Unmedicated birth comes with many benefits but also has its challenges. If you plan to avoid interventions, including pain medications, you need to prepare more than someone comfortable utilizing interventions to assist with their labor. This article explains why some parents choose unmedicated birth, what a physiologic birth without interventions looks like, and how to prepare for an unmedicated birth. Even if you plan for an epidural or other intervention, this article has tips to prepare and get as close as possible to the birth experience you want.
Article and Resources
Defining Natural Birth
The term “natural childbirth” was coined by an obstetrician in the 1930s with the book Natural Childbirth. He defined natural birth as birth with the absence of any intervention that would otherwise disturb labor sequence. He went on to publish Birth without Fear, which is still in print and widely read today. His view was that fear causes tension which creates pain, and he was an advocate for birthing without interventions.
The Negative Stigma of Natural Birth
There has been some criticism that all births are natural and that birth with pain medication or interventions is not unnatural. The New York Times argued that there is no universal definition of natural birth, and the term could shame women whose births are deemed not natural. For this article, we talk about natural birth as birth without pain medications and with little to no interventions. Birth is not a black and white choice between birth with no interventions in your bathtub at home and an emergency cesarean in a hospital. There is a wide array of interventions you or your care provider could employ to assist you in labor. We are fortunate to have access to these interventions when they are needed.
Pain in Labor and Birth
Choosing an unmedicated birth is not a rejection of the advances we have made in medicine. One popular question is, “You wouldn’t go to the dentist and have them work on your teeth without anesthesia. Why would you have a baby without anesthesia?” It isn’t as cut and dry as dealing with pain or not. The experience of labor and birth is about a lot more than whether or not you feel pain or discomfort. See this article on reframing how you think about labor pain.
Why Parents Choose a Birth without Interventions
The trend of unmedicated births grew in the 60s and 70s. Today, the list of people opting to have a natural birth is growing every year. Many celebrities who have all of the resources of money and medical care available chose to forgo a typical hospital birth with an epidural and birth without interventions. Some of the women on this list include Kate Middleton, Mila Kunis, Cindy Crawford, Gisele Bundchen, Demi Moore, and Beyonce. There are many reasons parents choose parents may choose a birth with little or no interventions. Most of those reasons center on not wanting to disturb the physiologic process of labor and birth.
All Interventions Involve Benefits and Risks
All interventions have benefits and risks. The risks involved vary with each procedure, and there are in-depth episodes of the Pregnancy Podcast that dive into the evidence on interventions.
- Vaginal Exams
- Group B Strep (antibiotics)
- Inducing Labor
- Electronic Fetal Monitoring
- IV Fluids
- Nitrous Oxide
- Other Pain Management Options
- Cesarean Birth
- Third Stage of Labor (Pitocin)
Birth as a Physiologic Process
Proponents of unmedicated birth often cite that women have been giving birth without interventions for thousands of years. This is true, and it goes back even further than that. Birth is a physiologic process that has been perfected over an extremely long period. Our bodies are built to give birth. The survival of our species depends on it. Let’s examine what the birth process looks like without interventions. Our understanding of this process, the hormones involved, and how they impact labor and birth is constantly improving. We do not know exactly how everything works. Understanding the birth process may help explain why some moms choose an unmedicated birth.
The Last Few Weeks of Gestation
The last few weeks of pregnancy are critical to your baby’s development. You pass maternal antibodies to your baby to help fight infections in their first days and weeks of life. Your baby is gaining weight and strength. They are increasing iron stores and developing more coordinated sucking and swallowing abilities. The last few weeks are also when your little one’s lungs mature and prepare for that first breath of air. Your baby is storing brown fat, which will help them maintain their body temperature in the first weeks following birth.
The Symphony Leading Up to Labor
As your baby and your body get ready to go into labor, your placenta triggers an increase in prostaglandin that softens the cervix to prepare it for effacing and dilating. Your estrogen levels rise, and progesterone levels decrease, which makes the uterus more sensitive to oxytocin, which is the hormone responsible for contractions. Nearing labor, your baby will move further down into the pelvis. While all of this is going on internally, you may notice that you have extra energy, which allows you to make any final preparations. You may have trouble sleeping, which is thought to help prepare you for being awake at all hours with a new baby. This symphony of everything is working together in sync starts your labor naturally when both you and your baby are ready.
During your pregnancy, oxytocin is a hormone that allows your body to absorb nutrients better, reduce stress, and helps you conserve energy by making you sleepier. During labor and birth, oxytocin is the driving force of your contractions. You need a steady flow of this hormone to keep labor progressing.
It isn’t a coincidence that oxytocin is also the hormone released when you have an orgasm. Oxytocin is known as the love hormone, and many people argue that the environment you give birth in should be similar to the environment you make love. Your labor will progress best in an environment where you feel safe and relaxed. In the wild, most animals retreat to a quiet, safe place to give birth. If there is any sign of danger, their bodies will halt the birth so they can react to the threat and find safety. Humans operate the same way. Your levels of oxytocin will be highest when you are in a safe environment. For some parents, this is at home or a birth center. Others feel safest in a hospital, and you can have an unmedicated birth with no interventions in a hospital setting. There is also a lot you can do in any location to modify your birth environment.
In the first stage of labor, when your cervix is dilating and effacing, your body produces a beta-endorphin hormone that can act as an opiate or pain-killer. This is a stress hormone you release under conditions of duress. The synthetic drug morphine acts similarly to beta-endorphin. It also suppresses the immune system, which is thought to be important in preventing your immune system from acting against your baby, who has different genetic make-up from you.
When you are in labor, and high beta-endorphin levels are released, this will reduce oxytocin levels, slowing down your contractions. While this may seem counterproductive to birth, this keeps labor at a pace where you can experience the positive effects and relief from beta-endorphins and at a pace where your body can handle the stress.
Beta-endorphin is similar to morphine in more aspects than just pain relief. Beta-endorphins also induce feelings of pleasure and euphoria. The high levels during birth can even help you enter an altered state of consciousness. This can feel like a high, similar to being high on a drug, but without any adverse side effects. You will sometimes hear birth educators or practitioners talking about a birthing mother being in labor land. This is used to describe this sort of meditative state where you are zoned out of what is going on around you and focused on what is going on internally with your baby and body.
Hormones in the Second Stage of Labor
At the end of the first stage of labor, your cervix is fully dilated at 10 centimeters, and you enter the transition phase. This takes you into the second or pushing stage of labor. This is where your fight-or-flight hormones come in, which are classified as catecholamines. These include adrenaline, also called epinephrine, and noradrenaline, also known as norepinephrine. Your adrenal gland secretes these hormones in response to stress, and they get your body ready for a fight or flight response. While these hormones can slow things down a bit in the first stage of labor, they act differently in the second stage, just before your baby is born. Right before the moment of birth, there is a sudden increase in catecholamines, especially noradrenaline, and this works with oxytocin, which activates the fetal ejection reflex.
Stereotypically when this happens, you will get a sudden rush of energy, you will be upright and alert, your mouth will be dry, and your breathing will be shallow. You could express fear, anger, or excitement, and the rush of these fight or flight hormones will cause several very strong contractions, which are designed to birth your baby quickly and easily. These hormones will also help your baby during birth by protecting them against the effects of hypoxia, which is a lack of oxygen; when your uterus contracts, oxygen flow is temporarily restricted. After birth, your levels of catecholamines quickly drop, which will help your body release more oxytocin.
Hormones After Birth
Once your baby is born, you will immediately get skin to skin. Oxytocin is continuing to be released, which is going to continue contractions. These contractions will be milder than the ones you experienced during birth. The purpose of the continued contractions is to push the placenta out of your uterus, close off the blood vessels attached to it, and start shrinking your uterus. This process is vital to prevent postpartum hemorrhage, heavy bleeding and can be a serious complication.
Effects of Hormones on Your Baby
All of the hormones you are going through during birth also transfer to your baby. Immediately following birth, both you and your baby will have really high levels of oxytocin, which will help promote bonding. The fight or flight hormones are going to make your baby alert for their first contact with you. Skin-to-skin contact will soothe your little one and help lower those adrenaline and noradrenaline levels.
The First Latch and Breastfeeding
One of the first things that happen naturally after birth is that your baby instinctively wants to latch on to breastfeed. If a newborn is placed on your abdomen after birth, they will use all of their senses; sight, touch, taste, smell, and sound to instinctively crawl up to your breast and latch on. Babies come prewired to breastfeed, and hormones have a lot to do with the process of your body producing milk and the breastfeeding relationship.
The hormone most associated with breastfeeding is prolactin, and it is also known as the mothering hormone. Throughout your pregnancy, you produce higher than normal prolactin levels, but the production of milk is inhibited until the third stage of labor when you birth the placenta. Your prolactin level decreases during labor, increases at the end of your labor then peaks at birth. This hormone does more than help you to produce milk. Prolactin also fosters nurturance from you to your baby, and that will overall help your breastfeeding relationship.
Oxytocin also plays a part in helping promote the let-down reflex, which is the reflex that causes milk, or initially colostrum, to be released, and this is going to help signal your body to produce milk. Another factor that will help to breastfeed is a peak in your beta-endorphin levels about 20 minutes after birth. This hormone also ends up in your colostrum and fosters some dependency between you and your baby.
Intervention Benefits and Risks
You can see that labor and birth is a complex process with a lot of moving parts. Although we are constantly improving our understanding of how everything works with physiologic labor, we do not fully know the effects of everything. Each intervention that is introduced will impact the cascade of hormones that occurs during the physiologic process of labor.
All interventions have benefits and, when needed, help mothers who are having trouble in labor and, in some cases, save lives. The downside is that every intervention also comes with risks. Some parents choose to avoid interventions because they are not comfortable with the level of risk.
It is difficult to compare an unmedicated birth to a medicated birth because often, one intervention leads to others. For example, if you opt to have an epidural, you are also opting into electronic fetal monitoring and IV fluids. When you examine epidural use outcomes, it can be challenging to distinguish effects from a single intervention when multiple were used.
Planning for a Birth Without Interventions
If you plan for an unmedicated birth and want to avoid interventions, you need to educate yourself and prepare ahead of time.
Regardless of what type of birth you are planning, the more prepared you are, the better likelihood of you getting the birth experience you want. This is especially true with an unmedicated birth. If you choose to have a birth without pain medication, you are responsible for managing your labor, and you want a lot of tools in your toolbox. This can include learning about different labor positions, practicing meditation or visualization, breathing exercises, hypnobirthing, or listening to music. Taking a birth class is highly recommended, and preferably, a class focused on an unmedicated birth if that is what you want.
You will need physical and emotional support during your labor. You should have your partner or a friend or family member with you to support you through your labor. The more involved they are during your pregnancy, the better. Please include them in your birth class and prenatal appointments. The more they know what to expect and how to support you, the better.
Consider a Doula
If you plan an unmedicated birth, one of the best things you can do is get a doula. In a review of numerous studies involving over 15,000 women, it was found that having continuous support during birth had a significant impact on birth outcomes. Involving a doula will increase the likelihood of you having a spontaneous vaginal birth, meaning you don’t require any intervention to go into labor, decrease the likelihood of using pain medications, reduces your risk of a C-section, or an instrumental delivery with forceps or a vacuum, and decreases the length of your labor. If you want a better idea of what a doula is and how they support you during labor, check out this episode.
Working with Your Doctor or Midwife
It is critical to have the support of your doctor or midwife. Ideally, you are working with a care provider with a lot of experience with an unmedicated birth. They will be better equipped to help you navigate any challenges that come up without employing interventions. You should be discussing your preferences for birth in your prenatal appointments throughout your pregnancy so when you go into labor, you are both on the same page to work together to get you as close as possible to the birth you plan for.
Using Your BRAIN
No matter how much you prepare, there is an element of labor and birth that is unpredictable and out of your control. Please educate yourself about different interventions, even if you do not plan to use them. If an intervention becomes necessary or you decide you want to opt into something like an epidural, you want to have some knowledge about it beforehand. If your doctor or midwife suggests a procedure, there are some excellent questions you can ask to help determine whether it is in your best interest to utilize the intervention. You can remember these by using the acronym BRAIN.
- Benefits: What are the benefits?
- Risks: What are the risks?
- Alternatives: What are the alternatives?
- Intuition: What does your intuition tell you?
- Nothing: What happens if you do nothing?
You can ask these questions to assess any intervention. Running through these with your doctor or midwife will help you understand all of the pros and cons and help you make the best decision for yourself and your baby.
Your Birth Plan and Your Back up Plan
Creating your birth plan will help you get clear on what you want and work with your care provider to ensure you are all on the same page. Typing up your preferences and handing a piece of paper to your doctor, midwife, or nurses during your labor will not guarantee you get the birth you want with the support you need. The value of having a birth plan is in the preparation you do with your partner and your care provider ahead of time. For example, if you do not want active management of the third stage of labor, you need to know that your care provider can and will support that choice. Some care providers have a standard policy of using Pitocin in the third stage of labor. If you need to work through any issues that you and your provider do not see eye to eye on, you want to do it early. You do not want to try and have a conversation about using Pitocin while birthing your placenta. Make it a priority to talk through your preferences during appointments before you are in labor.
If you would like to see a sample birth plan, I would be happy to send you a copy of mine as an example. Your preferences may be different from mine, but at least you can see an example of how a birth plan could be worded and structured. I did plan for an unmedicated birth at a birth center, and I had a backup birth plan in the event I ended up in the hospital. Click here to get free copies of these sample birth plans.
Preparing for Challenges
Labor can be a marathon, and you do not know how long you will be in labor. Exhaustion and sleep deprivation can be huge challenges. These are common reasons mothers who plan for an unmedicated birth decide to get an epidural. The best thing you can do is to go into your labor well-rested. If you are having some signs of early labor and can sleep, please do. Even if it is during the day, sneaking in some rest or a nap can be beneficial hours later. This also goes for your partner. If they are going to be by your side for the duration of your labor, they need to be well-rested.
Mindset can also be important as labor gets progressively more challenging. There is an article on reframing how you think about labor pain that may be helpful. Remember your reasons for wanting the birth you do and focus on the result of meeting your baby.
If you are reading or listening to birth stories, please focus on positive birth stories. Spending time on other people’s negative experiences and hearing horror stories will not help you go into your labor with positive expectations. You want to surround yourself with stories of people who triumphed and reflect on their birth as a positive experience.
The Business of Being Born is a documentray about physiologic labor. This was done by Ricki Lake, who is a huge advocate for physiologic childbirth. If you have not seen it, I recommend you do. It is pro “natural” birth, but it brings up some interesting statistics and comparisons between physiologic and medicated birth. You can rent the movie on Amazon. One other great resource if you are planning on an unmedicated birth is Ina May’s Guide to Childbirth. This book is about half informational and half birth stories.
You Always Have Choices
The bottom line is that you have choices. You do not have to choose between having your baby in a bathtub at home or in a hospital with a c-section. Birth is not a black and white choice between two opposing methods. You have an infinite number of options, and there are many shades of grey where you can combine the tools, techniques, and procedures you think will be best for you and your baby and craft the birth experience you want.
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