Normal Birth

Birth has been described as the most significant event in a woman’s life, whether for positive or negative reasons.²⁸ The nature of a woman’s labour and birth can affect her profoundly. But "normal birth" is now the exception, and women's experiences are increasingly medicalised. So what is a normal birth, why is it beneficial to women and their babies, and how can it be achieved?

What does Normal Birth mean?

The World Health Organisation²⁹ has stated that normal birth is:

"Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously [without help] in the vertex position [head down] between 37 and 42 completed weeks of pregnancy. After birth mother and baby are in good condition."

The Association of Improvements in Maternity Services (AIMS) has extended this definition to exclude any births where labour has been altered by technological intervention. Thus their definition of normal birth does not include one where labour has been induced or accelerated by drugs, or has involved amniotomy, epidural anaesthesia or episiotomy.³⁰ This definition may also be equated with natural birth - birth without interference. It may also be called physiological birth or straightforward vaginal birth.

There has been much discussion over what "normal birth" means to both midwives and mothers.^7,75,76 As the term "normal birth" has been defined in the literature we will use this phrase according to the AIMS definition to represent birth with no medical intervention. There is no intended judgment about the birth experience of women in the use of this phrase.

The Benefits of Normal Birth

Post-Natal Pain and Physical Recovery

Women who have had a normal birth tend to have less post-natal pain and recover more quickly than those who have had had interventions such as a forceps delivery or an episiotomy.

Following a normal birth, women often feel bruised and sore for up to a week as a result of the stretching of the birth canal. If a perineal tear has been repaired this discomfort may continue for longer.³¹ Following an episiotomy, a significant number of woman are still experiencing perineal pain several weeks after delivery.³² Instrumental delivery can cause significant trauma to the birth canal, together with perineal pain.³³ Recovery from this sort of birth injury can take much longer, as can recovery from a Caesarean operation.

The length of time it takes to recover physically has implications for other areas of post-natal life.

Self-Esteem

When labour and birth are positive experiences, a woman is likely to feel an overwhelming sense of achievement and emotional wellbeing.²⁸ A woman who has met the physical challenge of childbirth may feel exhilarated by it.

This increase in self-esteem can affect other areas of post-natal life.

Bonding and Breastfeeding

How a woman gives birth is said to influence her confidence and ability to mother.³⁴ A normal birth can boost self-esteem and give a woman confidence in her natural abilities. This in turn may make her feel she can trust her instincts about mothering and, like the birth, she will succeed.

There is evidence that the hormones involved in normal labour and birth (such as oxytocin and endorphins) play a key role by helping to initiate bonding with the baby.^35,73 As the first hours following birth are so important in establishing the mother-baby relationship, having a normal birth can increase the likelihood of a successful breastfeeding experience. As well as having the physiological advantage of the natural hormones, a woman having a normal birth also has a psychological advantage for establishing a good relationship with her baby. The confidence a woman feels about her mothering ability may influence whether she perseveres with breastfeeding if she encounters problems, as may her physical recovery. A woman who feels she has met the challenge of childbirth may feel that she can also meet the challenge of breastfeeding. In addition, a baby who has not been subject to various medical interventions is more likely to be settled and calm.⁷⁴

Post-Natal Depression (PND)

There have been conflicting reports as to whether interventions during birth can cause PND. It is possible that disturbances to hormonal processes caused by interventions may predispose women to PND. It is also possible that the psychological effects of a traumatic delivery, together with coping with the demands of a distressed baby may also act as a trigger.³⁶ However there may be many other factors involved, such as genetics, culture or social issues.³⁷

Making a Normal Birth more likely

There are many factors which affect whether a woman has a normal birth. Research has shown that the following increase the likelihood of a normal birth, by reducing the likelihood of interventions:

• in the later part of pregnancy, using upright, forward positions (where the hips are higher than the knees, and the shoulders are more forward than the hips) to help the baby get into a good position for labour⁶⁶
• Having continuity of care throughout pregnancy and birth from a named midwife or a small team of midwives⁸
• Having the continuous support of a female caregiver during labour⁹
• Remaining upright and mobile during labour²⁶

For women without complications, the following can also increase the likelihood of a natural birth

• Giving birth at home⁶ or in a home-like setting such as midwifery-led community unit²⁷
• Having the baby's heart rate monitored intermittently rather than continuously³⁸

For more information on how to help yourself have a straightforward birth, see our article written by midwife Jilly Rosser

Click to carry on thinking about your hopes for the birth.