Why do so few FTMs manage birth ‘naturally’?

[hopingforapeainapod]

Hi all, am 24 weeks with my first baby and have started online antenatal classes and have been quite scared by the stats they have shared with us. In my trust, 25% of first time mums are induced, 25+% end in c section, and around 25-35% end in instrumental births. Anecdotally, I have 4 friends who have given birth this year for the first time, and 3 have ended up in emergency c-sections, and 1 ended up with forceps and some quite nasty complications. Another one of my friends is now having an elective c-section because she has heard so many horror stories. All of this, plus all the maternity scandal and birth trauma stories in the news recently, has somewhat thrown my confidence and I now feel like giving birth vaginally without intervention is the exception rather than the norm. My mum also had complications with us (I was born via epistiomy and ventouse) and I’m quite petite, and I guess I am just doubting my ability here…!

Because giving birth used to be the #1 killer of women. It’s dangerous and we need medical intervention if we don’t want high maternal death rates like the Victorians had.

There was an option to have an epidural so I took it they don't give out metals for not having any interventions

This. Because the medical world now realises that giving birth involves the safe delivery of the child whilst also protecting the health of the mother…

Because we're badly designed.

From Wiki, and the hypothesis dates from the 60s, and has been revisited and questioned since, but not without validity in comparing humans to other primates in terms of birth:

The obstetrical dilemma is a hypothesis to explain why humans often require assistance from other humans during childbirth to avoid complications, whereas most non-human primates give birth unassisted with relatively little difficulty. This occurs due to the tight fit of the fetal head to the maternal birth canal, which is additionally convoluted, meaning the head and therefore body of the infant must rotate during childbirth in order to fit, unlike in other, non-upright walking mammals. Consequently, there is an unusually high incidence of cephalopelvic disproportion and obstructed labor in humans

https://en.wikipedia.org/wiki/Obstetrical_dilemma#:~:text=They%20also%20believe%20that%20as,resulting%20in%20the%20so%2Dcalled

As above, natural child birth can be very dangerous.

Also babies are probably getting bigger due to lack of natural selection. If there were no interventions, babies with massive shoulders who got stuck would have sadly passed away and not passed on their genes. Whereas now the big genes are passed on.

I had 2 natural(ish) births though. Both spontaneous, one I needed an episiotomy to manage the tearing and one the baby’s shoulder got a bit stuck so the midwife had to elbow me in the side basically to push him out. Even though these are classed as “interventions” they were very minor (but essential).

I didn't have a choice.
40 Years ago my waters broke.
11 hours later l gave birth to my first daughter with just gas and air.
8 years later l had my 2nd daughter in 7 hours with Gas and air .
Both vaginally.
So did my 5 siblings.
All healthy normal babies and delivery.
We didn't even know if we were having a boy or girl.
I've had worse pain in my life than child birth.

Sedentary lifestyles probably play a part. Birth is like a fitness endurance event and should be trained for by keeping active throughout pregnancy. There's a myth that pregnant women should rest up and move as little as possible and that's not good training for the main event.

(I accidentally walked about 6 miles and swam a mile on the day of my 1st birth and it all went pretty smoothly...)

Lots of reasons. More women are having babies these days who maybe couldn’t have had years ago. We also have more advanced fetal monitoring so issues are picked up in labour that wouldn’t have been years ago.

it can and does happen normally and naturally though OP, so do not give up hope.

This.

And also more women over 40 are having babies and more IVF which is great but probably means that they’re being offered inductions at 39-40 weeks. Plus NICE guidelines changed a few years back so anyone can request a section now, which is great because women should definitely have the choice, but may be skewing figures.

I know it’s more complicated than that but personally I like to think of interventions as a good thing that are there to keep mum and baby safe.

Just focus on what you can control especially knowing the circumstances in which you'd consider examinations and interventions versus not. It's so easy to be pushed down a pathway without realising if you agree to X then Y will no longer be your choice.

Benefits
Risks (of doing something versus nothing)
Alternatives
Intuitive response (what do you think and feel)
No action (what happens if we watch and wait for an hour/two/day)?

This last one is very interesting. In our department many women are made to have an induction they don't want because they are told it's too risky to wait. But then they can't get a bed for five days but apparently it's not risky enough for a section....it's all down to the individual risk level of the consultants.

I think there might be something in this.

My doctor said she saw an uptick in women being induced and having emergency C-sections due to the baby's poor position during COVID and she put it down to pregnant women spending even more time than usual on the sofa. If you work in a sedentary job until late pregnancy and then put your feet up for the last few weeks, there's a greater risk of your baby not being in an ideal position. Not just in more obvious ways like breech or transverse lie, but things like being back to back or brow presenting.

With my second baby I was a lot more active, went for long walks every day and tried to sit on my ball rather than the sofa in the evenings. DD was perfectly positioned and I had an uncomplicated VBAC with a lightly dosed epidural.

Personally, I think a natural birth requires LUCK in addition to lots of preparation! In the end it will be out of your hands but there are things you can do to increase your chances. I’ve given birth three times, naturally (no inductions, no instruments, no significant tears or stitches, no epidurals) and back home within a few hours. I did A LOT in the hopes of being in top shape for birth:

-Daily exercise and generally being active and upright until the end
-Healthy weight gain
-Pregnancy appropriate core exercises (they only take 5 min 2-3 times a week)
-Prenatal vitamins
-Reading in depth about how birth works. When you are scared it can stop the hormones which progress labour and open/loosen up your body. I can recommend my favorite books if you’d like.
-Active birth positions (on all fours has been my best as you can somewhat control the birth to prevent/reduce tearing)
-Perineal massages from about 34/35 weeks (none of my friends ever believe me about these but by the end you can see how you’ve stretched and how a baby will be able to exit!)
-Pelvic floor exercises
-EDIT: Forgot to say Hypnobirthing recording when you go to sleep as it helps with positive affirmations

But if, for example, baby is too big or poorly or there’s any danger, you need to be prepared to accept the help (and be at peace with this is advice). Your approach mentally is so important!

Your stats still suggest approx 75% of births are 'natural' or without intervention. I had to have induction with my 1st due to waters breaking, but nothing more than a pessary that then fell out. 2nd was born on only gas and air. Every birth is different, and as my midwife often said there's no medals for childbirth. Do what's best for you and baby, but intervention isn't inevitable.

Before the modern medical system, large numbers of women died in child birth. It was a form of evolution. The mothers with narrow pelvises, and their babies frequently died. meaning that women with genetically wider structures survived and produced children who also had wider frames.

That doesn't happen now in countries with comprehensive medical care, so a larger number of new mums are narrow framed and struggle to give birth without help.

Also take into account that a % of the induced mums don't actually need inducing, it is just a precaution. They would have been fine anyway.

It is scary though. I'm 5'8" and narrow. I laboured for 40 hrs before they lost ds, heartbeat and intervened. We both came home healthy, but had I been labouring 200 years earlier, I doubt either of us would have made it. A sobering thought.

I agree with the luck thing -- I did all this, had a very healthy, straightforward pregnancy, and as I don't drive, I was walking or cycling to and from work daily throughout the pregnancy, so very active. I walked ten miles across London on my due date to an appointment. My midwife was impressed by my fitness throughout.

I still never dilated at all, because DS was tangled in the cord and didn't engage properly. We'd both be dead if it weren't for modern obstetrics. One of my NCT group got HELLP syndrome. I'm all for interventions.

Agreed. Part of what helped me go in with as much ease as possible was remembering that at the end of the day modern medicine could monitor baby and help!!

That's not quite right I think - 25% end in EMCS and another at least 25% in assisted deliveries, which means forceps or ventose. So more like 50% of first time births.

Thanks all - I should clarify, I’m not against interventions, and understand in many ways they are necessary and we are incredibly lucky to be in the 21st century and have them. It’s just quite scary to think about as a FTM and I feel there’s a lot of polarisation at the moment - on the one hand you have hyonobirthing companies telling you ‘my body is designed to do this’ and that you can breathe your body out, and then on the other hand I have hospitals / medical professionals telling me that intervention is all but inevitable. I also agree there’s a huge amount of luck involved: all my friends who ended up with emergency c sections were fit and healthy right up until the end of pregnancy but there were circumstances (eg cord being wrapped around baby’s neck) that they couldn’t have possibly foreseen or prevented. I think it’s just the unknown that scares me: I would almost weirdly feel better if I knew I had to have a c section for example.

Moier I am glad you had no problems giving birth ,and went on to have successful ones.However it shouldnt be seen as a badge of failure, to have intervention of medical terms.many women are small (myself included) and have little option but to have C sections ,We are not "Too posh to push" by any means! Childbirth is still risky and we need to lower those risks!

Part of it is luck, part genetics and part go with the flo. I did find those of my friends who had strict birth plans, didn't want this, didn't want that often ended up with more interventions i think cos one thing didn't go to plan and they got stressed out and anxious and caused labour to slow down.

I had planned a c'section but ended up with a completely natural labour with little tearing and pretty minimal blood loss, gas and air for contractions and nothing for pushing. she arrives a bit earlier and faster than planned so i went with it.

But most of my family seem to have easy births (and get pregnant stupidly easily) despite all being petite but overweight and not overly active.

My advice is just go with it. don't stress too much and let your body do its thing and listen to medical advice,

All bodies are different. I was super fit (taking classes at my local gym 3x/week), yet needed an episiotomy and forceps, as a last ditch effort before they started prepping me for a caesarean. Fitness had nothing to do with the size and shape of my birthing canal. It doesn’t matter how you get there—the end result of a healthy baby and a healthy mum is all that matters. None of this was part of my “birthing plan”, yet here we are.

Please get yourself out the scared mindset. Look at those stats and realise how many women didn't have induction, intervention or C-section. Being nervous about birth is the worse as your muscles will be tenser and your body won't produce the oxytocin that gets labour going. Medical interventions can save mum and baby's lives. And don't over think it or over research it- I'm 28 weeks now, and am just keeping an open mind to whatever happens.

Well said

High intervention rate is also related to the fact that first births are now a lot later than they would have been historically.

OP I know it is hard but I would really encourage you to try to keep an open mind about birth. It’s really tempting to look at population wide figures and apply them to your own situation. There are also lots of people arguing against intervention at policy level (due to cascade on interventions etc) which doesn’t really translate to the decisions that you and your midwife or doctor will make when you are in labour. I went into it all with clear ideas about what I wanted (no intervention) and ended up with induction and ventouse- so I then felt I had “failed” or done it wrong somehow which really added to my distress about what had been a traumatic birth.

Second baby I had a great midwife who really encouraged me to take a much freer approach- choices around interventions being better made in the moment than ahead and will be driven much more by the specifics of that particular birth than by attitude beforehand- and this worked so much better.

We’re encouraged to research and work out what we want ahead as a response to decades of high intervention being the norm in every case. But that isn’t accurate any more- no one will be encouraging you to have any interventions unless they are medically indicated (if anything, we’ve gone too far the other way due to underfunding) . If they are medically indicated, you will be glad to have them.

I don’t think it helps that so many women are induced now.

It’s something like a third of births in the UK are now induced.

I reckon about 40% of women I know had an assisted first birth (usually forceps), and 40% EMCS. It’s been quite eye opening…!