Confident Birth

Normal birth?

What is "normal birth"?

Lamaze defines it as nature's simple plan for birth. I suppose it is an updated way of saying "natural childbirth" in an era when cesareans are so common that many women say that they have had natural childbirth when they have given birth vaginally, regardless of the medical interventions they experienced.

So, does normal birth imply that there is something abnormal about a woman who has had a cesarean or a highly medical birth? No! True, normal birth is the opposite of medical birth. Those who advocate for normal birth are attempting to reclaim the normalcy of birth in a culture where medical birth and its associated interventions are the norm. But it does not imply any judgment of those who have experienced such interventions. In addition, it must be remembered that no one is saying interventions are never necessary or trying to turn back the clock.

Certainly, a woman in labor may feel that there is nothing normal or simple about it! Her sense of time and ability to communicate may be altered while she has painful contractions every few minutes. So, while the day she gives birth is not an average day for any woman and her labor is unique to her, there is a universal pattern and rhythm to labor and birth when it is not interfered with.

A woman has a normal birth when she:

feels confident
trusts her ability to give birth
feels free to find comfort in her own ways
is well-supported
gives birth free from routine medical interventions

Why choose normal birth?

The advantages of normal birth are many! While it may appear or feel safe to have your baby in a hospital attended by an obstetrician, according to research medical birth can in fact be unnecessarily risky for low-risk women and their babies. In contrast, normal birth can offer women greater safety and an unparalleled sense of accomplishment. Normal birth allows a woman and her baby to avoid the risks associated with routine medical interventions - risks that are well-documented. In addition, a confident woman who gives birth according to her instincts is active in the birth process and gains a new appreciation of her own strength. She can even be euphoric.

Women remember their birth experiences for the rest of their lives. In a 1992 study, Penny Simkin found that women remember events and feelings from childbirth accurately for at least 20 years. It should be an experience worth remembering!

How can I have a normal birth?

According to Lamaze, "women who are fully informed, confident and supported will want normal birth, and . . . caregivers should respect the birth process and not intervene without compelling medical indication. These evidence-based practices adapted from the World Health Organization promote, protect and support normal birth:

Labor begins on its own
Freedom of movement throughout labor
Continuous labor support
No routine interventions
Non-supine (e.g. upright or side-lying) positions for birth
No separation of mother and baby after birth"

If you examine the list above you may see that, while not impossible, it is quite difficult to have a normal birth experience in a hospital attended by an obstetrician. You may have even heard this from friends who tried and failed. It helps to have supportive providers, opt for a midwife, hire a doula, and be educated about one's options and hopes - and then be lucky in your labor and delivery!

The first thing I would counsel any woman considering normal birth to do is think about how strongly she desires it and consider if there is a good match between her hopes and the common practices of her provider and birth location. From my experience you need to have at least one if not all of the following to achieve normal birth:

a birth environment that promotes normal birth and thus does not intervene in the birth process routinely - such as a birthing center or your home
- common examples of routine interventions include: IV, continuous fetal monitoring, no food and drink, being restricted to the bed
a provider that truly supports normal birth - usually a midwife although there are certainly some doctors who believe in the superiority of normal birth
experienced and continuous labor support - such as a nurse who is trained in comfort measures and who will stay with you (a rarity in most hospitals) or a doula or monitrice -- in addition to supportive loved ones
an understanding of the benefits of normal birth, a deep commitment to achieving it, and the confidence that you can do it
luck - in terms of a relatively uncomplicated and not overly long labor and delivery

How does this work? Here are some examples:

a woman who thinks she would prefer not to have an epidural is able to avoid it even though she gives birth in a hospital with a doctor because she has a 5 hour labor with no complications
a woman who very much wanted a natural birth is able to achieve her goal despite a long, painful labor in the hospital because she has a doula with her and a midwife as her provider
a woman who is fairly sure she wants a normal birth goes to a birth center and helped through her labor by a midwife, doula, nurse, and her partner - but no medications

So, if you think you might like a normal birth, can you go to the hospital without a midwife or doula and actually have one? It's not very likely if the hospitals in your area have high rates of epidurals and cesareans. It's important to think through what you want and be sure your birth location and those who will attend you are likely to help you achieve your goals. If you don't do this, and take action based on what you learn, you may be disappointed.

Where do I stand as a childbirth educator and doula?

Naturally, I have my own perspective on birth and my own opinions about childbirth options and interventions, based on my own experiences and research. I subscribe to the Lamaze Philosophy of Birth and believe in the benefits of normal birth. However, my goal is to help the women I work with and their partners make best choices for them, given their unique labors. As a childbirth educator and doula I am here to support mothers, regardless of their choices, not judge them. What is most important is not whether or not one has an epidural, for example. What is important is that the birthing woman feels supported, respected, in control, and that her expectations are met to the greatest degree possible. An epidural may be desired or even necessary for very good reasons - this can be said of all interventions. It is important to recognize this and stay flexible. I also believe that even in a birth in which there are many unwanted interventions there can be important victories. In a situation where things are not going as planned, I help women to have, acknowledge, and feel proud of these victories. I want to enhance every mother's confidence, not diminish it. I believe that taking childbirth classes, educating oneself, and hiring a doula will help!

For more information about normal birth:

A world of confident women choosing normal birth
- Lamaze's vision