@cstarkwe: No, unfortunately. I wish it were a joke, but obstetrical training focuses on pathology and complication and not on normal physiology. Additionally, the routines and policies that are standard for most hospital births in the US may be “normal” in the sense that they are numerically commonplace, but they are not normal in any real, physiologic sense of supporting optimal birth. OB/GYNs practice exclusively in hospitals and so virtually every birth they see (except for women who arrive already in advanced labor) is either surgical or, for the vaginal births, affected by these unnatural conditions. A few examples:
– nearly all women who give birth in a hospital do so in a recumbent position, either flat on their backs or semi-sitting. This might be because of hospital policy, and/or it might be because they are hooked up to IVs and monitors that de facto immobilize them in bed. In a normal birth, women instinctively move around and change positions to make themselves more comfortable, and in doing so they advance their labors and assist their babies’ passage down the birth canal. A reclining position narrows the birth canal, risks compressing the mother’s blood vessels and the baby’s umbilical cord, and forces the mother to work against gravity and push her baby upwards out of her vagina. When not confined to bed, many women naturally assume other positions for labor and birth that do a better job of opening up the birth canal and taking advantage of gravity: squatting, kneeling, sitting, standing with support, all fours.
– Most hospitals time labor against the Friedman curve, which prescribes an average length of time for each stage of labor. They typically use Pitocin to artificially accelerate labors that don’t adhere to the Friedman curve, and women know that they are up against a deadline: if they don’t give birth within the time frame, they are facing a C-section. This produces stress that works against the natural progress of labor. Interventions such as epidurals also slow labor. Furthermore, there is evidence that the Friedman curve is artificially short, especially for first-time moms. Besides which, it’s an average, which means that, by definition, half of all births will run longer. In any case, OB/GYNs are trained to push birth to conform to the hospital’s timeline, rather than nature’s. They also only spend a relatively brief amount of time with any given laboring woman – hardly any OB/GYNs simply sit with a woman in labor and witness the full natural process unfold, neither during their careers nor during their training. Incidentally, like the Friedman curve, due dates also represent an average length of gestation, the peak of a bell curve that extends for nearly two weeks on either side. According to the law of averages, about half of all pregnancies are supposed to go some length of time past their official due date (again, it is especially common for first-time moms to be on the long side). But most OB/GYNs are trained to induce before natural labor can start in pregnancies that go past the EDD. Induction and augmentation are, by definition, unnatural conditions for labor.
– Labor progresses best and most normally when women feel safe and secure, and are attended by people they know and trust, in familiar, peaceful surroundings, ideally quiet and with dim lighting. Many hospital birth settings are the antithesis of this: frequent intrusions, beeping equipment, the woman might be attended by the on-call physician rather than her own doctor, she will be attended by nurses she probably doesn’t know and doesn’t get to choose, and they may change shifts in the middle of her labor, there might be residents and medical students involved in her birth, and she has no control over it. All of this conspires to make labor slower and more difficult, which in turn increases the likelihood that she may end up with a C-section. This is known as the “harsh environment theory,” and Rebecca Dekker mentions it on her Evidence Based Birth posting that talks about why doulas are so effective at helping lower rates of intervention.
– Most births that OB/GYNs see involve at least one of the following: IV drips, Pitocin (synthetic oxytocin), narcotics, epidural anesthesia, continuous electronic fetal monitoring. None of these are part of normal birth, and all of them have been shown to increase morbidity. Obviously there are cases where their use is necessary and justified, and women who want anesthesia during childbirth should have access to it, but their use should not be dictated by policy or routine, but rather by medical necessity. Pitocin interferes with the interplay of maternal and fetal hormones that controls natural labor. Maternal oxytocin originates in the mother’s brain and causes contractions as well as emotional bonding. It also self-regulates, keeping the contractions far enough apart to protect fetal circulation and allow the mother a breather in between. Pitocin cannot cross the blood-brain barrier, so it cannot promote emotional bonding. It can only accelerate contractions, which it does much more intensely than the mother’s own oxytocin. This, in turn, can suppress fetal heartbeat and circulation and cause hypoxia. Pitocin also disturbs the mother’s endogenous oxytocin, which in turn can dampen bonding and delay milk production, complicating breastfeeding. IV drips can cause edema when mothers receive too much fluid. This can also artificially increase the newborn’s weight at birth and then later cause it to (appear to) lose too much of its birth weight too quickly afterward, as it sheds the extra fluid. Anesthesia is passed from the mother’s bloodstream to the infant’s and can make him/her sluggish, lowering Apgar scores and interfering with breastfeeding. Continuous fetal monitoring, in addition to immobilizing the mother during labor, has been shown to significantly increase the risk of C-sections and other morbidity without conferring benefits, as Rebecca Dekker’s Evidence Based Birth posts demonstrate.
– Most hospitals have policies of forbidding women in labor from eating and drinking, which runs contrary to nature. Labor is physically challenging, and a woman deprived of calories and fluids will become exhausted and may be unable to successfully complete the birth on her own. OB/GYNs don’t generally see women who have had the option of eating and drinking of their own free will, they usually attend women who have been fasting for hours, and they assume that such artificially depleted reserves of energy are “normal.”
Some of this evidence is outlined in the Millbank Report on Evidence-Based Maternity Care (2008). See in particular the sections beginning on p. 62 and p. 64. The Milbank Memorial Fund is an independent health policy research foundation.
If you’re interested in learning more, here are a few of the books I’ve been reading over the past few months:
Birth Matters (Ina May Gaskin, 2011)
Ina May’s Guide to Childbirth (Ina May Gaskin, 2003)
Safer Childbirth? A Critical History of Maternity Care (Marjorie Tew, 1995)
Pushed: The Painful Truth about Childbirth and Modern Maternity Care (Jennifer Block, 2007)
Obstetric Myths vs. Research Realities (Henci Goer, 1995)
The Thinking Woman’s Guide to a Better Birth (Henci Goer and Rhonda Wheeler, 1999)
Optimal Care in Childbirth: The Case for a Physiologic Approach (Henci Goer and Amy Romano, 2012)
Birth as an American Rite of Passage (Robbie Davis-Floyd, 2004)
Birth Models that Work (Robbie Davis-Floyd et al., 2009)
There is also a lot of excellent research-based information on the Evidence Based Birth site I referenced above, as well as at ChildbirthConnection.org