This may start out seeming harsh, but with over 7 years of supporting families and their births, research, and experience, you need someone to tell it like it is and I will also tell you my very best tips and tricks to see it through. This is a story based on so many hospital births that I’ve both seen and been told by clients over the years. And it goes better than most.
First off, let’s start with calling it “unmedicated” and not “natural.” There is nothing “natural” about giving birth in the hospital and it is specifically designed that way. The best you’re going to get is unmedicated. Everything about a hospital is designed to encourage you away from a natural birth, starting with the type of maternity care you get from an OB/Gyn or a hospital-based midwife. The constant tests, monitoring, late-term ultrasounds. All of it is designed to keep you doubting your body and your ability to grow and birth your baby. By creating massive amounts of doubt and worry, you will be much more compliant when in the delivery room.
Let’s assume you went into labor at home and tried to wait to go to the hospital until the 5/1/1 rule. First off, that rule if you’re a first time birther is complete crap in my opinion. You will get there way to early. You will get asked to get changed into something that doesn’t fit and makes you uncomfortable, in a brightly lit room that likely doesn’t have doors, then made to lie down on a bed on your back (a very unnatural position for someone in labor) then hooked up to monitors so that they can “watch” baby and your contractions for at least 20 minutes. They will make you give them three vials of blood and then put in a saline lock “just in case”. More with the “planting seeds of doubt” in your health and ability to birth. Then they will insist on a cervical exam in order to prove that you are in fact in labor and deserve to be in the hospital. And yes, you definitely have to lie on your back some more for this. They will ask you a whole host of questions about your health history, your pregnancy etc that theoretically should be in your chart and accessible which will make it extremely hard to stay in your “zone”.
Now let’s assume you pass all their tests and are admitted into a room, finally! It even has a labor tub! Woohoo! Wait! First they need to wrap your arm in plastic to keep your saline lock safe, then they need to find some wireless monitors for you so you can labor in the tub, so definitely don’t get in yet. You have to stand by the bed so they can keep monitoring your baby “just in case”. Maybe they let you sit on a birth ball. Wait! that moved the monitors and they can’t see your baby’s heart beat any more so you have to move into the bed so they can reposition those monitors. An hour has passed since you got into your room and you’re still not in the tub and are begging to be able to get in. Finally the nurse comes back in and says that baby looks good enough for now, you can get in the tub! It is heaven. Your husband turns down the lights and you can finally focus on your breathing again and the pain subsides a bit.
40 minutes goes by… The nurse comes back in and tells you to get out of the tub and back in the bed so that they can do their “intermittent monitoring” and watch baby’s heartbeat again for 20 minutes. You comply, but immediately upon laying down on the bed, your pain goes way back up, maybe your blood pressure does too, which causes baby’s heartrate to not look as good. All of a sudden, you have to stay in the bed and on the monitors “just to be sure everything is okay”. An hour of this goes by and the nurse agrees to let you go back to the tub because things have normalized again. You work your way back to the tub and get in. Finally! 30 minutes later, your doctor arrives and wants you to get out so they can check your cervix. So again, you comply, get out, lay on the bed while your doctor puts on a glove and some goo then “checks to see where you’re at”. You feel like you’ve been working so hard and are barely just able to get comfortable in the tub. Your doctor pulls their hand out and you’re 5cm. What!? You’re doctor says, “well that’s not a lot of change since you got here, I’ll be back in an hour to see if you’re making more change. If not, we should probably break your water or talk about pitocin.”
You feel so discouraged. You walk back to the tub and get in. Tears start flowing because you just want to be done. You don’t want pitocin and you don’t want your water broken, but you don’t want to have to get back on that bed either. Your partner is getting stressed because they don’t like seeing you cry and in pain. “Maybe you should just get an epidural.”
You get a really strong surge that takes you by surprise! Your partner squeezes your hips and it feels so good. You rolled onto your hands and knees but this tub is hard and it hurts your knees to be in this position. You try laying on your back in the water, but it hurts. You keep moving back and forth between reclining and knees. You find a rhythm that finally seems to be working for you and you’ve rediscovered your resolve. It’s been an hour. Your doctor walks back in and says they need to check you to see if you’re making any progress. They don’t watch you labor through some contractions or ask you about pressure or other sensations, just wanna know what your cervix is doing. You ask if they can check you in the tub. They say, “well I can try, but it’s hard to get a good angle.” You do NOT want to get out so let them “try” in the tub. After fishing around for a while while you squirm in pain from the vaginal exam, your doctor says, they can’t really tell but it seems like there isn’t a lot of change. They ask you to get out of the tub so you can get on the bed for a better exam and to break your water bag to “help move things along.” Your nurse says “since you don’t want medication, breaking your water is the more natural way to get things moving.” You consent. Sort of. Your doctor sticks a long crochet hook up inside you and breaks your water bag then stretches your cervix for a while and makes sure that the baby’s head comes down to apply pressure to the cervix. They congratulate you, and say that your cervix is now 7 cm and very stretchy! Oh thank goodness. You feel so grateful. You ask if you can get back in the tub but your doctor says no, because now that your water is broken, there’s an increased risk of infection. WHAT!? You’ve never read that anywhere and they definitely didn’t tell you that before they made you get out and have your water broken.
“Can I at least get in the shower!?” They say “no” and that now they need to monitor the baby for a while since your water bag is broken and sometimes babies don’t like that. Sure enough, baby has a heart deceleration right away and they put an oxygen mask on you and make you lay on your back so the monitors can read the best. You are so scared for your baby so you lay there in pain, doing what the nurse tells you to do. Your baby’s heartrate recovers well after the initial shock of the water going away and the touching of their head, but the nurse wants you by the bed so that they can monitor baby “just in case.” You ask if you can go to the bathroom so that you can have just a few minutes to yourself. While there, you can feel your baby moving and moving down. Your surges feel okay right here so you don’t want to move. You don’t say anything, you just stay on the toilet. 20 minutes go by and the nurse pops her head in and says that you need to get back to the bed and get on the monitors. You say you just feel like you need to poop. The nurse then says that you aren’t allowed to push on the toilet and definitely don’t push. She needs to check you again to see if you’re “ready to push”.
You’re so excited because you can’t believe that you might actually get your unmedicated birth! Is it really time!? You climb up onto the bed and the nurse checks your cervix again. She says you’re 9cm. So not time to push yet. You can feel your body nudging your baby down though and with each surge you give a little involuntary grunt. The nurse loudly says “I told you it’s not time to push! Don’t push!” You can’t understand why doing what you’re body is asking you to do is wrong, but you try to comply, but it’s so hard. 30 minutes goes by and you can’t stop yourself from pushing. The nurse goes and gets your doctor. They walk in and say they need to check your cervix to see if you can push (which you’re already doing). It is SO painful to lay on your back that you just want to die. Your doctor checks you and says “congratulations, you’re complete and can push!” You look around for help to help you find a way back onto your hands and knees to push, but your doctor and nurse have already broken down the bed and are putting up the stirrups. They’ve turned on a bright light “so that they can see what they are doing”. You ask if you can push in a different position and they say “well let’s just try this first”… Somehow you find yourself pushing on your back. Your doctor sticks their hands in your vagina and says “I’m just stretching you a little so you don’t tear.” Everything you read said that hands-off was better for preventing tearing but you can’t even talk because you’re so focused on trying to get your baby out.
“We can see your baby’s head!” Oh my gosh! Yay! It gives you the strength to keep going. Your doctor is still “in there” stretching away. Your baby is crowning. Then all of a sudden the head is out! Immediately your doctor puts their hands inside of you and grabs your baby’s shoulders, turn them then yells “push” so you do and before you’ve even had another contraction, your baby is on your chest! Oh my gosh! You did it! They immediately start rubbing down you baby. A minute goes by in a flash and the doctor suddenly clamps your baby’s cord and hands your partner some scissors and smiles and says “time to cut the cord!”. You had asked for delayed cord clamping. Your doctor says “60 seconds is delayed cord clamping”. The cord is cut. The nurse says “I need to take this baby over to the warmer to assess them.” You don’t understand, but you want your baby to be safe. To you, your baby looks fine. They are pink and crying and squirming. They take your baby away from you. Your doctor asks them to give you a shot in your thigh “to help with the placenta” then immediately starts pushing on your tummy and pulling on your cord. It hurts! You scream and ask them to stop. “Well you didn’t want an epidural and we need to get your placenta out.” Finally your placenta is out, but now you’re bleeding more than your doctor wants so they hook your IV up to a bag of pitocin. They put a diaper on your baby, a hat, and wrap them in a blanket then bring them back to you and say “congratulations.” You try to latch your baby, but it’s hard to do it while laying down and your doctor says you need stitches. Once that’s finally over, they sit you up and you can finally focus on your baby. You just get your baby latched and the nurse comes back and needs to take your blood pressure and then lay you back flat to mash on your belly some more. She says she will come do this every 15 minutes for the next hour. You’re tired and you just want to hold and nurse your baby.
So much of what happened here was unnecessary and definitely not natural. And none of it would have happened had you been at home or at a birth center. No regular vaginal exams. No discouraging talk or “Doubt Crumbs”. No hands-on delivery that caused your second degree tear. No forced birth of the placenta. Definitely no bag of pitocin. No laying on the bed for monitoring. No “60 seconds is delayed cord clamping”. No taking away of your baby. It was unmedicated. But was it natural? I think not.
- So, is unmedicated birth in US hospitals possible. Yes. In fact the nationwide unmedicated birth rate is about 30%. In the state where I live, Utah, the epidural birth rate is approximately 78%. Your odds are not particularly good. About 1/4. https://thefamilyway.com/general/do-you-know-the-epidural-rate-in-your-state/ Each state has a different rate and you can look at it here.
- Taking an out-of-hospital birth preparation class like this one here at https://birthsmarter.com/products/cbe can also significantly improve your chances and at least your understanding of what is going on.
- Hiring a doula gives you a statistically significant greater chance of going unmedicated and a decreased risk of cesarean birth. Babies also have a decreased risk of problems when a doula is employed by the family for labor.
- Choosing a hospital with a reputation for supporting unmedicated deliveries, that is certified “Baby Friendly”, and has unmedicated labor tools like labor tubs, birth balls, and birth stools can also help.
- Consider hiring a midwife at the hospital you choose instead of an OB. Though I’ve seen my share of “Med-wives” who practice exactly like an OB, there are some great hospital midwives out there that are much more supportive of things like delayed cord clamping, birthing in more supportive positions, two-step delivery, etc. OBs are surgeons first, so unless a surgical birth is very likely necessary for you, a midwife is likely a better option.
Here are some other helpful ideas to help you afford and have the birth you want.
- Research insurances before getting pregnant to find one that reimburses or covers out-of-hospital birth or at minimum the most “baby friendly” and “unmedicated friendly” hospital in your area.
- Ask your family and friends to donate to your Childbirth Education and Doula fund instead of buying you more onesies and baby stuff that you’ll never use.
- Take ownership of your pregnancy and birth experience. Do not rely on your care provider to give you all the necessary information. Read books, watch the documentaries, get educated on the system that you are buying into.
- Your partner, if you have one, HAS TO BE ON BOARD! They also need to read, watch, and understand why this is important not just for you and your health, but for your baby as well. “White-coat Syndrome” is so strong in our society and the last thing you need is your partner inadvertently sabotaging your birth plans.