Birth Part 1: Does natural birth matter?

 "All that counts is that the baby is healthy" is what many women are told and believe.  The research says something different: a woman's experience matters. A healthy woman experiencing vaginal birth is more likely to come out with a healthy baby and healthy self.  

A little research revealed that in North America, a woman is unlikely to get a natural birth in the hospital. Fewer than 2% of women in the U.S. are offered natural pain-relieving measures in a hospital, according to the LIstening to Mothers II (LM2) survey (the first comprehensive survey of women's birthing experiences in the U.S.). The majority of women in North American receive medical interventions, even if they explicitly say they don't want them. According to the LM2, many women reported being pressured into having their labors induced and to accept epidurals and even cesarean sections.

The cascade of interventions

Childbirth educators often talk about the "cascade" of medical interventions: the likelihood that once you receive one intervention, like Pitocin, you are more likely to receive another intervention, like an epidural. Many women never question these interventions, though they frequently are linked to babies being born by cesarean section. The Food and Drug Administration (FDA) has never approved Pitocin for the use of augmenting labor and it has been suggested now that mismanagement of Pitocin is the leading cause of liability suits and damage awards.

Continuous electronic fetal heart monitoring is another seemingly innocuous medical intervention that is linked to adverse outcomes. Even though it requires women to be strapped to a machine and therefore limits their mobility -- movement in labor is listed as one of the recommended comfort measures by Lamaze International -- it may seem that constant feedback on a baby's heart rate would reduce unnecessary interventions and surgical procedures. Yet, some studies have shown CEFM to be an ineffective indicator of fetal distress and one of the causes of the increase in cesareans.

"There is no scientific reason do to any of this stuff," says Dr. Mayer Eisenstein, founder and medical director of Chicago's Homefirst Health Services, which provides doctors and nurses to assist at home births. 

The cascade of interventions—Pitocin, epidural, CEFM—is linked to the rise in cesarean section rates in the U.S. and Canada. The World Health Organization recommends that the rate of cesarean births for any country not exceed 10 percent to 15 percent. The Centers for Disease Control and Prevention puts the U.S. rate at over twice that: 32 percent and the LM 2 survey suggests this number is on the rise. In Canada, the cesarean section rate is reported at 26.3% and is also rising. (Some provinces, such as British Columbia, are significantly higher with its 30.5%). 

Why are women in the U.S. more likely to die from childbirth than their peers?

The United States is one of the only wealthy countries where the maternal death rate is climbing. In 2004, the most recent year for which information was available, the maternal death rate in the United States jumped to 13 deaths per 100,000 (higher for African-American and Hispanic women) according to the National Center for Health Statistics. 

Among developed countries, 29 have better infant mortality rates than the United States, including Slovenia and Cuba, and 41 have better maternal mortality rates. That puts the U.S. near the bottom for safe births in the industrial world.  Canada fares far better but also reported a recent increase in maternal deaths, although this might be from better reporting, according to the Lancet. 

Why are women in the United States more likely to die from childbirth than their peers in other industrialized countries? The rising rates of medical intervention and surgery in birth and their attendant risks are a big part of the answer.

Is natural safer?

Babies born by cesarean section are nearly twice as likely to die than those born vaginally in otherwise low-risk pregnancies  and mothers are more likely to suffer severe morbidity (e.g hemorrhage resulting in hysterectomy, cardiac arrest, and major infection) in planned low-risk cesarean sections.

There are doctors and midwives in the U.S. delivering hundreds and even thousands of babies reporting much lower rates of intervention and, correspondingly, lower rates of mortality and morbidity.  Dr. Eisenstein's practice, for instance, has delivered over 14,000 babies at home. His practice maintains a cesarean section rate of less than 10%, an episiotomy rate of less than 1% (compared to nearly 35% in the U.S.) and virtually no need for pain medications or I.V. fluids.  Ina May Gaskin, founder of The Farm midwifery center, reports on over 2,000 births that 95% were completed at home with a cesarean rate of only 1.4%. 

The largest study of planned home birth in North America concluded that for low risk women using certified professional midwives home birth was associated with "lower rates of medical intervention" and "similar intrapartum and neonatal mortality to that of low risk hospital births." 

The take-away

Women who take an active role in planning for their births are more likely to be satisfied with their birth experiences.  Whether a woman chooses to birth in a hospital, birth center, or at home: there is some work she has to do to ensure she is getting what she wants/expects.  

Learn more about how to get the birth you want in Parts 2 and 3 (including a list of the books all pregnant women--and their partners--can read to help ensure a better birth).

Photo: Dmitriy Shironosov/ Shutterstock