Most mainstream resources and healthcare providers will tell you that your labor choices are yours, assuming adherence to hospital or labor venue policies and barring any major medical or safety concerns. However, most don’t tell expecting women that their choices may impact more than simply comfort and pain relief during labor, or encouraging labor to start.
Many women don’t realize that the events that accompany a baby’s journey into our outer world can yield life-long impacts.
In today’s world, it’s common to view labor as the means to an end. The step that every pregnant woman must take to finally have her beloved baby in her arms. Many want to minimize discomfort as much as possible, which the medical world has made possible through modern day labor interventions.
Now incredibly common, these interventions have shifted a perfectly designed, natural and biological process into a medically-supported, augmented event. As more research is done, we are slowly understanding the long-term effects that various common labor interventions can have on babies.
I continue to be in awe in the divine design of the human body. The woman’s body was perfectly designed to birth her baby and provide her with natural adrenaline and pain suppression to support the process. Sometimes issues emerge that require medical intervention, which are helpful, so long as it’s truly in favor of the baby and/or mother’s safety. Those emergency or intervention-appropriate situations yield life-saving outcomes that are very important.
In an otherwise healthy, low-risk pregnancy, most interventions are voluntary.
I went my whole life assuming I’d get an epidural when I gave birth to my first child. I mean, CHOOSING to feel every sensation of pushing a human watermelon out of my body? Ha! No. Thank. You. Watching the screaming ladies in the movies or on TV…listening to my own mom recount my birth story and how she blacked out in between Pitocin-worsened contractions…It wasn’t hard to convince me that I wanted nothing to do with the unimaginable pain of labor contractions.
If you asked me ten years ago (heck, even two years ago!), I would have laughed in disbelief if you told me I’d deliver my first child without pain medication.
I remember going to one of my pregnancy appointments and the nurse asked if I wanted an epidural like I was ordering a sandwich at Subway. “Do you want tomato on that?” I responded with a confident “Yes!!!” (to the epidural, not the tomato).
Later that evening, I started thinking twice about my response. Why was I just opting to do the epidural without even knowing the pros and cons of getting one, or whether there were any other options available to me? That’s when I started researching and realized there’s a lot that isn’t really talked about when it comes to labor choices.
I want all women to feel empowered and be informed throughout pregnancy. This includes the options available to them during labor. I thought I’d share some of what I learned about the most common interventions so that you can be informed and make the choice that’s best for you!
The Natural Childbirth Process
First, it’s important to understand the biological processes at play leading up to and during labor.
I was surprised to learn that your body begins preparing for labor in the days leading up to its start, as this article states:
“Increases in fetal catecholamines in the last weeks and days of pregnancy will prepare the baby’s lungs for air breathing after the birth. In animal studies, a surge of maternal oxytocin in the 24 hours around the spontaneous onset of labor is transferred to the baby via the placenta and protects the baby’s brain from low levels of oxygen during labor.”
Once labor begins, a series of hormones take action to help naturally progress labor. Oxytocin, the “love hormone”, causes contractions and continues to rise in pregnancy, reaching its peak (and the mother’s highest concentration during her lifetime) during the final pushing stage and upon first meeting with her baby. It also causes mama and baby to fall in love at first sight.
Also present are Beta-endorphins, stress hormones that help the woman deal with the discomfort of contractions and encourage her ability to naturally move with them and take positions as needed to feel relief. Lastly, adrenaline and noradrenaline (known as catecholamines) rise during labor to help the woman push her baby out.
Beyond these hormones, complex processes are happening inside the mother’s body to progress the baby out of the uterus, through the birth canal (turning the baby as he or she descends) and finally out of her body.
As you can see, childbirth truly is a perfectly designed, amazing and natural process when left undisturbed.
When a woman voluntarily chooses a medical intervention during childbirth, she becomes at risk for the “cascade of interventions.” This is a term used to describe the possibility of one intervention during childbirth leading to subsequent interventions.
Here’s an example: a woman plans to give birth without pain medications. The labor nurse offers her the option of an epidural to relieve her pain, to which she declines initially. After a few hours of intense contractions, the nurse again offers the epidural and the exhausted mother accepts, anxious for some relief. The epidural is administered and labor progresses to the pushing stage. During pushing, the woman is unable to feel her contractions and must rely on the doctor’s signals for when to push. After extended pushing, progression stalls and the baby begins to show signs of distress, so the doctor must assist delivery with forceps or a vacuum, or possibly recommends an emergency c-section for the safety of the baby.
As soon as one intervention is accepted, it yields the possibility that additional interventions may be required.
The cascade of interventions can lead a woman who only wanted one intervention, to wind up with a childbirth experience completely different from the one she envisioned.
Now that we understand this risk, let’s take a closer look at a few of the most common medical interventions and their effects on the birthing process.
Before we dive in, this post isn’t intended to make anyone feel defensive of their labor choices past, present or future. You must do what’s right for YOU. I do believe that mainstream media and medical resources create a perception that women can’t labor without medical support, which couldn’t be further from the truth! The purpose of this article is to help you make informed choices so that you can feel confident about your plan.
A Stanford study conducted between 2009 and 2014 found that 71% of women choose to receive an epidural for pain management. It is one of the most commonly chosen medical interventions.
Remember the mix of hormones at play during labor? Epidurals slow, and sometimes stop, the mother’s production of oxytocin. This can lead to contractions slowing and the start of the cascade of interventions when the medical provider initiates Pitocin (artificial oxytocin) to help progress labor.
Another challenge is the restriction of the woman’s ability to move. As this source says, “When physically able, women should be encouraged to change positions throughout labor to facilitate the fetus’s passage through the pelvis. Hydration and proper nutritional support should be maintained, as well as emotional support for the duration of the labor.”
Most women who experience a natural, unmedicated birth will tell you how “something took over” their body and mind and they were able to tune into exactly what position they needed to help progress labor. If you listen to other women’s birth stories, they will often say they used a range of positions and active movements based on what felt best at that time. During my labor, I could not sit still or lie down. If I did, my contractions were more uncomfortable. I stood, walked and rocked during labor, sitting and circling on my birth ball.
In addition, since a woman cannot feel her contractions with an epidural, she must listen to her medical provider’s instructions for when to push. However, since it’s not the medical provider’s own body, they must rely on the monitor to tell the woman when to push.
During labor, the body will actually initiate the pushing phase through what’s called the “fetal ejection reflex,” when those catecholamines (adrenaline and noradrenaline) are at their peak and give the woman the energy needed to push her baby out. During this stage, the woman’s contractions will change form and be at their most intense.
The problem with an epidural is that they lower catecholamine levels, potentially reducing her natural energy levels. To make matters worse, because the woman cannot feel her contractions, she may be told to push when her body is not actually ready to push. This can lead to prolonged pushing and the mother tiring and unable to finish. It can also lead to the mother pushing too hard and more severe tearing to occur.
During an unmedicated labor, the woman pushes when she feels the urge to push, following the signs of her body.
Additional concerning risks of an epidural include the following (which you can read about here):
- Challenges with initiating latch and/or breastfeeding within the first hour of life, reduced positive breastfeeding outcomes or unmet expectations overall
- Drop in maternal blood pressure
- Maternal fever and the effects on the baby
- Effects of drug toxicity on the newborn
- Neurobehavioral differences witnessed between babies exposed to an epidural and those who were not
One more thing. Ironically, studies have found that women who choose an epidural do rate high satisfaction in terms of pain relief, but have some of the lowest satisfaction rates for their overall childbirth experience.
Induction by Pitocin
I have heard stories of women who elect to get induced because they were so tired of being pregnant. Pregnancy is wearing and in the final weeks, many are definitely ready to meet their baby! However, forcing labor to start unnaturally has risks. Remember, our bodies produce hormones ahead of labor to prepare the mother and baby for the journey. This is another example of how amazing our bodies are and the benefit of allowing a woman to start labor spontaneously. If labor is forced to start by medical intervention, your baby could miss out on that surge of natural oxytocin, which may potentially lead to signs of distress in your baby, and further intervention by your healthcare provider (instrumental delivery or even c-section).
In addition, contractions as a result of artificial oxytocin (Pitocin) are typically much more intense and closer together than naturally-occurring contractions during labor. A woman who is planning an unmedicated birth, but needs to receive Pitocin, may get discouraged after prolonged contractions like these and ask for an epidural that they didn’t already want, which can lead to the risks mentioned in that section. This is why it’s important for women striving for an unmedicated birth avoid to avoid induction unless medically necessary. Talk to your provider about how long they’re willing to let you stay pregnant before scheduling an induction. Some tend to be on the more conservative side (40 weeks and some even earlier!), while others may be okay with allowing 41 weeks and a few days, for example.
Both my mom (the other woman behind GLA) and I had to have Pitocin during an unmedicated labor and the contractions were extremely intense, with little feeling of relief in between them. However, we both were still able to birth our first babies without medication.
Forceps and Vacuum Assistance
These methods of assisting delivery are done when the baby is in the birth canal and the woman is having a difficult time completing the pushing phase. The risks and effects of such assistance are outlined here:
“For the baby, instrumental delivery can increase the short-term risks of bruising, facial injury, displacement of the skull bones, and cephalohematoma (blood clot under the scalp).24 The risk of intracranial hemorrhage (bleeding inside the brain) was increased in one study by more than four times for babies born by forceps compared to spontaneous birth,25 although two studies showed no detectable developmental differences for forceps-born children at five years old.26, 27 Another study showed that when women with an epidural had a forceps delivery, the force used by the clinician to deliver the baby was almost twice the force used when an epidural was not in place.28” (Source).
Use of an epidural doubles a woman’s risk of requiring forceps or vacuum assistance during delivery.
Cesarean Sections (C-Section)
A woman might give birth by c-section for a number of reasons. She might have chosen this method because of a fear of or dislike around vaginal childbirth. She might have a pre-existing condition or anatomical challenge that makes c-section a safer method of delivery. Or, it might be an emergency mode of delivery following a traditional labor that slowed or stopped and the baby’s and/or mother’s health became at risk. Also, women who gave birth previously by c-section may choose (or be recommended) to give subsequent birth by c-section.
Sometimes a c-section can’t be avoided, but when it can, one should consider opting for vaginal birth if possible due to these concerns:
- C-sections compromise your baby’s microbiome – your baby receives the initial bacteria that becomes the foundation of its microbiome when he or she passes through the birth canal and out of the vagina. This beneficial bacteria is vital for immune health. Numerous studies on babies born by c-section vs. vaginally have found differing varieties of bacteria in the microbiome and increased cases of childhood allergies, asthma, obesity, eczema and more. Vaginal seeding, the process of wiping the mother’s bacteria on the baby post-c-section birth, has potential to help with this challenge, however research is limited.
- They can compromise breastfeeding success – unless it has been expressly communicated as your preference, it may not be normal practice at your hospital to initiate skin-to-skin contact immediately following baby’s birth. As a result, this can inhibit successful breastfeeding.
- Skin-to-skin contact may not be possible – as mentioned above, immediate skin-to-skin contact is crucial to initiate breastfeeding. It also helps regulate baby’s body temperature and provides opportunity for mother-baby bonding and early social and emotional connection with one another.
- They can lead to sensory processing challenges – labor is an amazing, perfectly designed process. Every stage has purpose. As the baby passes through the birth canal, it receives vestibular inputs. During a c-section, the baby is utterly lifted out of the mother’s belly, missing out on those important inputs. Research has uncovered differences in a variety of sensory processing areas between c-section and vaginally-delivered babies.
- There is possibility for infection – as with any surgery where the body is opened up, there is risk for post-surgical complications and infections.
- It is a surgery, meaning the healing process is much more challenging while also caring for a newborn. The fourth trimester is challenging enough. The added pressure of healing from surgery can be physically and mentally overwhelming to the mother trying to care for her newborn.
- It requires a longer hospital stay – since a c-section is a surgical procedure, you will have to stay in the hospital longer than a vaginal birth.
If your circumstances require a c-section, know that there are ways to prevent some of the risks outlined above. First, research the differences between a traditional cesarean and a “gentle” or “family centered” or “skin-to-skin” cesarean and talk to your provider about options available to you. Even if the hospital doesn’t traditionally follow any of those practices, your specific provider may be willing to accommodate some or all of your preferences. In addition, I’ll be writing an article with suggestions for an optimal recovery following a c-section – for both you and baby – stay tuned!
If it is not your plan to have a c-section, I still highly suggest researching the approaches mentioned above and adding an addendum to your birth plan that includes your preferences should the need for an emergency c-section arise. You can see a sample birth plan for such, here. Of course, in an emergency situation, your medical providers may not be able to meet your needs, but if there’s the chance they could, it’s worth communicating them.
If you have already given birth to a child via c-section, don’t let this post upset you. The ultimate priority is your baby being born safely, and you remaining safe as well. It can be traumatic for a mother who planned to give birth vaginally, to end up with an emergency c-section. If you can relate to this, I encourage you to read this post and also to know that many women successfully give birth vaginally after a c-section (also known as a VBAC). Do your research on this and discuss your options with your healthcare provider.
You CAN Achieve an Unmedicated Birth
Some women wish to have an unmedicated birth, but don’t fully understand the implications of many common, and seemingly harmless, interventions and their potential start to the cascade of interventions. This can lead to the woman feeling disappointed about her inability to achieve an unmedicated labor, even though the circumstances for how it progressed make sense given the information provided in this article.
If you want to give birth naturally and without medication, know that you CAN do it! It’s what our bodies were designed to do and it is a beautiful, miraculous process. Our next post on this topic will supply our top tips for achieving the unmedicated labor you desire.
Whatever labor preferences you choose, be sure to create a birth plan, so that you have the best chances of experiencing the labor you envision. Read our post on birth plans for help in this area.