Why Physiological Birth?
Why Physiological Birth?
Physiological birth and natural birth are used interchangeably in this piece of writing.
You could be forgiven for wondering in the midst of labour, or perhaps whilst watching a loved one labouring, what is so desirable about physiological birth anyway? I find myself driven to protect normal physiology in all aspects of pregnancy, birth and breastfeeding and this is appropriate as this is the job description of a ‘midwife’. As I read and learn over the years I am reminded again and again why physiological birth is so desirable physically, mentally and spiritually for most mothers and babies. I get that this is a political topic. There is no judgement from me as to the chosen mode of birth or feeding; I passionately believe in women making their own choices. I am talking about biology and physiology and what I have observed in the cohort of women I care for, who are oriented towards physiological birth, breastfeeding, and avoiding unnecessary intervention. Natural birth isn’t for everyone; it may not be the safest or indeed most desirable option, but there is physiology to be found even in a medical birth for example skin to skin in theatre during a caesarean.
Many women just want a physiological birth and to breastfeed, for reasons that they might not be able to articulate. I observed in my time in the NHS that the majority of healthy women in their first pregnancy wanted and planned for a natural birth. The 22-23 NHS maternity statistics suggest that only a minority will achieve this however (within the NHS system). There was a 49% total spontaneous vaginal birth (SVB) rate in 22-23 and this figure included inductions (33% of labours were induced). We can reasonably conclude that the SVB rate will be even lower for women having their first baby.
We don’t have to look very hard to find benefits of physiology in birth, and I will now outline some of these benefits. It goes without saying that there is a time and a place for medical intervention in a small minority of births.
Spontaneous start of labour - compared to induction
There is significant brain development in the final weeks of pregnancy and anecdotally I have observed this when comparing the behaviour of a baby born at 37 weeks compared to 41+ weeks. It is thought that the baby initiates labour via a protein released in their lungs, signalling their readiness for birth. At the onset of spontaneous labour, and as labour progresses, the baby’s bodily systems are optimally prepared for life outside the womb. For example lungs are ready to breathe air, and the brain and gut are ready to breastfeed. Maternal physiology undergoes changes in the final weeks of pregnancy too. The cervix becomes soft and stretchy, the uterus becomes more sensitive to oxytocin, and there are myriad brain changes in readiness for nurturing and bonding.
Home birth - compared to hospital
Reduced chance of needing a caesarean or instrumental birth
Reduced need for epidural
Reduced chance of ‘needing’ drugs to increase contractions
Reduced chance of severe perineal tears
Reduced chance of infection
Physiological or mother led pushing - compared to directed
Shorter pushing phase
More optimal blood flow to the baby
Less stress to pelvic floor
Reduced chance of tearing
More dignified
Perineal tearing - compared to episiotomy
Better healing
Less pain
Less nerve damage, specifically to the anatomy of the clitoris.
Optimal cord clamping - 30% of the baby’s blood is in the placenta at birth
Full quota of warm oxygenated blood
Stem cells
Increased iron stores during infancy with implications for brain development
In the case of a baby needing help to start breathing all of this is even more important
Skin to skin
Keeps the baby warm
Regulates blood sugars
Regulates heart rate and breathing
Sharing of microbes with implications for immune health
Releases oxytocin which leads to calmness and contentment for both
Less bleeding for the mother
Optimises breastfeeding
American midwife Rachelle Garcia Seliga describes these bodily functions as nature’s ‘blueprint’, the physiological unfolding of which creates conditions for health. Seliga cautions that to stray from the blueprint, is to create ripples downstream that may lead to ill health.
Sara Wickham writes beautifully on the many advantages of waiting for labour to start naturally (as opposed to induction or planned caesarean). See her website and books for more info. Sarah Buckley has written extensively on the hormonal physiology of birth and breastfeeding. See her website and books for more info. She outlines eloquently how breastfeeding and bonding are optimised by physiological birth. In which, the baby’s instinctive feeding instincts are not inhibited by drugs in the maternal bloodstream, or temporary damage to the baby's scalp or face following instrumental birth. From a practical perspective uninterrupted skin to skin and learning how to breastfeed are harder in the days immediately following surgery, when managing pain can be a challenge and mobility is reduced.
As the vast majority of my clients (100% in 2023) start labour spontaneously I get to observe how the delicate orchestra of physiology unfolds, and the ripple effects to mother and baby and the wider family. I observe in my practice that birth works well, almost always. If you consider birth to be a right of passage, as I do, there is also value in having got through it with minimal intervention; in simply being able to look back and say ‘I did that!’
My tips for physiological birth
A labour ward is not the optimal environment for healthy women planning a physiological birth. Labour wards are led by obstetricians who are experts in disease in pregnancy and complications in birth. Seriously consider birth centres and home birth.
Look after your body and mind in pregnancy with good food, exercise, mindfulness, good rest/sleep and reducing stress.
Learn about birth physiology and how the labour environment influences oxytocin and stress hormones. Hypnobirthing courses are particularly good at this.
Keep well nourished and hydrated in early labour.
If you are planning a hospital birth, wait until you are having strong, regular contractions before going in. Learn about coping mechanisms to use at home.
Epidurals can completely remove sensations and allow for much needed sleep. Know that epidurals come with associated interventions including continuous fetal heart rate monitoring, a catheter in your bladder, the need for drugs if contractions slow (synthetic oxytocin), and increased chance of instrumental birth such as forceps. You will also likely have a longer stay in hospital after birth.
To read/explore
Gentle Birth, Gentle Mothering by Sarah Buckley
In Your Own Time by Sara Wickham
The Positive Birth Company
Kathryn Graves Hypnobirthing