Why questions are good, but answers are better.

I recently came across an article on Popsugar entitled, The 23 Questions You Should Ask Before Deciding on a Natural Labour.

The article posed a lot of pretty misleading (and some downright silly!) questions, but no answers.

So while asking questions is a good (and important thing), I think answers are even better!

  1. Do I have any health complications that put me at an increased risk during a natural labour?

Perhaps a better question to ask is; will a high intervention, overly medicalised labour put my health and my baby’s health at greater risk than a normal, low-risk, physiological labour?

  1. What are the benefits for me and my baby?

Where do I start?

First of all – I prefer not to use the term, “natural labour”. It’s a loaded term and not a terribly accurate one at that. Normal, physiological labour is far better (and useful).

Here are just SOME of the benefits (that are all backed by high-quality, evidence-based research) of normal physiological labour:

Mother’s body will release a “cocktail” of hormones, critical for labour to progress efficiently.

Oxytocin (“the hormone of love”) – which help the uterus to contract efficiently throughout labour and also to expel the placenta following the birth of the baby. Oxytocin is also critical for mother-baby bonding and attachment, and plays a major role in breast milk production as well.

Epinephrine and Nor-Epinephrine (AKA “adrenaline”) the fight or flight hormones, designed for protecting our babies and also responsible for giving mum the much-needed surge of energy at the end of labour to help push her baby out.

Beta-Endorphins (nature’s painkillers) – beta-endorphins flood a mother’s body when labour intensifies, which allows her to enter a dream-like state and helps her to transcend the pain of labour.

Prolactin – the mothering hormone. This is the main hormone responsible for the production of breast milk. However, it is not a hormone exclusive to females. Males also produce prolactin, and studies have shown that fathers who hold their babies close to them, cuddle and kiss their babies – produce higher levels of prolactin, which helps them to become closer to their babies and more nurturing.

Want to learn more about the magic of birth hormones? Watch this clip with renowned French obstetrician, Michel Odent.

Women who labour without unnecessary interventions and medications are in much greater control of their labour. Their movement is not restricted, so they can move around freely and change their position frequently throughout labour.

They can take advantage of numerous comfort measures such as the shower, or a warm bath, heat packs, TENS machine, massage and counter-pressure, sitting on a birth ball. For some more inspiration on all the things you can do to find comfort in labour, check out my blog; The ABCs of Comfort in Labour: 26 great ideas to help you get through even the toughest parts of labour.

Women who labour without unnecessary intervention often have shorter, easier and less complicated labours.

And last, but definitely not least, research has shown that low-intervention, un-medicated labours improve early infant attachment and breastfeeding success.

  1. What are the risks and potential complications?

The alternative to a vaginal delivery is Caesarean section, which is major abdominal surgery. Compared to normal physiological birth, Caesarean birth carries significantly more risk. However, vaginal birth is not without risk (birth full stop will never be completely risk-free) and women should know all their options in order to make a fully informed decision. To learn more about some of the possible complications of a vaginal birth, check out this excellent article on belly belly.

  1. How does it impact the chances of needing emergency interventions and does it limit those options?

If a woman requires emergency interventions, then they will always be available, providing that her place of birth has those options available (for example, access to pain medications, anaesthesia and emergency surgery). By labouring normally, a woman is not limiting her options for pain relief or other interventions down the track should she request them, or if they become necessary.

  1. What is recovery like for a woman who delivers without medication?

Most women report that they recover significantly faster from a normal, uncomplicated (drug-free) labour and birth and breastfeeding usually gets off to a great start.

  1. Does this change the chances of tearing or swelling?

Women who labour with an epidural are at higher risk of requiring an assisted delivery (vacuum or forceps) which will significantly increase their risk of tearing during labour. In many cases, an episiotomy (surgical cut of the perineum) is required in order to avoid significant tearing.

A woman labouring without epidural can reduce her risk of tearing by doing the following;

  • Avoid labouring on her back. Instead, she should adopt upright or forward leaning positions for giving birth.
  • She should avoid being “directed” during the pushing stage of labour. Instead, she should push when she has the urge to push and should rest when she doesn’t. She should also limit the amount of time she holds her breath.
  • She should request perineal support while pushing (warm compress or warmed pure almond oil and gentle support from the midwife or obstetrician).
  1. Does it change the way or frequency in which I would push?

Women who push in an unmedicated labour will usually experience a shorter Stage 2 of labour (the pushing stage). Epidurals are associated with a longer second stage of labour partly because of the reduced contractivity of the uterus (a woman’s contractions are less efficient) and also because of the mother’s reduced movement in labour and ability to be in an upright position which allows gravity to assist with the descent of the baby.

  1. Does activity level during pregnancy help prepare the body for a natural birth?

There is no denying the fact that labour is a physical event (it’s called labour for a reason!) so it definitely helps to be in the best shape you can be in prior to giving birth. Does that mean you need to have the stamina of an Olympic athlete? Of course not! Gentle, moderate exercise in pregnancy (walking, yoga, Pilates and swimming are all fantastic), together with a good balanced and nutritious diet, will go a long way to improving your fitness and stamina in labour.

  1. Are there different ways I can start preparing my body early in my pregnancy?

Definitely! See Question 8 above! Eat well, exercise moderately most days and get plenty of rest during pregnancy.

  1. Are there specific stretches for your hips you can work on?

Prenatal yoga is wonderful preparation for labour, so find a class in your area. It’s also a great way to meet other pregnant women.

  1. What things can my partner do to help me?

This is a HUGE topic! Continuous support in labour is critically important. We know from a great deal of research that women who are continuously supported during labour have easier, shorter labours, are less likely to request pain medication, less likely to require an emergency Caesarean and less likely to experience perinatal anxiety and postnatal depression. Yes – it’s THAT important!

Partners need to understand the process of labour and birth just as much as mum does. Attending an independent childbirth education course will empower a couple and give them the information and tools they both need to have a positive birth experience.

  1. How often do you use interventions?

This is actually a great question! Most women never think to ask their care provider about their rate of intervention during labour and birth. It is very important that you know far ahead of time what your hospital or doctor’s attitudes towards interventions are. For example, if you are hoping for a low-intervention, drug-free , vaginal delivery and your hospital has a 90% epidural rate and your obstetrician has a 70% Caesarean rate – it’s time to change doctors and hospital!

  1. Can I deliver in different positions or do I have to be flat on my back?

Yes and NO!

A woman should be free to give birth in whatever position she wants to. Physiologically, it is far more beneficial to give birth in an upright or forward leaning position. For some women, a semi-sitting or side-lying position is most comfortable.

A woman should never be forced to give birth on her back. If someone tells you to do so, ignore them and give birth exactly the way you want to. Giving birth flat on your back serves no physiological benefit and it associated with a higher risk of severe perineal tearing. By compressing a major artery that carries blood from the lower half of the body (the inferior vena cava), a woman lying on her back for an extended period is also at risk of lowered blood pressure, which can also lead to fetal distress.

  1. When is it too late to change my mind?

In most cases, you can change your mind whenever you want to. However, in some circumstances, if a woman requests pain medication (such as an epidural), she may not be able to get one because a) there is no anaesthetist currently available or b) she is close to being fully dilated and the arrival of her baby is imminent.

Other medications are known to have potentially serious side-effects on the baby (such as narcotic or opiate medications like morphine) and if a woman’s care providers believe that birth is estimated within about a two-hour window, those medications will not be available.

  1. How will I know if there needs to be a change in my birth plan?

Birth plans are incredibly important documents, but they are not written in stone and women need to have a degree of flexibility. Very often, things won’t go exactly according to “plan” and therefore the best type of birth plan is one which is flexible and clearly communicates to her care providers her intentions, while acknowledging that sometimes things happen unexpectedly.

Want some tips on creating a great birth plan? Check out my blog; The dangers of “winging it” in labour and why every woman needs a birth plan.

  1. Are you supportive of natural births?

In the same way that you want to know your care provider’s attitude towards intervention, you want to know their attitude towards normal “natural” birth. Listen carefully to their answer. It will tell you a lot!

  1. Will you work with me to avoid pain medicine for along as is safely possible?

This is a stupid question because it implies that experiencing pain in labour is not safe. It is normal to experience pain in labour. And while at times, that pain will be intense, it is not something to fear. Nothing bad is happening to your body, and in fact, the pain of labour can be very informative. I love teaching the P.A.I.N. acronym in my Lamaze classes;

P – Purposeful

A – Anticipated

I – Intermittent

N – Normal

Pain medications carry risk, labouring naturally does not.

  1. What are your epidural and C-section rates?

Great question. Make sure you know this information well ahead of time (see: Question 12 above!)

  1. Are there any water options (like shower, bath, or birthing pool) during my delivery?

This question is a little misleading. Most hospitals and birthing centres offer showers and sometimes baths or birthing pools as well. Most women find labouring in water to be hugely beneficial in terms of helping to reduce pain in labour. Whether or not a woman can give birth in the water depends on the policy of her care provider. Again, it is important to know ahead of time what your birth location offers. Women labouring at home will have access to showers, bath or a birth pool throughout labour and will have the option of delivering her baby in the water if she wants to.

  1. Who will actually be delivering my baby?

You will be mama. You will be.

  1. How many natural births have you participated in?

It depends on who you are asking! If you are talking to your midwife, chances are most of the births she has attended and supported have been normal, vaginal deliveries. If you are talking to your obstetrician, there’s likely to be a higher percentage of assisted deliveries or births via Caesarean section. However, there are many other contributing factors including where a woman is giving birth. We know from research that Australian women birthing in a private hospital, with a private obstetrician are significantly more likely to have a Caesarean section compared to a woman giving birth in a public hospital where she is mainly supported by midwives throughout her labour.

  1. Do you have specific birth classes you can recommend?

Okay. Full bias here! I strongly believe that taking a Lamaze Childbirth class is a wonderful way to prepare for a healthy labour and birth. Lamaze International is widely considered to be the ‘gold standard’ of childbirth education. Literally millions of women around the world have benefited from Lamaze education which is evidence-based and promotes healthy and safe pregnancy, labour and birth. The vision of Lamaze International is “knowledgeable parents making informed decisions.”

  1. What are natural labour pain-management techniques I should work on?

I think it’s important to move away from the idea that a woman needs to learn specific techniques and more towards understanding how her own body works. A woman instinctively knows what helps her to relax, and de-stress. We’ve all experienced difficult and stressful situations in our life, and in many ways, labour is no different. While you might not have been in labour before, you have used instinctive tools and behaviours to help combat difficult situations. There are many, many tools that a woman can make use of during labour to help her find comfort. For some women, it’s water, for others it’s massage, counter-pressure and activating acupressure points or perhaps, heat packs, TENS machine or movement.

Most women will find that what works best is utilising a variety of comfort measures, combined with frequent position change and movement during labour. To learn more, check out the Lamaze Healthy Birth Practice #2: Walk, Move Around and Change Position throughout Labour.

Tanya Strusberg is the founder of birthwell birthright. She is a Melbourne-based Lamaze Certified Childbirth Educator and a Fellow of the Association of Certified Childbirth Educators (FACCE). She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), Empowering Birth Magazine, Rockstar Birth Magazine, Mum’s Lounge, Go Ask Mum and Whole Woman. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators. Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.