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Questions about childbirth answered

Questions on Quora answered by Linda Hessel, Researcher and Mother of Four
https://www.quora.com/profile/Linda-Hessel

If natural child birth is so painful why do most women opt for it? Instead why not go for cesarean delivery? What are the benefits and costs of natural childbirth?

I wanted my child’s birth to be as normal as possible; I did not want to introduce extra risk. Pain medication and medical procedures, management, and even the hospital environment in itself generally all adversely affect the body’s ability to give birth normally, and afterward to recover, bond, breastfeed, and experience instinctive mothering behavior . If you want to know the details there is an enormous body of literature that addresses it, much of it for the lay person. For me, the only cost of natural (i.e. unmedicated vaginal) childbirth was the temporary pain. I went an extra step and planned for unmanaged, unhindered, private births and postpartum. The benefits were enormous. My body was able to do everything it was capable of, releasing all the right hormones at the right times. No complications, no injury, no emotional trauma, no postpartum depression, a deep bonding and normal breastfeeding. It was worth every minute of the pain.

Is laying on your back while delivering the baby a natural way? If not, then why do doctors make women to go through such pain by delivering in an unnatural way?

A woman giving birth without any external instruction or prompting is extremely unlikely to instinctively lie down to give birth. In that sense it is unnatural, yes. It doesn’t make sense from a physiological perspective either. Gravity aids the efforts of the uterus when it is vertical, and works against it when it is horizontal. When vertical, the pregnancy-softened cartilage of the pelvis has greater freedom of movement, allowing the baby to maneuver ideally through the pelvis. Further, the gravity-aided pressure of the baby on the cervix helps it dilate evenly and sends feedback to the brain so that is releases the hormones necessary for a normal and quick second (pushing) stage. Lying on one’s back during labor also tends to be significantly more painful; I wouldn’t call being directed to stay in a painful position “natural”.

Did you use any particular method of childbirth delivery?

My first was a typical managed “natural” childbirth. I really had no idea about different philosophies of childbirth, I just went along with the medical professional. She was a bossy “take charge” type, constantly telling me what to do, which was often at odds with what I felt like doing. It felt like she had her hands up me way too often, she told me to stop making so much noise and moving around so much, she had me do second stage on my back having me push as hard as I could for hours, and she took the baby right away to clean him up. I felt bullied and physically and emotionally wrecked, and did not bond right away with my baby. For my other births I sought out “hands off” care and gave birth in a very private, non-distracting environment — I guess you could call the method “birthing like a cat”. Dark, warm, nobody talking to me or touching me, just letting my body do what it knows how to do instinctively. The more I did that, the smoother things went. No difficulty getting the baby out, no injury, no trouble bonding. I did do a waterbirth once — I wouldn’t do it again. I did love laboring in water though.

Do women ever get tired of pushing during childbirth, and if so, what happens when they can’t push any further?

To get the baby down through the vaginal canal shouldn’t be a marathon event. The medical professional can deem the cervix “fully dilated” but it doesn’t mean the body is ready to push the baby out, and pushing before the body is ready is only going to result in exhaustion for the mother and decreased oxygen and more stress to the baby. Gravity and the pressure of the baby’s head against the cervix (which is why it’s ideal for the mother to be vertical) will at some point trigger a “throwing down” kind of reflex in which the mother can’t help but *not* push, and within minutes the baby will be born. You can read more about this by googling “fetal ejection reflex”.

With my first, I was told to push when “fully dilated”. My body wasn’t ready. I was coached how to push and when. I felt no urge, and I pushed so hard blood vessels in my face broke. I was stressed and tense because there were three people staring at my vagina and touching me, I was in an uncomfortable position, my back was killing me, and I was told to be still and stay quiet. I pushed for two hours. It was horrible and I was injured. I was so exhausted I could barely muster the energy to hold my baby. With my others, I labored in privacy, with no distractions; the only people touching me were my husband and myself, I yelled and moved around as much as I felt like, and I was upright, kneeling. I waited for that “throwing down” feeling. Those babies came out quickly and easily, in two pushes, one for the head, one for the body. No injury; my genitalia felt back to normal within a week.

Does childbirth incline a woman towards childcare?

If you mean professional childcare, I’d say probably not, because it’s a whole different sort of thing from caring for your own children. If you mean does it increase mothering/nurturing/bonding feelings and behavior, then yes, that is what is supposed to happen, but it doesn’t always, and maybe not even often in our culture in which medicalized birth is often traumatic and mother and baby are immediately separated, breastfeeding is made difficult, and parenting practices that try to make the baby “independent” and “self-soothing” as soon as possible are encouraged, all which interfere with the hormones that chemically boost mothering behaviors instinctively.

How can I prevent hemorrhage during childbirth?

Give birth in an environment in which your body is able to respond physiologically normally to the birth of the baby. Don’t cut the cord immediately, don’t pull on it, don’t talk to the mother unless absolutely necessary, give her access to the baby immediately, keep the lights low, keep her warm. More explanation and instruction here:

Leaving Well Alone: A Natural Approach to the Third Stage of labour

How did having a ‘husband’s stitch’ after childbirth affect you or your partner?
https://en.wikipedia.org/wiki/The_husband_stitch

The better question is why would anybody do it in the first place? This misogynist procedure is based on the idea that childbirth stretches women’s vaginas out so that men can’t receive pleasure from them anymore, and that the solution to that is to sew up the vaginal opening nice and tight. Never mind how it is for the woman. First, childbirth does not ruin women’s vaginas. Vaginal tissue, when softened by hormones, is made to stretch and spring back afterward. (Sometimes women tear. This is rare and usually minimal when an episiotomy is not done, the birth hasn’t been interfered with, and the woman pushes when her *body* tells her to. Also worth noting is that a tear heals better than an episiotomy – jagged surface knits together stronger than a clean cut – and episiotomies make deep tears likely, like how a piece of cloth tears easily when cut but not when whole.) Second, because scar tissue doesn’t stretch, it’s going to hurt for a good long while and make sex suck. For many women it hurts for the rest of their lives. There’s no reason to hire a doctor who does these, and every reason not to.

What can I do to prepare for the pain of childbirth?

I did a lot of talking myself up in the months and weeks beforehand. I processed the trauma of a previous birth, and then I focused on everything that would be great about this birth, and my strength. I told myself how great I was, basically. 😉 And then, during the birth: access to loving and calm support when I needed it, complete privacy when I needed it, lots of walking around, dancing, swaying, feel-good music, zoning out, meditating, laughing, singing, eating and drinking when I felt like it, lying down and resting when I felt like it, massage, sexual arousal and release. When the contractions started coming fast and furious, I immersed myself in hot water. I moved around a LOT in and out of the water and made a LOT of noise, yelling, swearing. Being able to direct that “negative” energy outward, purging myself of it in a sense, helped so much. I had someone put pressure on my hips and sacrum; that helped a bit with the back labor. Going back and forth from hands-and-knees to knees to half-squats (one knee down, one knee up) helped. Not having someone putting their fingers in me (it’s not necessary) every hour helped. Not having someone dictate to me what to do helped. And last, waiting until I felt the urge to push and let my body “throw down” made for a fantastic trauma-free second stage.

Why didn’t humans evolve to ensure successful childbirth without medical assistance?

No animal has evolved to *ensure* successful childbirth. I guess you really mean, why didn’t humans evolve such that successful childbirth is normal?
My answer is, it did, for the most part. The human body is “designed” to give birth successfully. If it wasn’t, there wouldn’t be so many human beings here. But there is also (and always has been) malnutrition and disease. *Nature* – as a whole system – is “designed” to ensure that there’s also a lot of death. Once, in our barn, we found a feral cat who had recently given birth to several babies. One was alive. Death in childbirth is not that uncommon among mammals that are already struggling to survive. But you wouldn’t therefore assume that cats didn’t “evolve to ensure successful childbirth.”

There’s enormous cultural and social bias against women. There are all kinds of myths based on such biases, like women being primarily emotional and men rational, women not being suited for leadership roles, women not liking sex, etc. The inability of most women to give birth normally is one of those myths. Women’s pelvises are *just too small*. Well, how would we know that exactly, when for the past few generations women have been made to give birth in greatly unnatural circumstances? Birth is a biochemically-orchestrated birth process, and the brain and instinct is deeply tied into that. Mammals’s bodies perform best in childbirth when they feel unobserved, unstressed, and safe. Yet we expect this biochemical process to unfold normally when a woman is in a strange brightly-lit place surrounded by strangers yelling directions at her, in a prone or reclining position, expected to not make noise or move around, often given drugs that interfere with her body’s ability to release the necessary hormones, probed by strange hands in painful ways. And then we say, when she has trouble, “Oh, her pelvis must be too small.” Talk about irrational. When a woman is upright in labor, the parts of her pelvis move to accommodate the baby’s movement and descent; the baby’s head puts pressure (gravity) on the cervix, which signals to the brain to release more hormones to soften, stretch, and lubricate her tissues. And yet we continue to keep women on their backs and stressed, we continue to see almost all of them have huge difficulty, pain, and some degree of complications, and we continue to wonder why “humans didn’t evolve to ensure successful childbirth.”

Does natural childbirth hurt?

It does to some degree for most women. For me it hurt a lot. Not the contractions so much (those were not much worse than menstrual cramps,) and not the emergence of the baby, but for me the pressure on my sacrum (“back labor”) was pretty awful. If I hadn’t had back labor the whole thing would have been a breeze, enjoyable even. There are definitely factors that can make it worse. Stress, fear, anger, restricted mobility, and forced pushing certainly make it harder and more painful. When I was made to labor on my back and push before my body was ready (both are common in modern birth management) it was traumatic and injurious. In that case, the pain wasn’t normal, it was my body telling me “this isn’t right, stop doing it this way!” But at the time I didn’t feel I had a choice but to do what I was told. I learned better and chose birth attendants for my other births that didn’t strong-arm me into laboring in an unnatural way.