Friday, May 6, 2016

Why We're Choosing a Natural, Unmedicated Birth

A decade before I got pregnant, I knew I wanted a natural birth. At first, my reason was superficial and a bit silly: I liked the idea of doing something challenging. I saw an unmedicated birth as akin to hiking Mt. Everest or winning a Pulitzer--something very challenging that not everyone is able to do.

When people began to tell me how stupid I was for considering a natural birth, my research began in earnest. That's when I realized that the value of a natural birth is much deeper than just surviving a challenge and showing people I could do something they think I cannot. Natural birth offers numerous health advantages, and it more neatly matches my feminist values.

My decision to have an unmedicated birth has been met with surprising pushback. A lot of people insist it is simply impossible, even though it's what millions of women have done for as long as there have been women. Others become immediately angry or defensive. There's a lot of judgment and blame in birth culture, and I suspect that guilt also plays a role. Women are taught that, no matter what they do as mothers, it's wrong. So when a woman hears my plans for a natural birth, she may see it as an attack on her own birth choices. Because so many women are deprived of any choice at all when they give birth, simply hearing about another woman's plans may trigger feelings of regret, victimization, and inadequacy.

I'm not going to defend my choices any more, and I'm not going to engage in arguments that make everyone involved feel terrible. Birth should be a happy event, not a feud over how best to birth a child. And really, my answer to queries about why I'm having a natural birth should end there: because I want to. Because it's my right. Because it's no one's god damn business.

Like the women who feel judged and shamed for their medicated births, I too often feel defensive. So here's why I'm choosing a natural birth.

No One's Birth is Superior to Anyone Else's 
I loathe the term natural birth, since a massive "natural living" movement has endeavored to elevate that which is natural above all else. Nature has created a lot of shitty things, and natural isn't always best. More importantly, no one's birth is superior to anyone else's.

I want to say that again, since every time I talk about natural birth I get accused of being smug and self-righteous: No one's birth is superior to anyone else's. 

As long as a woman freely chooses what happens to her, her choices are valid. And they are no one else's business. Epidurals during childbirth, as far as I'm concerned, are a human right. Though I would never opt for one and think women are often ill-informed about the risks, I absolutely endorse women's right to elective C-sections. Birth, after all, can be triggering to rape victims, last for days, and leave women feeling traumatized. Some women simply prefer a more predictable approach, even if it is more dangerous.

I believe in women's right to full reproductive autonomy, and I will defend the right of any woman to do whatever she pleases while birthing--whether it's unplugging the IV and storming out of the hospital, or threatening her doctor with homicide if he doesn't cut the baby out right this second. 

It's anti-feminist to belittle the importance of choice during childbirth. If you're not interested in why women choose the approaches to birth they do, then you're not particularly interested in women's well-being, given that most women eventually give birth. Telling women not to talk about their birth choices silences them, supports the myth that women's choices about parenting are trivial, and obscures the very real coercion (and even assault) many women face in the delivery room.

What a Natural, Unmedicated Birth Means to Us
A lot of women "try" for a natural birth. That's some very odd phrasing. We don't talk about other difficult things this way. No one says they're going to try to graduate college, or stay married, or quit smoking. The notion of "trying" contains within it the likelihood of defeat. That's bullshit. Do it or don't do it.

Women who say they're trying for a natural birth may not realize something important: an epidural is typically the last, not the first, "unnatural" thing that happens in birth. A number of factors increase the risk of an epidural; they also pose more risk to the mother and baby than an epidural. For me, a natural birth is a foregone conclusion, and that means we're avoiding the following:

  • Electronic fetal monitoring: Numerous studies have shown absolutely zero benefits associated with strapping a belt to a laboring woman and continually monitoring her baby. Instead, continuous and intermittent fetal monitoring both increase the odds of C-sections and other unnecessary interventions. This monitoring is also uncomfortable, impeding women's movement. We're allowing our provider to periodically check the baby's heart beat, but I will not be continuously strapped to anything. 
  • Intravenous fluids: It's safe to eat and drink during labor. Indeed, the American Society of Anesthesiologists says that women could actually benefit from eating during labor. That means that intravenous fluids are totally unnecessary. They can also artificially inflate the baby's weight, causing a host of complications--including creating the illusion that the baby has lost more weight than he or she actually has, since the baby will shed the artificial weight after birth. IVs are painful, make it difficult to move around, and give you less control over what goes into your body. They're not for me. 
  • Hospital gown: There is no medical reason to wear a hospital gown. Should an emergency arise, you can be cut out of your own clothes just as easily as you can be cut out of a hospital gown. A gown exposes a laboring woman more than necessary, can make her feel like an inmate, and is simply unnecessary. This isn't just my opinion. At least one study suggests that hospital gowns impose an unhealthy power dynamic. I've always been a fashionista, and I want to wear my own comfortable clothes during labor. 
  • Vaginal exams and cervical checks: Checking dilation a couple of times can be helpful, and I'll allow it. But hourly cervical checks are totally unnecessary. A Cochrane Review found no difference in outcomes between women who declined and accepted these exams. They can be painful. They are absolutely intrusive. And for women who feel most comfortable when their privacy is protected--like me--they may be harmful. 
  • Too many intrusions: There will not be medical students or an endless cast of characters in my delivery room. We will be dimming the lights, closing the door, and requiring all visitors--including doctors--to knock. I can hear the objections already. "You can't do that." Actually, we can. Informed consent to medical care is a cornerstone of a democratic and fair society. Our providers have already agreed to these terms, and with good reason: privacy in labor helps it move more quickly and reduces complications.
  • Episiotomy: We feminists are collectively outraged at the practice of female genital mutilation,  but many of us are perfectly content to let doctors cut open our vaginas. It's safer to tear naturally, and episiotomy only offers medical benefits in rare emergency cases. Even then, there are typically better alternatives. Episotomies can have life-altering consequences, including urinary and fecal incontinence. So I'm saying no. 
My amazing team of care providers--Dr. Brad Bootstaylor and the midwives at SeeBaby--supports my plans. They agree with me that these options are the healthiest for me. That doesn't leave much room for concern-trolling about how I'm being silly or ill-informed. Dr. Bootstaylor attends natural births each day, and his C-section and intervention rates are enviable. He knows something a lot of doctors seem to have forgotten, and that's why I've chosen him.

We Believe in Science 
Natural approaches are often best. Pesticides can destroy the environment. Some plastics may cause cancer. Antibiotic overuse could spark a deadly epidemic. We know this all because of science. Jeff and I believe in the power of critical thinking, rigorous peer-reviewed studies, and continued re-evalution of data. We don't believe in blindly trusting authority--even doctors.

Why? Because science. Science tells us that doctors prescribe unnecessary medications, push women into C-sections for their own convenience, and continue to contribute to a national opioid abuse epidemic. That doesn't mean I hate doctors. They are dedicated, often underpaid, and rarely get the credit they deserve for the very difficult decisions they make. Truly some of my favorite people in the world are doctors; many of them readily admit to me that medicine is in crisis, and that doctors don't get to be scientists anymore. Doctors are imperfect, and I would rather defer to research than the whim of a single doctor.

The research is clear on my birth choices: they're safe. Any doctor who disagrees is simply ill-informed.

Natural Birth is Typically Safer
Nature does not always know best, and it is a complete myth that women's bodies are made to birth, and therefore birth is without danger. The problem is that an epidural does nothing to reduce danger in childbirth. It's nothing more than a painkiller. And it carries a number of risks:
  • An increased risk of C-section and other interventions. 
  • The need for continuous fetal monitoring and IV fluids, both of which we wish to avoid. 
  • The inability to feel the lower half of the body, thereby impeding pushing, increasing the risk of a severe tear, and limiting the mother's control over her own birth experience. 
  • A severe spinal headache. 
  • A dangerous drop in blood pressure. 
  • Unknown risks to the baby. 
  • Slowed or stopped labor. 
  • Shivering, ringing in the ears, nausea, and urinary retention. 
  • Urinary tract infection due to the catheter an epidural renders necessary. 
  • Difficulties with breastfeeding, particularly with establishing a good latch. 
  • An increased risk of fetal distress. 
  • Rarely, nerve damage. 
And of course, like any medication, an epidural carries more severe risks, such as shock, allergic reaction, and even death. Given that it does nothing to make labor safer, and much to make it less safe, I've decided it's not necessary for me. Pain is temporary. The after-effects of a traumatic birth can last forever. 

Factor in the myriad risk factors associated with the interventions I've already mentioned, and it becomes clear why women tend to recover more quickly from a natural birth. I'd much rather experience intermittent severe pain for a few hours or days than subject myself to an indeterminate recovery and the risk of permanent birth-related side effects.

We Believe in Reproductive Rights, Informed Consent, and Bodily Autonomy 
I'm consistently disappointed by how little attention the feminist movement has paid to reproductive rights issues beyond abortion. Abortion is legal. But women's right to choose births they want--births based on scientific evidence, no less--is constantly under legal threat. Women routinely undergo birth-related procedures--including those that can permanently alter their life and sexual function, such as episiotomies--without their knowledge or consent. Where is the pro-choice movement? Feminists should be screaming at the door of every doctor who has cut a woman against her will.

Instead, they're more likely to deride a woman for asserting her bodily autonomy. The notion that natural birth is stupid and anti-feminist is rampant in the feminist movement. In some sectors, you're lucky to get an acknowledgment that mothers are people who can be feminists, or that they're even relevant to feminism. Somehow the experience of almost 90% of women just doesn't matter.

I'm not that kind of feminist. I believe in reproductive rights from cradle to grave. I know that, without informed consent, you end up with horrors like the Tuskegee Syphilis Experiment. I believe that the most fundamental right is the right to control what happens to your body. And for that reason, I will never work with a doctor, hospital, or other provider who wishes to undermine these rights. It's not about doing what's natural; that just happens to be what I prefer. It's about having control. I endorse every woman's right to control her body, no matter which choices she makes.

Birth Should Not Be Traumatic
1 in 3 women suffer symptoms of PTSD after giving birth. Something is very wrong when the mot fundamental act we undertake as a species leaves women unable to cope. A birth in which I do not have control would be traumatic to me. Other women may have different approaches. My desire for a natural birth, my constant communication with my providers, and my insistence on having final say over everything is the product of my desire to come out of birth stronger, not traumatized.

Birth as a Rite of Passage
I like doing difficult things. I think life is more fun when it includes challenges. Birth is going to be a challenge, and I'm excited about it. I imagine the rush of endorphins I feel after I push my baby out will be like nothing I have ever experienced. For me, a natural birth is the best way to achieve that experience.

It might not be for others. I don't like all challenges. I'll never go skydiving. I got oral surgery without anesthesia because I was afraid. Every woman has the right to choose which challenges she does and does not want to undertake. And no one has the right to take from me the challenge of childbirth.

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