Are you wanting a natural birth in the hospital? You can do this - I believe in you! I’ve witnessed lots of mamas realize their desire for their birth from both my classes and my doula work. If you plan to give birth in the hospital setting, understanding what your healthcare provider and the hospital can do for you and, more importantly, what they CAN'T do for you is essential to increase your chances of having the birth you really want and to feel good about your experience.
Most births in the United States do take place in a hospital – about 99%. Births at home or in a free-standing birth center (meaning it’s not attached to a hospital or in a hospital) represent a much smaller segment of society. It’s important to know that in the hospital setting, natural birth is rare. It’s a big deal on the labor and delivery floor when a mama gives birth without an epidural or pain relief of any kind. No one working on the labor floor believes it’s going to happen, including your OB.
Hospitals that have true midwifery programs witness more births that avoid using pain medication so it’s not so much an anomaly, but they are rare to find and difficult to access (especially here in Los Angeles). Births that are fully natural (a.k.a physiologic birth) without any unnecessary intervention are practically going extinct in this institutional setting. That’s the reality of most hospital births.
That doesn’t mean you should give up hope or your dreams are impossible. No, no, no. As I wrote before I have lots of mamas from my classes and also doula clients who achieve their goal despite the many obstacles. Understanding the terrain and the choices you can make makes a big difference for new parents.
For some context and comparison about the hospital situation, let’s look at the work of Dr. Robert Bradley (author of Husband-Coached Childbirth and founder of the Bradley Method, which I teach). Dr. Bradley practiced solely in the hospital setting. He helped over 20,000 babies be born during his time as an obstetrician; in his practice 95% of the mamas had a natural, un-medicated births; his cesarean birth rate was 3% (compare that to current stats for the U.S. which is 10 - 11 times higher at 32%). Some mamas and babies needed help with either medication or surgery, which is nothing to be ashamed of – we are fortunate to live in modern times where there is the technology to help when it really is needed. Dr. Bradley had excellent outcomes for the women and babies under his care with very, very low rates of complications.
Why was this? These wonderful outcomes did not occur because hospital birth itself is inherently safer; nor did it occur because the hospital Dr. Bradley had privileges at had a reputation for handling all births in a more natural manner (they didn’t). No, the mothers and babies in Dr. Bradley’s practice experienced natural births and interventions only when necessary because of:
MOTIVATION: The women in Dr. Bradley’s practice were personally motivated for natural birth
PERSONAL RESPONSIBILITY: Understanding that this was ultimately their birth and their baby, the accepted that it was up to them to do what needed to be done in pregnancy (like nutrition, exercises and making personal decisions) to ensure the best outcome for their baby and themselves.
PREPARATION: Mama and partner (Coach) prepared intentionally over several months with prenatal/childbirth classes for a good birth experience to welcome their little one and to be prepared for the changes of new parenting
THE RIGHT HEALTH CARE PROVIDER: Dr. Bradley himself was dedicated to supporting women and the family unit with the least intervention possible.
Dr. Bradley had a deep, unwavering belief in the importance of the natural processes during pregnancy, birth and postpartum. To interrupt the chain of events put in place by Mother Nature could have profound and distressing consequences in both the short and long term. He always put the interests of the mother and baby first – not fitting in with his medical peers, appeasing medical malpractice attorneys or making the hospital administration/staff happy.
Such is not the case for the vast majority of obstetricians and hospitals today. OB’s who practice like Dr. Bradley are extremely rare (Hello? Where are you?!). Doctors are not trained in medical school to support natural birth, they are trained to intervene and very few are able to or interested in bucking their belief systems or the institutional constraints placed on them (which Dr. Bradley did). They also have numerous real as well as perceived pressures influencing their practices like maintaining medical malpractice insurance and hospital privileges.
What about hospitals? They advertise themselves to be “the safest place” to give birth. Statistics don’t support this perception. The problem is our system of medical care, which is profoundly influenced by living in a capitalist system and the way we set up our society. Hospitals are institutions and businesses that are compelled to protect their own bottom line -- making money as well as staying in the black and out of the courtroom matters most to them. Natural birth costs them money – there are no extra procedures to do or charge for. My goodness, why on earth would they promote something that would make them work harder and bring in less revenue?
In addition, hospitals maintain within their halls a self-imposed hierarchy, which first and foremost prioritizes the needs of the institution over families and individuals. The traditional healthcare community creates specific rankings of authority among medical professionals. While the hospital marketing department aims to convince you that they provide you with the safest and best care, on site the staff do not automatically place you at the center of your birth. Rules, routines and regulations to protect the provider and hospital come first. As the birthing mother you are perceived in this institutional setting to be near the bottom of the hierarchy with the doctor authoritatively seen as above you.
Does this mean you shouldn’t give birth in a hospital? Not at all. It’s important to be completely honest with yourself about where you feel safest and this may very well be the perfect place for you. You know what you truly need. Hospitals are really great at dealing with emergent situations and they have everything right there – that will likely give you a lot of reassurance. When you feel safe you can move forward in your labor because you know you are in the right place.
To have the best experience and outcome it is important to understand that the hospital setting is simply a very specific environment that runs a certain way. It’s extremely helpful to understand this and to not be naïve about the system. It’s just facts and not a value judgment of your choice. Your choice is a perfectly reasonable one. Understanding there exists systemic issues doesn’t mean letting fear run amuck or dropping into a state of despair. You just need some navigation tools.
There is so much you can do to have a great birth in the hospital. When you understand what you can bring to the table, it definitely makes a difference. If you are leaning more natural (and even if not), here’s what you can do to increase the odds of the birth experience you want:
Choose your health care provider carefully: This is one of the single most important choices that can make or break your birth intentions. Many couples do not spend much time vetting their provider and assume that their doctor knows everything and will honor their process. Simply hiring an OB as your provider lowers your chances of having a natural birth and increases the risk of having a cesarean birth because of how they have been trained, how they practice and a lack of continuity of care. Working with a midwife increases your chances of birthing without medical intervention. Unfortunately, in Los Angeles there are not a lot of true affordable midwifery programs offered in the hospital setting. So it’s rough here and there are not a lot of options. Since you are likely to have to choose an OB, it’s important to ask your doctor questions to make sure they will truly support you. When was the last time one of their patients (I hate that term) had an unmedicated birth, one with no pain relief? What do they recommend to help you achieve your goal of a natural delivery? Advice they should give you: take the most comprehensive, pro-active prenatal classes you can and think of hiring a doula.
Choose your hospital with intention: If you have a choice of hospitals, find out more about each of them. Things you are looking for are if the hospital is Baby-Friendly and hopefully Mother-Friendly. Do they have a midwifery program? How robust is it? For example, Kaiser Panorama City is better known for natural births (more robust midwifery program) than Kaiser Woodland Hills (although I have been to natural births there, it’s not their mainstay). All hospital birth is fractured care with shift changes and people in and out – so none will be perfect, but some are way better than others. Most important is that you feel confident in their care (whichever hospital it is – there usually isn’t one that’s right for every single person) and don’t expect them to be anything more than what they are.
Educate + prepare yourself: When I wrote about asking your provider for suggestions to help you achieve your goal, the importance of prenatal education should have popped out of their mouth right away. Being ignorant leaves you and your baby vulnerable. Education is not about learning that everything has to be perfect. It is the chance to be in a place to be able to make decisions and take actions that can support your family goals and values. It’s about being in a place of personal power. Ignorance is not bliss when it comes to your baby’s birth. Your provider should be encouraging your path to self-knowledge and feeling of agency – you are the parent after all.
A great birth class not only includes important information about pregnancy, labor + birth, postpartum and, hopefully, breastfeeding, but also has active practice components so that you and your partner physically incorporate practices into your preparation weekly. The advantage of taking classes with a real live person is that you have a relationship with your teacher and she is someone you can reach out to when needed. Do not shortchange yourself in your preparation – Google searches, Instagram posts and YouTube videos are not really helpful – they might be fun (and sometimes alarming) and you may get some info, but it’s not preparation – it’s on the surface, not deep which is what you need. I don’t like pre-recorded self-paced video programs, either – less than 10% of people finish those. You deserve better.
Prepare your partner: Yes, it is in your best interest to encourage your partner to be educated and prepared if they haven’t already expressed and shown an interest in this (which I really hope they have!). It’s best done through a thorough childbirth education series because, from my experience, most male partners are not going to read books or do any other work than paint the nursery and put the infant car seat in the car if it’s not spelled out to them. Clueless partners (whatever their gender) leave you and baby vulnerable and if they aren’t made specifically aware of their role (because society will not do it for them), YOU are the one left to deal with it all. Lots of couples have shared with me that they were surprised by how taking my Bradley Method classes helped them create a close relationship with their partner as they moved into the parenthood journey; each week provided a chance to have many deep conversations about what was important to them.
This is so important. As someone who has been with my life partner for 36 years, it is vitally important for your relationship to work together and be in communication – you are setting the foundation of your family. Because I teach a 12-week series of classes that deeply prepares partners/fathers, I know there are wonderful, caring partners willing to put in the work – they are the best! It gives them time to integrate a strong sense of their role in the birth room. Without preparation, some partners will be vulnerable to transferring their own personal power and authority to medical care providers thinking that the medical team will take care of it all for them (which usually doesn’t end up happening the way they expected). Partner support and advocacy is essential for a positive experience.
Make sure you have continuous labor support: Some couples choose for this to be solely their partner (this is possible with a Bradley Method series, but I don't recommend to have only your partner if you are taking any other birth prep series). Some couples choose to hire a doula or labor support professional which can be very helpful for a lot of couples navigating the birth space. Labor and birth are different. It can be really hard for many partners to witness hours and hours and hours of labor and you going into a trance state dreamily saying repetitive mantras to yourself alternating with outbursts of how hard and painful it is. Having someone who isn’t freaked out by your process, understands it and encourages your labor state is priceless. The hospital is not going to do that and they are not even with you in the room most of the time; you can have half a dozen different nurses in and out of the room each one asking similar questions to the last one (it’s a bit crazy making). Sometimes the stuff that comes out of a nurse’s or doctor’s mouth is so the opposite of what needs to be said or done for a laboring mama’s confidence and flow, it’s hard not to stare at them in disbelief and ask, “Are you for real?” I know as soon as they leave (and many times before) I’ve got to do recon and re-frame everything. A doula's job is not that of a medical care provider. She helps to hold the emotional and mental space along with your partner as well as helping with many practical support tools throughout the process. This can make a huge difference in your experience and your partner’s experience.
These are some important basics to consider if you are planning to birth in the hospital and yet also wanting your birth to be more natural. You can have a great birth experience when you understand that there are things you personally need to take care of and arrange ahead of time to ensure that you are well supported during this major transition. Pregnancy is an important time of preparation – take full advantage of this time by putting in place what you need for your best birth.
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