Natural birth in the hospital….how realistic is it?

This is one of the most common questions I get. Your goal is to have a natural birth, awesome! But is this realistic to do in a medical setting? Well, that depends! If you have certain medical conditions or are having severe pregnancy complications, a 100% natural birth may not be possible and you may have to mentally prepare yourself for birth interventions and medical pain relief. However, if you’re having an uncomplicated pregnancy and are in good health, chances are better, though not without roadblocks.

Most women who attempt natural birth in a hospital setting struggle to achieve their birth goals because the hospital setting is built specifically for medical interventions. If you’re having an uncomplicated pregnancy, an alternative birth setting such as a birth center or home birth will significantly increase the chance of having an all natural birth. If you want a natural birth but aren’t comfortable with a birth center or a home birth, that’s ok! But, be prepared to fight for it!

Here I’ve compiled a list of ways to increase the chances of having a natural birth in the hospital.

Side note: Natural birth is not for everyone. If you know you want pain relief, awesome! You know yourself and your limits. I am here to support that, too! This article is specifically meant to help women seeking a natural birth in a hospital setting.

• Hire a doula. Yep, someone like me! It doesn’t have to BE me, but hire someone you can trust to help educate you, answer your questions, assist in managing your pain naturally, and advocate for you. It is never too early or too late in your pregnancy to hire a doula.
• Find a provider who is supportive of natural birth. Some hospital systems have groups of midwives that have hospital privileges. While midwives that work in hospitals tend to be much more medical than those who work out of hospital, they do tend to be more naturally minded than your typical OB. You may however find a great OB who is super supportive! Interview providers and get a feel for things. If you have red flags, run to the next one and try again. Many women find their concerns with their medical providers grow over time and come to a head right before birth, but then feel it’s too late to switch. It is never too late to switch providers.
• Ask Questions. Ask what your providers personal induction rate is. Ask about their C-section rate. Ask if they’re okay with you naturally going to 42 weeks before starting an induction. Ask if they’re doula friendly. If they get defensive or upset, chances are it’s because they don’t want to give you the real answer. Some are simply more respectful of personal choice.
• Avoid Inductions. Induction is the number one battle we fight today, and most of them are elective. This means they’re often done with no real medical reason (or a weak one). Many women are routinely asked to induce labor at 38 or 39 weeks gestation, usually at the convenience of the hospital. First time moms average a natural gestation of 40 weeks and 5 days. If your provider is asking you to induce, ask for a BPP (Bio-Physical profile). This looks at the baby and the placenta to see if induction is really needed, or if you can wait a few days, or even a few weeks. Inductions are long and exhausting, so most women who get them end up needing an epidural just so they can sleep. It’s not that they can’t handle the pain, it’s the exhaustion after 24-48 hours of slow progress because your body was forced before it was really ready.
• Avoid Pitocin. Pitocin is given via IV during almost all inductions and many spontaneous labors. It is the artificial form of oxytocin, which is naturally made for your body. Pitocin is routinely given to most women in the hospital in order to speed up contractions and make labor progress faster. Again, this is excellent for the hospitals bottom line but not always the best for mom and baby. Some babies don’t tolerate Pitocin well and will go into distress, increasing the chance of c-section. Mom’s report much more pain with pitocin contractions, as well as less time to recover between them. This means, you’ll likely be begging for that epidural just to get a break!
• Get used to saying NO. More often than not, you will be offered induction, interventions and pain relief again and again. It is not uncommon to be in the delivery room and be pressured consistently until you give in. Get used to saying no, being firm, and setting clear boundaries. It’s okay to say things like “I do not want to induce until 42 weeks. Please do not ask me to schedule an induction prior to that unless there is a very clear medical indication for induction.” or “I am aware of my pain relief options including epidural and have chosen not to receive these. Please to not ask me if I would like them. I will ask if I change my mind.”
• Avoid vaginal exams before labor. Vaginal exams before labor are generally done out of curiosity, and are almost always unnecessary. It is common for other procedures like membrane stripping or breaking your water bag to be done during these exams. THESE ARE OFTEN DONE WITHOUT CONSENT. Unfortunately, some providers will do this without asking permission. Additionally, cervical checks can cause bleeding and irritation, and sometimes cramps that will confuse you and make you think you’re going into labor. It also increases your chance for infection.

Use your B.R.A.I.N when making decisions.
B: Benefits. What are the benefits?
R: Risks. What are the risks? No intervention or medication comes without risks.
A: Alternative options. Do you have other choices?
I: Intuition. What is your gut instinct telling you?
N: Nothing. What happens if you do nothing and wait 1 hour to decide? 1 day? 1 week?

• Show up late. The women who I’ve seen be successful in having a 100% natural hospital birth almost all have one thing in common: they showed up at the hospital well into active labor. Showing up in early labor, or just baaaarely dilated enough for them to admit you, is a recipe for a long hospital stay with more interventions. Being in a hospital of stressful for most women, which means they’re more outwardly focused, vs focused on what is happening internally. Their ability to naturally cope with pain is greatly reduced. They’re hooked up to monitors that beep and need to be adjusted constantly, which makes it hard to relax. They they get trapped in a Fear-Tension-Pain cycle. Labor at home as long as you can without risking a birth on the road. Your doula should be able to labor at home with you and help you determine when it’s time to go to the hospital.
• Have a birth plan and discuss it beforehand. If your provider is arguing with you about your birth plan and telling you they don’t support it, it’s time to change providers and find one that does. Set up expectations before the big day, so there are no surprises when your doctor tells you that what you want isn’t going to happen. Your provider will also be able to tell you what is realistic and what is not, based on your health concerns. Make sure to go over it with your doula as well!
• Have plenty of copies of your birth plan. Give them to every staff member that enters the room. Many nurses really like the simple, visual birth plans that have become so popular. It saves them time and is easy to read quickly and clearly determine what your wishes are. There is an excellent free birth plan template here.

• Find tools for coping with pain naturally. Work with your doula, listen to podcasts, read all the books you can with positive natural birth stories, and take natural birth classes. Knowledge is power. There are a ton of excellent tools available to help women in labor. Some of the most common ones I use with laboring women are: repositioning, rebozo wraps, essential oils, labor combs, massage, birth affirmations, prayer, water (tub or shower), and mood setting things like music and low lighting.
• Trust your body. Your body was quite literally made for this. It knows exactly what to do and when to do it. Embrace the power of birth and let your instincts take over. When you and your baby are healthy and your pregnancy is uncomplicated, you really don’t need any medical interference. Giving birth naturally has a big mental component, so stay positive. You’ve got this!