Note: It’s important to start by saying that this blog post is not about my birth. I’m still pregnant (37 weeks 5 days) as I write about this, and my intention is simply to talk about the different options Ben and I have considered about how our baby comes into the world.
I’ve purposefully titled this blog post “A Natural Birth” because I wanted to bring attention to the varying definitions of what is meant by “natural.” In an article I read recently about natural births in China, a midwife was quoted as saying the following:
“… it became popular for women to give birth by Caesarean section around 2000. As they were limited to one child, women would opt for C-sections because they are more convenient and carry a reduced risk for the newborns.” This changed again with the advent of the second-child policy, which was fully implemented at the beginning of last year [2016]. Since then, Xiao has observed a noticeable increase in the number of women opting for natural births. “Now, due to the second-child policy, women have been considering the risks associated with C-sections more carefully,” she said.
In this example, a “natural” birth is considered a vaginal birth, as opposed to a c-section. In the United States, a “natural” birth is sometimes used to refer to a birth that’s not only vaginal but also unmedicated. Others might define a natural birth as being one done at-home or even in water. In other words, the term “natural” can be quite vague, and it has become controversial. After all, aren’t all births natural, whether performed in an operating room or a living room? Were women who had c-sections or epidurals somehow less of a mother because of the medical interventions involved in bringing their children into the world?
All births are natural.
All women (and transgender men) deserve to be appreciated for the ways in which they bring new life, hope, and warmth into the world. The New York Times does a great piece on this topic here. Throughout this blog post, I will try to use more precise terms to refer to different types of birth options that are available to those who are pregnant.
A Caesarian Birth
I’ll start with caesarian births. I’m purposefully not calling it a c-section because that emphasizes the medical procedure more than the new life or lives brought into the world. In China, a caesarian birth is more expensive than a vaginal birth, and as is mentioned by the midwife above, changes in policy are encouraging doctors and pregnant mothers to have vaginal births instead. Of course, whether or not to have a caesarian birth is not always a matter of choice. Sometimes, due to fetal distress, a breech position, or a medical condition like placenta previa, a caesarian birth is the safest option for both mother and child.
As such, Ben and I reviewed the options we had available to us for a caesarian birth even though we were hoping not to have one. For instance, it was important to us that he be able to accompany me into the operating room. This was not an option for many, if not most, hospitals in China, which is one reason we wanted to give birth at the hospital we chose. We also wanted to have the baby born a little more slowly, to give the baby more time to clear their lungs for that first cry. (A vaginal birth naturally slows down the birthing process in a way that a caesarian birth does not. A doctor can pull a baby out of one’s uterus much faster than they can out of your vagina.) We also wanted to stay together as a family. Sometimes after a caesarian, the baby is taken for newborn care, and the father and baby will leave the mother to be sewn up before she’s taken to recovery. This means that sometimes the mother and baby are separated for a few hours immediately after birth.
Ultimately, Ben and I would want a family-centered caesarian birth, if a caesarian became necessary. You can see a video example of such a birth here. However, we can tell from the questions we’ve asked at the hospital so far that the experience of the couple in this video is not something we would be able to replicate where we give birth. For example, there is a concern that if they lowered the sheet to allow us to see the birth of our child, Ben might faint. The OB we are seeing said that this has happened to her in the past when a father stood up and looked over the partition without permission and fainted at the sight of his wife’s open uterus. The doctors then had to focus their attention on the father when they should have been focusing on the mother and baby. I personally think after all the vivid videos Ben and I have watched of births in the last few weeks that we’d both be fine, but it’s hard to convince the doctor of that.
An Induced Birth
An induced birth is another option that could occur if labor does not start on its own after a woman’s water has broken or after the woman is past her due date. It may also occur if the woman has been in labor for many hours and is not making progress in the effacement and dilation of her cervix. Other reasons a woman may be given for an induction, include preventing the baby from growing too big. Women with gestational diabetes sometimes have larger babies, and a doctor may want to induce labor before a woman even reaches her due date to prevent the baby from growing too big.
An induced birth is the type that I want to avoid the most. This is because the hospital where I plan to give birth would use Pitocin to induce labor, which is a synthetic form of oxytocin, the hormone that naturally induces labor. Many women report that the contractions caused by Pitocin can be even more intense than natural contractions, often leading these women to have an epidural even if they wanted an unmedicated birth (discussed below). There’s also a chance that the drug may not work, and the woman will then need to have a caesarian birth.
While hoping to avoid an induction, Ben and I needed to educate ourselves on the topic. For example, we needed to find out how long after my due date the doctor was willing to wait before suggesting induction. Would it be 7 days, 10 days, more or less? In our setting, it seemed that one week or 7 days was the best we could hope for. This was of some concern to me after learning that 50% of first-time moms go into labor naturally by 40 weeks and 5 days. The other 50% go into labor after that. This doesn’t give the other 50% of first-time moms much time to get that baby out before their OBs start to get antsy. As I mentioned in my previous post, The American College of Obstetricians and Gynecologists considers 41 weeks or more to be “late term.” This means that many first-time moms are likely to face the recommendation of an induction because their babies are considered “late.”
Evidence-based Birth discusses this topic in great detail here, and I would recommend reading the section entitled “How long is a normal pregnancy? Is it really 40 weeks?” in particular. Essentially, what I learned from my reading is that using the starting date of my last menstrual period (LMP) to calculate my due date is quite inaccurate. My 12-week ultrasound, sometimes called a dating scan, is a significantly more accurate representation of my gestational age. Despite this, the hospital still used my LMP to determine my due date as August 10th. The problem is that even just a few days difference between my gestational age according to my LMP and according to the ultrasound still puts me at risk for a non-medically necessary induction. One OB, for example, said that she wouldn’t feel comfortable waiting longer than 1 week past the due date on record to induce me.
So, what does that mean exactly? It means that I could be induced on August 17th when my 12-week ultrasound scan put my due date at August 13th. This would make me only 40 weeks and 4 days at the time of induction. As mentioned above, only 50% of first-time moms will go into labor by 40 weeks and 5 days.
When I first became pregnant, I was so concerned about premature labor because of my history of adenomyosis that it never occurred to me that the baby may actually come later than I ever thought. Throughout the pregnancy I’d been telling people that the month of July was fair game for the baby to come, but I’ve come to realize that the chances of that happening are actually quite low. While I originally thought that there was little chance the baby would be born as late as mid-August, I’ve come to realize that the chances of me going past my due date are the same as the chances of me giving birth beforehand. After all, a due date is just a median number for when you could give birth. Based on the 12-week ultrasound scan, the research suggests the following likelihood of me going into labor naturally:
A 10% chance of going into labor by August 3rd.
A 25% chance of going into labor by August 9th.
A 50% chance of going into labor by August 15th.
A 75% chance of going into labor by August 22nd.
A 90% chance of going into labor by August 27th.
In other words, after looking at a summary of several different studies on the topics of due dates, I came to realize that the best estimate for my due date was August 15th, that median number above. However, the baby may not make an appearance until August 27th, or note that there is still 10% chance it could be later. If you’re feeling confused about the dates at this point, that’s not surprising. It took me some time to figure it out too. You can find a good article that summarizes the information here.
Essentially, what these studies are all really reinforcing is that due dates are just estimates, best guesses. Unless there is maternal or fetal distress, there is no reason to induce labor based on these dates. Moreover, our assumptions about how long a pregnancy should last still errs on the side of being too short. Due dates based on LMP originates from research done in the 1800s, but modern findings are having a hard time dispelling this practice. In my pregnancy encyclopedia, for example, the information about a baby’s development stops abruptly at 40 weeks, even though a baby could be born healthily as late as 44 weeks!
It makes a lot of sense to me that the labor and delivery will go more smoothly if the baby chooses the day of his or her arrival. Since due dates are just estimates anyway, it seems wise not to get too attached to one date or start a domino effect of medical interventions based on when we think the baby should come.
An Unmedicated Birth
At this point, you are probably starting to sense that Ben and I want a family-centered, low medical intervention birth option.
In China, giving birth at home or at a birth center is not a thing yet. Perhaps the very wealthy or some places (that I know nothing of) in the larger cities have that option. However, when Ben and I decided to give birth in China, we were accepting that it would have to happen in a hospital. Now, it’s important to mention here that I’ve talked to many foreign women of different races and nationalities, and they’ve felt that the care they received when giving birth in China was quite good. Of course, that’s not everyone’s experience, but many people have been able to find a hospital experience that has been on par or even exceeded their experiences giving birth in the US or other countries.
I also feel confident that I will receive good, maybe even exceptional, care at the hospital where I’m going to give birth.
However, Ben and I are going to be taking a path not well-traveled as we want an unmedicated birth. An unmedicated birth is one in which you utilize natural pain relief techniques like massage, counter pressure, hot and cold therapy, water, and much more to get through each of your contractions, knowing that these contractions are pushing your baby into the world. In a setting where moving from caesarian births to vaginal births is already considered a big step toward decreasing medical intervention, asking for a vaginal birth without an epidural must seem, well, medieval.
When I talked to my OB about it, she wondered why women should struggle through the pain of labor when the technology and medicine exists to spare them this suffering. She also seemed suspicious that this was not something I wanted but something I was being pressured by my husband and his family to do. She wasn’t the only one. When I talked to the labor and delivery nurse about it, she said to me, “It’s the patient’s decision whether or not to get an epidural. It’s not your husband’s decision. You decide.”
It was clear to me that there was some sort of cultural concern underlying these statements. So, I started to research the phrase “unmedicated birth” and “natural births” in China. One article written in November of 2018, “China to Encourage More Natural Births with Epidurals,” is short enough to include in full:
As of next year, having a child in China will be less of a pain – literally.
China’s National Health Commission announced on Tuesday that it would be implementing a pilot program to increase the rate of spinal or epidural anesthesia injections for childbirth, which will be implemented in 2019. The pilot plan aims to raise the rate of epidurals given for natural birth to 40% and further reduce the rate of Cesarean sections.
Presently, the epidural rate in China is under 10%, compared with 80% in the United States, due to a shortage of anesthesiologists and low incentives for hospitals to provide the procedure, which is low in price but requires many hours of supervision. The pilot program will train anesthesiologists, obstetricians and midwives and encourage hospitals to education expecting parents on the use of epidurals or spinal injections for natural births.
China’s low epidural rate means that many women are faced with the option of a caesarian birth with anesthesia or a vaginal birth with little in the way of pain medication. You can read more here about Rongrong Ma who suicided because of the pain from an unmedicated vaginal labor and her family not agreeing to have a caesarian birth. After reading this story, which occurred just two years prior, I started to understand why the doctors and nurses seemed to take affront at Ben asking questions about an unmedicated birth option.
The idea that I would want to give birth unmedicated when an epidural was an option seemed to come across as impossible to the hospital staff. I got the sense that taking advantage of the epidural was the empowering, freeing option for the modern woman. By choosing not to have it, I was somehow betraying progress and setting a bad example for the women who would come after me. It was like I would somehow trivialize the pain of labor or diminish the incredible accomplishment of women who do give birth with an epidural or other medical intervention.
After reading these articles and my experiences discussing my birth plan at the hospital, I started to realize that China was in a “let’s move women from caesarians to vaginal births with epidural” mind-frame. I couldn’t see the move from epidural to unmedicated even on the horizon. How would Ben and I pull off the kind of birth we really wanted in a setting where what I was asking seemed to be viewed as backward and oppressive? How did I convince the doctors and nurses that I wanted to be fully present in my body for the birth of my child? How did I explain that unless either I or baby was in life-threatening danger, I didn’t want them to intervene in nature’s most natural dance of bringing a new life into the world?
I was on shaky ground. An unmedicated birth is most successful in a setting where people are experienced in dealing with them, where the nurses and doctors believe in the benefits of giving birth with only the medical intervention necessary. This was not the setting I was in.
Even so, I wanted to try. And not just try, I wanted to do it. Not to prove a point to anyone. Not to set women forward or back. Not for Ben and his parents. Not for anyone but me and the baby. Pain relief comes with side effects that can make me or baby unable to fully experience our first meeting. Sometimes people call this moment the Golden Hour, when the baby is placed skin-to-skin with their mother, and the first breastfeeding can occur. Pain meds or other forms of medical interventions can delay or circumvent entirely that first moment of bonding. For me, unless there is a medical emergency that makes that hour of bonding a secondary priority, it is my primary motivation during labor and delivery.
The way I see it, Ben and I have conceived this baby, and Ben and I can bring him or her into the world too. We would just need to take it one contraction at a time, and utilize the expertise, support, and facilities of the medical staff and hospital to ensure that baby and Mom were safe.
But how to get everyone on board before this baby comes? I’m not sure. Even the OB I’m talking to now about my birth plan may not be the one that delivers my baby. Even so, I am going to try. I am going to tell everyone the story of all that it took to bring this baby into the world. The thing that I’m most sure of is that I must do my own research, and I must advocate for myself. When I do those things, I get the best healthcare available, and I feel the most empowered.
This is my body. This is our baby. This is our choice.
**The featured image is from a maternity photo shoot that Ben and I did, which will be the topic of the next blog post.
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