Natural Childbirth

Natural childbirthr
I keep a copy of the obstetric bill for my birth and mother’s four day stay in the hospital. It was $63.29. Of course it was 1947, but still. The average hospital birth these days with a discharge in twenty-four hours is $8,000 to $10,000. Childbirth is the biggest source of income for US hospitals, and the four-million or so births a year end up costing over fifty billion dollars a year. One third of mothers undergo C-section when the recommended level should be one-third to one-half that number. One third of women have an episiotomy incision to assist in delivery of the infant head, whereas probably only a third need it .Somewhere around half of women have induced labor. There is a strong constituency out there who propose an alte
ative approach to labor and childbirth, that is, natural childbirth. They are very vocal about the “medicalization” of what amounts to a natural process. They point to the fact that although American healthcare has the most technically advanced system in the world; it ranks about thirty-seventh among other worldwide healthcare systems in efficacy, and it ranks fourteenth in mate
al morbidity at six months. On the other hand, we have the American College of Gynecologists (ACOG) who are strongly lobbying lawmakers to prohibit out of hospital birthing practices. Surely what’s best for the infant and mother lies between these strong variances of opinion.
One thing you have to give the natural childbirth proponents is their emphasis on education. Whether it is live lectures, internet blogs, or programmed courses, they teach, teach, and teach. They advise on morning sickness from the time of conception, what fetal movements feel like, what Braxton-Hicks contractions later in pregnancy feel like, and the continuing physiologic changes in the mother’s body as the pregnancy progresses. They teach about diet, exercise, birthing positions, how to distinguish true labor, and the progress of natural labor. I have to admit sometimes in the medical model the pregnant patient is given a bottle of prenatal vitamins and basically told, “We’ll take care of the rest.” The mother might be told in advance what day she is to come in and have her labor induced, and be reassured that she will have an epidural anesthetic when any true discomfort occurs. Maybe she gets put into a kind of twilight sleep and has little memory of her labor. Each intervention of this sort might interfere with the progress of normal labor.
Another thing you have to give the natural child birth promoters is their habit of including the father into the birthing process. Instead of his hanging out in the waiting room drinking cup after cup of coffee, he’s right there with the mother assisting her with breathing techniques, techniques that involve physical distraction and mild levels of hypnosis, and other natural ways such as massage to diminish discomfort. Perhaps he helps her assume the various birthing positions or helps in any other number of ways. The basic concept is that he has attended all the teaching programs, and he knows what is going on at any given time, and feels confident to step in as he is needed.
Anecdotally, I might interject my own experience with natural childbirth. I have a generation of nieces and nephews who all agreed among themselves to utilize one nurse midwife at a birthing center. There were a total of twelve children born. None of the mothers required C-section, episiotomy, or epidural anesthesia. All infants were born in hearty condition and were doing well at their first birthday. I was impressed.
The negative side of natural childbirth, especially if there is not a physician and an operating room readily available, is that things can go wrong very fast during the course of some labors. The infant can suddenly show distress, if the cord is around his/her neck or if the placenta starts to detach or malfunction, the placenta can come out first causing severe bleeding, or the mother may have toxemia with severe blood pressure elevation and seizures. The nurse midwife is not able to prepare for these and other eventualities. Theoretically an infant or a mother, or both, could be lost under these circumstances. This is why ACOG has taken its stance against home deliveries. Most of the time deliveries go well, and the outcomes are good, but there are those few cases that would haunt a medical professional for the rest of his or her life.
So that’s the dilemma. Do we treat every pregnancy like a potential disaster and err on the side of over-intervention, or do we relax a little bit and let nature take its course? Of course the answer is somewhere in between. Excellent prenatal care will identify many problem pregnancies which could be passed along early to physician specialists. Likewise a nurse midwife or primary care physician should have certain intuitive skills to identify and refer potentially complicated pregnancies. My hat is off to both of these groups of medical practitioners who skillfully manage pregnancy and delivery.
John Drew Laurusonis, M.D.
Doctors Medical Center