| Natural childbirth | |
|---|---|
| Intervention | |
| MeSH | D009321 |
Natural Childbirth is a philosophy of childbirth that is based on the belief that women who are adequately prepared are innately able to give birth without routine medical interventions. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. The term "natural childbirth" was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in the 1930s, which was followed by the 1942 Childbirth Without Fear.
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Historically, most women gave birth at home without emergency medical care available. The "natural" rate of maternal mortality - where nothing is done to prevent maternal death - has been estimated at 1500 per 100,000 births. In the United States circa 1900, before the introduction and improvement of modern medical technologies, there were about 700 maternal deaths per 100,000 births (.7%). [1] (However, natural childbirth advocates recognize the importance of emergency medical intervention, which can avert maternal or neonatal death.)
At the onset of the Industrial Revolution in the 19th century, giving birth at home became more difficult due to congested living spaces and dirty living conditions. This drove urban and lower class women to newly available hospitals, while wealthy and middle-class women continued to labor at home.[2] In the early 1900s there was an increasing availability of hospitals, and more women began going into the hospital for labor and delivery. In the United States, the middle classes were especially receptive to the medicalization of childbirth, which seemed to promise a safer and less painful labor.[3] In fact, the ability to labor without pain was part of the early feminist movement[1]. With this change from primarily homebirth to primarily hospital birth came changes in the care women received during labor: although no longer the case, in the 1940s it was common for women to be routinely sedated and for babies to be delivered from their unconscious mothers with forceps (termed by Dr. Robert A. Bradley as "knock-em-out, drag-em-out obstetrics"). Other routine obstetric interventions have similarly come and gone: shaving of the mother's pubic region; mandatory intravenous drips; enemas; hand strapping of the laboring women; and the 12 hour monitoring of newborns in a nursery away from the mother.
Beginning in the 1940s, childbirth professionals and mothers began to challenge the conventional assumptions about the safety of medicalized births. Physicians Michel Odent and Frederick Leboyer and midwives such as Ina May Gaskin promoted birthing centers, water birth, and homebirth as alternatives to the hospital model. Some research has shown that low-tech midwifery provides labor outcomes as good as or better than those found in hospital settings with fewer interventions, except for a small percentage of high-risk cases.[4]
Many women consider natural birth empowering.[5] A woman who is supported to labor as she instinctively wants to, is a woman who will likely feel positive about her birth experience and future parenting skills. Her baby is more able to be alert and placed on her skin (promoting maternal bonding) and breastfeeding is more likely to be enjoyable and successful.[6] Studies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves mother-infant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with the mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life, a practice seldom done when birth occurs in a hospital setting.[7]
Research has estimated that up to 95 percent of women can safely give birth without medical interventions (including, but not limited to, epidurals, caesarian sections, vacuum extraction, and forceps). Therefore, the midwifery model of care, which usually holds a more holistic approach to labor and delivery, tends to avoid such routine interventions (which can lead to complications for both mother and infant) when used for the sake of convenience, and rely on medical tools only when they are deemed absolutely necessary to ensure safety [8] .
Instead of interventions, a variety of non-invasive methods are employed during natural childbirth to aid the mother, since they do not to carry the inherent risk of medical procedures. Many of these stress the importance of "a mind-body connection," which the techno-medical model of birth tends to ignore. Pain management techniques other than medication include hydrotherapy, massage, relaxation therapy, hypnosis, breathing exercises, acupressure for labour, TENS, vocalization, visualization, mindfulness and water birth. Other approaches include movement and different positions (i.e. using a birthing ball), hot and cold therapy (i.e. using hot compresses and/or cold packs), and receiving one-on-one labor support like that provided by a midwife or doula. However, natural childbirth proponents maintain that pain is a natural and necessary part of the labor process, and should not automatically be regarded as entirely negative. In contrast to the pain of injury and disease, they believe that the pain of childbirth is a sign that the female body is functioning as it is meant to.
Some methods used to augment labor without medication require that the woman is an active participant in the birthing process. They include frequently changing positions and walking. Birth positions favored in natural childbirth - including squatting, hands and knees, or suspension in water - contrast with the popular lithotomy position of a medicalized birth (woman in hospital bed on her back with legs in stirrups), which has consistently been shown to slow and complicate labor [9] . Methods to reduce tearing (instead of an episiotomy) include managing the perineum with counter-pressure,[10] hot compresses, and pushing the baby out slowly.
Some women take birth education classes (such as Lamaze, the Bradley Method, Brio Birth, CAPPA, ICEA, Hypnobabies.) to prepare for a natural childbirth. Several books are also available with information to help women prepare. A midwife or doula may include preparation for a natural birth as part of the prenatal care services. However, a study published in 2009 suggests that preparation alone is not enough to ensure an intervention-free outcome. [11]
A recent study revealed the rates of medical intervention in childbirth in the U.S. found that 93% of mothers used electronic fetal monitoring; 63% used epidurals; 55% had their membranes ruptured; 53% received Pitocin to stimulate labor progress; and 52% received episiotomies.[12]
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