What Happened to Natural Births?

By Michael Bielawski

What if at some point in the future there are no more natural births? People would talk about natural birth as a sort of urban legend or conspiracy theory, questioning that there was ever a time when women didn’t always induce their births and have Cesarean sections. If the current trends continue, at least the US and Korea, this future may not be so far-fetched. For example in Korea, Cesarean (also known as c-section) births are at a world-leading 43 percent, followed by the US at about 33 percent.

What started as a final backup plan for emergency situations has become a trendy first option for women planning “designer births”. These days you often see women in movies and TV shows planning their Cesareans as if they were planning a hair cut. It’s discussed so casually you could well assume that there is no other option.

How did this come to be? Some things have changed that seem to correlate well with the rise in C-sections. These are the absence of midwives (nurses specifically for delivering babies) at births, births taking place at hospitals instead of at home and more drugs being used now than in the past.

For example, from 1900 to 1955 the number of US births at home dropped from 95 percent to just one percent, according to the documentary The Business of Being Born (co-produced by actress Ricki Lake). During that period hospitals ran ad campaigns depicting midwives as incompetent and generally unqualified to deliver babies.

An ironic revelation according to Child Birth Connection’s “Listening to Mothers” survey (2006) is that nearly one quarter of US women who had Cesareans reported pressure from doctors to do so, and conversely the doctors cite fear of malpractice lawsuits as their main reason for carry out Cesareans.

About 20 percent of US births are artificially induced, according to the National Center for Health Statistics, which essentially doubles the chances of a C-section, according to a Yale University study, because the baby isn’t always ready to come out in an induced labor.

The Yale study found an increase in Cesareans of 53 percent between 1996 and 2007 and the number of natural births from mothers who had previously had Cesareans fell from 44 percent to just 8 percent from 1998 to 2009. And the study revealed that infant mortality has not declined while the rate of C-sections has been dramatically rising.

Marsden Wagner, M.D. of the World Health Organization (WHO) pointed out in Lake’s documentary the sharp contrast between the US and other nations in how they go about giving birth. “Everywhere else in the world, that’s what they do (using midwives). You can go to Great Britain, France, Germany, Scandinavia, Australia, New Zealand, Japan… go to all the highly developed countries where they are losing fewer women and fewer babies around the time of birth and what do you see? You see midwives attending 70 or 80 percent of all the births.”

And then there are the drugs. They can certainly relieve pain for the short term, but they can also cause complications leading to further interventions, further pain and eventually a Cesarean section. In probably the most effective sequence of the documentary, you get this potential domino effect of interventions, effectively articulated by one of the featured mothers:

“So if you are not dilating (making progress) rapidly, which you’re not likely to do if you get an early epidural (to relieve pain) in labor you will be given Pitocin (to induce contractions). Eventually the pain of the contractions is overwhelming the epidural so you need to up the epidural and then labor slows down more so then you need more Pitocin. Now you are not feeling the pain of the extra Pitocin because you got the epidural but the baby is getting compressed blood and oxygen supply because Pitocin contractions last so long and they’re so strong that the blood and oxygen flow to the baby is compromised. So then the baby is likely to go into distress and then you are sent off for an emergency Cesarean for the baby in distress from contractions induced by the Pitocin which was necessitated by the epidural…”

Doctor Eugene Declero of Boston University added “Step by step, one intervention leads to a series of interventions and the net result is the mother finally ends up with a Cesarean and everyone says thank God we are able to do all those interventions to save the baby. The fact of the matter is that if they didn’t start the cascade of interventions none of that would have been necessary.”

So what is an ideal C-section rate? The WHO estimates the ideal rate should be between five and ten percent. In the US the level has increased from about 4.5 percent in 1965 to almost 33 percent in 2010 according to reports.

At the end of the day, over 95 percent of women prefer natural birth to Cesarean according to a study by the University Of Ulsan College Of Medicine. The conclusion was that practitioners and the overall healthcare system were primarily to blame for the dramatic rise in cesareans.

Finally, my own wife just had a baby boy, born without any interventions at a natural birthing center called Mediflower in Seoul, Korea. The head doctor at this center, Dr. Chung, is sometimes jokingly called “Dr. Do-Nothing”. Because that is the whole point, if everything is going fine then there is no reason to intervene and potentially create problems. Their idea is to give women the best of both worlds. They have all the technology and medicine of a hospital but with a home environment and midwives who encourage as few interventions as possible. Their Cesarean rate is an impressive three percent.

Natural birthing centers are expanding all over Korea, but keep in mind they are more expensive than regular hospitals. But regardless of where you have a birth, you can still have a midwife. And you can still do research and with the right preparations you can probably have a relatively natural birth at any conventional hospital, or even in your home.

In conclusion, the statistics do seem to support the use of midwives, be it at home or in a hospital. The drugs can help, just be aware they can potentially lead to further complications. I think most people would agree that natural birth should be preferable to Cesarean birth unless there is an emergency.