Human Childbirth Is One of the Most Important Natural Processes of Human Life

BIRTHING METHODS, LOGIC AND PHYSIOLOGY – ISSUES SURROUNDING THE NUMBER OF CAESAREAN DELIVERIES.

By Stephanie Lloyd, 10112842.

Human childbirth is one of the most important natural processes of human life. It has been and will continue to be as long as mankind lives as it is essential for the start of new life. It has also however always been a very painful process and complications endangering the mother and/or babyare always a possibility. It is for this reason that people from all different cultures and throughout history right up to today have invented many different birthing methods in an attempt to increase comfort and decrease complications during childbirth. This logic behind the invention of each new childbirth method is also very much based on the physiological well-being of both mother and child. In modern western societies, there are many different birthing methods to choose from which all come under one of the three main categories of birthing methods. These are natural childbirth, assisted natural childbirth and surgical childbirth. Natural childbirth includes any form of vaginal birth that does not involve the use of drugs and/or medical equipment. This could be a birth using a midwife, a Doula (birthing assistant) or an ‘enlightened’ doctor in either a hospital, a birthing centre or at home. Natural birthing also includes the use of techniques such as the Lamaze method, the Bradley method, the Leboyer technique, HypnoBirthing and water birthing. Assisted natural childbirth involves a vaginal birth with the aid of drugs and/or medical equipment. This includes the use of an epidural anaesthesia, forcepsor having a vacuum-assisted birth. Surgical childbirth is the Caesarean section (C-section) which has a lot of controversy surrounding it in today’s society. This is because of the vast increase in the number of caesarean sections that are performed and the fact that most of the procedures are done without any medical reason. These numbers are still on the rise and so there is a major push to decrease the number of c-sections and to return to natural childbirth. This is a very topical issue in modern western societies and the question of why officials feel this move away from c-sections and towards natural childbirth needs to made and whether this is valid, is discussed as a part of this investigative review.

NATURAL CHILDBIRTH

Natural childbirth being vaginal birth without the use of any drugs and/or medical equipment can be done in many different ways. There are a variety of different places, a variety of different attending personnel and a variety of different techniques a woman can choose from in order to give birth naturally.

A midwife is a nurse trained specifically in the assistance of childbirth who can not only help with the medical side of things, but is there to offer support and coaching as well. A midwife can attend childbirths in hospitals, birthing centres and at home and they are a very common choice of women wanting a natural birth (Bygpub.com n.d.).

The logic behind the assistance of a midwife goes back as far as medieval times where midwives were the only choice of birthing assistant available. It was widely recognised that birth was a difficult process and that someone should always be in assistance during this process not only to assist with the physiological needs but also the emotional needs of the woman. Naturally it was seen as more appropriate for a woman to attend a birth than a man and so the professional midwife came about and is still around today for the same reasons. A lot of women also prefer the more ‘motherly’ and womanly approach of the midwife, as opposed to the very clinical and unemotional approach of a male physician. The presence of a midwife can also be calming for this reason which benefits both the mother and child in the way of the reducing the detrimental effects of extra high cortisol levels and by increasing relaxation which aids a quicker and easier delivery.

A Doula or labour assistant is a woman who has been highly trained and certified and who belongs to a Doula association (Optimal Wellness Center 2000). They are not nurses so cannot provide as much medical assistance as a midwife but they are still able to provide some physical support. Their main job is to provide emotional support, encouragement and wisdom during childbirth which has been found to be very beneficial as is having the father-to-be in the room which is encouraged by Doulas (Optimal Wellness Center 2000).

There have been studies done on the beneficial effects of having a doula present at childbirth which show a reduced chance of caesarean sections, reduced epidural or other painkiller use, reduced duration of labour, reduced use of forceps, reduced chances of health complications and hospitalisations for the baby, reduced maternal bleeding, reduced levels of anxiety and a more positive birthing experience for the mother just to name a few (Optimal Wellness Center 2000). These positive results show the logic behind choosing a doula to be present at childbirth, but mainly the emotional support given during this event is logical enough.

Home births as opposed to hospital births are growing in popularity in modern western societies. There is a lot of logic behind it in that birth is a natural process not a medical procedure so why should one need to be in a hospital (Bygpub.com n.d.), unless of course there is a high risk of complications for mother and/or child or the baby is preterm.

There have been many studies done on the safety of home births which can either be done with the assistance of a midwife, a doula or unassisted. For low risk women the figures show that home birth can be a safe option for 90 percent of women with the appropriate prenatal care and attending personnel (Johnson, Daviss 2005). Home birth is also logical in the way that it is much less expensive for the individual and for the government and as long as there is medical assistance at hand if it is needed, it also provides a much more relaxed and familiar environment (Johnson, Daviss 2005). Where stress reduction during birth is important in the way of the physiology of both the mother and the child, home births are a logical birthing method.

Another study done with more than 5000 women planning home births with Certified Professional Midwives, found that the outcomes for both mother and child were the same as for low risk mothers giving birth in hospitals, but with a fraction of the intervention (Johnson, Daviss 2005).

Also it was found that home births that are uncomplicated cost 68 percent less than in a hospital and births that are initiated at home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of caesarean delivery (Anderson, Anderson 1999).

The Lamaze method of childbirth was developed by the obstetrician Fernand Lamaze after he observed techniques for ‘painless childbirth’ on a trip to Russia in 1951 (Kegel Exercise.com n.d.). These techniques were based on the work of Ivan Pavlov, the Russian psychologist that argued that the brain plays a major role in the perception of pain (Kegel Exercise.com n.d.). The Lamaze method assumes that birth is a natural and healthy process that can run its course with very little need for medical intervention. It comprises of three main techniques; relaxation methods, breathing exercises and pushing during contractions. It teaches that through massage, learning how to isolate different muscle groups, meditation and mental imagery a woman can diffuse stress during childbirth (Kegel Exercise.com n.d.). Moving around during labour is also emphasised as is keeping the pelvis tilted towards the floor to make the best use of gravity. Breathing exercises are another part of the Lamaze method where each of the three stages of labour has a different breathing pattern (Kegel Exercise.com n.d.).

The logic behind this method is that of Pavlov’s idea of pain being mainly a perception and so through mind control with things like the breathing exercises, the meditation and mental imagery, the pain can be controlled. Relaxation is also an important outcome using this method that again is logical due to the great benefits, physiologically and emotionally, to both mother and child of a low stress environment.

The Bradley method was developed in the late 1940s by Denver obstetrician Robert Bradley (Kegel Exercise.com n.d.). It is similar to the Lamaze method but it does not teach breathing exercises. Instead it concentrates solely on relaxation exercises to control the pain of labour that involve massage and touching by the husband, reassurance by the husband to boost the mother’s confidence and a technique called ‘warmth’ where the woman imagines herself standing in a warm shower (Kegel Exercise.com n.d.). It also strongly encourages the woman to move about during labour as movement helps manage pain. It teaches that the women should walk about, have a shower and change positions as much as possible and to try and avoid lying on her back as this can cause the most tremendous amount of pain (Kegel Exercise.com n.d.).

The logic behind this method is the philosophy that it is possible to give birth without drugs, which was unheard of in the days that this method was invented. Again increasing relaxation and decreasing pain are the main focuses which are very logical in childbirth.

The Leboyer method was established by Dr. Fredric Leboyer in the 1970s (Pregnancy-info.net n.d.). It advocates giving birth in a very quiet room where the lights are low or dimmed. It also recommends that the baby’s head is not pulled so that the birth can be completely natural. Once the baby is born it will be massaged to encourage it to take its first breath, instead of smacked, and the umbilical cord will only be cut until it has stopped pulsating so that the baby will be able to take its first breath in its own time without being forced to. After this the baby will be placed on the mother’s stomach where she massages it to ease its crying and the closeness will also encourage bonding between mother and child. A short while after this the Leboyer method suggests putting the baby in a warm bath to try and recreate the atmosphere from which the baby came (Pregnancy-info.net n.d.).

The logic behind this method is that babies that are born with as little stress as possible are more content and although this is debateable, making the birth less stressful for the mother is always a positive. The more relaxed the mother is during birth, which all these techniques encourage, the more beneficial it is for both mother and baby physiologically and emotionally. Also respiratory distress can be minimised with the techniques used to encourage the baby’s first breath and due to all the calming techniques the birth can be much more pleasant and fulfilling for the mother.

HypnoBirthing, the Mongan method, is a very unique and relatively new birthing method that makes use of hypnosis (HypnoBirthing® n.d.). It is a relaxed and natural method that allows women to use their natural instincts to bring about safer, easier and more comfortable birthing in a way that most mirrors nature. It was created by Marie Mongan who received the Rexford L. North award at the convention of the National Guild of Hypnosis on August 13th 2005 (HypnoBirthing® n.d.).

The logic behind this method is that hypnosis can let a woman fully concentrate on the birthing process and so all her energies are used to try and make the birth as easy and relaxed as possible. She would also be more relaxed in a hypnotised state and this would most probably help in managing the pain of childbirth. All this is debateable but hypnosis is used in many other situations for similar reasons and the hypnotised state would seem to be favourable due to the incredible pain and stress experienced in childbirth.

Since the 1960s water births have become an increasingly popular childbirth method throughout the world (Home Birth Association of Ireland n.d.) with a Swiss childbirth clinic noting that water births have risen to 40-50 percent of all spontaneous births throughout recent years (Mercola.com 2000a).

Water birth involves the mother labouring and delivering in a water bath especially for this process (Home Birth Association of Ireland n.d.). The water should be kept as pure as possible, free from any chlorine and fluoride and with no residues from chemical cleaners left in the tubs (Mercola.com 2000b). The water is heated to 37.5 degrees Celsius, body temperature, and attending personnel can have clear access to the mother and child and so can the father who can even sit in the bath with the mother at the time of delivery.

There are many benefits associated with water birth with the main ones being effective pain relief, enhanced relaxation, an increased sense of privacy and a reduction in the need for intervention, that clearly make it a logical option of childbirth (Home Birth Association of Ireland n.d.). Water has many physiological effects on the mother in the way of effective pain relief during labour like reducing strain of the joints, muscles and ligaments that have to be stretched during birth and a softening and relaxation of the perineum (Home Birth Association of Ireland n.d.). In the way of enhancing relaxation water is very good as it gives slight buoyancy and provides a flowing sensation around the mother which in turn helps her to concentrate fully on the birthing process in order to make it much easier and quicker. Mothers also find the process much more fulfilling and pleasant in such a relaxed, natural surrounding as water. Another huge benefit is that the baby is born into a very similar environment from which it came and so the stress of birth on the baby is vastly reduced. If the umbilical cord is not cut immediately then the baby also has the chance to play with its first breaths as opposed to being forced into them (Home Birth Association of Ireland n.d.).

The Swiss childbirth clinic mentioned before, reports that water birth babies are healthier due to all these enormous benefits to both the mother and child. They also found that an episiotomy was only performed in 12.8 percent of water births as opposed to 35.4 percent in normal bed births. Also bed births still had the highest percentage of 3rd and 4th degree lacerations at 4.1 percent. The loss of maternal blood is the lowest in water births and fewer painkillers are used. The average arterial blood pH of the umbilical cord is significantly higher and the Apgar scores at 5 and 10 minutes are also higher in water births. Infections of the neonate have not been found to occur more often and there have been no cases of water aspiration or any other perinatal complication of mother or child which might be water-related (Mercola.com 2000b). This method of birth only seems logical.

ASSISTED NATURAL CHILDBIRTH

Assisted natural childbirth is a vaginal birth with the aid of drugs and/or medical equipment which includes the use of epidural anaesthesia, the use of forceps and a vacuum-assisted birth. These are all used when natural birth becomes difficult and so are most often not planned into the birthing process.

An epidural is a local anaesthetic that is administered in repeat doses into the epidural space of the spinal column to numb the nerves from the uterus and birth passage without stopping labour. A successful epidural puts the woman into an almost pain-free awake state throughout the entire labour and delivery (The-health-pages.com n.d.). Only when the woman has started active labour will the epidural be given and this is done by injecting a large needle into the epidural space and inserting a catheter for repeat administration. Throughout the whole birthing process the woman will be given fluids intravenously and at times her bladder may have to be emptied by the use of catheter as she does not have control over her abdominal organs. The woman will also have to remain in bed the entire birth as she will not be able to walk and in some cases she is not able to push either which will mean that a nurse will have to push on her abdomen to help deliver the baby. The use of forceps might be needed as well due to the woman’s inability to push during contractions (The-health-pages.com n.d.).

The logic behind this method is simply of pain relief during childbirth. The epidural drug used does not make the woman drowsy before or after the birth and little medication reaches the baby (The-health-pages.com n.d.). Mostly this procedure is a safe one.

The use of forceps in birth is called a forceps delivery and involves the use of a spoon-shaped device that resembles are pair of salad tongs (forceps) to pull the baby gently from the vagina (Heatherton n.d.). Forceps are only used when the cervix has fully dilated and if the umbilical cord has dropped down in front of the baby into the birth canal, if the baby is too large to pass through the birth canal unaided, if the baby is showing signs of distress and if the mother is too exhausted to push (Heatherton n.d.). Before using forceps the mother’s bladder may need to be emptied using a catheter and the perineal area may be cleaned with soapy water. Then a local anaesthetic is administered to the perineal area and quite often an episiotomy is performed (Heatherton n.d.). An episiotomy is where a cut is made in the perineum to allow the vaginal opening to enlarge even more without tearing and this is not only done for forceps deliveries but in normal deliveries as well (Heatherton n.d.). After this the obstetrician slides half the forceps at a time into the vagina and around the side of the baby’s head to grasp it and pull during contractions. This can cause the baby to be delivered on the very next contraction. Sometimes nerve damage and temporary bruising on the baby’s head can occur but with an experienced physician this chance is vastly reduced (Heatherton n.d.).