Rwina Balto
PhD Student, College of Nursing
March 23rd, 2021
The Shift in Natural Childbirth
In the past few years, consumers have shifted their terminology around birth and have begun to label their births differently. These days, when consumers ask for a natural childbirth experience, it turns that what they most often mean is that they want a vaginal birth. As a midwife, when mothers tell me they want a natural birth, I view it as them wanting to labor without pain medications and to receive physical and emotional support from me. In midwifery, this is called 'Being 'with woman', where births are just like they were in the past, natural and without medical interventions.
Natural birth is still vaginal delivery but without medical interventions, while vaginal birth is not necessary a natural delivery because of the interference of technology. With global modernization and the vast growth in the economy, healthcare, and the population, technologies are becoming more available and accessible. Technology reached beyond operating rooms and made its way through labor and delivery units. While there are benefits to having a natural childbirth, there are also benefits to using advanced equipment, like having the ability to save a mother and her baby's life when complications occur. Yet, it is not necessary to use technology when labor is progresses on its own physiologically with hormonal cascades, and it could in fact be harmful. Labor interventions are widely used among obstetricians, and it is not their fault. It is just the way they were trained in medical schools. By obstetricians increasing the use of epidurals and narcotics during birth, inducing and augmenting labor with Pitocin, and using suction and forceps, they contributed to the major shift in birth terminology. All these methods could lead to a vaginal but not natural birth. Therefore, women’s understanding of natural childbirth has changed.
What is Natural Childbirth?
A
natural childbirth occurs when a pregnant person gives birth without medical
aid. In a natural childbirth, labor and delivery occurs without
medications or monitors; however, the patient is assured of equipment
availability in case anything goes wrong or becomes complicated. Natural
childbirth involves having a baby physiologically by the power of the human’s
innate capacity of the woman and baby. This is no different from how women used
to give birth thousands of years ago. Women’s bodies respond to a hormonal
cascade that starts the process of labor on its own. Naturally released Pitocin
is responsible for the womb's contractions, moving the baby toward the birth
canal. Moms then feel the urge to push until the baby is out. This birth is
more likely to be safer and healthier, because there is no medical intervention
that interrupts the physiological process for labor and delivery.
History
In the 1900s, women used to give birth at homes as hospitals were not widely available. Labor was attended by the traditional “Granny midwives;” their main duty was to support women during childbirth. Later, midwives have been replaced by doctors, especially among rich families. Following that, in 1910, Twilight anesthesia was found to ease pain and sleep during labor- morphine and scopolamine- medications that affect mothers' memory during birth and increase the risk of mothers and baby’s death.
Surprisingly, most doctors at that period of time did not have formal education. They forced deliveries by: using artificial Pitocin, cutting an episiotomy, and using a vacuum and forceps to deliver the baby. They then extracted the placenta, gave another dose of Pitocin to contract the uterus, stitched the cut they made, and they were done! All these interventions led to the emergence of infant deaths due to the associated injuries.
In opposition to the medicalization of childbirth, Dr. Grantly Dick-Read issued a book in 1942 explaining the benefits of natural childbirth and calling for the return to normal and the avoidance of harmful interventions. Following that in 1950, The National Organization for Public Health Nursing stressed pregnancy and birth as a natural process.
What It Was Like Giving Birth In Every Decade Since
the 1900s
The Shift to Midwifery-led Care
With the recent increase in the rates of cesarean sections, inductions, and other interventions, it is time now to call for action and shift the paradigm to return childbirth to midwives as promoters of natural birth and better health outcomes. Only high-risk deliveries should be given to obstetricians so midwives can be in charge of all low-risk cases. In fact, countries like Finland, Sweden, and Norway have the highest survival rates for mothers and infants worldwide. Nordic countries' systems highly support the investment in midwifery education and foster industrialization and welfare development. Midwifery is one of the oldest professions, but it is still not fully recognized either by cultures or healthcare systems.
What is Modern Midwifery
A certified midwife provides comprehensive primary care services for women beginning in adolescence through menopause. They are competent to provide gynecologic and obstetric care, preconception, family planning services, care for women during pregnancy, childbirth, and the care postpartum. Their scope of practice also includes caring for newborns up to 28 days of life and treating male partners with sexually transmitted infections (American College of Nurse Midwives, 2021).
Public Awareness about Midwifery
CesareanRates(2021)
The use of unnecessary medical interventions is resulting in poor health outcomes. Induction of labor and cesarean section rates are increasing and thus cause harmful effects to mothers and their babies (DeJoy, 2010). There is a need to further expand the midwifery workforce within healthcare systems and enhance public awareness about natural childbirth and midwifery practice as an available option for women (Newick et al., 2013). Research has shown that women tend to avoid midwifery services because they don’t understand the role of a midwife (Peprah et al., 2018). Therefore, promoting community education about midwifery care is fundamental in preventing harm and providing the best available care.
The view of natural childbirth has changed over the years and after the invention of medical technology. People used to perceive natural birth as a physiological process that only needs support from a birthing assistant or a traditional midwife without an obstetrician's attendance. Nowadays, obstetricians have taken control of the natural birthing process, and birth is still vaginal, yet not natural. The midwifery profession's return helps give back control to women and promotes the original concept of natural childbirth.
References
American College of Nurse-Midwives (2012). Definition of Midwifery and Scope of Practice. https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000266/Definition%20of%20Midwifery%20and%20Scope%20of%20Practice%20of%20CNMs%20and%20CMs%20Feb%202012.pdf
American College of Nurse-Midwives (2019). The Credential CNM and CM. https://www.midwife.org/acnm/files/cclibraryfiles/filename/000000008158/Revised_CNM-CM-CPM_Comparison_Chart-December2019.pdf
https://birthtools.org/What-Is-Physiologic-Birth
DeJoy, S. B. (2010). “Midwives Are Nice, But...”: Perceptions of Midwifery and Childbirth in an Undergraduate Class. Journal of Midwifery & Women's Health, 55(2), 117-123.
https://acnm-acog-ipe.org/wp-content/uploads/2019/07/History-and-Culture-of-Birth_-final-combine_Rev.pdf
Newick, L., Vares, T., Dixon, L., Johnston, J., & Guilliland, K. (2013). A midwife who knows me: Women tertiary students' perceptions of midwifery. New Zealand College of Midwives Journal, (47).
Pajalic, Z., Pajalic, O., & Saplacan, D. (2019). Women's education and profession midwifery in Nordic countries.
Peprah, P., Abalo, E. M., Nyonyo, J., Okwei, R., Agyemang-Duah, W., & Amankwaa, G. (2018). Pregnant women’s perception and attitudes toward modern and traditional midwives and the perceptional impact on health seeking behaviour and status in rural Ghana. International journal of Africa nursing sciences, 8, 66-74.
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