“Did you have a natural birth?”
My GP was doing a routine post-birth examination six weeks after the birth of my first child.
I instinctively told her that yes, I’d given birth to my son naturally. But when I added that I’d taken morphine and gas, she corrected me: “Oh, so you mean you had a vaginal birth. Not a natural birth.”
I nodded to confirm, but I was secretly crushed. This doctor had just informed me, a mother who recently pushed a 4 kilogram baby out in a way that seemed physiologically impossible, that I didn't have a natural birth, just because I accepted medical pain-relief.
This medical terminology is a problem. Our society needs to change the language we use to describe the many ways women give birth, and stop consciously or unconsciously spreading the underlying message that a drug-free birth is somehow more brave and noble.
I first heard of ‘natural birth’ from my pregnancy yoga instructor and it was a concept that was completely foreign to me. Like many first-time mothers, I had assumed that the definition of vaginal and natural birth were synonymous.
Stop consciously or unconsciously spreading the underlying message that a drug-free birth is somehow more brave and noble.
But as I learned more about what natural birth meant, and spoke to mothers who had recently given birth without pain-relief, I began to hope for a similar experience myself.
‘If they can do it, I can do it,’ I thought.
This was my first oversight. When it comes to childbirth, nothing is certain or equal.
Later, at my antenatal class, the midwife described the various forms of natural, assisted and medical pain-relief that were available and emphasised the risks. Administering an analgesic or epidural too close to birth may cause complications and minor risks to the baby’s and mother’s health, and it’s important that pregnant women be informed of this before they accept pain relief.
While every woman hopes that her labour will play out in an uncomplicated way, it’s important not to be too focused on a birthing ideal, or feel pressured to give birth in a certain way.
Fortunately, some women don’t feel this pressure at all; in fact research shows that women from different cultural backgrounds may experience different levels of this ‘pressure’.
Professor Dennis Pashen is the National President of the Rural Doctors Associations and has more than 40 years experience working with Indigenous communities. He believes that societal pressure to birth without pain medication is a “middle-class, metropolitan phenomena”.
“I haven’t noticed any pressure for particular birth strategies or techniques [for Indigenous women],” he says.
Fear has a profound effect on a “women’s emotional health and increases the likelihood of a negative birth experience”.
In other cultures, though, there is a clear expectation of whether or not the woman will receive pain relief. For example, this summary of multiple studies demonstrates that Dutch women find birth pain empowering and this sense of personal control acts as a kind of buffer for the pain. While Ecuadorian women believe childbirth pains are a punishment that must be endured to obtain the reward of a child. There is a strong cultural expectation that they will endure childbirth pain unmedicated.
Many studies, including a recent 2012 report, have tracked the societal rise in a women’s fear of childbirth pain with the increased use of obstetric interventions, especially induction, epidurals and caeserean-sections. The study compared the attitudes of women in Sweden and Australia and identified the way women’s fears and attitudes towards childbirth affected their birth outcomes. The study concluded that fear (present in 33 per cent of the Australian and Swedish women involved) has a profound effect on a “women’s emotional health and increases the likelihood of a negative birth experience”.
There are so many factors that determine the way a woman labours; the anatomy of the mother and risk factors, including obesity, pre-eclampsia or the position of the baby to name a few. The personal context of the mother should be considered too, for example, whether she suffers from anxiety, or if she has a support person present.
Fiona Bogossian is an Associate Professor at the University of Queensland’s School of Nursing, Midwifery and Social Work. She agrees that each woman experiences the pain of childbirth differently, depending on a unique set of circumstances, including “her culture, previous pain experiences, and whether she feels safe and supported in birth”.
A woman may feel out of control or fearful during labour, but according to Prof Bogossian, the role of the midwife is to “assist her to cope with the pain, explaining all alternatives and allowing the woman to decide the care she receives.
“When this is done well, the woman feels in control of the decisions around pain relief. This, along with appropriate preparation for birth and debriefing following birth, is key to resolving the differences between expectations and reality.”
The issue is not every woman receives this standard of care and level of debriefing in hospital.
Ultimately, pain relief options available in hospital are there for a reason, and a mother should not feel judged for accepting these, as she needs them. For me, vaginal birth equals natural birth, anaesthesia or not.
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Image by Liam Wilde (Flickr).