Natural Hospital Birth: Safer
By Homebirth Mama
January 23, 2008
We hear about a “natural birth” being better, but never the reasons why. Usually in the media it’s depicted as a woman screaming in agony as her bewildered husband with the bruised hand looks on. A natural birth is one where there are no medical interventions, such as pain medication, episiotomies (cutting the perineum to make it bigger for the passage of the baby) or augmenting the labor (synthetic hormones to make the contractions stronger).
To decide if natural childbirth is better, you really only have to look at the records of homebirth midwives. They never use pain medication, rarely perform episiotomies and never augment or induce the labor. If those do occur with a planned homebirth, it is typically after a woman has been transferred to the hospital for continued care. Despite the labor and birth taking place in the person’s home, with no immediate emergency cesarean available, the mortality rate was the same as births in the hospital. In a comprehensive study evaluating homebirths, there were 12.1% of planned homebirth women who transferred to the hospital during labor. Here are the rates of interventions:
|
|
Homebirth |
Hospital Avg. |
|
Epidural |
4.7% |
>50% |
|
Episiotomy |
2.1% |
33% |
|
Vacuum extraction |
0.6% |
5.5% |
|
Cesarean Section |
3.7% |
30.1% |
As you can see from the chart, the homebirths had drastically lower intervention rates, and still managed to have the same risk of serious injury or death. And all of that without the “just in case” operating room located down the hall.
With this in mind, one has to wonder what the mortality rates would be for hospitals if they followed the philosophy of homebirths (no interventions). With a cesarean available in case of those unexpected emergencies, it would only stand to reason that the mortality rate for mothers and babies would go down, maybe so that homebirth was more dangerous.
Even though the philosophy of hospitals is to induce, augment and medically manage a laboring woman, it’s within a woman’s scope of power to make her birth less dangerous than someone who has a birth with all the bells and whistles.
Epidurals are often the beginning of what is called the “cascade of interventions.” Because once the epidural is in place, the mother has to be on an External Fetal Monitor (EFM), which measures the contractions and the heart rate of the baby. One of the risk factors for epidurals is lowering of the blood pressure of the mother (30-35% of epidurals lower blood pressure), and the heart rate of the baby. This can put the baby into fetal distress, which is cause for an immediate cesarean. Hence, the EFM, to make sure that the baby is healthy throughout labor.
Epidural complications include a prolonged first stage of labor, 20-26% increase of malpresentation of baby’s head (in a position that makes vaginal delivery harder), prolonged pushing phase of labor, 5 times greater risk of surgical vaginal delivery (forceps or vacuum extraction), and an increased risk of cesarean section (up to 50% greater risk). Other, more serious complications include bladder dysfunction (25-34%), maternal fever (<15%), spinal headache (1-10%) and uneven, incomplete or nonexistent pain relief (10%). Maternal fever is of particular note, because when it is present in a laboring woman, it’s not known the cause of the fever, which makes the hospital treat it as an infection, thus adding antibiotics to the fray.
Another common effect of epidurals is a reduction in the strength of the contractions, because it interferes with the production of natural hormones in the mother’s body. This leads to an attempted correction by the use of Pitocin, a synthetic form of oxytocin which the mother’s body makes. Pitocin is put into the body through an IV in the arm.
Alternately, pitocin can be the beginning of the ‘cascade of interventions,’ when labor is induced. 80% of women who have Pitocin say that the contractions are more painful with the Pitocin, so many women have an epidural soon after the pitocin drip is started. When Pitocin is used, EFM is almost always in place, because it too can cause fetal distress, due to the increased intensity of the contractions.
EFM seems like a wonderful achievement for evaluating an unborn baby, but studies have not linked it to improving the outcome of childbirth. Instead, EFM is linked to increased cesarean rates, because of a high false-positive rate. This means that sometimes it says that the baby is in distress, and it isn’t. So the mother is rushed to the operating room for an emergency cesarean, all because a machine was wrong in saying that the baby was not tolerating labor well.
The increase in these interventions often lead to a cesarean section surgery, which puts mothers at even greater risk of infection, hysterectomy, respiratory complications, hemorrhage, or death. Babies are at a higher risk of premature birth, breathing problems and injury. Most people know about a longer recovery for a cesarean, but they aren’t always aware of the long term effects of the surgery, which includes greater risk for future pregnancies (miscarriage, stillbirth, infertility), uterine rupture and even decreased maternal bonding with the newborn.
When you sit back and look at the numbers, it seems perfectly obvious that the safe option is to have a natural childbirth. The pain, after all, is temporary. It’s something that women have effectively endured for millennia, and only recently has it become common to dull that pain. Having a natural childbirth isn’t about getting that badge of courage, or proving that you can tolerate pain. Natural childbirth is about looking at the evidence, and deciding that it is safer for you, the baby and any future children, that you plan for an intervention-free birth.
This isn’t to say that there isn’t a time or place for medications, drugs or surgical procedures. Those things are life saving treatments for many women. But the vast majority of women are harmed by these interventions; or, at the very least, not saved by them. When 1 in 10 women who receive an epidural don’t feel the positive, pain reducing effects of that epidural, it means that 1 in 10 have to endure labor without pain medication, and often without any means of preparation to cope with the intensity of childbirth. It makes more sense to learn the coping techniques of natural childbirth (hypnosis, Lamaze, etc), so that in the event of an epidural being unsuccessful, you have something that has proven to be effective in reducing the amount of pain a mother feels.
When you look at the list of things that can happen in a medicated childbirth, you have to ask… why? To prevent some temporary, natural pain? It does end. In fact, for some women, childbirth isn’t even painful in the slightest. Intense, yes. Hard, yes. But not painful. Not everyone is so lucky, and many women have painful births, but it does end. And the temporary benefits of a medicated birth (no pain) do not outweigh the possible risks, like spinal headaches (said to be worse than childbirth), fetal distress and cesarean.
Having a medicated birth does not guarantee a pain-free outcome, but it does decrease your odds of having a positive birth experience.
Having a natural childbirth does not guarantee a 100% positive outcome. But it does improve the odds.
In the end, you have to look at the evidence, and your particular situation. Is there something about you that makes you incapable of having a natural childbirth? It’s doubtful, but possible. Would having a natural childbirth benefit you and your baby? According to the evidence; yes. It’s up to you, the expectant mother, to weigh these questions and evidence to decide what is best for you.
References:
Admission EFM does not improve outcome
Satisfaction with Planned Place of Birth
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