Birth Options Series – Normal Vaginal Delivery In The Hospital

Welcome and thank you for listening!

Inge Burger is a new mom with a 5 month baby girl, Lika – she lives in Jeffreys Bay with her husband Tabu. Inge is a stay at home mom at the moment. After trying to fall pregnant for quite some time Inge had a natural (vaginal) birth in August 2021 at St George’s hospital in PE – she had a very good experience.

Not all vaginal births are equal

Many midwives and mothers use the terms ‘normal’ and ‘natural’ birth interchangeably – how wrong they are!

Common definitions of the word ‘normal’ include ‘according to an established norm, rule or principle’ and ‘conforming to a type, standard or regular form’. Natural, on the other hand, is defined as ‘faithfully representing nature or life’ and ‘not produced or changed artificially’.

Abnormally normal
In terms of birth, the two words each encompass typical features. A normal birth follows the medical model initiated by Western medicine. This was streamlined with the rise of obstetrics as a separate specialisation, and birth taking place in a hospital rather than a dedicated birth facility or at home.

It is not unheard of for protocols and procedures to be implemented routinely in ‘normal’ birth, despite research advising against them. Continuous electronic fetal monitoring (EFM) is common, often leading to wrongly diagnosing poor progress or fetal distress, with unwarranted medical interventions to follow. Hospital protocol and medical doctors’ orders triumph over maternal preferences. From a natural perspective, normal is risky business!

Shift and midwife changes may occur during a normal birth, exposing a woman to the disruption of more than one midwife caregiver. There may well be a restriction on birth partners allowed at her bedside.

Other questionable characteristics of a ‘normal’ birth include:

  • Very little walking around or mobilisation by labouring women
  • Women seldom given oral sustenance, but may have unnecessary intravenous fluids
  • Routine, too frequent vaginal examinations
  • Semi- and supine position, with impaired coccyx mobility and lack of gravitational support
  • Induction and/or augmentation of labour
  • Medical pain relief
  • Instrument delivery
  • Episiotomy

The original normal

The confusion in terminology probably arose from the clinical approach to birth – Western medicine’s focus on structure and function, and preventing pathology. And so, natural birth midwives and mothers have had to take a stand to ensure that birth as a woman-centred, life and family experience, can still take centre stage. So arose the concept of natural birth.

Natural labour and birth ­– more often safer than a normal birth – take place either in an active birth unit or at home, and the couple’s preferences are taken into account, when safe for mother and baby. The emphasis is on offering advice and information to enable personal choice, rather than directing proceedings. EFM is only done intermittently and many other routine hospital procedures are omitted, or done only as required. Induction, episiotomy, and intravenous fluids are, for instance, unusual.

Mothers are actively encouraged to eat and drink, and movement and upright positions in labour and birth are supported. Medical pain relief is seldom used, with natural pain relief methods being offered. Most importantly, the atmosphere is serene and calming, to alleviate anxiety. As in a hospital labour, careful observation is done and referral is made if major interventions become necessary.

Natural should be the gold standard

‘Natural’ has also been defined as ‘established by moral certainty or conviction’. Despite protocols and staff shortages, midwives and obstetric nurses in both private and state birthing facilities have amazing power to improve the experience and outcomes of low-risk labours.

Many labours that turn into high-tech situations could be averted by low-tech midwifery skills, which are grounded in solid evidence. These skills improve the experience for women and their midwives!

Women need to feel safe, respected and undisturbed to facilitate hormonal action. Midwives need to learn to trust Mother Nature, women’s bodies, power, physiology and themselves again. The best birth outcome is natural, rather than normal!

This episode covers a beautiful birth story which illustrates clearly the difference between a ‘normal’ and ‘natural’ birth.