Birthing is not always a walk in the park. The birthing 'playground' has many options, and like all playgrounds you need to watch out for bullies. You may want to avoid the slippery dip...
Considering birth this way, you can see the concept of the cascade of intervention (though this scale is not about the cascade). This scale highlights that certain choices (hopefully informed) move us down the scale, away from natural birth.
Sometimes it is medically indicated. With informed birth preparation, this can be a good experience. It does not need to be traumatic, dramatic, stressful or crushing. Many women talk positively of their births, no matter where on the scale it is, because they were prepared, felt respected and included and understood what was happening.
The scale also shows that the move away from natural birth starts with intervention. Induction interventions include the ‘stretch and sweep’, hormone gel inserts, artificial rupture of membranes and synthetic oxytocin. There are many more inductions than are necessary, and this often is enough to cause a cascade. Knowing when to accept intervention is important.
Sometimes an induction ‘kick starts’ labour, and a women labours and births on her own. However, once a labour is induced, it will be managed. This may involve monitoring and observation, restrictions on the mother and interruptions that actually inhibit effective labour. The mother may now have a time frame and limit she ‘must’ labour to. If labour is not following this ‘schedule’, it may become augmented. This usually means synthetic oxytocin (which restricts movement and increases intensity). Often this is accompanied by an epidural.
Often an augmented labour leads to an augmented birth. This might be directed pushing, vacuum assistance, or forceps. Often the mother will be in stirrups. This birth is usually set up for the benefit of attendants, not the mother.
A managed third stage is often routine, and many women do not realise they have options or even what is meant by ‘third stage’. A beautiful and spontaneous (unaugmented) labour and birth can be interrupted by a managed third stage. This often leaves a mother feeling ‘dealt with’, rather than involved with the birth. Usually a separation from baby occurs at this time.
Moving down the scale means moving away from a natural birth. This in itself is not a ‘bad’ thing, but given that most women say that want a “natural” birth, this is worth consideration.
Many people consider a vaginal birth is a natural birth, but when we consider how these interventions affect labour, birth and beyond, it becomes apparent just how removed from 'natural' birth is. There are risks involved with interfering with birth, if the mother feels left out of the decision process, or forced to consent without understanding, she is at risk of post natal depression, birth trauma and difficulties breastfeeding and bonding with her baby. This matters.
Before birth, this scale of options needs to be understood.
Your obstetrician is unlikely to explain it to you.
Your midwife may mention it.
You will probably hear ‘horror’ stories which describe it (but do not explain it)…you will be told you have nothing to prove, that birth is not a competition, all that matters is a healthy baby, and various lines of bullshit that really mean: You Do Not Matter.
It is Your Body. Your Choice.
You are not a baby making factory, a vessel, devoid of emotion. How you feel about your birth, how you prepare for it, is essential. This is not about candles and incense, mood music for the sake of ‘experience’. This is about creating a birthing space that makes the mother feel safe and loved. This is about HUMANISING birth.
For most women, this is a very daunting concept.
Where do you even start with understanding this, and personalising your birth, when your OB or midwife do not explain it..and certainly not with enough advanced notice to make an informed decision?
The answer is: Informed Birth Preparation!
You may even like to consider a doula. The doula bridges the gap between personalised birth and routine birth. The doula helps you navigate the gauntlet, so to speak. Smoothing the way, so you can marvel in the wonder of your pregnancy, birth and baby. The doula gives you the space to BE, your pregnancy is not happening to you, but is of you.
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