Fed up with natural childbirth

Birth “activists” dominate the conversation about childbirth in the US, giving the erroneous impression that they speak authoritatively and for a large proportion of women. Nothing could be further than the truth.

They dominate the conversation for several reasons. First, birth has a profound hold on their imagination. While most women view birth as a way for the baby growing inside to get outside, there is a small group of women for whom birth has an outsize importance. These “birth junkies” will cheerfully admit to being obsessed with birth, and get a great deal of their apparently limited self-confidence from their belief that giving birth vaginally without pain medication counts as an “achievement.”

Second, the internet and social media have magnified their voices. As in the case of vaccine rejectionism, natural childbirth advocates have created an alternate world where facts are fabricated, scientific evidence is ignored, and there is no context for understanding the information presented because the advocates lack basic knowledge of childbirth, science and statistics.

Third, it is a money making industry. Natural childbirth advocates love to accuse obstetricians of making money from the care of pregnant women. Those accusations generally ignore the current realities of reimbursement for medical care, and grossly exaggerate the purported “economic benefits” to health professionals of childbirth interventions. Meanwhile they carefully neglect to mention that natural childbirth represents 100% of the income of natural childbirth educators, homebirth midwives, and doulas, not to mention natural childbirth authors.

Fourth, they feel compelled to proselytize. It is not enough for a “birth junkie” to have the birth that she desires. YOU must also have the birth that she desires in order for her to feel validated in her choices. And, as is often the case with proselytism, natural childbirth advocates aren’t content with selling the virtues of their beliefs; they feel compelled to criticize everyone else’s beliefs in the strongest possible terms. Birth choices are not simply choices; they represent an epic battle between the forces of the purportedly “educated” and uneducated. They symbolize a conflict between “good” mothers and bad mothers. Perhaps most offensive of all, they are portrayed as a Manichean struggle between those who love their children and those who don’t love them enough.

I, for one, am fed up with the posturings of natural childbirth advocates, and there’s no question that I’m not alone. The vast majority of American women do not subscribe to the central beliefs of the natural childbirth philosophy: that vaginal birth is superior, that epidurals symbolize weakness, and that all women can and should breastfeed their infants for a year or more.

I am fed up with the assertion that vaginal delivery is the only way “real” women give birth.
I am fed up the the claim that C-sections are the avoidable result of not trying hard enough to have a vaginal delivery.
I am fed up with the canard that C-sections are “unnecessareans.”
I am fed up with the belief that pain relief in labor is dangerous and that forgoing pain relief is an achievement.
I am fed up with the claims that labor pain is “good” pain, “pain with purpose” and the remarkably hateful claim that “less pain equals less joy.”
I am fed up the idea that childbirth educators are qualified in any way to give medical advice on any topic.
I am fed up with self-proclaimed natural childbirth “experts” who lack basic understanding of science and statistics.
I am especially fed up with anyone who dares to assert that childbirth choices separate those who love their babies from those who don’t love them enough.

I’ve created the Facebook group Fed up with natural childbirth for “women who don’t need labor pain to feel authentic, don’t need a vaginal delivery to feel like a woman, and don’t need sanctimommies telling them how to feed their babies.”

Join me if you feel the same.

  • Squillo

    Vaginal birth is NORMAL.
    So what?

    First time C-sections should be for EMERGENCY ONLY.
    First-time c-section should be done when indicated, whether for a clear emergency or to prevent a potential emergency. Or when the mother prefers it and there is no contraindiction.

    Epidurals are not necessary for all women.
    Totally agree. But since we’re setting up strawmen, unmedicated birth isn’t best for all women, either. And women who want pain relief should receive it in a timely fashion, barring contraindications.

    Most women can breastfeed and should be given the support necessary to succeed for a year or more.
    Agree. A woman should receive the support she needs to feed her baby, regardless of how she decides to do it. Breastfeeding should be allowed anywhere mothers and babies are allowed. Formula feeding should be allowed anywhere mothers and babies are allowed. Neither should be an excuse for strangers to offer unwanted opinions.

  • RNS

    Wow. I’m sorry you have come across natural birth advocates who are like this. Every single one I have ever met or talked to fully acknowledges the necessity of medical interventions when they are truly needed or wanted by the birthing woman. There are responsible midwifes and doulas, there also is evidence based research supporting natural birth for HEALTHY, low-risk women IF THEY WANT IT. No one should ever shame a woman for wanting pain relief or a scheduled c-section. A good natural birth practitioner will uphold her choice for that at the same time as helping a different mom through a non-medicated birth.
    Please do not lump all natural birth practitioners into the same crazy bin, because now you sound just as crazy yourself on the other side of the coin. There is a middle ground. When you start fighting with each other are you really doing any good at all for the birthing mothers you are supposed to be serving?

    • Squillo

      I guess I have a problem with the notion of a “natural birth practitioner.” What is the definition of “natural birth?” And what does a natural birth practitioner do that other practitioners don’t do?

      • RNS

        I guess one of the problems is natural birth practitioner is a category with more specific designations under that umbrella. My personal definition is a person who works in various capacities with healthy, low-risk, birthing women in a primary approach that minimizes medical procedure. This person recognizes the natural process of labor and birth first, supports and provides an environment that nurtures that process, and helps the mother and her family navigate choices which gives her confidence in the process. At the same time it is the responsibility of this caregiver to also provide information on all alternatives to any issue that may arise including medical procedure. This information must include benefits and risks. Ultimately, he or she leaves the choice up to the mother and her family. If the non-medical method is not that woman’s choice then that decision must also be supported.
        This basic model of attending to birth I have seen from midwives AND EVEN obstetricians. An obstetrician CAN be supportive of non-medical childbirth in a healthy mother and fetus. I wish more were like that. Medical Interventions, pain relief via drugs, and surgical procedure should be reserved for when it is necessary and/or if the mother wants them. Yes, a mother and fetus that has been healthy can develop problems during labor and delivery, then thank goodness we have modern medicine available. The approaches can work together, especially when you evaluate the details of each pregnancy on a case by case basis. Some women, and some pregnancies should be medically attended to from the beginning. A good “natural” practitioner will recognize that and refer the woman to someone else accordingly.

        • Squillo

          Thanks for your considered reply. I think, frankly, that as you define it, it’s a distinction without a difference. A good birth attendant does all those things as a matter of routine, except perhaps “recogniz[ing] the natural process of labor and birth first.”

          That’s where I find the idea of a natural birth practitioner problematic because “recognizing” natural birth is meaningless. If by that you mean “prioritizing” natural birth I find it problematic because that waltzes close to ideology, which is precisely the problem many people have with so-called “natural birth advocates.” A clinician should not be in the business of prioritizing a particular set of values, but rather prioritizing health. She should certainly respect a patient’s values when they do not compromise her first duty.

          I agree with you that both midwives and OBs can be good clinicians and supportive of women’s desires. YMMV, of course, but I think that for a subset of “natural birth practitioners” — i.e. non-CNM/CM midwives– reverence for the natural supersedes the duty of care. Birth activism in the U.S. (I can’t speak for other countries) seems to revolve around convincing women to see birth in a very particular way rather than doing things that would actually be beneficial to most women, like advocating for wide access to reliable birth control, access to adequate pre-natal care, access to adequate pain relief and yes, access to VBAC.

          • Medwife

            I’m a little confused at the definition of terms here, too. I mean, I’m a CNM. Of course I recognize birth as a natural process, just like digestion and the menstrual cycle and so on are natural processes. But my job is to look at the well being of the mother and baby as the process is ongoing and if one or both are not tolerating that process, if it’s not looking like it’s going to result in a healthy (and happy as possible) mother baby dyad, I’m not going to hesitate to intervene with the most effective, acceptable to mom tools at hand. I don’t really care about preserving the natural process. I had a mom just recently who was having a very rapid labor and although she told me when I admitted her that she didn’t want an epidural, when things shifted in contraction intensity and she did not seem to be coping as well, yeah, I brought up an epidural because that would have been the most effective, safest pain relief. That’s an evidence based fact. I offered non-pharm methods as well and she opted for some of those instead of an epidural but I still think I did the right thing. If that makes me not a natural birth provider, even though that’s what she had (by her definition), that’s ok. Everybody turned out healthy and happy.

          • RNS

            I think it does make you a natural birth provider and a very good one.

          • RNS

            I am enjoying this discussion. Thank you.

            I can get behind a lot of what you’ve said here. In no way should any caregiver prioritize a certain approach, but there are specialties. Perhaps my use of the word recognize was incorrect. Let me say that an OB is generally more practiced at and trained in medical procedure including surgery. A nurse midwife is generally more practiced at and trained in non-medical methods but can do things like administer pain medications when needed or desired. A doula is generally more trained and practiced at providing continuous support and helping the mother use position and other methods for pain relief. No one should be stepping on anyone else’s toes. The have different specialties, different training, different experience, and differing abilities to be there with the mother. A doula can be there constantly, the nurse midwife frequently but not constant since he or she has other mothers to check on, and the OB at the delivery or called in if needed for a CS (he or she has the least amount of time available to any one person).

            They each have their roles, and how the choice of who is there starts with the mother. If I am looking for a care provider and I know that I want pain medication, I’m not going to look to a home midwife or doula. If I end up needing a CS, who do I want to do it? Definitely and OB.

            Here’s another example among just OBs. Let’s say an extraction method becomes necessary. Foreceps or vacuum are similar, but if my OB has done more vacuum extractions and is most comfortable there then that’s what I’m going to ask him or her to do.

            I 100% agree that the is a subset of “natural caregivers” who do have an unbalanced “reverence for the natural that supersedes the duty of care.” This is a huge problem. My issue with this post is all people who specialize in “natural” childbirth were lumped into the same category.

            And I love your last sentence about birth activism in the US. It’s true. However, from what I’ve witnessed it is not just the activists on the “natural” side. There are plenty of professionals in the medical community that also miss the boat on doing things that are truly beneficial to women. No one knows it all, but our knowledge is greater, and we can serve our patients better if we work together.

  • Guest

    I had an emergency c-section with my first child. The other 6 births were vaginal. They were all healthy babies over 9 lbs. my first vaginal birth (which was in Washington state) was an 11 lb. baby who was 24 inches long. The birth that was traumatic for me was the one that I had to be cut open for. ALL of my OBGYN’s have strongly suggested and supported my decision to v-bac. My least traumatic birth was the one I did without drugs or epidurals (which by the way….all of my OB’s shy’d away from epidurals and drugs). I have had 7 OB’s, and 7 out of 7 promoted natural birth in the hospital at birth centers. I think you may well be a bit outdated with your beliefs. Every woman has the right to choose their experience, their should be no judgement on either side. My experiences ranged from one extreme to the other.

  • Poogles

    “Of course Amy is fed up with natural birth and will talk it down. She is an OB/GYN. Natural childbirth is a threat to her income!”

    Uh…what? Unless you are one of those who defines “natural birth” as having to take place outside of a hospital, it makes no difference to an OB’s income if the mother forgoes pain relief or other medications. It doesn’t even make a difference to the OB’s income if the mother delivers vaginally or by CS.

    Not to mention – Dr. Amy is retired and has been for years, she has absolutely NO financial stake in the game.

  • yentavegan

    I will forever sing praises to the ob/gyn who delivered dd#5 by c/sec as per my request. My body, my baby, my choice! Any questions?

  • MRaff

    I share your sentiments, Dr., and I am extremely fed up with hearing about natural childbirth and the danger of drugs administered via an epidural. Our bodies were not made to endure childbirth, they were made to endure gestation. Whether or not a mother survived the childbirth before modern medicine was a crapshoot. The rates have sunk to 2% today in the States, but it is still not 0%. The fact that labor runs a large enough risk of killing us without medical intervention is proof enough that nature did not intend for every single pregnant woman to survive childbirth. I would surmise that part of the reason community child-rearing came about and is still popular in undeveloped countries is because of the high rate of maternal mortality. Also proof is the fact that maternal mortality rates have only decreased in *developing* countries while undeveloped countries, without access to the same level of medical care, still have maternal mortality rates comparable to what the States had in the 1800s. You’re not just accepting the likely pain of a natural childbirth, you’re running the risk of mortality for both you AND your child. But, these advocates would not and could not advise you to forgo medical attention entirely. So if that’s the case, what’s so natural about it? The portion where you’re in agonizing pain? What natural childbirth advocates can and are basically saying is that if you’re privileged enough to live in a developed country, you should “choose” to try to experience the “real” thing partway, but there comes a point in the process where medical attention is necessary, especially if an emergency arises, and in that case, certainly don’t miss out on the medical intervention that your class status will afford you. It is a ridiculous double-edged sword because it’s not just a matter of women wanting to experience pain, its that they’ve been fooled into thinking that their bodies were made to 100% survive this extreme physical anguish, and while they can likely do it, it should not be a social tool used to divide pregnant women into weak or strong, or empowered and disempowered, etc. The bottom line is, I am privileged enough to afford medical treatment–the kind that offers pain relief, I understand the risks of the drugs administered via an epidural, and I understand the history of the miseducation of women both without and within our community enough to know that a natural childbirth is not what’s safest for my child. And who is touting these perspectives anyway? Moderately educated, middle to upper-class, white women? Yeah. I’m totally shocked.

  • yrsa

    Natural birth is abhorrent to me from an anthropological point of view. So we learned to walk upright and then half of our mothers started dying- which would have been okay if it facilitated any sort of evolutionary change in the past 10’s of thousands of years. But it’s now a distant pipe dream thanks to medical interventions. Don’t get me wrong, I am all for medical interventions because there’s no choice in the matter now. You want to wind a baby through that bony, labyrinthine, evolutionary-nightmare of a structure you call the human pelvis? Be my guest. I’m getting mine cut out with all of the necessary precautions taken. (And go stuff a pineapple in it if you think you can tell me to do otherwise)

  • Guest

    Bitter much??

    • John hedlenssonn

      ad hominem much?