Is wanting a natrual birth unrealistic? Is it all down to luck?

[digggers]

my own experience and the experience of friends really makes me wonder about this. There's no ryhme or reason, it's just so random.

Are people who prepare for and experience the birth they want just lucky? Is childbirth something you can prepare for and influence? Or is an open mind and a thankfulness that in our country we have medical help on hand the best approach? Or should all medical help be viewed with distrust!

I agree that having good midwifery is important, but for me it made no difference- had 2 amazing midwives and an excellent Obs attending the birth, and still had an epidural with 3 top ups as I had such bad referred pain in my hips that I would have asked to die rather than endure it for another 8 hrs (i know that sounds dramatic but it's true- felt like I was being racked).

Maybe I just underestimated it- figured I'd be ok as very fit with "childbearing hips" but baby went back to back, and got pretty stuck (2 hrs of intense pushing on hands and knees/ assisted squat) despite being under 7lbs with only an average sized head.

What's important for me isnt that I didnt get a natual birth but that I think the right decisions were made by the mw's/ obs and that I managed a vaginal delivery with minimal damage- had a small last minute episiotomy which healed brilliantly.

Luck. I did hypnobirth cds, read Ina May Gaskin, drank gallons of raspberry leaf tea, bounced on balls, walked around, hugged trees, sang, listened to soothing music, you name it, I did it, ended up with emergency c-section due to a serious complicaton during labour. Thank goodness for medical science, without it I wouldn't have my wonderful son.

"Luck"

Yes sometimes, but not always surely?

But then you'd get similar c/s rates across hospitals serving similar communities, which isn't the case at the moment.

My local hospital has a c/s rate of 26%, despite the fact that diabetes, pre-eclamsia, fibroids and hypertension are much more common in the population they care for than the national average. Another hospital a few miles to the south which serves a much more affluent group of mothers has a c/s rate of well over 30%. Surely not all of this can be down to chance? Not when it happens year after year?

And if luck was the only or main factor how can you explain the fact that women who book a homebirth have c/s rates about half of that of low risk mothers who give birth in hospital?

"I think the biggest factor is hospital. As soon as you go into hospital, birth becomes (and I am making the word up) medicalised IYSWIM."

Have you ever come across this article, OneLieIn? 'Fish Can't See the Water'

here

tittybangbang - the women who have home births are ususally in the low-risk group for c/s anyway! That's how you explain it!

"tittybangbang - the women who have home births are ususally in the low-risk group for c/s anyway! That's how you explain it!"

Did you miss that bit when I mentioned that they have lower rates of C/S compared to similar low-risk mothers giving birth in hospital?

NICE guidelines on C/S state that mothers should be told that having a homebirth appears to reduce the likelyhood of c/s by about a half. Obviously they wouldn't make this recommendation on the strength of studies comparing low risk mothers booked for homebirths with higher risk mums booked for hospital births. They're not stoopid ya'know!

no it is not all down to luck.

if you are having a hospital birth, try not to have it at night, on weekends or a bank holiday.

the chances of it being natural at these times are cut significantly.

That must be luck too foxytocin-I have had night and a Sunday and all have been fine.

"That must be luck too foxytocin-I have had night and a Sunday and all have been fine."

Well - it usually is fine!

But there is less likely to be an experienced consultant on hand in the middle of the night or at the weekend if you run into trouble. Hospitals with the best consultant cover tend have lower rates of c/s.

I would agree with the staff on duty- but it is really still down to luck. My worst was a Wednesday afternoon, but that was only because it was so busy-for some reason a lot were born that day and there were a lot of complications-the staff were over stretched and rushed off their feet. Luckily I didn't have complications. On my Sunday afternoon it was blissfully quiet and they were pleased to have something to do! All luck.

Tbh the stats that tittybangbang quotes kind of sum it up really. If it were all down to luck, then you'd expect to have pretty similar rates of interventions and natural births everywhere. In fact, it varies widely from country to country and region to region. As titty says, when you compare like with like, low risk with low risk, how come women giving birth at home have far lower rates of intervention than those in hospital? Can anyone seriously think that's all down to chance?? Course not.

They have a lower rate of intervention at home because they are not allowed a home birth if they have a high risk in the first place! Statistics are useless to the individual -if they are the one case that goes against the trend.
People like to think that they have control but they don't.
I was well prepared but I only needed a medical complication for it all to go wrong. I get pregnant easily and I give birth really easily-it isn't down to me-it is pure luck-like having a natural singing voice or lovely hair-or being born into a family with lots of money.

I think mostly it's luck, or good odds shall we say, my 6 births went as follows
first emsc hospital terrified, poor support
second elective section
third vbac hospital, baby three weeks late, I had excellent support, no pain relief
fourth vabac hospital, 2 weeks late
Fifth vabac home birth, three weeks late
sixth vbac home birth three weeks late, baby in awkward position, he had to turn in order to be born, and he did but he couldn't flex his head as hand in the way. But he could have NOT have turned and then we would have needed help. That was luck.

So my vbacs were fantastic and in order to help me I had a doula, I read and read . I did all I could to maximise my chance of having a baby the normal way, HOWEVER, what happened on the day I believe was down to luck. If the babies had become stuck, distressed etc then I would have needed intervention. I consider myself lucky as a lucky thing on a lucky day that it all went well.

It isn't a great deal of help knowing that you should avoid certain times-it isn't as if you can think 'it is midnight on Bank Holiday weekend -I won't have it tonight'! or 'home births have less medical intervention, so I will have it at home and therefore I won't need medical intervention'.

Think it's mostly luck, you can read up and be prepared, less scared for the first time..
and a birth plan focuses on 'in an ideal situation'.. but..

With all the will in the world, if things go start getting hairy, i.e baby has cord around neck,starts getting distressed because it's taking too long, etc etc then of course they have to intervene.. As a lot of those situations cannot be predicted , or preempted until labour actually starts , think these details are down to lady luck

I was 'lucky' i didn't need any intervention,even tho' DS1's arrival lasted 38 hours,( DS2 was quicker).. So completely natural births ,just a tens machine, but my best mate who had planned a natural birth beat herself up about the fact she ended up having a Csection.. There was nothing she could've done differently, it was bad luck, plan and simple!..

"They have a lower rate of intervention at home because they are not allowed a home birth if they have a high risk in the first place!"

Actually women who have their babies at home appear to have c/s rates about half that of similar low risk mothers giving birth in hospital. The studies compare like with like - not low risk home birth mums with a mixed or higher risk hospital control group.

"People like to think that they have control but they don't"

But choosing where you give birth and who looks after you CAN and often DOES make a very big difference to your likelihood of having a normal birth. Otherwise you'd get roughly identical rates of c/s and other interventions across all hospitals serving similar populations.

"'home births have less medical intervention, so I will have it at home and therefore I won't need medical intervention'.

Actually it can be a huge help. Was to me. Was the reason why I chose a home birth - to reduce the likelihood of complications occurring in labour.

"If the babies had become stuck, distressed etc then I would have needed intervention".

If it's all just down to luck, why does having a doula appear to reduce your risk of needing a c/s and the need for an epidural? Labour is a physiological process and the way you respond to what's going on in your body sometimes DOES make a difference to outcomes. Women who mobilise during labour and who are able to avoid becoming terrified are less likely to experience prolonged labour, which can be caused by supine positions and by an excess of adrenaline (produced by the 'fight or flight' response. Failure to progress is the most common reason for emergency c/s - labour is augmented and then the baby starts to become distressed. It's a very common pattern in hospital births.

I'm not arguing that luck isn't a big part - if your baby is coming ear first, or your blood pressure goes right up, or you have a placental abruption, a really tight nuchal cord - well nothing you do will make a difference. You'll need a c/s. But it's not ONLY about luck!

I think that we as human beings often have difficulty understanding risk and probability and relating it to the world around us. There clearly isn't a black and white answer to the Q posed by the OP.

Understanding that there's always an element of luck in birth, does not preclude understanding that there's also an element of influence (not control). This isn't an either/or argument.

There's plenty of evidence that you can stack the odds in favour of positive birth outcomes (or a "natural" birth, if you prefer). You can minimise the risk of needing interventions. This doesn't eliminate the risk, it just reduces it.

If 18 out of every 100 women in a hospital setting undergo a certain intervention, while only 1 woman out of 100 women (matched for risk-level and socio-economic status etc..) undergo the same intervention in a home birth group, then it appears that this intervention is less likely to be carried out in a home setting. If you were keen to avoid this particular intervention then, all other things being equal, you would be wise to choose the home birth group. However, you could still easily be the unlucky 1 in 100 who needs this intervention anyway.

Given the evidence, it's irrational to absolve yourself of all personal responsibility and just cross your fingers. It would also be irrational to confuse influence and control, and to assume that by preparing as best you could, you'd guaranteed the birth you wanted.

You can stack the odds in your favour. You can't completely load the dice.

I think a lot of it is luck TBH.

The birth isn't about you and how prepared you are, how many natural birth experts you are channelling etc...

There is another person involved, your baby
and how they react and act in their birth will govern how the birth goes.

No amount of reading Ina May or chanting will help you if your baby doesn't want to play 'natural birth' ball.

As a Doula I think its a combination o LOTS of things.
However, in my experience, it is possible to prepare for a normal/natural birth (barring rare emergencies) and make it much more likely to be successful.
Some things are down to luck (baby postion in labour, pelvis shape) but there is plenty that can be done to help labour progress, malpositioned labour is an interest of mine so have tried lots of techniques out and I think you can shift babies into better positions wth good support. (Anecdotally, in the 25 births I have attended, I have seen better outcomes since I started using Spinning babies techniques)
My top tips would be
1 Get a doula (i'm not biased lol) I honestly beleive this is the number one thing that makes a normal/natural birth more likely
2 Consider birthing at home
3 Prepare to be relaxed s possible in labour (Hypno birthing etc
4 Consider using a\pool for pain relief and mobility
5 Stay fit and active during pregnancy
6 Read Ina May, listen to positive birth stories and videos
7 Use Spinning babies techniques
8 Get informed, take control, make a birth plan
9 Relax!
Sure there are loads more, but I need to go to bed!

Selina

I remember joking to my OH that the women in our antenatal class who'd booked into hospital and said they wanted all the drugs going ASAP, would be the ones with natural births, and the ones who were stocking up on whale music and aromatherapy oils and PMA, and had booked into the MLU, would be the ones who had interventions.

With just one exception (me!) I was right!

Maybe the women who had decided in advance that they were having pain free epiduaral births had less fear because they pictured a calm controlled birth, and that is why they ended up delivering quickly and with no interventions?

or luck?

I think its all luck these days, despite what you sometimes hear at some NCT classes (like mine), NHS MWs do aim towards the natural, and hold of on interventions as long as they can (sometimes too long IMO) So really the majority of people who CAN have safe natural births, do!

Its different in other countries where intervention are the norm you need a strong will to be fight if you want to aim for a natural birth. Here I had to fight FOR interventions which I knew I needed before they did!

I don't think it is down to luck for the record. I think it is down to the hospital having enough staff to serve women properly.

'Busy' times like that Wednesday, picesmoon, should not happen. When the hospital finds itself 'busy' it should be bringing in bank staff to relieve the stress from the contracted staff and to serve women and babies properly.

It is therefore down to budget that so many women end up with poor outcomes, not luck.

After one night of being ignored and patronised because they would rather follow guidelines rather than listen to me. Then I ended up in the high dependency unit because what had been an problem became a crisis right under their noses.

I don't know if they were 'busy' that night or not but I was not given the care I deserved and would never ever labour in a hospital again. What happened to me wasn't down to bad luck. I may as well had been in a barn somewhere because though staff was physically present, I don't know if they were busy or not. (A hospital with all private rooms) They sure were not looking after me.

tittytittybangbang I think you should tag this at the end of all your posts:

"Actually women who have their babies at home appear to have c/s rates about half that of similar low risk mothers giving birth in hospital. The studies compare like with like - not low risk home birth mums with a mixed or higher risk hospital control group."

I think that the poster who mentioned 'natural selection' hit a definite nerve. If we look at the facts, in many countries, cultures and throughout history, childbirth has been a KILLER to many women.
These women were the ones who didn't have access to medical intervention etc and were the unfortunate victims of the fact that their bodies simply weren't up to the task of giving birth.
Evolutionarily, the fact that we stand up and walk on two legs means there is a compromise in other areas, pregnancy and childbirth being one of them. So, some of us simply aren't built to give birth successfully. Those who are, they are the LUCKY ones.
Medical intervention is simply cheating nature, not necessarily a bad thing, but certainly helping life along that otherwise probably wouldn't thrive. That is why the birth survival rates are so much better in developed countries.
To be harsh, I honestly don't believe nature intended for us all to survive childbirth.
So I believe, irrefutably, it's LUCK. I had a terrible first birth: cord round baby's neck, back-to-back three day labour, followed by post-natal pre-eclampsia (which I didn't even know existed). I accept fully that Nature probably had me down as one of the ones not meant to survive. Thankfully, the help of the modern medical systems available have blown a big raspberry in nature's face and the DCs and I live to tell the tale.

Togorama - THANK YOU!

So helpful to have a reasoned voice setting out the fundamental issue here so clearly. I agree with everything you say.

But typical that most posts which follow your fail to acknowledge the logic of your point that "Understanding that there's always an element of luck in birth, does not preclude understanding that there's also an element of influence (not control). This isn't an either/or argument." [frustrated face]

"NHS MWs do aim towards the natural, and hold of on interventions as long as they can (sometimes too long IMO) So really the majority of people who CAN have safe natural births, do!"

Not so - maternity care is now so protocol driven and the public and the medical profession are so risk averse that it's actually incredibly hard for midwives to sit on their hands and let birth unfold naturally, without intervention.

"I think that the poster who mentioned 'natural selection' hit a definite nerve. If we look at the facts, in many countries, cultures and throughout history, childbirth has been a KILLER to many women."

But interesting that the maternal mortality rate went down from around 1 in a 100 in the UK throughout most of the 19th century, to less than 1 in a 1000 by the 1950's when the c-section rate was less tha 5%!

Most maternal mortality in the past was caused by childbirth related infections caused by poor hygeine, miscarriage, eclampsia and thrombosis, not obstructed labour.

The reason for the very maternal mortality rate in many developing countries today is a lack of basic care in pregnancy and labour and poor maternal health prior to pregnancy. Supplying drugs to reduce postnatal haemmorhage and eclampsia, and training local midwives in a range of basic techniques to diagnose problems in pregnancy results in the biggest fall in death rates, not vastly higher availability of c-section.

I agree with zazen and the birth isn't about you-it is mainly about the baby. Of course you should be prepared, I went to classes, ate the right foods etc but women are made to feel that they 'failed' if they didn't get the birth they wanted when that part is pure luck. They didn't fail-they just had events outside their control. My births were easy-immediately I had done it I wanted to do it again-it was such a wonderful experience! If there had been complications I wouldn't have felt that way. We are all different-that is not to say that anyone is wrong.
If I take Selinadoula's list:

1 Get a doula (i'm not biased lol) I honestly beleive this is the number one thing that makes a normal/natural birth more likely -not something I am likely to do-unless I knew one that I trusted and liked beforehand.

2 Consider birthing at home- too much of a pessimist-I want to be in the right place if necessary.

3 Prepare to be relaxed s possible in labour (Hypno birthing etc

Agree but just natural relaxation.

4 Consider using a\pool for pain relief and mobility

Not much point since I have never got anywhere near being examined until 8cm dilated.

5.Stay fit and active during pregnancy

Agree totally.

6 Read Ina May, listen to positive birth stories and videos

Would rather not.Talk to people that I actually know.

7 Use Spinning babies techniques

Not heard of so couldn't say.

8 Get informed, take control, make a birth plan

Certainly get informed but I refuse to make a birth plan-much better not to have expectations. Keep on very friendly terms with the staff and they ask you at the time.

9 Relax!
Agreed.

This is not to say that I am right- but I am right for me. I would be completely wrong for someone else. People should do what they want to do and not feel that another way is better.
To me birth is a completely natural process. Keep active, fit and healthy in pregnancy. Prepare with breathing exercises etc.Stay relaxed-don't get worried by negativity and horror stories of others. Carry on as normal through the early stages -keep friendly with the staff and don't give them lots of things to remember. Go with the flow!

But as I say I was just lucky and couldn't have had better births.