There are plenty of natural birth advocates out there–I know because I keep having to plaster a vapid smile on my face when they spout half-truths and didactical opinions at social gatherings. I’ve yet to meet an avowed unnatural birth advocate, so I’ve decided to take up that mantle for myself. So, if you are pregnant, or might be some day, here are some thoughts on why you might not want to have a natural childbirth.
The natural birth advocates will tell you that everything from epidurals to c-sections have risks that you should avoid. They are half right. Epidurals and c-sections have risks. But not having an epidural and/or having a natural birth have risks, too. They just have different risks. You should make your decisions not with the delusion that you will be able to minimize all risks, but that you can minimize the risks that you most want to avoid. For example, you are more likely to end up with an infection if you have a c-section. You may want to avoid that risk at all costs. More power to you, sister. But a c-section (especially if your baby is large) will lower your risks of future urinary and fecal incontinence considerably. You will also avoid a considerable amount of labor and postpartum pain. You will also be able to schedule your delivery. To some women, these things aren’t important. To others, they are. I think there is a vestige of paternalism in the idea that anyone (whether doctor, mother-in-law, or natural birth advocate) can weigh these risks for another woman and inform her which option is “safer.” (It is hard, for example, to imagine a male cancer patient not being given a choice between chemotherapy, radiation, and surgery when each would have different risks and benefits in his case.) I am also very concerned about the downplaying of women’s pain as inconsequential. Again, you don’t see men rallying around the banner of the Natural Dentistry Movement.
Similarly, home birth minimizes some risks (your risk of being in a hospital, your risk of losing control of the situation, your risk of other medical interventions, your risk of sleeping in a strange bed and not eating what you want to eat) and increases others (your risk of delay for additional treatment if something does go wrong). Again, weighing these risks is a very personal issue and I fully support any woman who chooses a home birth based on her own assessment of the risks.
I do, however, have some problems with how that risk assessment is happening. First, many women have a negative perception of c-sections because their experience with them is something like this: they were laboring along just fine, thank you, when all of a sudden a bump on the monitor meant that all hell broke loose and they were hustled in for an emergency c-section. Scary–all that rushing around and changing of plans right in the middle of things. Not to mention that they got to recover from labor and a c-section, which statistics suggest is the hardest recovery of all. So a woman who has had an emergency c-section may not be the most objective source of information.
I also have a problem with the assumption that a c-section is something foisted on an uninformed or deceived woman by a lazy or malpractice-paranoid doctor. Undoubtably this does happen. But many women choose c-sections based on an informed assessment of the risks (see above).
You may be curious about my personal background: I had a poor experience with natural childbirth followed by two very successful elective c-sections. If I am blessed with another child, I would without hesitation choose another c-section. It isn’t the right choice for every woman, but it is for some. I hope that at some point, prenatal care will involve women being provided the data concerning the risks of various birthing options so that they can make their own choices and that their health care providers will then support them in their choice of home birth, natural childbirth, medicated childbirth, or c-section. We need better data for this to happen. (For example, very few studies bracket purely elective c-sections, so the data makes it look as if c-sections are actually much riskier than they are because they do not account for the underlying situation that led to the c-section. There is also a terminology problem even in the medical literature: sometimes ‘elective c-section’ is used for people like me who walk into an OB/GYN and say, “I want a c-section despite having no medical need for one” and other times it is used to mean the opposite of ‘emergency c-section,’ meaning that the doctor decided before labor began to perform it [for any or no medical reason].) But this article is a start. This is also interesting, as is this.
A final note: I welcome comments from natural birth advocates, including links to data. Please present us with as much information as you can find on risks and benefits. Just refrain from weighing those risks and benefits for anyone but yourself.