So you want a natural birth.....
Well then, don’t try to have a natural birth, prepare for and do a natural birth!
When I talk with my patients about their labor and delivery plans, many mothers tell me they are going to try to have their baby without any pain medication. Unlike a lot of obstetricians, I am always really positive about this. After delivering close to 3,000 babies, I definitely feel like the less we mess with labor, the better it tends to go. While studies are not conclusive about whether an epidural really increases a woman’s risk of a cesarean, we know epidurals cause blood pressure changes in labor that may lead to fetal distress. Epidurals make a woman more likely to experience a fever or intense itching in labor and often slow labor to the point that a mother requires medications to increase her contraction strength or frequency. Pushing may be difficult and she is more likely to tear or need a vacuum or forceps to deliver her baby. While a natural labor might not be right for every woman or every labor, there are certainly enough reasons to consider not using one if you are able to.
However, a natural birth is hard work! You wouldn’t wake up tomorrow and decide to run a marathon without preparing for it. You need training. A natural birth requires the same sort of mental fortitude and physical conditioning as a full length marathon and even burns around the same amount of calories.
To prepare your body for a natural birth, you need to provide yourself with good fuel throughout your pregnancy and build up your physical strength and endurance. This is easier if you have already been in a good routine of regular exercise and eating a healthy well-balanced diet prior to pregnancy, but in our fast-paced, work-focused culture, many women do not enter pregnancy in optimal condition. The good news is that the old fashioned advice of “don’t start exercising in pregnancy if you weren’t doing so before pregnancy” has been disproved time and time again.
We now know that exercise is nothing but good in pregnancy and significantly reduces your risk of gestational diabetes, a large baby, hypertension, or a cesarean. By reducing the risk of these complications, it also reduces your risk of being induced, which makes it a lot easier to avoid pain medications and epidurals. Your goal should be to eat a diet high in protein, with lots of fresh produce, that is low in carbohydrates, especially avoiding heavily processed foods or foods high in sugar. This can be hard to do in the first trimester, when most women crave bread and bread alone, but as long as you get your diet on track by 16 weeks, you should do just fine.
As far as exercise goes, you should be striving for a least three exercise sessions per week, of at least thirty minutes, where you get your heart rate up and work up a sweat. It is best if you mix it up a bit and do a combination of cardio, strength training, and stretching/toning exercises such as yoga or Pilates. Unfortunately, just being generally active throughout your day does not achieve the same results as true, dedicated exercise. There is nothing your doctor or midwife can do during your labor that will reduce your risk of cesarean and increase your likelihood of a natural delivery more than if you keep to a regular exercise schedule and a good diet during pregnancy.
You also need to prepare your mind for natural birth. Start by reducing the effects of stress in your day to day life by practicing meditation and deep breathing. This is easy to start as early as your first trimester. If there are issues in your relationship, seek out a good counselor to help you both begin to work through these challenges, because the addition of a child into your life is only going to amplify those issues and you will need the support of a loving a caring partner as you journey through pregnancy and labor. Think about labor and your changing body in a positive way, repeatedly telling yourself that this is something you CAN DO!
Avoid negative birth stories, as these only serve to build up anxiety and make you apprehensive about the birth process. When women enter labor fearful of delivery, their bodies tense up in response to the sensations of labor and that tension makes those sensations feel worse! A big part of labor preparation is training your body to soften and work with the forces of labor, rather than clamp down and resist them.
A thorough labor course, that provides an arsenal of tools to cope with labor discomfort, is an essential part of that preparation. Your childbirth educator is your labor trainer. It is not enough to simply know what will happen on the day of labor and practice breathing through a few contractions while bouncing on a birth ball on one Saturday afternoon. You need to spend several weeks learning and practicing the methods you will use on the day of labor. Hypnobirthing, the Bradley Method and Lamaze International all offer more extensive labor preparation, each with their own philosophy and strategies. You should research several methods and choose the one which aligns best with your own philosophy, however, studies have shown that meditative methods of childbirth education, such as Hypnobirthing and Hypnobabies, tend to have the best results.
Finally, choose a supportive team of labor coaches and health care providers. You will need others to provide hands-on support during your labor process. Your partner is an important part of that support, however a third person in the room, who has experience with labor, is immensely helpful, especially if that person is a professional doula. Having a doula support you during your labor significantly reduces the chance that you will require either an epidural or a cesarean. Equally important is choosing a doctor or midwife for your delivery who is open to and encourages natural birth plans and delivers at a hospital where a significant number of patients labor without pain medications, so you can be assured that the nurses and staff are comfortable with patients walking, eating, using hydrotherapy, and delivering in the positions most comfortable for them. If over 90% of the patients at your chosen hospital receive an epidural or your doctor or midwife tells you “well, you can try to do it without an epidural,” then you should consider changing your team to one that will actively work to help you achieve your labor goals. Because in natural birth, you cannot simply try, you must do.
Dr. Michelle Aristizabal is an obstetrician-gynecologist in Montclair, New Jersey and is affiliated with multiple hospitals in the area, including Hackensack University Medical Center and Saint Barnabas Medical Center. To read her latest book, Natural Labor and Childbirth - An Evidence-Based Guide to the Natural Birth Plan - CLICK HERE.