Something to Prove

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Six Natural Ways To Reduce Pregnancy Related SwellingThe other week I was watching Ellen and a very pregnant Kristin Bell was on.  I should say now that I quite like Kristin Bell from what I can tell.  She seems nice, funny, and pretty down-to-earth for Hollywood standards.  During the interview, Ellen asked her if she was planning to have a natural birth.  Ms. Bell responded with a huge shake of the head and “I’ve got nothing to prove!”

Whether or not Kristin Bell meant the comment or if it was a joke, it’s a sentiment that you often hear from many mothers who plan (or planned) interventions in advance, and it got me wondering about why this is the belief around natural birth.  I posed the question on Facebook and got some very insightful comments from people, reaffirming a lot of what I thought and providing insights I hadn’t.  It seems a bit of deconstruction is needed here to better understand why there is a backlash against natural birth…

Problem 1:  “The people who birth naturally boast so much it’s like they think they’re better”

This is something I’ve heard for a while now.  And yes, I don’t think anyone can claim that a many women aren’t proud of themselves for having a natural childbirth these days.  It is a badge of honour so to speak.  However, does this mean they went into it trying to prove something to themselves, or worse, others?  I don’t think so.  If anything, I believe most women opt for a natural childbirth either because a) they know the risks of interventions and opt against that, or b) they have a natural faith in their body to birth naturally without intervention.  When they succeed they are happy (even if they are trying to prove something to themselves).

Some women plan for a natural childbirth and do not end up with it.  I think the same two reasons stated above apply to them as well, except the world just didn’t agree.  These women often feel disappointment and sadness over the loss of the natural birth experience and I believe this contributes to the view that others have about natural childbirth advocates and women thinking they’re “better”.  If I end up disappointed and sad that I had an epidural and share this with a woman who planned her epidural right from the start, she might take it personally and think that I must think it’s a “bad” thing to have if I feel disappointed.  What people forget is that what is good and bad will differ for each of us.  It’s often said these days that no one can make you feel bad about a personal choice you made for yourself if you made it informed and with your needs (and your family’s) in mind, but for some reason people seem to forget this in favour of feeling defensive.

Interestingly, I can’t help but feel that the “nothing to prove” comment also speaks to an awareness that a natural birth is a challenge (the reasons why will be touched on below, and in a society that is focused on the “easy” way of doing things, why would birth be any different?  But do we put people down who are proud of themselves for training and running a marathon or losing a significant amount of weight?  Not that I’ve seen, but somehow birth is different.  (Though there are many women who chose interventions who do not get defensive or feel bad when they hear of another mother’s natural birth.  To me, this is the biggest sign that a woman truly educated herself and made the decision that was best for her, regardless of what it was.)  We MUST remember that when one woman speaks of her birth, her expectations, and her experiences, it is not a commentary on anyone else’s birth, expectations or experiences, just her own.

Problem 2: “There’s absolutely nothing wrong with epidurals/pitocin/etc.”

I won’t get into the research too much here because I’ve done it all over this site, but yes there are risks associated with these interventions.  Sometimes the risks will be worth it, especially if other complications are happening and these can help remedy them, but when nothing’s wrong (and I include when doctors are following charts for dates instead of the pregnant woman in front of them)?  You get risks.  I’m sorry if people don’t like hearing that, but it’s true.  I covered the issue with epidurals (and tangentially pitocin) here and the risks associated with c-sections here.  These risks don’t mean that the choice may not be right for some families, but they will have hopefully educated themselves about the risks and the benefits and realized the risk:benefit works in favour of opting for the intervention.

One of the comments I got on the epidural piece that I would like to address here (and have updated that piece) was that the research was outdated; that epidurals were improved with no risks anymore.  Except that’s not true.  There has been ample research in the last couple years showing that epidurals are linked with a 4 to 8 fold increase in intrapartum fever in the laboring mother[1][2][3][4].  The problem with that?  Fevers are associated with negative greater intervention and greater risk for neonatal brain injury[3].  Furthermore, epidural-related temperature increases are linearly related with risk for hypotonia, assisted ventilation, low Apgar scores, and seizures[4].  If the temperature does not increase then there are no known negative effects of the epidural, but currently researchers and doctors have no idea why a fever is brought on by epidural analgesia or how to determine who is most at risk.  The fact that many people are unaware of this screams that women are not able to give informed consent for these interventions.  But that’s a whole other issue.

The real problem here is that as long as people believe that there is no risk or negative outcomes associated with interventions, their use will continue to proliferate and those who seek to avoid them will be considered as zealots or that they must have something to prove.  Because, after all, if there’s no good reason to go natural, why would you want to?  (Please note the sarcasm there.)

Problem 3:  The system is set up against you.  [A.K.A. The REAL Problem]

Let’s face it – the system as it stands in many North American cities is against natural birth.  Though it has nothing to do with what people think, it does influence the degree of pride that a woman may feel after having a natural birth.  With the hospital being the primary birthing locations for many women, they start off in a space that is dedicated to interventions and not letting nature run its course, intervening only when necessary (unlike certain hospitals in Europe where the focus is on natural birth).  Entering the hospital you also start the clock ticking because they have rules and guidelines about how long you can be in any one stage of labour.  If you don’t meet their criteria, they will intervene unless you have a system in place to fight them, and even then as we know from other stories, you run the risk of having people like CPS called on you (though very rare, it sadly does happen, see here for an example).  The question is though: How good is it for you to be trying to labour and having to defend yourself from the onslaught of doctors or nurses telling you that you need this intervention?  You also get the scare tactics, the times they tell you that your baby will die or that you are putting your baby at risk by not acquiescing to everything they want, even when nothing is wrong.  Of course, once you start down the path of interventions, you’re more likely to need another and then possibly another.  This is why we have c-section rates around 30% and intervention rates near 75%; although an unmedicated birth is historically normal and “natural”, it is by far not that today in Western societies.

[I remember when I was pregnant and speaking to a professor about birth as her partner had giving birth months earlier, I mentioned that I was planning a home birth.  Her response?  “Oh – we chose the hospital just because our primary concern was safety.”  Yes, if you don’t birth in a hospital you must not be concerned with your child’s well-being.  Ugh.  My response?  “Oh, well, I chose home because my primary concern is safety.” Shocked look followed, but opened up discussion on the science behind homebirth where I live.]

Not all hospitals, doctors, or nurses are like this, but far too many are.  So when a woman is able to birth naturally and succeeds at this, she has overcome many obstacles that are ever present in our society.  She is naturally proud of this and this pride probably has as much or more to do with not falling into the “system” as the actual experience.  Being able to own one’s body and be in control of the birthing process (as much as anyone can be in control) when we’ve been told – explicitly and implicitly – that we can’t do it, that we need doctors, that we can’t handle the pain of childbirth, or that something will go wrong, is incredibly powerful, and something worth sharing.

Again, I feel the need to reiterate that not all women will have the birth they want.  Not all women will birth naturally with no interventions, despite the plan to do so, and they are not lesser than any woman who was able to do it because of different circumstances.  It’s not that they didn’t try hard enough or trust their bodies enough, but there are times when things go wrong –not to the degree we’re led to believe and sometimes what goes wrong is fixable without medical interventions — but we are all glad that they are there when needed.  Furthermore, for the women who don’t want a natural birth, that’s okay too, but just because you don’t want it doesn’t mean someone else feels the same.

***

Natural birth isn’t about a woman feeling inferior in some way and thus having to prove herself to someone.  In fact, the idea is insulting, yet pervasive in our society.  Perhaps in every natural birth there is an element of showing the system that it can be safer when natural or that following one’s instincts and body is not inherently dangerous, and this is something worth discussing so women understand their options.  I can’t help but feel that this negative attitude towards natural birth stems from a medical system that knows it may have to drastically change if women truly were free to make their own choices in their births and only expect to be supported in those choices.  This means there is also nothing “wrong” with not having a natural birth.  Each woman needs to make a decision for herself about the type of birth she wants and make sure she is fully informed about what it is she is choosing.  Some will choose interventions, some won’t, and when the decisions are made because it is best for that woman, no one has anything to prove.



[1] Shatken S, Greenough K, McPherson C.  Epidural fever and its implications for mothers and neonates: taking the heat.  Journal of Midwifery & Women’s Health 2012; 57: 82-85.

[2] Riley LE, Celi AC, Onderdonk AB, Roberts DJ, Johnson LC, Tsen LC, et al. Association of epidural-fever and noninfectious inflammation in term labor.  Obstetrics & Gynecology 2011; 117: 588-595.

[3] Segal S. Labor epidural analgesia and maternal fever.  Anesthesia & Analgesia 2010; 111: 1467-1475.

[4] Greenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E.  Intrapartum temperature elevation, epidural use, and adverse outcome in term infants.  Pediatrics 2012; 129: 3447-454.

Comments

  1. says

    I sometimes boast about my natural births, not becuase I think I’m better than everyone, but because I’m proud of achieving my goal! I had many challenges to overcome in order to do this and I don’t see why I shouldn’t be proud of my accomplishments. If these were not other woman’s goals, that’s fine, they were MINE. If other women were unsuccessful, I can empathize, my pregnancies and 1st birth didn’t go how I planned either. It was pretty traumatic.

    There is a great deal of misinformation out there about birthing and babies, a great deal of cultural knowledge has been lost over the last few generations. I wonder at the defensive posturing many women take when it comes to pregnancy, birthing and breastfeeding, in raising kids in general. These things have become a taboo subject in polite company much like politics and religion and I can’t think of anything less empowering.

  2. says

    I sometimes boast about my natural births, not becuase I think I’m better than everyone, but because I’m proud of achieving my goal! I had many challenges to overcome in order to do this and I don’t see why I shouldn’t be proud of my accomplishments. If these were not other woman’s goals, that’s fine, they were MINE. If other women were unsuccessful, I can empathize, my pregnancies and 1st birth didn’t go how I planned either. It was pretty traumatic.

    There is a great deal of misinformation out there about birthing and babies, a great deal of cultural knowledge has been lost over the last few generations. I wonder at the defensive posturing many women take when it comes to pregnancy, birthing and breastfeeding, in raising kids in general. These things have become a taboo subject in polite company much like politics and religion and I can’t think of anything less empowering.

  3. Amy Mayes says

    This is a good article. I think the accusations come from the lack of understanding that childbirth is a challenge regardless. It's a mental and physical challenge. A c-section is a challenge, a medicated birth is a challenge, a completely natural birth is a challenge. They're just challenging in different ways and at different times.

    Having done it both ways – first labour prostaglandin-induced with nitrous oxide and pethidine, second labour prostaglandin-induced with nitrous oxide, and third labour a spontaneous home water birth – I will say that my unmedicated labour was NOT harder, and I'm not a hero for doing it. I still feel proud. Why? I guess, because for the first time I felt empowered and in charge of what was happening to me, and because the road there was paved with tears. I was victorious. And it was still painful, although less so than my first two.

    I want every woman to know she has options – options I didn't really feel were available to me during my first two births. The second was an okay experience, but I'll keep talking about childbirth because I believe women deserve more than okay; they deserve euphoric. If I'd HAD to have a caesarean, or even a hospital birth, I would have grieved, and I would have wanted to be surrounded by people who felt that it was my prerogative to grieve, whatever the circumstances. I wouldn't have wanted to hear 'at least you had a healthy baby' – because MY experiences matter too. Birth experiences matter. And every woman's experience is different, even when the manner of birth is similar. Until we start listening to women and respecting their feelings on very personal and life-changing events, resentment will continue to simmer under the surface and be shared at the least opportune moments (usually with other pregnant women).

      • LSM says

        HI Tracy I love your blog particularly as it is evidenced based. However I did want to comment that one of the reasons that women who had interventions during birth or haven’t breastfed get upset is that it is always assumed that it was our CHOICE. In fact your last paragraph spoke all about CHOOSING between intervention and natural birth. So where does that put all those women who HAD to have intervention because not doing so would have led to serious consequences for their baby or themselves. and yes I have had people – all women – harass me about whether I am going to breastfeed/have a natural birth etc and I have seen on forums how women have been almost been accused of being child abusers for choosing interventions at birth. Funnily enough though I have yet to meet a woman who has chosen interventions at birth or not to breastfeed just because she couldn’t be bothered.

        Perhaps I am being over-reactive here because I had to have an emergency caesar – if I hadn’t my child would either be dead or brain damaged and probably me as well. I constantly feel I have to justify my CHOICE, and then I get the ‘oh but we didn’t mean people in your circumstance’. Well who did you mean because I think people like myself are actually the majority.

        • says

          I’m sorry you feel this way, but I have to say I felt I was pretty clear with this being aimed at those who chose interventions in advance. At the start I said, “Whether or not Kristin Bell meant the comment or if it was a joke, it’s a sentiment that you often hear from many mothers who plan (or planned) interventions in advance, and it got me wondering about why this is the belief around natural birth.” And several times I speak of women in your situation as well, who don’t plan an intervention but have to have it anyway. For example, “Some women plan for a natural childbirth and do not end up with it. I think the same two reasons stated above apply to them as well, except the world just didn’t agree. These women often feel disappointment and sadness over the loss of the natural birth experience and I believe this contributes to the view that others have about natural childbirth advocates and women thinking they’re “better”.” And again, “Again, I feel the need to reiterate that not all women will have the birth they want. Not all women will birth naturally with no interventions, despite the plan to do so. And they are not lesser than any woman who was able to do it. It’s not that they didn’t try hard enough or trust their bodies enough, but there are times when things go wrong. Not to the degree we’re led to believe and sometimes what goes wrong is fixable without medical interventions, but we are all glad that they are there when needed. It’s just the “when needed” part our society needs to work on.”

          But your comment on the last paragraph is because this piece was aimed, as I stated at the start, towards those who have planned it and have this view of natural birth. I hope that makes sense and that you can see that I am very aware of the lack of choice many people have. However, from my own experience in Canada, I would say selecting interventions is far more common than not. Most women I know who gave birth knew they were having an epidural before heading in. And I know women who knew they were never going to try breastfeeding because they just didn’t want to.

          I hope that helps :) And I’m glad you had the options for an intervention to save your baby :) THAT’s what medicine is great for :)

          • LSM says

            tracy thanks for your reply. As I said I am probably over-reacting due to my own experiences. Perhaps we are talking over a cultural or more correctly medical divide? I am in Australia and in my experience and all the women I have talked to we are well informed of all the options and pros and cons. In my city (a small one!) most women birth in a hospital but our major maternity hospital has a birthing suite attended by midwives which is designed to be like home but with ready access to medical facilities next door if needed. This same hospital has been (successfully) trialling a home birth program where low risk mums are attended by hospital midwives in their own home. Most women I know went into labour with an open mind about pain relief but with an intention to use as little as possible. I am unsure of the exact figures but the overwhelming majority of Australian women intend to and do commence breastfeeding – our problem is more maintaining breastfeeding (rates have plummeted by the time bubs is 6 months). It is illegal for formula companies to market infant formula and it is health department policy that only mums who are formula feeding are given information about preparing formula and bottle feeding and staff are not allowed to advise on brands only formula type ie reflux formula. So I guess what I am saying is that the culture here is very much pro ‘natural’ in contrast with what you describe in Canada and US. I guess as I see it the pendulum keeps swinging to extremes and with research we need to find the right balance between maximum numbers of healthy bubs and mums and minimal intervention.

          • says

            I completely agree we need to find that balance! I think it’s great you’ve got a good balance happening at your hospital – I wish more were like that. It is hard to speak cross-culturally about these issues because often, as you point out, there are vast differences country to country – which is great :) Places like Canada and the US can look to places like Aus or parts of Europe where things are different and work towards having policies like that in place!

            I do thank you to take the time to write though – it’s important that people see these differences and hear about them, even via comments, so that they can see what we need to aim for and what is “normal” elsewhere :)

  4. stephanie says

    Australia’s “the today show” did an interview this week with a dr who apparently has delivered thousands of babies. This dr said that women do not know the risks associated with natural birth eg prolapse and basically that interventions particularly c sections are the way to go. A midwife also interviewed basically said
    what a.crock of shit. Dr then finishes by contradicting himself that natural/vaginal birtg is the way to go (he seemed to think they were the same thing regardless of interventions). Anyways i thou
    ght it was rather amusing. I tried to find a link for you but the website is shit.

  5. erynnsilver says

    I knew I could do it. I said I could do it. I did it. I’m proud of that; there’s always a chance of failure.

  6. MsBurrows says

    I chose an epidural with my first with no issue. With my second, I ended up having complications related to it. The entire experience was awful, but for me the worst part, once my baby was okay, was the fact that the hospital staff continued to act like nothing happened, and pretty much wouldn’t talk to me at all about it. I wasn’t angry. Even though I caved to pressure, ultimately it was my choice and I didn’t blame them. But the failure to acknowledge what happened did upset me, and the whole thing is why I do natural childbirths. I’m not trying to prove anything. I’m trying to protect my baby and myself. We may make different choices (assuming there are choices to be made) but at the end of the day, I think we all have the same goal in mind. It’s not a medal, it’s a healthy baby.

  7. says

    Natural birth ers let them brag! I have heard repeatedly that c section recovery is more difficult, let them brag about that too!! Having a baby is tough. Period.

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