Why less is (usually) more in childbirth and maternity care
Have you seen any content on TikTok or Instagram that made you feel terrified to give birth in a hospital? You're not alone. But we want to take a deep, collective breath and name the elephant in the room:
Sometimes interventions are a necessary component of a healthy, safe birth, either for the baby or the birthing parent, or for both of them.
Are interventions overused in childbirth?
You bet. And that's largely due to the way hospitals are designed and operated. But if you know your way around that facility before you give birth, you will be much more equipped to understand what that facility—and the people working inside of it—can and can't offer you.
How will I know which interventions to accept or deny?
There are cases when folks just don't know ahead of time which interventions they will actually need or which ones they will decide they want until their birthing day arrives. And that bit of uncertainty is normal. The important thing is to determine whether your care provider's philosophy aligns with your own.
But the main way to become prepared in this regard is to take a birth preparation class like HelloBirth. Using HelloBirth's PICTURE Birth Method, you'll receive our signature scenario-based training in class, which will allow you and your birth time to understand the available options, why they might benefit you, why they might not be right for you, and how to decide with confidence which ones to accept or turn down.
Is natural birth better?
Natural birth, generally defined as birth without medical interventions, does have some benefits in cases of healthy, low-risk pregnancy and birth. The main benefit is optimized hormonal production, which works to support and facilitate the birthing process as well as early newborn bonding and feeding. Another major benefit of an unmedicated birth is the ability for the person giving birth to respond to their own body's urge to push, which tends to happen when the baby is well-positioned and ready. This can help to minimize damage to the birth canal. There are certainly no absolutes with this scenario, but this is one reliable way to "strategize" and reduce the risk of tearing.
What about home birth?
Home birth with a midwife, by default, carries with it a "less is more" approach. Licensed home birth midwives keep watch on your process to ensure it remains healthy and low-risk, and are trained to spot potential problems before they occur. They use tools of the trade such as running blood work and blood pressure checks during pregnancy, and a handheld Doppler to listen to your baby's hear tones during labor. Choosing to give birth at home with a midwife is a way to set the stage for a birth which won't require you to ask for or insist on the kind of support that will help you reach your goals and preferences.
However, it's a super smart idea to have a well-thought-out Plan B in place. This should include a smooth transfer of care protocol and process, as well as a tour of the hospital where you would transfer if necessary, so that you would already know exactly what to expect prior to that decision being made. You would also gain valuable insight into how to navigate that system in a way that's in keeping with your preferences. The preferences might look different than the ones you had in your own home, but they're still yours to maintain.
When might I want to consider medical intervention?
There are quite a few complexities which can arise throughout the course of a pregnancy, labor and birth, and at each stage there will be the question: should I intervene or should I do nothing? Sometimes, doing absolutely nothing is a perfectly reasonable and acceptable choice! And of course no matter what, it is always your body and your choice to make.
Here are a few of the major circumstances that can occur during pregnancy, labor and birth when a person might want to consider accepting an intervention (a medication or a procedure). The list is not exhaustive. And please, as always, consult your midwife or obstetrician if you have any concerns about yourself or your baby during pregnancy, labor and birth.
- Hyperemesis gravidarum (HG). HG is a severe form of pregnancy sickness characterized by extreme, persistent nausea and vomiting that prevents you from keeping food or liquids down, often leading to dehydration and weight loss.
- Gestational diabetes (GD). Although some GD can be controlled or even reversed with some dietary changes, (see Real Food for Diabetes) sometimes the only way to cure GD is to give birth to the baby!
- Cholestasis of pregnancy. A liver condition that slows or stops the normal flow of bile. Occurring mostly in the third trimester, it causes severe, unrelenting itching without a rash, usually on the palms of the hands and soles of the feet. While it resolves after birth, it may require medical management due to risks to the baby.
- Induction for post-dates pregnancy. Post-dates is considered to be 42 weeks of pregnancy. Especially if you are over age 40, have other warning signs such as decreased fetal movement, more than one high blood pressure reading, low fluid detected by ultrasound, and/or suspected large baby, reaching 42 weeks of pregnancy could be a reason to consider getting induced. A combination of these circumstances may also prompt a valid consideration to induce earlier than 42 weeks.
- Your birthing facility doesn't offer any support for unmedicated birth, such as a birthing tub or nitrous oxide, and you haven't taken a comprehensive hypnobirthing class! Although this scenario isn't recommended, it's a common one for people who choose to give birth using an epidural (and a major reason why epidurals are so common)!
- Your birthing process isn't progressing in a healthy manner. Taking a long time doesn't always mean there's a reason to intervene. But if the process is taking a long time and you and/or your baby are showing signs of distress, that's a good reason to consider options for speeding up the process, such as augmenting the labor contractions with Pitocin.
Well that's kind of a long list! Shouldn't I just plan to accept any intervention that's offered to me?
We definitely get why it seems that way! But just keep in mind that most of these conditions are relatively rare, and many times the "less is more" approach is going to allow everything to unfold just as it should. When a minimalist approach is combined with a highly supportive environment, and you're supported by an expert team, including a birthing partner who took classes with you, a doula, and a care provider you trust, there's this rather magical thing that can happen which is that birth works! Now there's absolutely nothing wrong at all with considering and accepting interventions that are offered to address a specific problem that has presented itself. But for HelloBirth students using the PICTURE Birth Method, they'll have the pros and cons right at their fingertips and be able to decide if it's realistic to keep going with the original birth plan, or to make a necessary change.