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.
For more on birth and birth options, see my birth resources page.