primitive part of the brain precedence over the “rational brain” (the neocortex).

Anything that inhibits this shift of consciousness – including fetal heart monitoring, bright lighting, conversation, observation and expectations of “rational” behavior – will very likely interrupt the natural birth process.

Conversely, when we provide the right environment for a woman during labor – conditions in which she feels safe, private and unobserved – we facilitate the instinctual coordination of birth that is part of every woman’s genetic heritage.

Dr. Buckley observes4:

Undisturbed birth represents the smoothest hormonal orchestration of the birth process, and therefore the easiest transition possible; physiologically, hormonally, psychologically, and emotionally, from pregnancy and birth to new motherhood and lactation, for each woman. When a mother’s hormonal orchestration is undisturbed, her baby’s safety is also enhanced, not only during labor and delivery, but also in the critical postnatal transition from womb to world.

This, together with modern hygiene and the availability of advanced emergency medical techniques, give us a better chance of an easy and safe birth than any of our ancestors have had in the history of the human race.

In the next few articles in this series, we’ll be exploring the hormones involved in the birth process and how medical procedures such as epidurals and induction with synthetic oxytocin (pitocin) interfere with the exquisitely regulated (and still poorly understood) hormonal orchestration of undisturbed birth.

Note: I wrote this article on 7/16, and have scheduled it to be published on 7/22. If my wife Elanne has gone into labor and we’ve had our baby before then, it’s likely I won’t be able to respond to comments for a while.

Articles in this series:

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  1. Odent M. Birth and breastfeeding: rediscovering the needs of women during pregnancy and childbirth. Clairview Books 2007. ↩
  2. Odent M. Birth and breastfeeding: rediscovering the needs of women during pregnancy and childbirth. Clairview Books 2007. ↩
  3. Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.96 ↩
  4. Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.97 ↩

80 Comments

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  1. This is wonderful. It’s funny, actually – when I was pregnant and preparing for our home birth, I had that exact Odent quote written out and stuck to the fridge. Our birth was fantastic, by the way, but not undisturbed. When our midwife arrived, even though I knew her well and trusted her, my labor stalled. She made a wise move and left, coming back only when I had begun to push. I immediately felt the need to perform when she arrived – I felt like a watched pot. I labored best when I was alone in the shower – dark, isolated, enclosed. For my next birth I will choose a midwife who is comfortable sitting on her hands…in another room 🙂

  2. I started to google this subject after seeing a dog give birth. In nature what happens to the placenta and umbilical cord?
    -c

    • In most meat-eaters I know of, the mother eats the placenta. Don’t know what herbivores do, or what usually happens to the umbilical cord.

      • Sheep eat all the afterbirth (I grew up on a farm) I believe it’s the same for all herbivores as fresh blood attracts carnivores.

  3. It sounds like a lot of folks are defining a “good” birth as painless and quiet. Like Chris says, every woman is different and every birth is different. Mine hurt like hell, and I hollered. But I had the first in a hospital with an epidural, and that hospital experience was why I was so determined to have the second at home. There’s more to a good birth than the absence of pain, and there’s nothing wrong with hollering when you need to. Sometimes life hurts like hell. That doesn’t make it wrong, or bad.

    I’d like to add that the thing I have been most struck by, in the births I’ve been fortunate enough to be part of either at home or in hospitals, is how much more traumatic the experience is for the baby if it’s done in a hospital. My first baby was taken away from me almost immediately, put naked under bright lights (screaming in terror), scrubbed and poked and prodded. She was then given back to me until she was taken away again to be weighed and measured. My God! during most important, sacred moments of life, the first experience of being alive, the most important thing we can do is weigh and measure? And is there anything at all that makes sense about mammals having their young taken away from them–and mammal infants being taken away from their mothers–at birth? (And this was just my own. I’ve seen the same kind of callous, invasive, unnecessary “medical” abuse of other newborns elsewhere, even in supposedly “modern” birthing suites.)

    My second (at home) I was able to hold in my arms and nurse until I began to have contractions to deliver the placenta; her grandmother and sister then took her and held her and talked to her and gazed into her eyes (and counted her toes). The beauty and profundity of the experience of birth, of being welcomed into a loving world, was fully respected. Hours later, when everyone was settled, the midwife did all those silly “checks” (hips, weighing and measuring) and her grandmother gently, lovingly cleaned her.

    If all else were equal for the mom and the birthing process I would still say stay out of the hospital for the sake of the baby. Bad enough the way laboring mothers are seen as medical problems; babies aren’t even seen as feeling, sentient, aware human beings.

    I also have to say it is absolutely tragic to me that a woman who posted here was so traumatized by her observation of medicalized birth that she chose to have her babies cut out of her. What a telling indictment. (Not of her, but of what she witnessed.) And what a tragedy for her. Giving birth is one of the most profoundly empowering, fulfilling, spiritually immense, ineffably rewarding experiences a human being can have.

    It’s like if the only thing someone knew of sex was having witnessed many violent rapes, so she chose to get pregnant via artificial insemination rather than suffer what she thought “sex” was. (And in that circumstance, who could blame her?)

    • “It sounds like a lot of folks are defining a “good” birth as painless and quiet.”

      This. I haven’t given birth yet, but I’ve heard many women who have say that making grunting and crying out significantly diminsh the pain.

  4. I can only speak of my own experience. I gave birth to my daughter 6 weeks ago, at home in a birthing pool. She was 20 days late. The ‘labour’ technically took 6 hours, but I was labouring for about 90 hours before that. Labour started spontaneously and my daughter was delivered without interference and a minor tear to my perineum. Unfortunately she didn’t rotate before her shoulders came through. The midwives present think I probably wouldn’t have torn at all if they had.
    There was HUGE pressure on me to be induced, and failing that, to have a hospital birth with constant monitoring (especially for a first pregnancy). I know if I had succumbed to the pressure rather than following my instinct and my body’s lead, my birthing experience would have been drastically different, and not in a good way.
    I found giving birth painful. I made a lot of noise as I found it helped me to get in touch with the raw power and energy I found deep inside and needed to see me through the birth experience. Despite being at home and feeling safe, I still went to my own little world in my mind and being ‘cocooned’ in water helped that as well as helping diminish the pain.
    I firmly believe in womens’ ability to give birth- it’s one of our primary physical functions, and as we are all different, so we have different needs for giving birth. My daughter needed 42+ weeks to be ready to be born, and I’m glad I gave her and me the time we both needed.
    I look at her now, asleep beside me, and say to her- well done! We did it together! What a team!
    That is my wish for all mothers-to-be out there- that their birthing experiences can be empowering and amazing.

  5. Couldn’t put it better myself. Hence ‘Syntonic Birth’: ‘characterising a high degree of emotional responsiveness to the environment’; birth requires the mother to be’ in harmony with her environment’. (Website going live soon)

  6. I’m sad but not surprised that the Dr decided to have elective caesareans (statistically the riskier option) because she had been traumatised by observing standard hospital birth practices. Plenty of midwives, too, take the elective C/S road because they do not trust birth based on what they see and do in their jobs. Here in Australia episiotomies are “relatively” rare but what is not rare, unfortunately, is the lack of patience and respect for the natural process. Once a woman gets past the ridiculous “due date” she starts accumulating stress from people pestering her about when the baby will be born. Then she is frightened or coerced into induction way earlier than necessary which, especially in first-time mums, often leads to augmentation and forceps, vacuum or C/S.

    If the Dr ever had the chance to observe a typical homebirth she would see a woman working with her pain (as opposed to a rescuer coming along to “relieve” it for her), choosing positions to facilitate birth, being well and lovingly supported, nourished and respected. As far as evolution and baby’s head size is concerned…babies’ heads mold, turn, flex and otherwise ease their way through the pelvic bones. The biggest problem these days is the rush to get the birth over with, which results in too-strong augmented contractions pushing the baby down before natural rotation and other adjustments have occurred.The woman grows the baby, so she can most likey give birth to it (leaving aside the poor nutrition of some women where an excess of sugar and fat may make the baby bigger than it should be). Also Optimal Fetal Positioning is vital to know – correct posture can ensure a more straightforward labour when the baby is sitting with its spine toward the front of the mother’s belly. Many women have a more painful and prolonged labour because of slouching and other poor posture – easliy fixed if you know how!

    Lastly, the Dr might have had a good quick recovery from her C/S but, I can assure her, many thousands of women do not. The benefit to the baby passing through vaginal flora is no myth but is well supported by research. The abdominal musculature of some women NEVER completely recovers after this major surgery and pain can go on for months. And pelvic floor problems are present in women who have never given birth vaginally and are often caused by rough instrumental births. Pelvic floors are built to withstand normal, gentle progressive birth rather than forced pushing or pulling. It is actually irresponsible to recommend C/S as the preferable method of birth for anyone – going into labour is always better except in rare instances, because labour is good for babies and lets us know that the little one is ready for birth. I also think it is scare-mongering to put the bugaboo of GBS and herpes, as well as anoxia and asphyxia, into this discussion as valid reasons for choosing C/S. Infections are screened for and usually picked up and treated antenatally and throughout labour. And it is disingenuous to imply that babies don’t have breathing problems if born by C/S – respiratory distress and meconium aspiration are far more likely to happen as a result of C/S than vaginal birth. As with all great events in life, there is no such thing as a risk-free option and we health professionals are there to keep an eye on things – at home as well as in hospital.

    I think Chris’ observations are absolutely spot-on and any pregnant woman reading this can take his information to the bank!

  8. I agree that women need to be in a safe place away from observation to give birth.

    I had my first in the hospital and I felt like everyone was just staring at me waiting for me to do something. It felt really awkward. Understandably I failed to progress and was given pitocin and an epidural.

    My second and third babies were born at home and I felt so much more comfortable. I progressed easily and am very happy with those births.

  9. Like Dr. Deans I am also concerned about how modern human physiology affects the birth process. Aren’t our heads evolving to be larger?

    • No. Our brains have shrunk since the advent of agriculture. And it can’t be that our skulls have gotten thicker because evidence in graves and at archaeological digs tells us the exact opposite.

      I mentioned Weston Price to Dr. Deans above. Go look at his book, it’s free online–he’s got some photos of skulls that are instructive.

  10. I wonder about our agricultural narrow pelvic outlets. Like longevity and height, pelvic outlet is also smaller since the advent of agriculture, I imagine this would affect birth. (ps have observed the end stages of many births well there was no prenatal care and no education – last minute footling births are always exciting, to be sure). Having been pregnant myself, I would have found a lack of knowledge about the process terrifying. Like Breastfeeding (which does take some cultural wisdom to learn some of the subtleties), birth I imagine, in humans, has been a cultural process for thousands of generations.

    • I wonder how much of birth problems have to do with pelvic outlet (or width) and how much to do with things like vitamin D deprivation. I know low D status is linked with pre-eclampsia; found that on ScienceDaily a while back. Then the other day I was reading that one of the symptoms of rickets in adults is a pregnant woman cannot give birth, and both she and her baby die. Lightbulb went on. I suspect there’s a continuum there, and that if we bothered looking, there are other similar problems related to deprivation of other nutrients. Our pelvises loosen up during pregnancy *anyway* so I really think poor nutrition is what’s making a lot of the difference just in how things work in those 40 weeks and during childbirth.

      Weston Price was talking about how the American Indians he visited had been able to give birth without effort before the industrial foods came along, then after those foods were pretty well entrenched, they started having to go to hospitals and still had long and difficult labors.

      I bet the more grain there is in a culture’s diet, industrial or not, the worse it gets.

      • There was a fascinating study about the effects of diet over generations, using cats. (The book I read about it is called Pottenger’s Cats.) Basically, he tracked cats that were fed deficient food (not unlike what we feed them in commercial pet food today) and compared them over several generations, then started feeding those cats an optimal diet and tracked how many generations it took them to recover. For cats whose ancestors ate poorly, they experienced longer and more difficult labors, and were more likely to have skeletal deformities including narrowed pelvises. It took four generations on the optimal diet before their health matched the control group’s again.

  11. How are you going to treat the umbilical cord? Are you scared of giving you’re daughter an “outie” bellybutton?

    • Ben, I am going to answer you as though you are serious. As far as anyone knows, innies or outies are genetic, not determined by the treatment of the umbilicus at birth. Secondly, at all 5 of my childrens home births, we waited until the cord had finished pulsing the babys’ blood into their body, and then we clamped with….. a sterile cord clamp that I ordered from an obstetric supply. I also had oxygen available at my birth, and sterile instruments. Really though, you are more concerned with the belly button than a mothers perineum or abdomen?

  12. Childbirth Without Fear is a great book.
    I believe women should make the choice that feels right for them, but let us not forget the health and comfort of the baby also. I prefer to give birth in a hospital. Having modern medical help at hand if needed is a great comfort for me and allows me to labour without worry. I needed it for my third child and hate to think of the outcome without it. After experiencing (without drugs) what it is like when things are going wrong I can’t imagine how some women must suffer when help is unavailable. We don’t expect to die during childbirth in our modern lives, but women used to and still do in parts of the world. I can only imagine it must be the worst way to go for both mother and baby. Childbirth is natural, but not without risks. I thank modern science for reducing that and take advantage of it.

    • My baby was crying all the way down the hall when they finally got done poking and prodding at her following her birth. Great health and comfort there. Then they tried to “help” me nurse her by shoving her face onto my breast.

      With my son they pulled his head out of shape with a vacuum extractor and then kept him in the nursery because his pulse o2 was lowish (I don’t remember what the number was), then I got no instruction on how to nurse him, then when his blood sugar dropped they gave him a sugar-water bottle. His head shape never did recover. Poor baby. That was 1996.

  13. The Bradley Method is more about education – how birth works rather than how to do it. The stages of labor, how to know which one you are in, the physical and emotional signposts. It also is about how you can prepare your body – stretching and so forth.
    I am sure all those women who have their babies alone know all these things because it is part of the collective wisdom of the group. Sadly, our culture has gotten away from that.
    I think women do need a bit of direction/information about how to give birth simply to counter the pervading myths that say birth is a medical emergency. If all you ever see of birth is the screaming and the complications that are on tv, and you have never talked about birth as an empowering or positive experience with anyone, how can you trust your own body?

    I am very glad I took the class before my first. It is probably what set me on my path to other alternative (meaning not CW) ways of looking at health.

    A waterbirth was a good way for me to be undisturbed with my first. I had him in a hospital, but it was like I was in my own world in that tub. I had my husbands hand to hold, my doula rubbing my back, and otherwise the occasional face of my midwife or nurse to check on us. It took a while, but was amazing.

    • This is why I’m a bit puzzled by his disaproval of the Bradley Method. It isn’t that women need to be educated on how to give birth but rather uneducated from what is currently ‘common’ knowledge. Perhaps he hasn’t heard of it?

      • The problem is that birth doesn’t work the same way for all women. The stages of labor are more grey than black and white, different women will progress through them in different ways. Odent reports in his books that the women who had the fewest preconceptions about what labor was supposed to look like often had the smoothest and least complicated deliveries. That said, if the Bradley Method (or any other method) empowers a woman to get more in touch with her body and the process of natural birth, I’m all for it.

        • I really have to agree with this comment. I arrived at the hospital not dilated at all in pretty heavy labor and got pats on the head and laughs about how long I had to go. My baby was out an hour and a half later. I wish I hadn’t been thinking I would endure another twelve hours of that 🙂 I do agree with Sara that women should know how a normal unhindered birth actually is… it’s just too bad that we can’t learn that from our mothers and aunts and grandmothers anymore.

      • It would really help if men would stop treating women like machines where if you figure out how the parts on one work, that’s how the same parts on all the machines work. And men seem to be most guilty of this when it comes to sex and childbirth.

        It’s not a good approach for ANYONE to take, but usually when a woman looks at a guy that way, it doesn’t result in him having stitches two or three layers deep in his abdomen.

  14. Being a doctor myself, I had seen and heard enough during my obstetic and paediatric rotations to opt for 2 caesarian sections. Most women do give birth normally and without serious problems but some do not.

    I did not want to go through eg 24 hours of labour and a forceps delivery + or – emergency c/section and risk the baby being brain damaged. Also labour is EXTREMELY painful. Either that, or all these women were just screaming their head’s off for hours just to torture me. I would describe the result of my hospital experiences as Post Traumatic Stress Disorder.

    Also the midwives had no respect for a woman’s vagina. They performed episotomies with using up to three cuts without any anaesthetic. Women jumped off the table in pain and they simply denied what they were doing was painful. “It was at the height of a contraction, so it couldn’t have hurt them any more”.

    This was in the UK. I hope to God things are better in the USA.

    Luckily a kind obstetrican granted my wish for the sections. If things don’t progress as expected, don’t worry about a section. It is very straightforward.

    It is very important that you are an advocate for your wife at home or in hospital. In hospital, she is powerless, and you have to listen to her and get the staff to listen to you.

    One midwife giving birth, was tearing the skin on her husband’s hand and swearing like a trooper. She said afterwards that she had no idea how painful the experience really was. She thought all the women she had dealt with were just making a fuss and had low pain thresholds.

    I didn’t do that. It was an absolute cake walk. The staff said they had never seen a woman so happy to have a section as me. I was showering independently 5 hours after my second section. Your pelvic floor remains intact. It DOES take longer to get your abs back. You can’t do eg crunches for six months but it comes alright by 18 months.

    Don’t show this post to your wife. Just bear it in mind.

    • Did you consider the part where the baby’s health depends on the mother’s microflora? It seems like the babies need the bacterias from the mother, which only a vaginal birth can give.

    • Wow, it makes me sad how you described the UK deliveries. That’s really horrible. My babies were born easily, I didn’t scream and actually enjoyed my deliveries, had no pelvic floor damage, and my babies didn’t have to leave me at all for over two hours… I loved my births. I wish more women had the opportunity to enjoy theirs.

        • I find you comments ignorant and insulting. I am a midwife working in the NHS in the UK and have been for many years. Yes some women do have traumatic births, yes some women are poorly cared for, but to suggest that this ONLY happens in the UK is at the very least absurd.
          We work very hard to ensure that women are able to have the type of birth that they wish for. As a dr you describe births you saw as barbaric and the episiotomy quote is horrific. I can honestly say in the numerous births I have witnessed and attended I have NEVER seen this happen. Please also remember that as a dr you are only usually present for births where there are some difficulties apparent and so miss out on witnessing all the wonderful straightforward normal labours and births that we as midwives are privileged and delighted to help support women through.
          I don’t doubt that what you saw influenced your decision to have c section electively and your skewed view of birth. As midwives we see the good and the bad – I have been present for more traumatic, high risk and dangerous births too, but am fortunate to have been involved with the overwhelming proportion of positive births.
          I understand and respect your choice to have your babies by elective c section, but I am deeply offended by the suggestion that women in the UK only have normal safe births with healthy babies by the skin of their teeth, so to speak. I respect your profession, so kindly respect mine.

          • I have only seen one vaginal birth where the woman was in control, the perineum was intact, there was only moaning rather than screaming, and the baby came out well. This was my final delivery as part of my preparation for the diploma in obstetics and gynaecology exam.

            Since I had finally, met the “Black Swan” I chose not to attend any more births. It would just be too upsetting to attempt to witnesss another, and I chose to end on a high note. Overall I spent 8 weeks as a medical student in obstetrics, 6 months on an obstetrics rotation and 3 months on a neonatal paediatric rotation. What I saw and heard is what I saw and heard. I only saw one vaginal delivery that I would have been happy with if it was me. You can do the maths. Not good enough probability.

            Lorraine, I chose to be delivered in an operating theatre by fellow doctors. Thankfully my wish was granted. Fortunately I was cared for in an exemplary fashion by midwives who had been students or juniors when I was working in the same hospital.

            I do hope that the frankly barbaric practices that I witnessed repeatedly are declining. The way it went was, if the woman is having her first birth see needs an episiotomy and if she has had an episotomy before she needs another one. Some gave local anaesthetic but many did not. When I confronted them with the obvious agony of the women they just shrugged their shoulders. Some midwives were unhappy about it but they did what they were told.

            I am so happy that I have two sons. I will never have to see them give birth or agonise over what they are going through. What my friends have gone through in childbirth reflects in general the very dangerous, painful and body wrecking experience that childbirth can be. Eg late miscarriage, stillbirth, third degree tears, 24 hour labour then forceps deliveries, 24 hour labour then trial of forceps and then emergency sections. One friend had 4 great vaginal births but she had them in Norway.

            I am not at all happy with the NHS and I do hope that the USA “you get what you pay for” will result in a much better standard of personalised care for expectant women.

            There may be many caring professional NHS midwives but unfortunately I didn’t meet them when I was making up my mind about my delivery method.

            For those women who choose to have a natural birth, it is as unfair to subject them to a high tec sausage factory birth as it is to deny women who are too well informed to push the caesarian that they want.

                • It makes me sad that you experienced birth this way, but I think it only coorraborates the authors point. Hospital birth is not natural, and often not even humane. I have given birth 5 times at home.I have delivered twins as a primip, had a shoulder dystocia, but I only screamed through one labor, while dealing with a Bandles’ Ring, that was dealt with at home, through touch and relaxation, no one will believe me, because the hospital treats this condition with a csection, and I do not have photographs to back me up, although i do have witnesses. I loved my births, and I love the homebirths I have been lucky enough to attend as a friend/doula. I chose homebirth because My friends who had delivered in the hospital all had horror stories, and episiotomy scars, while i still have an intact perineum,

            • ” I do hope that the USA “you get what you pay for” will result in a much better standard of personalised care for expectant women.”

              It doesn’t. I was on military coverage for my first birth and Medicaid for my second and both were nightmares that I would never repeat. I should have just stayed home and done it myself.

              • The military & Medicaid are provided by the government, so you’re not really paying for it. Thus, the comment about “get what you pay for.” If you have better insurance, that you pay for yourself, perhaps you would get better care. It’s not right, but it’s common in the US.

            • “This was in the UK. I hope to God things are better in the USA.”
              “I am not at all happy with the NHS and I do hope that the USA “you get what you pay for” will result in a much better standard of personalised care for expectant women.”

              Sometimes. It definitely makes it easier with regard to choosing practicioners that agree with your beliefs – if a doctor is hostile to your plans, or ‘insists’ you do something else (like if a doctor told you they wanted you to try labor naturally first, and they’d only perform a c-section if you had this and this and this happen during labor), you can just walk out and go to a different doctor. The downside is that there’s likely not a better doctor down the street. Quality doctors, midwives, and hospitals all exist, but there are many more inadequate ones.

              There’s two other common America-specific problems when giving birth, if you’re interested. One is that the organization that liscences and oversees midwives provides little to no punishment in the face of malpractice. The general attitude is that cracking down on the bad ones will make midwifery look bad overall, and may lead to it being banned. This isn’t incorrect, there are quite a number of Americans who think it should be illegal to give birth outside of a hospital, but the end result is the bad apples keep circulating, and mothers and babies get hurt.

              The second thing, which affects doctors very strongly and midwives to a lesser degree, is that “doing something” is percieved as always being better than doing nothing. This is why, for instance, many hospitals will not allow women to give birth there without continuous fetal monitoring. If they use it, and something goes wrong, they can say “well at least we tried to find any problems.” If they use only periodic fetal monitoring, and something goes wrong, they can (and have) been held legally liable for nothing doing everything they could to prevent it. Malpractice suits resulting from damage to the child caused by these interventions are routinely thrown out or simply disbelieved by juries.

              The problem is, our system doesn’t actually function as a free market. We’ve created a system where it’s in a doctors’ best interests to provide sub-optimal care. Intervening as frequently as possible is the best to protect themselves from lawsuits and insure their long-term ability to continue practicing medicine.

              On a related note, my cousin is a pediatric nurse in a large hospital. When she gave birth there she was allowed to continue laboring with her daughter’s cord wrapped around her neck. It took many hours, but the baby was born safely. It was an open secret that if she had been anyone else she would have been given a mandatory emergency c-section. Doctors in America know perfectly well what’s best for the mother and child, but it’s too high a risk for them to practice medicine this way with just anyone.

    • Clearly you have not seen how American OBs treat *their* patients. And you’re making Chris’s point. There is still a lot of interference whether the “birth provider” is an OB or not. You just talked about major abdominal surgery like it was no big deal. You would think so. They waited for you to be all the way numbed before they cut into you. They didn’t do that with me. But then, you’re an MD and I was just a Medicaid recipient. Guess my daughter and I didn’t really count.

  15. Excellent, and I hope more women will take back their birth experiences. I had my 3rd (and last) baby at home, in my bedroom, on my bed, just me and her father through labor, and the midwife got there just in time for the birth (labor went faster than expected). It was nothing short of amazing, beautiful, empowering, and in stark contrast to the 2 hospital births I had previously, where I was merely a passive participant in what everybody else wanted to do to me. Even in the most accommodating of hospitals, birth is unnatural in some aspect. It’s really too bad the pendulum has swung so far in the direction of treating birth as a medical condition that needs to be so hyper-managed. Kudos to you for advocating truly natural birth.

  16. Some of the points you mention remind me of the Bradley Method. What is your take on the Bradley Method?

    • I’m generally not in favor of any “method” that assumes women need to be taught to give birth.

        • I don’t know of the Bradley Method. Care to elaborate?

          I know of the ‘Marie Mongan Method’ (HypnoBirthing). Syntonic Birth promotes the Syntonic Birth ‘Method’ but it’s more an “approach”, a natural approach to childbirth. Symantics?

          Does ‘method’ instil confidence or are there other words that people prefer??

  17. Chris , could you comment on the birth position. Some say that giving birth in a sqaoting position, than traditionally lying on the back.

    • The birth position should be determined naturally and spontaneously by the laboring woman, not by any preconceived notion. According to Michel Odent, lying on the back is about the most unnatural position for birth you could imagine.

      • Lying on the back whilst birthing does the following:
        1) prevents the tailbone and pelvis from moving freely thereby preventing the full range of opening for the baby to move through. Test: breathe in deeply whilst in a squatting position and notice how the in-breath creates an easy opening of the vagina and how there is a subtle but crucial movement of the tailbone and sacral area. Next, breathe in to the same area whilst lying on your back and notice now that the tailbone has nowhere to go and the breath does not create the same easy opening in the vagina.
        2) causes the baby’s journey down and out to work against gravity thereby not maximising on efficiency which a more upright position would
        3) can cause restriction of blood flow and therefore oxygen supply to both mother and baby and can cause faintness
        4) can be more painful than in an upright or all fours position
        5) allows the birthing professionals a better view and easier access to “deliver” the baby without them kneeling or bending down or contorting themselves, which is why it has been adopted in western medicalised cultures over the last few centuries! Far from being “traditional”, this practice originated in 17th century France when male doctors first entered the birthing room, requiring women to lie on their backs so they could use their forceps more easily, thought to have started when Louis XIV wanted to view the birth of his mistress’s child more easily. [see p.11, ‘Birth Reborn’ by Michel Odent]
        A squatting position is the most efficient position for childbirth but requires strength to maintain for any length of time. However, kneeling in wide-legged stance can be quite efficient and more restful. An all-fours position is useful to slow things down if need be and is reported to be helpful with relieving lower back ache. I agree with Chris that a woman should birth in positions in which she herself is intuitively guided and that may well change according to what is happening for her at any given stage. To be in touch with her intuition, she needs to trust her body and the process and be allowed the privacy and focus to access that mammalian state of consciousness to which Chris’ article and quotes refers.

        • Basically, if it hurts, change position til it doesn’t. You might have some discomfort but it should *not* be *agonizing.*

          If they’ve got you on your back, by definition you can’t change position.

          I had two disrupted and traumatic birth experiences that way. So did my kids. The second labor ended in a c-section that was initiated before the anesthesia had kicked all the way in.

    • Something I find ironic is the fact that while your are pregnant they recommend you don’t sleep on your back as the weight of the baby will cause arteries/veins in the back to be compressed and limit blood flow, but it then becomes perfectly fine for a woman to labor for 3 days sometimes in that position. Doesn’t really make sense.

      • This is a very good point – I knew about both of these things, but somehow never put the two of them together. Thank you.

      • I have thought of this stay off your back/get on your back issue as well, and also the fact that I’m warned against brie cheese, herbal teas (I so need some valerian!) and all manner of drugs–until the birth, and then no one has a problem loading me and my baby up with all kinds of them, none without side effects!

  18. My husband and I planned a home birth (after one c-section and one hospital VBAC) with our third child. The night I went into labor my sister-in-law, who had two home births under her belt, sent me an email simply telling me to enjoy my birth. I remember reading it and feeling excited, having never thought of labor as something to be enjoyed. It was the most amazing and beautiful experience of our lives and I believe it was because I was left alone to do the work I needed to do in an environment where I felt completely safe and supported. Enjoy your birth!

  19. Best wishes to you and your wife on a smooth and perfect delivery. I’m due at the beginning of August and am hoping for a VBA2C, but have chosen to do it in a hospital for certain reasons. This article was really good and I hope to incorporate some of the ideas into my birth plan. My OB is very much into giving a lot of privacy and minimal intervention during labor, so I feel lucky for that.

    • I am sending good vibrations to you for your VBAC2C. Have a wonderful birth.

      It is interesting that you feel lucky to have an OB who will leave you some privacy and offer “minimal” interventions. But this is not LUCKY. It is what you deserve. Every woman deserves this while having her baby.

  20. Mr. Kresser:

    Have you and your wife opted for home birth, birthing center or hospital birth? My wife and I are weighing our options. Thanks.

    Chris D

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