Childbirth is a natural occurrence in the lives of women. And labor is unpredictable.
Natural birth are births that are not planned, works according to its own timetable and progresses naturally. Natural birth has none to minimal use of medical (obstetrical) and surgical procedures and interventions such as anesthesia, the use of forceps, vacuum extractions, inductions, epidurals, episiotomies and/or caesarean section (C-section).
Natural births can take place either with an obstetrician-assisted hospital birth or a birth at home with the help of a midwife or a completely unassisted birth.
Labor alone can be an incredibly powerful and overwhelming experience for any woman giving birth as it can create a feeling of having lost control of the situation. It gets worse and frightening when an unexpected situation adds up wherein the baby is in danger and an emergency surgery or some other kind of medical intervention becomes inevitable.
Women who are healthy are often made to take tests, have drugs, or opt for surgery and/or other interventions that can be easily avoided even after the mom-to-be or the baby doesn’t show the need for it. These interventions are disruptive, uncomfortable and puts a woman in utter distress while giving birth, making it to be a traumatic or difficult birth.
Here are 12 ways natural birth can be hard to come back from:
12 Needing General And Spinal Anesthesia
Women are all different and each woman’s labor experiences are different. Some women need no anesthesia while some are not able to tolerate pain and anxiety when labor is long and contractions are strong. Many of us may plan for a natural childbirth but the unexpected might happen making anesthesia a desirable and necessary option.
If an emergency caesarean delivery as an intervention is inevitable because something goes awry during labor and the baby is showing signs of distress, general anesthesia is considered the fastest method to deliver the baby. In general anesthesia, medication is given through the vein to make the woman lose consciousness so that the baby is delivered safely without any pain. Sometimes they are gases which are inhaled to put the woman to sleep.
Spinal anesthesia is generally used when there arises a need for forceps delivery or caesarean section or during labor. A needle is inserted well below the spinal cord and when it enters the spinal fluid, the medication is placed which will numb the woman in labor from below her ribs, hips to her legs. Pain from labor contraction disappears and the numbness lasts for 1 to 2 hours until it wears off completely.
General anesthetics are used less often now as they have serious side-effects, like a mother’s breathing may slow down or stop; heart rate may change and blood pressure may drop; may stop contractions of the uterus and cause excessive bleeding after birth; and the chances of babies getting affected is also there: may have breathing difficulties, difficulty in latching on to suck and have poor muscle tone.
11 Epidural Becomes Necessary
Epidural anesthesia, a regional anesthesia given through a tiny tube – catheter which is placed just outside the spinal canal, is a popular method of pain relief during labor that when administered, blocks pain to that particular part of the body. An epidural can be given for labor, vaginal delivery or for C-section. Epidurals block the nerve impulses from the lower spinal segments resulting in decreased sensation in the lower half of the body. More than 50% of women giving birth at hospitals prefer epidural anesthesia over general anesthesia.
Though popular, this method can be traumatizing for the woman giving birth to her child as it may cause her blood pressure to suddenly drop; the woman, in particular, may experience a severe headache due to the leaking of the spinal fluid; it can cause labor to slow down or stop; epidurals can make it difficult for the woman to push resulting in her having to opt for additional medications or interventions like forceps, vacuum or finally a Cesarean and/or the woman might experience backache, soreness, shivering, nausea or find difficulty in urinating.
In rare cases, the woman might experience permanent nerve damage in the area where the catheter was inserted. It is also debated that a baby might experience respiratory depression, or an increase in fetal heart fickleness thereby increasing the need to opt for forceps, vacuum, episiotomies and/or cesarean delivery. Studies suggest that few babies may find trouble in ‘latching on’ leading to difficulty in breastfeeding.
10 Induction By Drugs
Induction of labor has been on the rise as it is convenient and can accommodate busy schedules of working to-be-parents. This method is not a natural birthing process because medical interventions are used. Labor needs induction when complications like preeclampsia, gestational diabetes or hypertension is found in a to-be-mom or when the amniotic sac has ruptured; or when the pregnancy gets prolonged beyond 42 weeks or when the mom develops an infection in her uterus and/or when the baby seems to be in danger due to a decrease in the supply of nutrients from the placenta.
Medications in the form of suppositories are inserted into the vagina so that a mom-to-be can go into labor the next day or low doses of medications in the form of the hormone ‘oxytocin’ are administered through an IV to stimulate contractions.
Other methods are: use of prostaglandins, Foley catheter or cervical ripening balloon, sweeping the membranes/manually separating the amniotic sac from the lower part of the uterus, and/or by amniotomy where a small hooked instrument is inserted through the cervix to break the amniotic sac.
Inducing labor is generally safe but few risks are there which vary according to an individual’s situation and the methods used. Inducing oxytocin or prostaglandins can cause contractions to be difficult to manage without any pain relief and labor can progress too quickly; making it a traumatizing experience for the mom-to-be and the baby under stress. In rare cases, may cause placental abruption or even uterine rupture.
9 Assisted Delivery
Assisted vaginal delivery is when the obstetrician must make use of either forceps (a pair of spoon-shaped surgical tongs) or vacuum device to help pull the baby out of the birth canal. Such delivery is generally recommended by the obstetrician when the mom-to-be is struggling to push the baby out for a long time and is worn out by doing so. Also, if the baby’s heart rate becomes non-reassuring when the baby is almost out of the canal.
Generally, an episiotomy (a small cut between the vagina and anus) is needed to make room for the forceps to be inserted.
The obstetrician may also use a flexible, rounded cup to the head of the baby in the birth canal. This cup is either connected to an electric suction pump or a small handheld pump that creates vacuum pressure to hold the cup securely on to the head of the baby. While the mom-to-be pushes hard, the doctor gently pulls the handle attached to the cup thereby pulling the baby out of the birth canal.
Use of forceps or vacuum can cause a bruise on top of the baby’s head and could take few weeks for the bruise to heal. Chances of facial nerve injury in the baby through these instruments is possible though rare. But, these assisted deliveries are riskier for the mom-to-be as they can tear the cervix, vagina, perineum and the anal sphincter.
8 Forced Caesarean Surgery
Every 30 seconds a caesarean is performed in the US. C-section is the most common surgery in the US and make up to 30% of all births taking place in the US. This operation is conducted to deliver the baby to be born through a cut in the abdomen so that the baby is not born through the birth canal. Caesareans are generally planned but when an unexpected problem arises during labor and the baby-to-be born is in distress and needs to be delivered immediately, emergency C-section needs to be conducted.
Caesareans can lead to long-term side effects such as chronic shock, bonding deficiencies and invasion-control complexes. The recovery period is generally longer in caesarean birth than after a vaginal birth and the new mom could feel sore around the wound for several weeks; in unplanned caesarean birth, some women may experience mixed emotions as the birthing doesn’t take place as they expected it to happen.
7 Tear From Here To There
An episiotomy is an incision made in the perineum (the tissue between the vagina and the anus) during childbirth. This routine is now no more recommended though can be used in some rare cases such as when the baby is large or is in an abnormal position.
Initially, it was believed that an episiotomy would help prevent more extensive vaginal tears during childbirth; heal faster than a natural tear and would help preserve the muscular and connective tissue support of the pelvic floor. However, research now suggests that episiotomy doesn’t prevent any such problems at all.
Women who have undergone episiotomy may tend to lose enough blood at the time of delivery and it’s even more traumatizing after the procedure because the recovery makes the new mom uncomfortable and painful as the incision could be more extensive than a natural tear; could create an infection; could cause urinary and/or fecal incontinence after childbirth and pain during sex after childbirth.
6 Pain In The Perineum
An immense amount of pressure on the perineum is put during vaginal delivery as it gets stretched to accommodate the baby’s head. The perineum may just have bruises or a tear and/or a cut (‘episiotomy’) by the doctor/obstetrician to widen the vaginal opening to accommodate the baby’s head. If the tear is deep and/or if episiotomy is performed, then it needs stitches as they can help with the healing process.
Even if the birth takes place without any natural tear or episiotomy, the perineum area may still be swollen and/or tender due to the pressure.
The deeper and the longer the cut, the longer is the recovery time. A lot of discomfort could be felt for few weeks. But if the cut/episiotomy gets extended to the rectum, the pain could prolong for over a month. New moms who get pain in the perineum area could have trouble urinating and passing bowel movements. Chances of having incontinence of urine, gas and feces is more and could continue having for over months or even years.
5 Psychological Distress
Medical studies have evaluated that obstetric interventions especially during the first childbirth has traumatizing experiences in many first-time moms creating psychological effects making them vulnerable to grief, post-traumatic distress, depression and shock.
Women who had either forceps-assisted vaginal births or an unplanned caesarean seem to have poor health and psychological impact on their wellbeing post childbirth. A lack of control, anxiety, prolonged period of labor or uncertainty during labor and after childbirth explain the psychological impacts reported by these women.
Even babies who had traumatic births are likely to be psychologically affected. Study have found such babies to be anxious and aggressive. They may grow up with lack of confidence and self-esteem.
The mom and baby being in distress during labor, the post-trauma stress dealt by the mom affects the early bonding between the mom and her child. Also, the new mom can feel that she is completely isolated with no socialization and can thereby become angry, depressed and start feeling lonely. These symptoms may make it even more difficult for the moms to bond with their babies.
4 Emotional Mess
Pregnancy brings in a huge transition in the life of a woman wherein the nine months is spent by the to-be-mom involving a complex mix of many moods and emotions that are either of excitement and joy of nurturing a baby or of being worried, terrified and impatient about the approaching due date and motherhood.
Changing hormones like estrogen and progesterone too play a major role in a pregnant woman making her more sensitive to the ongoing changes thereby making them vulnerable to irritability.
Some of the emotional impacts are: mood swings due to hormonal changes; fear of having a miscarriage, the well-being of her growing baby and whether she would be a good mother and take good care of her newborn; along with such fears comes anxious thoughts and forgetfulness due to hormonal fluctuations; some women are weepy most of the times due to fluctuating hormones and too much of crying can lead them to depression; some women wonder at the rapid bodily changes they see in themselves during pregnancy and develop concerns over their appearance resulting in their lack of self-esteem and confidence; and lastly a sense of loss if the birthing didn’t take place as expected, for not being able to experience and participate in the birth of her baby and for not being conscious when the baby is born can impact women emotionally.
3 Can Suffer From PTSD
Women who experience severe distress, helplessness or lack of control during childbirth tend to develop Post Traumatic Stress Disorder (PTSD), a condition wherein the new mom has symptoms of anxiety, flashbacks and nightmare. An actual experience where the life of the mom-to-be is threatened or where she witnesses a threat to the life of her newborn gives immense stress to the new mom leading to PTSD. New moms are bothered by intrusive thoughts and memories that could interfere with their daily life.
Studies say that some such women miss their routine medical care to avoid reexperiencing the traumatizing childbirth and seem to also fear trying to conceive the second time and so avoid sex.
In few cases, it is noticed that women suffering from PTSD, experience profound concern over the health of their babies with a constant fear that they could die.
Breastfeeding too gets adversely impacted due to PTSD caused by a traumatic birth experience.
Other symptoms of PTSD include weepiness, irritability, panic attacks, feelings of detachment from loved ones, bad dreams, frightening thoughts and insomnia. In extreme cases, the feeling of something going to go wrong can manifest itself into suicidal thoughts.
2 Prenatal Maternal Stress
Maternal stress during pregnancy is also a huge risk factor that may have significant consequences for the developing fetus and may result in lasting effects on the newborn’s health, the development and function of the newborn’s immune system; and the cognitive (ability to think) development of the newborn.
Some real-life events, such as death in the family, unemployment, ongoing marital discord is a type of stress that can have drastic consequences on the mother and her fetus.
When the mom-to-be gets exposed to such stressful consequences, apart from influencing the cognitive, behavioral and physical development of her baby, it may also risk the baby with other mental health disorders, such as autism, schizophrenia and depression. Babies exposed to such stress may show difficulties with paying attention and can be aggressive.
1 Bowel Or Urinary Mishaps
Labor and delivery (vaginal or C-section) affects the muscles and nerves in the pelvis. As soon as the baby’s head starts moving down towards the pelvis, pressure is exerted against the wall of the pelvis and more greater pressure against the muscles and nerves. Soon after, the cervix dilates, and labor begins. The mom-to-be waits for the contraction to start, and when she feels it, holds her breath and pushes down as hard as possible so that the baby is pushed out of the birth canal. This hard pushing presses the baby’s head against the muscles and nerves of the mom’s pelvis to such an extent that the normal flow of blood is cut off temporarily until that push is paused. This deprives oxygen and nutrients to the tissues, making it more susceptible to injury.
Pudendal and the pelvic nerves, are the two nerves that lie on each side of the birth canal within the muscles of the pelvis that get crushed with the push of the baby’s head. Now, these nerves are supposed to carry the signals from the brain to the muscles that hold the bladder and rectum in place. If these nerves get injured during the pressure of a prolonged labor, the signals which are meant for the muscles around the bladder, vagina and rectum do not get transmitted properly. These muscles then become weak and loose. Over time and with age, the normal supporting tissues of the bladder, rectum and uterus too weaken resulting in what is called as incontinence of urine or stool, or prolapse.
So, whether its vaginal delivery, forceps delivery, episiotomy and/or C-section, the nerves, tissues and muscles of the pelvis and the bladder invariably gets damaged/injured.
No two women can experience childbirth in quite the same way, so regardless of how a woman decides to give birth, ‘a woman should have all the possible information she can regarding her childbirth options, so that she can voice her concern during the childbirth process, advocate for what she wants and make the most informed choice’ with the much-needed help from her partner and a best, qualified and compassionate doctor.
Sources: Parents.com, MidwiferyToday.com