What’s natural about natural childbirth?

Jender at Feminist Philosophers has a recent post about natural childbirth. She writes that the literature supporting natural childbirth is too often misleading.

Telling women that if they shop around hard enough for the right midwife, and work hard enough on their relaxation techniques and positions they’ll have a great uncomplicated time is SERIOUS misinformation.

She raises an issue similar to my post earlier this week, where I argued that a general preference for ‘natural’ ecosystems over ‘improved’ or ‘disturbed’ landscapes can be justified empirically but not with metaphysics.

‘Natural’ childbirth can mean many things to different people, from vaginal birth, to a birth without pain medications, to a birth that minimizes interventions, to a home or unassisted birth. Sometimes--perhaps too often, as Jender notes--there is a belief that if labor and birth are allowed to progress in their own time and their own way, then the labor will be less painful and delivery will be uncomplicated. And then, when the labor and delivery are slow or complications do develop, a mother whose goal is natural childbirth could feel disappointed, cheated, or even ashamed, as though she was unable to achieve what “should” be a natural biological function.

But this view entails attaching a prescriptive metaphysics to the concept of ‘natural.’ It is analogous to saying that wilderness should be valued more highly than agricultural fields because wilderness is ‘natural.’ But I like to eat bread and grapes and artichokes! Still, without buying into a flat-rate preference for natural landscapes over cultivated ones, I think we can still justify on empirical grounds why we should look to what is natural to identify the conditions in which humans and other creatures flourish.

Likewise, empirical evidence and some well-accepted criteria for healthful outcomes are what is needed to support natural childbirth and, most importantly, to support educating expectant mothers about the physiological process of birth. A good education would include what sort of pain can be expected and the average duration of active labor (which, for first-time mothers, is 20 hours, more than many practitioners allow before augmenting with pitocin).

When C-section rates rise, so do mortality rates for mothers. Mothers who have had C-sections are more likely to have additional complications, take longer to recover (on average, of course), and are less likely to breastfeed. In addition, they are more likely to have complications with subsequent pregnancies. Other interventions, such as pitocin induction, epidural pain-relief, and electronic fetal monitoring are implicated in poorer outcomes insofar as they contribute to the likelihood of unplanned caesarean birth.

The evidence supports taking steps that are likely to give women more control over birth, more autonomy during labor, and more choice than is usual in US maternity wards. But intending a natural childbirth is certainly no guarantee that labor will progress according to a plan! It would be heartless to deny the necessity and high value of medical interventions when needed, not just for emergencies like placental abruption, but also for pain relief when unexpected pain is harming a mother’s ability to give birth.

Rixa has written recently on what should be done about rising caesaraean rates. She quotes Michael Odent:

The primary objective should not be to reduce the rates of caesareans: it would be dangerous, if not preceded by a first step. This first step should be an attempt to promote a better understanding of birth physiology and particularly a better understanding of the basic needs of women in labour.