Benefits of a Natural Birth

Some feel that "going natural" is a rite of passage in life, and offers empowerment to those women who experience a normal labor and birth. While this is true for many women who experience it, still others claim a similar experience after having a medically managed delivery. So for the purpose of this article I will discuss the physical aspects only of how starting labor on your own can start you on the path to having a normal birth.

In essence, induction of labor is a symptom of a culture that is taught not to trust our bodies. The 2005 Listening to Mothers II study suggested that 41% of women are induced into labor, and still more are given drugs or procedures to "hurry things along". Some of the most common reasons for inducing labor are actually the most questionable, even according to the American College of Obstetricians and Gynecologists, and highly reputable books like A Guide to Effective Care in Pregnancy and Childbirth. These are five of the most common, yet questionable, reasons for inducing labor:

1. "Baby is getting too big" - The prospect of pushing out a larger than average baby can be enough to scare a woman into accepting an induction, but there are a few reasons why this practice is an unacceptable standard. For one, babies do not have hardened skulls until several weeks after delivery, they are designed to mold and and form to the shape of a woman's pelvis, no matter the size of either one. Also, the fear that a big baby could make birth dangerous is unfounded because half of shoulder dystocia cases (where the baby's shoulders get stuck after delivery of the head) occur with average sized babies. Other reasons why "macrosomia" is not a medical indication for induction: fetal size appears to level off after 40 weeks gestation, ultrasound measurements of fetal size are likely to be inaccurate when a baby is larger than average and can be misleading by up to a pound smaller or larger than the actual size, and induced labor is actually contraindicated for large babies.

2. Gestational Diabetes - Women who have high intakes of sugar in their diet often have larger babies. However, new research suggests that there is no such thing as gestational diabetes, rather that a pregnant woman's metabolism changes, and thus her sugar levels appear higher than normal, even if she is in good health. Obviously, a good diet is beneficial to a good birth, but even if a woman is diagnosed with gestational diabetes, it doesn't mean that labor induction is medically indicated.

3. Too little or too much amniotic fluid - This one is becoming more common in my experience. A woman goes in for a routine ultrasound late in pregnancy and she is told that her amniotic fluid level is a bit higher or lower than average. She is then scheduled for an induction, since a low or high level could indicate that the placenta is getting "old". In reality, amniotic fluid is only an indicator of placental troubles if it is at a significantly abnormal level. Dehydration of the mother could in itself cause the fluid level to be a little low. Plus, the test is questionable in it's accuracy, since it is more a guestimate that anything else.

4. "Failure to progress" in labor - This diagnosis is based on the concept that labor and birth must be quick, but in fact there is no prescribed length of normal labor. If mom and baby are doing well, than there is no reason to rush her to delivery. There are several ways that a woman progresses through labor, not just in cervical dilation, and sometimes a baby just needs a bit more time to turn into the right position for birth.

5. Convenience, for mother or caregiver - Your caregiver may come up with a questionable reason to induce because induction is more convenient, and some women prefer to schedule their baby's birth date. In 2004, 12,000 babies were born every weekday, compared to 8,000 on days of the weekend. Unless there is a very good medical indication, the risks of induction far outweigh the benefits of inducing for convenience.

Risks of inducing or augmenting labor (Pitocin, prostaglandins, amniotomy, and herbs when used inappropriately):

Increased pain

Intrauterine infection

Septicaemia

Early decels in fetal heart rate

Fetal distress

Cord prolapse

Reduced fetal oxygenation

Fetal bleeding

Cervical bleeding

Placental bleeding

Water retention

Hyponatraemia

Coma

Convulsions

Maternal death

Fetal death

Water intoxication

Uterine hyperstimulation

Uterine rupture

Newborn jaundice

Nausea

Vomiting

Diahrea

Fever

Rise in leucocyte level

Headaches

Dizziness

Hemorrhage

Amniotic fluid embolism

Fetal brain damage

Increased instrumental and cesarean deliveries

Interference in bonding and breastfeeding

Failure to progress in labor

Although these risks can be serious, the benefits of using them appropriately may outweigh the risks when used for very good medical reasons. Only 5-10% of pregnancies normally fit this description and include the following indications:

1. Gestation past 42 weeks - The due date should really be a "due month" because a healthy baby can be born between 38 and 42 weeks, and sometimes even outside this time period. As Dr. Michel Odent has said, you don't pick all your apples on the same day. Approximately 3% of pregnancies, if left alone, would go beyond the 42 week mark, and only about 10% of babies get into trouble after 43 weeks of pregnancies, so although a truly postdate pregnancy is reason to consider induction, other aspects of the mother's and baby's health should be considered as well, to make sure that the benefits of induction outweigh the risks.

2. Evidence of placental malfunction - Sometimes a placenta will gradually stop functioning well before the baby is ready to be born. Obviously this is not a good situation for the baby, so it would be better to cut the pregnancy short in this case. Placental malfunction can't be diagnosed until after the birth, but signs of it occuring include a significantly declining fetal growth rate, and little fetal movement. It is reassuring to know that even at 42 weeks, 95% of placentas are functioning just fine.

3. Too small for gestational age - although some babies are born small because of genetics, this can be a sign of placental malfunction.

4. Preeclampsia - This prenatal health condition indicates stress on the mother's body, it's way of saying "I've had enough!" If not monitored carefully, and induced if symptoms are reaching dangerous levels, serious consequences could result. However, mild pregnancy-induced hypertension (moderately high blood pressure) is not an indication for induction.

5. Premature rupture of membranes - If the mother's water breaks before contractions start, it is safe to wait 48 hours before inducing, unless there are signs of infection. One 1996 study said there was no increased rate of infection up to four days following rupture of membranes! If this happens to you, you can reduce your chance of getting a uterine infection by abstaining from sex, showering instead of bathing, keeping vaginal exams to an absolute minimum, and not inserting anything else into your vagina either. Your vagina is a sterile environment until something is inserted, and even sterile gloves inserted can carry bacteria from the vaginal outlet up the vaginal canal.

6. Fetal hypoxia in labor - If the heart rate of the baby starts reacting negatively to contractions, it can be an indicator that he is not getting enough oxygen and the labor is stressing him out. Although electronic fetal monitors have high false positive rates for fetal distress, a clear pattern of hypoxia is a strong indicator for hurrying labor along (if close to birth) or for cesarean section (if birth is not imminent). Fetal hypoxia and distress rarely happen when a woman goes into labor on her own and she is given no drugs whatsoever during labor.

If you do consent to an induction or augmentation, NEVER allow your doctor or midwife to give you Cytotec. This drug is very dangerous because it frequently causes hyper-stimulation of the uterus, which can easily lead to fetal distress and uterine rupture, and has a much higher rate of fetal and maternal death than other induction drugs. This drug is not approved by the FDA or it's manufacturer for the purpose of labor induction, but sadly it is still used in many hospitals across the United States.

If your doctor or midwife suggests that you be induced or given drugs or herbs to augment labor, ask questions like these to make sure that you are fully informed of the pros and cons to the decision that you make (specific information on labor inducing drugs can be found on the NIH or CDC websites. You can also check my references for more information):

1. Why are you suggesting this? Is it medically indicated?

2. Is the drug FDA approved for inducing labor?

3. How will it help me?

4. What are the risks and consequences associated with it?

5. How often do your patients need an epidural after this drug is used?

6. How often do your patients need an instrumental or cesarean section after this drug is used?

7. What are the alternatives and their pros and cons?

8. What happens if I don't get induced?

Safer alternatives to drugs and herbs for inducing labor, if it is medically indicated, include nipple and clitoral stimulation, unprotected sex, long walks, gravity, and spicy food.

Now, after scaring you about inductions and bad births, I will tell you what a woman's body will most likely do if she is left alone and trusted to do what she needs to do.

There are several theories as to what starts labor, and no one knows for sure how to explain this mystery of nature. Most likely this is about what happens. The pregnancy is a time of creating and developing the baby's organ systems and all the intricacies that allow the baby to survive outside the womb. Near the end of pregnancy, as the baby's lungs (the last to finish development), or the adrenal glands, send enzymes and chemicals to the mother's brain through their blood supply. This enzyme and/or chemical signal tells the woman's body that it is time and she begins to produce prostanglandins that soften and loosen her cervix, and oxytocin (the body's natural version of Pitocin) to begin effective contractions that will open her cervix.

As the contractions increase in frequency and strength, they force the baby to move downward against the cervix, which triggers the release of more oxytocin, which causes contractions that open the cervix and push the baby down. It becomes a natural cycle of labor, and the majority of women will do this on their own within a safe time period if they are "allowed" the opportunity.

References

"Creating Your Birth Plan" by Marsden Wagner, M.D., M.S.\

"A Guide to Effective Care in Pregnancy and Childbirth" Second Edition, by Enkin, Keirse, Renfrew, and Neilson

"Pushed" by Jennifer Block

"Born in the USA" by Marsden Wagner, M.D., M.S.