Saturday, April 4, 2009

Normal Childbirth?

I've read lots of articles and blog posts and email conversations surrounding the many perceptions and definitions of "normal" childbirth and "natural" childbirth. One thing I've learned is that these definitions are extremely fluid and subjective. One person may define natural childbirth as any birth that is vaginal, others believe that a natural childbirth is one without any medical procedures or medications. What is defined as a procedure can even by tricky - while most of us would agree that artificially rupturing membranes is a procedure, what about a vaginal exam?

Personally, I would define my first child's birth as natural, even though my membranes were ruptured (with my consent) when I got to 10cm and they were bulging, and I had some electronic fetal monitoring. Because I had nothing attached to me (IV, catheter, epidural) and no medication, that fits my personal definition of a natural birth.

What's the big deal about this anyway? Well, as a former high school English teacher, I am a person who appreciates unambiguous language - I like it when people intentionally use the right word for something. In fact, this drives my husband crazy sometimes because he'll come home and use the word flu to describe just about anything going around his office. This word sets off a chain of (annoying, if you ask him) question: a stomach flu? the real flu? how long did it last? was there a fever? etc. Any cold with a fever or vomiting episode fits his definition of flu, but mine is much more narrow. What I want to know is what he might have been exposed to, and what symptoms I should be on the lookout for in the children, and his definition doesn't help me figure that out!

Back to childbirth - does it matter if someone discussing a natural birth means that she didn't have a cesarean, and is basically using the word natural because she doesn't want to say the word vaginal in regular conversation?

The word normal is even more slippery, because its definition is shaped so much by what is normal in any given culture or sub-culture. Normal could mean a very medicalized birth, with IV, epidural, catheter and prone pushing or it could be a homebirth with a midwife attending as a "guardian" who supports the mother and checks on the baby, but who does not do anything medical in nature beyond checking baby's heart tones and examining the placenta and the mother afterward for tears.

I started thinking about these definitions because of a question I read in the Midwifery Today newsletter:
"If the general public continues to be indoctrinated into medicalized birth, how can we expect women to stand up and fight against the marginalization of freestanding birth centers and midwifery in this country?"

— Colleen Bak
Indoctrination is a serious word. This question (or call to arms!) is all about definition, to me. If the definition of natural birth encompasses physiological birth and birth that is medicalized with procedures and medications that may or may not be evidence-based, it becomes very, very hard for people to understand and appreciate the benefits of physiological birth to mother and baby, as well as making that type of birth seem even more unusual than it is. A big part of why I offer independent childbirth classes (and write this blog) is because these are my ways of making a difference: they're my small way to fight against the indoctrination that pervades birth as portrayed on mainstream television and in movies, on TLC's Baby Story, and in some books and classes about birth.

[And yes, I threw another birth category into that paragraph: physiological. What is physiological birth? defines physiological as "characteristic of or appropriate to an organism's healthy or normal functioning". I like Dr. Kotaska's explanation, from Jennifer Block's book Pushed, “An unmedicated birth in an environment where a woman feels comfortable, where she’s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is physiological birth.”]

Before I eat lunch I want to wrap this up with a few more links. Lamaze International offers its defining qualities of normal birth with these six care practices. By normal, they mean normal physiologically, not culturally.

And I want to point you to the free online sample of the excellent journal, Birth, where they've posted the articles from current issue (March 2009). The article that directly applies to this post is the editorial, "What is Normal Childbirth and Do We Need More Statements About It?", where you can read more about the words normal, natural, and physiological as they relate to birth. I'll leave you with a quote from the editorial,
"Clearly, 'normal’ has a different meaning in different countries. The dominant cultural definition and experience of childbirth in North America and elsewhere are widely recognized to be medical and technological in both philosophy and practice (3,5), and as evidenced from the medical inclusion criteria for ‘normal birth’ listed in the British and Canadian statements (1,4). As long as birthing systems continue to evolve in this direction, definition of ‘normal’ will evolve to keep up. Provider and consumer groups will have to continue to make their voices heard in support of natural childbirth and, hopefully, a more normal ‘normal childbirth.’"
And that's my addition to what I hope will swell to a growing chorus of women who support a more normal "normal childbirth".

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
New Mothers Support Circle

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Blogger Sarah A.T.J. said...

Interesting! I'm the same way with my vaguely spoken husband. It does drive him mad too:)

April 4, 2009 at 1:27 PM  

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