Why is a completely natural birth the optimal choice?

REASON No.6: A fizzy-logical third stage causes an all-time oxytocin high

Here I’m talking about the oxytocin peak which occurs after a truly undisturbed physiological third stage of labour.

I use the term ‘fizzy-logical’ advisedly because we can’t refer to a physiological third stage which is disturbed, where caregivers are only ‘going through the motions’ of allowing a physiological third stage. The fizziness (euphoria) arises when both the woman’s body and mind— since emotions are linked so closely to hormone production—are left alone throughout labour, as well as immediately postpartum, and when the woman’s privacy and first, spontaneous, intimate contact with her newborn baby is completely undisturbed. The logic behind doing this is the peak in oxytocin production itself. As explained in Note 6 on page 113, in Note 22 on page 123 and Note 18 on page 233, and on pages 149, 165, 177 and 196, research shows that as long as the new mother has had no drugs or artificial hormones throughout her labour and as long as she is undisturbed and warm enough, she will typically produce more oxytocin soon after giving birth than she will at any other time in her whole life. (Since even Entonox interferes with this natural oxytocin production—see Note 78 on page 245—even gas and air prevents this surge, it seems, so could affect bonding and maternal evaluation postnatally.)

There must surely be a biological reason for this all-time oxytocin surge. Since this hormone has long been associated with loving behaviour (which will obviously facilitate bonding between the mother and her new baby) and since it is also precisely the hormone which is required in order to ‘get that placenta out safely’ (and prevent PPH), it seems easy to argue that optimal birth is in fact true physiological birth. I use the word ‘true’ (meaning ‘undisturbed’) because it has been widely reported that mammals giving birth in the wild do indeed seek out a private place, where they won’t be disturbed. Creating similar conditions for human women would seem sensible if the desired outcome is not only better bonding, but also safer expulsion of the placenta.

REASON No.7: When they use drugs for pain relief (and side-step the natural processes), women end up disempowered, upset and depressed

Negative emotions postnatally... Visiting many baby groups in different places has confirmed my impression that many mothers experience early motherhood as negative and disempowering. Women typically sit around, barely talking to each other or only exchanging superficial information and comments, in an apparent effort to display an ability to cope, despite behaviour which suggests difficulties. Many women have told me they are too overwhelmed to go to groups. Of course, a lack of openness could be attributed to tiredness or a kind of identity crisis after passing into the uncharted territory of motherhood. Certain information and statistics, however, confirm the notion there might be deeper reasons.

A survey commissioned by Mother & Baby magazine in 2002, which collated the responses from 3,000 women, found that 86% of respondents reported they were in pain after giving birth for an average of 24 days; almost a third of these said they were in ‘considerable pain’. According to MIND, the leading UK mental health charity (see www.mind.org.uk) new mothers usually get the ‘baby blues’ for two to four days after the birth. MIND reports that doctors usually put this down to hormonal changes or to ‘the experience of being in hospital’. Negative feelings after giving birth—which are said to include feeling emotional, difficulties sleeping and loss of appetite, anxiety, sadness, as well as feelings of guilt and inadequacy—are apparently so common, they are considered normal. Have we as a culture come to terms with the lack of empowerment which results when women don’t experience the natural endorphins produced in a physiological birth? When women don’t experience the usual postnatal hormones—particularly oxytocin (which is also the hormone of orgasms) and prolactin (which induces relaxation and mothering feelings)— are women plunged into unnatural depression? After all, women who’ve had drug-free physiological births have reported minimal postnatal pain (both emotional and physical), but obviously more research needs to be done to confirm that outcomes certainly are better postnatally without interventions. The long-term effects of a failure to experience the natural endorphins and hormones of birth and breastfeeding are difficult to estimate, but one cannot help but wonder why 31 million anti-depressants were prescribed in the UK in 2006, many of them no doubt to adult women of childbearing age. Apart from the many women who go to their GPs complaining of general depression, the Royal College of Psychiatrists reports that 1 in 10 women are diagnosed with full-blown postnatal depression. This apparently leaves them feeling depressed, irritable, tired, sleepless, not hungry, unable to enjoy anything (including sex), unable to cope, guilty and anxious.

How many women who don’t ever get to their doctors also experience feelings of disempowerment, sadness and depression? How many women go into hospital to give birth feeling optimistic and possibly even excited, but later come out feeling angry, disillusioned and even betrayed? In that survey conducted by Mother & Baby magazine over 81% of respondents admitted being frightened during their labour and 53% said that childbirth had been ‘far more shocking’ than they’d expected. 57% felt their antenatal classes had not revealed the truth about the experience of giving birth in the UK today. That was in 2002. Has the situation changed since then? Are these women representative of all women in the UK?109 What is the truth, which women found so shocking? Judging from many birth stories I’ve read (some of them published, others sent to me while I was researching birth), I conclude that a great number of women feel regrets about some of the interventions they have while they are in labour or giving birth. The simple, but uncomfortable, truth seems to be that many interventions are felt to have been unnecessary, perhaps done for the convenience or control issues of caregivers, not safety.

From Sylvie Donna's book, Optimal Birth: What, Why & How. Note that a companion edition for pregnant women is also available, Birth: Countdown to Optimal.