Rethinking “NORMAL” in childbirth

According to the Oxford English Dictionary, the adjective normal can be defined as “Constituting or conforming to a type or standard; regular, usual, typical; ordinary, conventional. (The usual sense.)”  When we talk about normal childbirth in the United States, we must be clear about what we mean.  For about 70% of childbirth, vaginal birth is considered to be the norm, but with ascending cesarean rates – well beyond the recommendation of the World Health Organization, normal includes a great amount of intervention upon the natural physiological process of childbirth.

If you have a normal pregnancy, you will be considered low-risk in childbirth.  This applies to about 90% of pregnant women.  Women who are considered high-risk in childbirth usually have been diagnosed with eclampsia, pre-eclampsia, gestational diabetes, placenta previa, and the like.  The 30% cesarean rate includes both groups – low-risk and high-risk – I believe.  Regardless, if 90% of women who carry babies to term are considered low-risk, then why is our cesarean risk any greater than about 10%.  (Interesting that the WHO recommendation is 10-15% cesarean rate.)  This is NOT normal.

Nor is it natural.  Aha, another term that is usurped and applied willy nilly to and by women who bear children.  Many people equate natural with vaginal birth.  I beg to differ.  Whereas 70% of women give birth vaginally, I’m sure it’s a relatively low percentage that do so naturally. 

Here are some excellent definitions from the Oxford English Dictionary for the adjective natural:

  • Existing in, determined by, conforming to, or based on nature. Existing or present by nature; inherent in the very constitution of a person or thing; innate; not acquired or assumed.
  • Consistent with nature; normal, expected.    a. Ordinary; conforming to a usual or normal character (or {dag}constitution).
  • Normally or essentially connected with, relating to, or belonging to a person or thing; consonant with or inherent or proper to the nature or character of the person or thing.
  • Based upon innate moral feeling; instinctively or immediately felt to be right and fair, though not prescribed by any enactment or formal compact; having a claim to be followed or acted on even if not legally prescribed. Cf. NATURAL LAW n., NATURAL JUSTICE n. Obs. [I really like this definition!]
  • Based on nature or the intrinsic properties of a thing.    a. Of a period of time: determined by cycles in nature.
  • Of a medicine, treatment, etc.: avoiding the use of pharmaceuticals and other artificial or manufactured substances; alternative, complementary, or homeopathic.
  • Not unusual, exceptional, irregular, or miraculous; explicable in terms of natural phenomena. Cf. NATURAL CAUSES n. 1. Obs.
  • Not unusual, exceptional, irregular, or miraculous; explicable in terms of natural phenomena. Cf. NATURAL CAUSES n. 1. Obs.

And . . .

natural childbirth, childbirth in which the mother-to-be uses methods of relaxation and physical cooperation with the natural process of childbirth (advocated by G. D. Read in 1933); (now also) childbirth with minimal medical or technological intervention; a birth of this kind.

Note that our definition of natural childbirth has changed since Read named a preference for it in 1933.  Now we consider natural childbirth to occur with minimal intervention.  I still maintain that intervention is not natural.  It might be normal, but I’ve already discussed that.

What sorts of interventions in childbirth do I consider to be unnatural?

  1. Induction – even if (big “if”) it’s necessary, that doesn’t mean it’s natural.  Even natural induction methods such as ingesting castor oil are not natural.
  2. Augmentation – often women who have had labor induced need augmentation such as pitocin to speed up dilation and strengthen labor contractions.  Very rarely should dilation and the labor process in general need to be rushed.
  3. Pain relief – why not rely on the endorphins produced by your own body to get through labor?  Epidurals are not natural.  What is natural about having a needle stuck close to your spine and medication that numbs part of your body?  If part of your body is numb, how well do you think your body will respond to the baby’s needs to descend and move into place?
  4. Rupture of membranes – it doesn’t matter if you are 9cm dilated (as I was when my CNM suggested that she break my amniotic sac), the outcomes are not necessarily any better.  In my case, the baby never descended.  Never.  That is not natural.
  5. Cesarean birth (link opens pdf booklet from ICAN) – surgical birth is a blessing when it is used responsibly.  However, with a cesarean section rate of 30%, it is obvious that this life-saving surgery (major abdominal surgery) is being abused in practice.  And women are able to select this surgery of their own volition for childbirth.  Many of them just don’t know any better . . . they should . . . but they don’t.  ACOG should be disbanded for this and numerous other abuses of power with regard to defining what is and what isn’t safe and in the best interest of the mother and child in childbirth.

 In closing, women, their partners, family members, friends, and care providers must rethink what is “normal” with regard to childbirth in this country.  Normal should follow natural.  Normal should be governed by nature.  Normal doesn’t need treatment or intervention, and when it does, it is not appropriate to define it as normal or natural. 


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