After over 30 years of the plebiscite, the epidural has lost some of her aura and the future mothers are asking for more and more information when it comes to its necessity and its secondary effects. The number of women who consider childbirth without epidural increases every year. There is also an increase of women who don’t go for the classical maternity facilities childbirth preparation but opt to search for alternatives: sophrology, haptonomy, prenatal singing, prenatal yoga… A lot of women express the wish to be in charge of their baby delivery and to let their body do what it knows how to do. In summary, more and more women want a physiological childbirth.
In this article, we will see:
1 • What is physiological childbirth? A variable definition
The answer depends on who is giving it, depends on his training, on his experience, on his function, on his fears and on his knowledge on physiology. The answer from a doctor, a maternity hospital midwife or a home birth midwife will be different… Induction or spontaneous start of labour, vaginal delivery or cesarean, with or without Syntocinon (artificial oxytocin given through intravenous infusion during labour), with or without epidural… For some, a childbirth is considered physiological if the baby is born through vaginal birth, some will add without instrumental assistance.
For others, a physiological childbirth is when the essential needs of the woman in labour are respected (we will enter the subject in depth later) and the baby’s essential needs are respected and that no one interferes in the process, as per this Michel Odent quote that you can hear in the documentary film “DO NOT PUSH!”
Physiology is a science on its own. It gives back to “bio” (life) its place, and puts the science (the medicine) back in its place. It is not about denying the medicine that has allowed humans to live better and longer. Let’s review the important stages of this evolution:
- In 1846, Semmelweis found out about the microbial world and the contamination principle that put in place the rules of asepsis like we know them today as elementary rules (especially since spring 2020).
- In 1885, the rabies vaccination then the other vaccines (I am talking about vaccination, not experimental gene therapy…).
- In 1928, the penicillin discovery (natural antibiotic contain in some fungus that entered therapies in 1941)
- Progress in surgery… From antiquity to the present day
But an old belief is still present in people‘s minds: that before their transfer to hospital, the majority of women died in agony or from their blood draining out of their bodies. This is not true. The puerperal fever brought into the birth rooms by doctors, who came from dissection rooms was destructive – it is true – but not on women who gave birth at home.
In my documentary film ”Don’t push!”, the historian Marie-France Morel, president of the birth society of birth story, lays out facts and reminds us that only one birth out of 100 ended in the death of the mother in the 17th century. That happened in a time when ultrasound and the advancements mentioned above, hadn’t yet been discovered. Let’s remember an unquestionable reality: women have been giving birth throughout the years and humans have flourished.
Childbirth isn’t a pathology and when women have a low-risk pregnancy (over 85% of women) and benefit from a follow-up (which is the case for most European women today) when we respect physiology everything happens perfectly.
2 • So what is physiology ?
We are cultural beings and though we surf the Net better than in the Paleolithic, when it comes to the survival of the species, we are very close to our caving ancestors. Reproducing, eating, protecting ourselves from bad weather & predators… Answering our vital needs comes from our reptilian brain. Our neocortex brain has very little to do in that field and we have to be cautious that it doesn’t undermine this natural process.
As reported by Israël Nisand, the president of the College of the French Gynecologists and Obstetricians, it is readily admitted that humans are more people of culture than people of nature, guided by their knowledge and not by their instinct. The definition of instinct is the following: a set of complex behaviours identified genetically – which often leads to the conclusion that a woman doesn’t know how to deliver her baby. Even though the instinct role in human life can be debated, the question isn’t there. Birthing doesn’t come from an instinct but a body reflex like breathing, sneezing, vomiting, orgasming, digesting… There is nothing to understand except to let it happen because the baby and the mother’s body do the work, ideally without neocortex stimulation & without external interventions. Telling women that they don’t know how to birth their babies is like telling them they don’t know how to breathe.
Note: we know that stress can disturb digesting, sleeping, even breathing, it is the same when it comes to birth.
We are now getting closer to physiological childbirth
Like in all the other processes linked to the specie survival (feeding – digesting, sleeping, the « flight or fight » reflex, reproducing), hormones are determinant in childbirth:
- Oxytocin, known as the love hormone, causes contractions in the uterus & the baby’s descent,
- Endorphins allow the mother to enter her bubble & not to feel pain,
Read the article on “childbirth hormones”
Watch the film “DON’T PUSH!” subtitled in english
For labour to happen physiologically, that is, without medical intervention, some conditions need to be met to allow this subtle and fragile hormonal sequencing. Let’s go back to basics, let’s say that to give birth well, you need to be in the same conditions as if you wanted to come:
- Intimacy (not to feel observed)
- Neocortex activity reduced
- And for that, darkness (Physiologists discovered that the melatonin receptors – supporting sleepiness – are activated by darkness – and have an impact on the uterus)
- Soft warmth
- Eating and sleeping as per the woman’s needs and desires… As desires are the manifestation of someone’s needs
Let’s add to that verticality and movement, and there are the conditions that ensure a 95% chance of an easy and quick delivery: a physiological birth!
Note : I already hear comments about the possible complications like shoulder dystocia or birth hemorrhage : I don’t deny these complications. Most of them can be anticipated today. For these two complications, verticality and movement can easily solve the first one and respecting the basic human needs during labour can bring to zero the cases of the second one. I will not mention here the complications that are the direct consequences of the medicalisation, one intervention creating another one and so one… I explain everything in the documentary film “DON’T PUSH!”
3 • What about the epidural in all this?
The first choice that is offered to pregnant women is to take or not the epidural. For a lot of them it seems absurd and backward not to take it. Epidural anesthesia is a wonderful progress. To welcome the contractions, a woman needs to plunge in herself and disconnect her neocortex. When confronted with a medical structure and followed by an unknown medical team, with members often made impatient by the understaffed team they work in, stressed by alarming considerations, questions and everything that stimulates the neocortex, it is very hard to manage pain and enter the birthing dance. The epidural can become really helpful to relax and not to block the process.
If the epidural is compatible with a quick and easy vaginal birth, that we could qualify as physiological, making the choice of taking it as soon as labour starts can have important consequences. Though some maternity wards have a process that allows mothers to stand up and walk around the building – the ambulatory epidural, the epidural analgesia requires immobility.
Note : in fact, it is often possible to still move with an epidural, but once relieved, women don’t feel the need to move and become passive.
Though in classical views of birth scenes, the woman is often in a laying down position with her feet in stirrups, it is easy to understand that to “go down”, the baby needs his mum to be vertical! And that to engage in the pelvic bowl and unstick an arm or a shoulder, movement is a precious ally. So ideally, we stay in motion, we walk, we squat down, we go up and down the stairs, all that while staying in touch with our feelings will guide our movements. Therefore, we choose the epidural only when we feel we can no longer do without it. We all have to determine our limit, but if we don’t tempt it…
To understand more on the journey of physiology : ● Watch the film “DON’T PUSH!” ● Read my article “Birth, pain or a voyage” ● Read my future article “The ambulatory epidural”... when it’s completed
4 • Let Mothers choose !
In France, we have the Kouchner law. Are you aware of it? It can be summarized as this: “Prior to any medical act, free and informed consent must be given by the patient and this consent can be retracted at any time.”
Therefore, anyone can request any information on any procedure that can be offered and can refuse it. This is often the case for patients in cancer treatments. It is rarely the case in obstetrics. By default, because it has been planned like this, women believe that they are incapable of giving birth by themselves. They rely, sometimes blindly, on the doctors and don’t take the time to get informed and to choose. If you are reading this article, I guess it is because you want to put all the chances on your side and make choices that reflect who you are. You won’t regret them!
To feel listened to and respected is the key to oxytocin secretion
The logic goes like this : The physiology explains to us the basic needs of a women in labour. It is the respect of her needs that allows her to secrete the precious oxytocin hormone, which allows labour to progress favourably. For some women answering these basic needs means staying at home, entering their bubble and not be disturbed. For others, feeling safe means being in a maternity ward, surrounded by a medical team and not to feel too much pain. Because this pain, if not welcomed, becomes suffering and therefore a stress factor, which will create adrenaline secretion.
Let’s remember that adrenaline is the « flight or fight » hormone, not the birth hormone . Here is the role that adrenaline plays during labour :
- In early labour, if a woman is stressed, she secretes adrenaline which blocks the labour. Back in the caveman days, the presence of a predator triggered a peak of adrenaline, which blocked the birth process and allowed the woman to go and give birth somewhere else. Today, the classical situation is labour starting quietly at home, then we decide to go to the maternity ward. On the road, we face traffic jams, fear of having forgotten something, the sitting position that makes it harder to manage contractions. Another possibility, when we arrive there, the midwife can’t find your file, makes inappropriate comments and the woman secretes adrenaline. The labour that was progressing beautifully at home, starts stagnating. The classical scenario! On the contrary, for some women being at home is a source of stress and oxytocin will replace adrenaline in her body as soon as she arrives at the hospital.
- At the end of the labour, it is the adrenaline that creates the ejection reflex, a very strong push feeling like a cannonball. Back to the caveman days, the scenario would be like this: “A tiger!” adrenaline/ very powerful push/ baby ejection/ I catch my baby/ I flee away from the tiger! It is harder to define the scenario today but I believe I can exemplify it with my own story: For my first child, born at home with no midwife present, everything happened marvelously well until I felt the head in my vagina and I wondered how long it would stay trapped there! Adrenaline / very strong push and a baby that was born like a cannonball! Outcome: perineum complete and well recovered.
Once more the important part is listening to ourselves and having our choices respected. Notice, having to battle to have your birth project respected, when you are at 7cm dilation, is not at all supportive in the labour process.
5 • The epilogue on induction childbirth
I have to finish this article with a very trendy word: induction. It represents on its own, the biggest action against physiology, even if some doctors enjoy showing you the contrary.
It is acknowledged that the baby dictates the pace in childbirth (and in the parents’ life for the years to come, even if it isn’t the subject of this
article). In fact, even if nothing is demonstrated, it seems clear that either the baby or his matured and ready to function in an airborne environment lungs, decide when the work starts. (I will soon write an article on “the role of the baby during birth”). Once the baby gives the quick start, the subtle hormonal dance begins along with the labour in the mother’s body and the baby’s active journey towards the light. With induction and whatever the procedure used, we force the baby out, who was clearly not ready to be born and therefore is not going to be very “collaborative”… (It is exceptionally rare that a baby forgets to come to the world and dies in the womb).
Of course at 41 weeks, he nearly finished to tidy his room. And can catch up with the timing. But at 37, 38 and even 39 weeks, it is not as obvious. Of course, the medical intervention can guarantee a successful outcome (meaning mother and baby alive). Unfortunately though, while using artificial oxytocin support, the contractions are more intense, closer to one another, more painful for the mother and harder for the baby to swallow.
Induction is most often linked with an epidural and here our physiological birth project has vanished. In summary, a delivery that starts with induction is not a physiological birth.
In France, if you are a woman in your first pregnancy, that everything is presenting itself right, it is possible that your gynecologist offers you to participate to the study « FRENCH ARRIVAL » (which came from the American study “Arrive”). This study comes from America and involves a double-blind experiment on two groups of women in their first pregnancy, all going well, with cephalic presentation, not expecting twins… A perfect scenario for a physiological birth. The study requires the induction of the first group at 39 weeks and nothing for the second group. The objective is to show that we can reduce the risk of cesarean. I won’t go in more detail here, but I would strongly recommend that you decline this offer with a knowing smile.
Keep in mind that in principle, you have everything you need inside you to accompany your baby into the light. 85% of the pregnancies promise the very bright future of a physiological birth, as long as the process is not disturbed. The most important thing is that this journey is as beautiful as possible for you and your baby. Give yourself the means to make choices that align with who you are. Keep in mind that pathology exists and that in some cases we can thank the miracles that medical interventions contribute to. Welcome the idea that everything doesn’t always happen how we hoped for. But, if at every moment, you feel heard, that you understand what you are going through, you and your baby will be confident and can confidently advance a step on your journey together.