Natural Birth Options

Studies show that women who give birth naturally can achieve healthier birth outcomes. Natural births are nothing new. Chances are your parents, grandparents or great-grandparents gave birth naturally, i.e. at home with a midwife and a relative or friend acting as a doula to support the birth. What are the options for a woman who is not at risk of complications and wants to give birth naturally?

Home Birth

Familiarity and control often times is what prompts a woman to want to birth at home.  A woman that plans to have a home birth with a midwife attending can have comparable outcomes as that of a planned hospital birth in interventions and adverse maternal outcomes.[1]  Other reasons that a woman may choose to have a home birth is for wellbeing, to avoid medical interventions and to have a more fulfilling birth experience. Things to consider if you are interested in a home birth:

• Homebirths are generally not recommended for women considered at risk for adverse outcomes to themselves or their babies. Your obstetrician or midwife can let you know were you fall.  Typically, women over 35-years of age are considered high-risk or have a greater potential of adverse birthing outcomes, like gestational diabetes and pre-eclampsia.  So, medical professionals may discourage these women from birthing at home.[2]
• Preparation of your home is needed. Are you planning to birth in water?  Then you will need an adequately sized bathtub or will need to rent a tub designed for birthing.  Will you need to meal prep for yourself, family and those that will be helping to attend to the birth? 
• Your midwife may arrive with many essentials, but you may also need to provide some items, like clean sterile towels and natural lubricating oils. Also, many birthing mothers are quite relaxed with essential oils like lavender. [3]   You may also desire to have lighting that resembles candles and soft relaxing music.

Water Birth

When giving birth in water, the lower body is immersed in warm water. Although there is conflicting evidence, a woman may choose to give birth in water to relieve her pain and calm herself and her baby.[4] 

Birthing Center

Birthing Centers can be a compromise between giving birth at home and giving birth in a hospital, offering the comfort that feels like home while providing the security a woman may want that is associated with a hospital. Some birthing centers are directly attached to the hospital, perhaps on the same or a neighboring property or in a directly attached wing of the hospital. 

The rooms of some birth houses are designed like bedrooms or hotel suites and decorated in soft, calming colors. For mothers who wish to give birth in water, some birth centers have birthing pools or large showers with benches. Although complications can occur, birth experiences are generally positive [5]. So what are the advantages and disadvantages of birth centers?

Advantages:

• An atmosphere that feels like home, with the security of a hospital.
• Overall positive birth rates, with few adverse outcomes.
• Reduced interventions, allowing for a more natural birth.
• Birth is attended to by a nurse midwife or midwife that has been trained to act swiftly to adverse birth outcomes.
• Doulas are welcome and often times present to assist the birthing mother.
• The laboring mother has the freedom to eat, drink, move and walk, or use the toilet, as she pleases unless there has been a need to administer an epidural or other drug that prevents her from doing so.

Disadvantages:

• If emergent care is needed, an obstetrician or other doctor should be called in or the birthing mother should be transported to a hospital facility.  
• Depending on the birthing center, if there is a need for the birthing mother to have an epidural, or pain medication, she will likely need to be transported to the hospital.
• There may not be a birthing center in the area in which the birthing mother lives.
• Care at birthing centers is not covered by all insurance carriers.[6]

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Hospital Birth

Some women choose to give birth in hospital because they believe that giving birth in a hospital is safer. In addition, there are women with particular health problems that make a hospital birth a suitable choice. These women also benefit greatly from the support of a doula, who comforts and cares for them and represents their decisions. 

Natural Birth Preparation

If you know that you are pregnant, you should consider whether a natural birth is an option for you. Discuss with your obstetrician or midwife at your antenatal check-ups whether your pregnancy is at risk of complications. If you fall into the “risk” category in any respect, you should play it safe and strictly follow the instructions of your obstetrician or midwife. Even if you are eligible for a natural birth, there may be negative outcomes at the beginning or later stages of labor. However, if your risk is minimal as assessed by your obstetrician and midwife, you should consider including natural birth alternatives in your birth plan.

Research and Ask Questions

To effectively express your desire for a natural birth naturally, arm yourself with facts and science-based research that you can share with your obstetrician. Birth preparation is key. [7] Educate yourself about the birth process and the impact that childbirth can have on women, and on you in particular. If there are procedures or interventions that you do not want, share this information with your obstetrician or midwife. 

Your Birth Plan

Write down your birth plan as clearly and precisely as possible. Data shows that mothers who have a birth plan have better labor and delivery outcomes. Talk to your care team in advance and express your desire for your birth plan to be integrated into your labor and birth, if possible.[8] 

Preparation is Essential

In conclusion, information and preparation are crucial to a successful labor and birth, and a solid care team, including a doula, can be beneficial in supporting a successful labor and birth. 

RESOURCES

[1] Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician [published correction appears in CMAJ. 2009 Oct 27;181(9):617]. CMAJ. 2009;181(6-7):377-383. doi:10.1503/cmaj.081869

[2] Lampinen R, Vehviläinen-Julkunen K, Kankkunen P. A review of pregnancy in women over 35 years of age. Open Nurs J. 2009;3:33-38. Published 2009 Aug 6. doi:10.2174/1874434600903010033

[3] Tabatabaeichehr M, Mortazavi H. The Effectiveness of Aromatherapy in the Management of Labor Pain and Anxiety: A Systematic Review. Ethiop J Health Sci. 2020;30(3):449-458. doi:10.4314/ejhs.v30i3.16

[4] Harper B. Birth, bath, and beyond: the science and safety of water immersion during labor and birth. J Perinat Educ. 2014;23(3):124-134. doi:10.1891/1058-1243.23.3.124

[5] Alliman J, Phillippi JC. Maternal Outcomes in Birth Centers: An Integrative Review of the Literature. J Midwifery Womens Health. 2016 Jan-Feb;61(1):21-51. doi: 10.1111/jmwh.12356. Epub 2016 Jan 15. PMID: 26773853.

[6] Courtot B, Hill I, Cross-Barnet C, Markell J. Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High-Value Model of Care. Milbank Q. 2020;98(4):1091-1113. doi:10.1111/1468-0009.12473

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division of Behavioral and Social Sciences and Education; Board on Children, Youth, and Families; Committee on Assessing Health Outcomes by Birth Settings; Backes EP, Scrimshaw SC, editors. Birth Settings in America: Outcomes, Quality, Access, and Choice. Washington (DC): National Academies Press (US); 2020 Feb 6. 2, Maternal and Newborn Care in the United States. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555484/

[7] Lothian JA. How do women who plan home birth prepare for childbirth?. J Perinat Educ. 2010;19(3):62-67. doi:10.1624/105812410X514459

[8] Hidalgo-Lopezosa P, Hidalgo-Maestre M, Rodríguez-Borrego MA. Birth plan compliance and its relation to maternal and neonatal outcomes. Rev Lat Am Enfermagem. 2017;25:e2953. Published 2017 Dec 11. doi:10.1590/1518-8345.2007.2953