In the mix of "vaginal birth versus cesarean birth" lies the question of what is the definition of normal childbirth and what is natural childbirth. To date, no one has clearly written about this definition dilemma…
The World Health Organization defines normal birth as: "spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition."
Lamaze International has six criteria (the four from the WHO plus two more) by which they identify normal birth: 1) labor begins on its own; 2) freedom of movement throughout labor; 3) continuous labor support; 4) no routine interventions; 5) non-supine (eg. upright or side-lying) positions for birth; 6) no separation of mother and baby after birth.
The Association for Improvements in Maternity Services (AIMS) has defined normal birth as "a physiological birth where the baby is delivered vaginally following a labour which has not been altered by technological interventions". Specifically excluded from their definition are women who have had artificial rupture of membranes, induction or acceleration of drugs, epidural anaesthesia or episiotomy. "Normal birth" is often used interchangeably with "natural birth", "physiological birth" or "straightforward vaginal birth" and can be defined as a birth where there has been no technological intervention. Interventions may include inducing labor, and augmenting/accelerating labor using certain medications or by amniotomy/breaking the waters. It includes using epidural anesthesia, having an assisted delivery (forceps or vacuum extractor) or a cesarean section."
It is important also to realize the emotions surrounding cesarean birth that when speaking about normal or natural birth. While a cesarean birth may not be what the new mother wanted for her birth experience, it is the way it needed to be for the safety of the baby and the woman. Many women find no difficulty in the experience of cesarean birth, while others mourn the loss of the feeling of the baby moving through the birth canal. Regardless of her feelings, care providers should honor the new mother's feelings about her operative delivery.
According to AIMS, birth without medical intervention may have many benefits. The following are some that have been suggested by writers on the subject:
- much less postpartum pain
- quicker physical recovery from the birth
- increase in self-esteem as a result of the birth
- enhanced bonding with the baby
- reduced likelihood of post-natal depression
- a calmer, more settled baby
- an easier breastfeeding experience
There are several ways a woman can increase the likelihood of having a normal birth. These include educating oneself through books and childbirth education classes, seeing herself as part of a health care team, and asking the five questions of Informed Consent:
1. What is the proposed treatment or procedure? Make sure you fully understand what is suggested and how it is done.
2. What are the benefits?
3. What are the risks?
4. What are my alternatives?
5. What would happen if I did nothing?
Women place their own sense of importance on birth. This sense varies by degree and by definition. Hence, the constant questioning of what is normal and what is natural. Some women who wish to have a normal birth, as set forth by the organizations listed above, find that it is not possible in their community. Clearly and unquestionably, the safety of the baby and woman are of greatest importance, and medical interventions may be vital for some women during the birth process.
Empowerment is, therefore, a key piece to this puzzle. For when women are informed and educated, empowerment is next. Empowerment will then shine a light on what is normal and what is natural.