There’s been a lot of discussion in the news lately of a local “natural-birth friendly” OB-GYN whose obstetrical privileges were abruptly suspended. After two weeks of daily protests outside the hospital in question, the doctor’s privileges were fully restored. He resigned that same day.
(Cherylyn at Mamas and Babies offers a summary and some perspective.)
Much of the news coverage of the events included opinion on who does and doesn’t support “natural birth” or “natural birth practices.” The protesting women said that they could no longer count on having natural births in this hospital, while the hospital representatives insisted that their facility supported natural birth practices.
The problem is that the term “natural birth” is a slippery one.
Now, I’m not interested in telling anyone else how they should give birth, or whether they should plan a natural birth. There are good reasons for choosing all sorts of birth attendants, birth locations, and birth philosophies. And I can’t comment on what the culture of birth is like at this particular hospital, as I have no experience with it myself. But I do want to talk about the confusion that can arise in discussions of natural birth, because understanding the differences here can help us better navigate our options.
Sometimes “natural birth” refers to a vaginal birth, as opposed to a cesarean section.
Sometimes “natural birth” is used to describe a birth where the mother doesn’t opt for medicinal pain relief.
Sometimes when referring to “natural birth,” people mean birth in comfortable surroundings. A birth where you can play music, dim the lights, and have your loved ones nearby—all things that help the body to naturally progress through labor and birth.
These are all valid birth choices, but they shouldn’t be the only “natural” choices available.
Many of the protesting women were interested in “natural birth,” meaning
physiological birth. Birth attendants who support physiological birth generally practice under the physiological model of care (also known as the midwifery model of care), as opposed to the pathological model of care (also known as the medical model of care).
I know we’ve talked about this before, but: in the physiological model, women are active partners in their care, and the health care provider’s job is to support the normal, healthy processes of pregnancy and childbirth. (Should a woman develop complications during pregnancy or birth, their midwife or doctor would provide evidence-based responses, including the possible transfer of care to another type of practitioner.)
The pathological model, in contrast, focuses on the possibility of complications, and offers more medical management in preparation for such complications. (Read more about both models at Our Bodies, Ourselves or at Childbirth Connection.)
There’s a place for both of these models in our health care system, and I believe women should have access to the type of care that best suits their needs. And of course, in the real world, there’s some overlap between the two models. Sometimes, for example, a health care provider will encourage practices that facilitate physiological birth, while still working under the philosophy of the pathological model.
So when a birth professional or a hospital representative says they support “natural birth,” we may need to ask more questions. Are they in favor of unmedicated childbirth? Vaginal birth in most cases? Are they saying that they offer comfortable surroundings? Or that they follow the physiological model of care? Are they advocating physiological birth, or only natural birth “practices”? If their philosophy follows the physiological model, do their policies and outcomes reflect that?
If you have a preference for one of these types of care or another, these are important distinctions.
Because if we aren’t clear on what options are being offered, we can’t make informed choices. And these choices—choices about the surroundings we give birth in, choices about what birth philosophy underlies our care—these are choices that every pregnant and birthing woman should have the opportunity to make for herself, clearly.
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For more on birth and birth options, see my birth resources page.
{ 14 comments… read them below or add one }
Thank you so much for this post, and for the link to my blog
I really appreciate your explanation of the different types of “natural birth”. I agree that there are so many different interpretations that it becomes confusing when trying to navigate childbirth options. I also agree that we should be clear on what’s what when making our own birth choices. Information = Education = Empowerment
Cherylyn, yes! I’m with you. I believe that information and education lead to better birth outcomes, more satisfying birth experiences, and more empowered parents.
What I wish I would see in hospitals–more than a birth tub, or natural lighting, or a bed for a spouse–is a real commitment to choices. By real, I mean a dialogue, before the birth happened, about what the woman’s wishes were. Too many of my friends have returned from births saying, “They said I had to ___”, or “I wanted ___, but ____happened instead.” Or, “They said I would want ___, even though I didn’t.” Dialogue, instead of filing a birth plan in a chart, and abandoning it at their convenience.
And on our side, I wish I saw more women taking responsibility for their births, advocating for themselves and their babies, and not blindly trusting others to make decisions for them. Or even trusting a birth plan to compensate for lack of trust in an institution. A friend of mine, due in August, just changed her insurance, her hospital, and her OB because she didn’t finally trust the practitioner. It may seem like a risk to do something like that (and thankfully, she had that choice), but how much riskier to leave her birth in the hands of someone she didn’t trust?
Yup, I’d like to see more commitment to a philosophy that respects women as autonomous decision-makers in their care, rather than just offering specific “practices.” Especially when those practices (birth tubs, for example) don’t usually turn out to be available to everyone, and turn out to be available at the discretion of someone other than the laboring woman.
And yes, for sure, I’d like to see a cultural shift away from trusting the maternity “system” and toward individuals making education-based and values-based choices.
my original MD (family practice) for my 1st pregnancy agreed with my desire for “natural birth,” but it became glaringly obvious her standard for that was only a vaginal birth. we parted ways & i went to a freestanding birth center!
good luck to those trying to “Build Babies by the Sea”!
Good for you, for making a change to care that fit your needs! That can be so hard to do, I think, especially in a culture that doesn’t much value alternative choices.
Thank for this post! I’ve thought about topic so many times…there are so many definitions of what natural birth is to so many different women.
I once saw this question asked, “Did I have a natural birth if my epidural wore off by time I actually birthed my child? I could feel everything!”
Hmm…I guess so? Depends on who you’re asking.
Exactly! Could be? Depends?
And when we’re making decisions about our care, we should know what the people around us think “natural” means!
This makes a lovely jumping off point to think of our own definitions of natural birth, what this means to us, and ultimately what kind of medical treatment and relationship we are looking for. So often it seems like we assume that we’re on the same page and then get frustrated when it turns out we weren’t, when in fact, nobody bothered to make sure we were even in the same book.
Yes! I hope that encouraging each other to ask questions and get precise answers is one way we can ensure healthier, more satisfying, less frustrating experiences.
You know,in the past, I’ve heard Dr.Biter refer to “normalizing birth”. I believe he means a birth that follows the physiological model of care, while also keeping the pathways open for a pathological one if needed.
I do like the idea that birth is a normal process, not necessarily a medical emergency. I wonder what would happen if we replaced the term normalized for natural, as in, “I’d like to try to have a normalized birth?” I see that as a birth where everything is assumed healthy until proven otherwise instead of the other way around. Does this make any sense?
That’s what physiological birth is. The physiological model doesn’t assume that complications will never arise–but, as research suggests, that most of the time pregnancy and birth will progress normally. Interventions aren’t entirely absent, they’re just reserved until needed. (In the pathological model, interventions are often used ahead of time, because there’s always a chance that a complication will develop.)
Wow, ok, thanks so much for this education. I had no idea about these distinctions. I have to say I think “normalized” has a better shot at catching on though:)
I don’t know how you know so much, Melissa, but I sure am lucky to get in on some a that good stuff as often as I do!
The thing about “normalized” is that it means “to make normal.” Birth–the experience of spontaneous labor and delivery–already is normal, as it exists.
But what you can try to make normal is the perception people have of birth, and the cultural understanding of birth. Our cultural understanding of birth is heavily skewed toward the medicalized; to normalize that would be to change the popular notion of birth, so that instead of thinking of it as something dangerous, we would understand birth as a natural process that usually works just fine without assistance.
A professional working in a birthing environment like a hospital could also try to normalize the routine experience in that environment– so that instead of getting more medicalized treatment by default, a woman would be treated as though her birth was normal unless she needed or requested something else.
But yes, it is an easier word to throw around, for sure.