Why We Won’t Use the Term ‘Natural Birth’ in NYT Parenting
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This week, we’re focusing on becoming a parent. We have articles on home births, C-sections, epidurals, adoption, inductions, unmedicated births, VBACs, legal basics for L.G.B.T.Q. families — the list goes on.
One thing we noticed while editing and researching these pieces was that writers used the term “natural birth” to mean a variety of different things. Some used it synonymously with unmedicated birth — no Pitocin to induce labor, no epidural to provide pain relief. Others used it to mean vaginal birth. Still others used “natural birth” to mean midwife-assisted birth with as few interventions as possible.
In fact, there is no universally accepted medical definition of the term“natural birth,” according to Dr. Julie Chor, an assistant professor of obstetrics and gynecology at the University of Chicago. We strive for clarity when giving guidance, and so have decided to avoid the term in favor of more specific, less confusing phrasing.
Additionally, we realized that the term “natural birth” could shame women whose deliveries were deemed not “natural” — whether they had C-sections, needed to be induced or simply desired pain relief.
Even parents who are doctors are vulnerable to this kind of shame. Dr. Anne Drapkin Lyerly, an obstetrician and professor at the University of North Carolina School of Medicine and author of “A Good Birth: Finding the Positive and the Profound in Your Childbirth Experience,” has had five C-sections. Though she understood why these operations were medically necessary (she’s a slight 5-foot-2, and her first four babies weighed around 10 pounds each at birth), when she was going through it, “I felt sad and ashamed even though I had all the rationality,” Dr. Lyerly said.
The origins of ‘natural birth’
The term “natural childbirth” was first coined in 1933 by Grantly Dick-Read, a British doctor, with the publication of his book, “Natural Childbirth.” In it, he argued that the “civilized” British women of the day were avoiding pregnancy — and driving down the birthrate for the middle-and-upper classes — because of their unreasonable fears of pain during labor. He believed that their fears caused tension, and that tension caused pain, so if women could become less fearful of childbirth (and hence experience less pain), they might help to reverse “the decline in middle class fertility,” wrote Dr. Ornella Moscucci in the B.M.J. Postgraduate Medical Journal.
Paradoxically, Dick-Read didn’t believe in drugs. He defined “natural childbirth” as when “no physical, chemical or psychological condition” disturbs the “normal” sequence of labor. With deep breathing, faith and a little preparation, Dick-Read believed that most women shouldn’t need anesthetics during birth because they’d be so ready for it that they wouldn’t feel pain. He even claimed to have had a patient who said, upon feeling contractions for the first time, “Isn’t it heavenly?”
Dick-Read brought his ideas to the United States in the late ’40s, but similar philosophies had already gained traction there. Though the terms were slightly different — “pain-free birth,” “prepared childbirth” — their beliefs were essentially the same: that a more relaxed, unmedicated birth meant a happier, healthier mother and baby.
The “natural childbirth” movement gained more followers in the ’50s and ’60s, but didn’t really take off in the United States until the ’70s, according to Dr. Randi Hutter Epstein, a writer-in-residence at Yale School of Medicine and the author of “Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank.” That’s when works like Ina May Gaskin’s 1976 book “Spiritual Midwifery,” which described the euphoria of unmedicated home birth, became best sellers.
The “natural childbirth” movement was an effort to give women control in the birth process, and to push back against the paternalistic medical establishment, which at times had embraced dangerous treatments.
“Doctors gave commands and handed out drugs,” Dr. Hutter Epstein wrote of midcentury obstetricians in “Get Me Out.” Because doctors believed that “bloating” triggered pre-eclampsia, for instance, some prescribed diet pills laced with amphetamines to prevent women from gaining more than 15 pounds during their pregnancies.
But the “natural birth” movement that once empowered women during delivery has now created a culture in which some women feel shame at not having a “natural birth” — as if their bodies are somehow defective. Furthermore, focusing on the method of birth can exclude and diminish the experiences of adoptive parents and parents who use surrogates or other kinds of assisted reproductive technologies.
A ‘good birth’
While Dr. Lyerly was a professor at Duke and performing research for “A Good Birth,” she and her team of researchers interviewed 101 women from racially and economically diverse backgrounds who gave birth in all types of situations — from scheduled C-sections to unassisted home births — and included women who had different birth experiences for each of their children.
Dr. Lyerly identified five qualities that led women to feel that they had “good births,” regardless of how their babies came into the world: agency(capacity to make their own choices, even if things didn’t go according to plan), personal security (a sense of safety during birth), connectedness(with medical providers, family members and with their babies), respect (an acknowledgment that birth is a transformative life event) and knowledge (understanding their bodies, and also understanding that birth was a process they couldn’t fully control).
I love the framing of a “good birth,” because it removes the false dichotomy of “natural” versus “unnatural.” The outcome everyone wants for their delivery is a healthy baby and a healthy mother. Health includes emotional health, too.
Jessica Grose is the lead editor for parenting at The New York Times. Jess was the founding editor of Lenny, the email newsletter and website. She also writes about women’s health, culture, and grizzly bears. She was named one of LinkedIn’s Next Wave top professionals 35 and under in 2016. Follow her on Twitter @JessGrose.
This article was first published in NYT Parenting on May 7, 2019.