What is a 'natural birth'?

[GlitterandSparkle88]

This may seem like a silly question, one which until recently I thought I knew the answer.

Anyway why I'm asking is I have had various other mums tell me that I haven't had a natural birth.
I had a vaginal birth with an epidural -(under consultants request) as far as I was aware a vaginal birth regardless of pain relief was a natural birth but since receiving some comments from rather judging people I'm starting to wonder what is classed as a natural birth?

[LillianFullStop]

at judgy people! birth is very personal and individual and anyway you go about it is difficult with some degree of pain requiring recovery.

I think medically in people's notes they might differentiate between a natural vaginal birth VS an assisted/instrumental birth VS c section.

I agree with PP above - how can they class G&A as natural and an epidural isn't? They are both drugs! Is it because it can be administered by someone who isn't a doctor? Should it then be called a doctor free birth? Or a midwife only birth?

How about the "naturalness" before and after the birth?

If a natural birth results in a more serious tear requiring a doctor to perform the stitches/sutures instead of a midwife... is that no longer natural because of the doctor's involvement?

Or can you still have a natural birth if you conceived with the help of IVF treatment?

Some definitions say it's natural due to the lack of intervention and anaesthesia. Does a natural birth rule out local anaesthetic for stitches too? that just sounds barbaric to me!!

Basically it's all bollocks and horribly tries to put too much pressure on women to live up to a certain standard instead of doing what is best for them.

[ShowMeTheElf]

I always presumed that women who had a ababy had a natural birth and John Hurt didn't.

What a load of hokum. A natural birth is any birth.

[Donatellalymanmoss]

Post birth complications and conception have nothing to with describing the way a baby came out to medical professionals who need to know that particular piece of information to assess post birth care for mother and baby.

It's social attitudes to birth that need to change.

[TurquoiseDress]

I think people tend to use the term "natural birth" for anything using a vaginal delivery and I don't think it's a particularly helpful term.

The word natural does imply that any other way is un-natural by comparison.

Anyone reading their birth notes will see NVD (normal vaginal delivery) or SVD (spontaneous vaginal delivery). The expression "natural birth" is pretty meaningless.

I have a friend who had an emergency CS for her first baby.
With her second she had a vaginal delivery- with forceps, episiotomy and extended 3rd degree tear- she made many comments on her FB announcement that it was a "natural birth" with other so-called friends questioning how natural it was.

She got very upset with it all and it was so unnecessary from others making judgements. She admits that she was very hung up on not having another CS and "doing it properly".

Each to their own- if I ever become pregnant again, I will be booking in for an elective CS as soon as possible (first baby CS for maternal request).

[MrEBear]

I always took "natural" to mean vaginal without being induced or forceps etc. In an ideal world it is exactly how birth should be, fairly calm, and without too much pain. I'm lucky I laboured at home for a long time then had a fairly natural water birth with lovely warm water and gas n air. I'd love to have the same experience again.

Truthfully I don't envy anyone who needs a c-section or the recovery from it. The thought of someone shoving forceps up me to pull a baby out doesn't exactly sound pleasant. But what is the alternative? Mothers and babies dying in childbirth? If help is needed then its needed and the important thing is mother and baby both come out of it alive and do eventually recover.

The idea of being induced, contractions coming on really strong from the beginning terrifies me. But what is more important me getting my lovely calm gentle birth experience and fairly quick recovery or the risk of something happening to my baby?

[AnnMumsnet]

mouldycheesefan - can you check your inbox please?

[Igottastartthinkingbee]

This is the irritating thing about childbirth. For some reason it has to be a competition. Baby out safely is the only thing that matters surely. I had two very different experiences, first was an emergency premature section, the second was a lightning quick vaginal delivery with gas and air. But both babies were out safely so the mode is irrelevant in my eyes. A friend recently told me she felt she had failed because she hadn't been able to give birth without assistance (one section and one with forceps). She did not fail!! She had two beautiful healthy kids! Anyway, I digress, natural birth presumably is a vaginal unassisted delivery? But who cares as long as you're all through it relatively unscathed.

[moobeana]

I suppose in most basic terms natural = as nature intended, so vaginal birth. But I don't really like where it heads next, making c-section become 'unnatural'

[HalfStar]

So what's the difference between a NVD and a SVD? SVD is if it's not induced?

I'm always amazed when I read on Mumsnet about people making passive aggressive digs about other people's birth or babies or breastfeeding or just life in general...the barefaced rudeness of it! I honestly think I'd laugh from shock if I heard anyone tell me I hadn't done it right for some reason.

OP - congratulations If this person is making digs like that she must be stressed and insecure about something in her own life because I don't think these kind of comments are normal tbh.

[Lj8893]

SVD - spontaneous vaginal delivery

NVD - normal vaginal delivery

So you could use either term for a spontaneous birth, but you would use NVD for an induced but normal (non instrumental) birth.

[BummyMummy77]

Natural birth where I am means no pain relief including gas and air. Which isn't legal here anywhere.

Due to midwives not being licensed here I didn't get any pain relief at all.

[OhNoNotMyBaby]

I don't get the term 'natural childbirth' at all either... It's an oxymoron IMHO. All childbirth is 'natural' in that you get pregnant and then you give birth.

HOW you give birth is irrelevant to the pride and joy most people feel - Dads as well as Mums. And to imply that you are somehow 'better' than someone else because you "did it all by yourself' is just meh and gives me the rage.

FWIW, 1st DC - every intervention except C-section. Did I feel less of a mum? Absolutely not!

Don't let anyone judge you for the way you gave birth.

[GlitterandSparkle88]

It's good to see that most of you find this irritating/insulting too, husband kept saying I was being over sensitive.
I really don't get these people who turn it all into a competition all I care about is that my baby is happy and healthy and full of love I don't care if he hits a milestone before another baby or is slower to hit one everyone is different. I'm just so happy to have him here and to be able to give birth wether it was "natural" or not I know how lucky I am to be able to

[silverfishlondon]

Great post ! Ive wondered the same.
Ive found myself picturing the 'alone naked in the forest' thing when ive heard people talk about a natural birth, only to find out what they were refering to was anything but natural. I think natural usually just means not section- out the natural hole! But without instruments would also make sense- coming out under your natural power without being pulled.
Not judging anyone- emergency c section here.

[minifingerz]

I prefer the term 'physiological birth', by which is meant starts spontaneously and concludes without the involvement of instruments, surgery or synthetic hormones.

Epidural doesn't generally fit this description because if often requires augmentation with syntocinon and a managed third stage.

It's really not so controversial. '

As for whether it matters, well, who can say, but it's of interest to me that in the space of about 50 years it's become vanishingly rare.

Some student midwives conclude their training in big teaching hospitals having hardly ever seen a physiological third stage, or a physiological breech birth. That's got to be a worry.

[KP86]

Minifingerz, whether that's a worry depends on how the outcomes compare across the decades. Infant mortality, birth injuries of both mother and child, general satisfaction with the process etc.

I agree that I think sometimes birth is too medicalised (eg. pushed to c/s for twins or breech instead of attempting a vaginal birth) but I think there must be proof to show it's generally better overall because birth with intervention costs the system a lot more and so wouldn't it be better to keep it 'natural' if possible?

[minifingerz]

It's a worry because health professionals need a full skill set! Women do still have - albeit in small numbers - natural third stages and vaginal breech births. Midwives who have inadequate experiences of these things are not safe practitioners.

"but I think there must be proof to show it's generally better overall because birth with intervention costs the system a lot more and so wouldn't it be better to keep it 'natural' if possible?"

I think what's happened isn't that health professionals are always delivering evidence based practices, but that there is a massive amount of defensive practice, and that the fall out from this is very high rates of birth injuries and traumatic births involving instruments and emergency surgery.

The RCOG did an audit of outcomes at different hospitals where they adjusted the figures for the particulars of the hospital to allow those reading the audit to make meaningful comparisons of the data.

here

The average rate of normal birth for first time mums in the UK (that's birth which doesn't involve induction, instrument or c-sections) is 44% (it would be much lower than that if they extended the definition to include labours which don't involve augmentation with syntocinon or a managed third stage). But you can see from that chart that in some hospitals the range is from 32% to 62% - and those figures are adjusted to take into account the demographic using the hospital.

For third degree tears for first time mums the range is from 2% to 9%. The hospitals at the top and bottom of the range both have similar c-section rates.

For induction the range is 43% to 16% induced labours for first time mums.

In other words there are widely differing practices at different hospitals, suggesting that there are other factors than NICE mandated evidenced based recommendations affecting clinical decision making and birth outcomes.

[MrEBear]

I would think that their must be plenty of evidence that a c/section is safer for both twins and for breach babies.

Would you be the mother who's baby is breach who says "Yes midwife I'll have a go at delivering naturally so that your student gets the experience of a breach birth, regardless of the fact it is likely to cause me a lot of pain, especially if baby gets stuck and it is likely to end in emergency c/section"

[minifingerz]

Some women don't want a c-section and won't consent to one. I know two women pregnant with twins who both refused inductions and epidurals. One had a waterbirth in a hospital birth centre, one had a homebirth. Both made fully informed choices to birth their babies in this way.

Some women choose a vaginal breech birth. Some women give birth to breech babies before there is time to get them to theatre to do a c-section.

Midwives have to be able to care for women in any situation.

[minifingerz]

"I would think that their must be plenty of evidence that a c/section is safer for both twins and for breach babies"

From the current patient information leaflet given to women who have breech babies who are being cared for at Kings College Hospital, London:

"The balance of benefits and risks is uncertain, particularly for
women who have had a previous birth. Results of a trial of over
2,000 women around the world giving birth to babies in breech
position was published in 2000. The study concluded that it is best
for a breech baby to be born by caesarean section as the risk to the
baby was higher with a vaginal birth.
In the three-year follow-up of this study, there were no long-term
differences comparing the immediate outcome of breech babies
born by caesarean section or by vaginal birth. More research found
that the differences in outcome between these two groups was only
short-term, although most doctors have still recommended that
breech babies should be born by caesarean section."

[TheHubblesWindscreenWipers]

But haven't managed third stages reduced pph massively?

Here in Sweden, they have a very hands off approach and I know of four women who have had vaginal breech births. I suppose it's a virtuous circle - the more experience the teams have, the safer it becomes and the more feel comfortable having a vb.

And your point about practising defensive medicine is spot on - when things go wrong they can go very wrong and there's definitely a real risk aversion. How you balance that with over medicalising is a conundrum. No easy answers here.

[NickyEds]

If 'natural birth' were to be defined as:
-no induction
-no augmentation
-no pain relief
-vaginal birth
-no managed third stage
I think Ionly know one woman who has had a natural birth! She had her baby on the living room floor and had delivered the placenta by the time the paramedic got there.

[minifingerz]

From the NICE guidelines on Caesarean Section:

In otherwise uncomplicated twin pregnancies at term where the presentation of the first twin is cephalic, perinatal morbidity and mortality is increased for the second twin. However, the effect of planned CS in improving outcome for the second twin remains uncertain and therefore CS should not routinely be offered outside a research context. [2004]

1.2.2.2 In twin pregnancies where the first twin is not cephalic the effect of CS in improving outcome is uncertain, but current practice is to offer a planned CS"

In other words there isn't always clear evidence guiding practice and you see wide variations between individual doctors and hospitals.

[NickyEds]

mini My dd was breech (toes to forehead) at every scan up to 36 ish weeks and it was made very clear to me my options: manual turning (with the associated risks)or elective section, they wouldn't hear of any talk of vaginal birth as they said it simply wasn't safe.

[minifingerz]

"How you balance that with over medicalising is a conundrum. No easy answers here."

I agree!

"But haven't managed third stages reduced pph massively?"

Possibly. But it's a very complex issue.

Physiological third stages are much more common for women giving birth at home (I think about a third have a natural third stage). Blood transfusions in this group are about half what they are in a similar low risk group of women who choose to labour in an obstetric setting, where almost everyone has a managed third stage.

For me it always comes back to the evidence in BirthPlace 2011, which flags up that healthy women who opt for obstetric units for their births have very much higher levels of intervention in their births with no improvement in outcomes for the baby compared to similar women who used birth centres. The only conclusion you can reach from those figures is that there is an excess of intervention happening in some settings.