Why Natural Birth: The Cascade Of Interventions

“If you have the option, why would you not?” asked my cousin, aghast at my choice to refuse an epidural. My answer to her question is a long-winded one, but important nevertheless. 

The United States, with all its medical advancements, has one of the highest infant mortality rates in the developed world. Incidentally, we are also one of the greatest employers of (often unnecessary) interventions such as the epidural, induction, and planned c-section. What was once an instinctive and natural process has descended into the “Knock ‘em out, drag ‘em out” nightmare described by Dr. Robert A. Bradley. At what point will the unnecessary surgeries and deaths cause us to question the status-quo? While I won’t pretend to know the reasons for going natural, I will gladly share with you my reasons for doing so, beginning with the infamous Cascade of Interventions. 

You probably know the following scenario, if not personally, then vicariously through a friend. You’re 41+ weeks pregnant and Baby won’t budge. You’ve pushed for a little more time, but your OBGYN is tapping her foot impatiently. Words like “stillbirth” and “shoulder dystocia” are effectively used to pressure you into an induction. And so it begins. 

The Pitocin drip starts and within an hour you’re buckled over with agonizing contractions. You ask for a dilation check and…two centimeters? How on earth will you make it to ten? The doc offers an epidural which you gladly accept. The pain slowly dwindles as the anesthesia flows. You are soon unable to feel or move your lower half. Much more comfortable, you lay back and wait patiently to progress. “Birth isn’t so bad”, you think to yourself as you nod off for a nap.

Suddenly you’re awakened by the angry sound of hospital monitors. “Baby’s heartbeat dropped, we need to move you.” You’re groggy and confused, but you do as the nurse tells you. Still unable to maneuver yourself, she repositions you. No luck. The nurse leans you to one side and then the other, but the monitors continue their merciless siren. You’re now freaking out as a horde of medical staff comes streaming into the room. Their voices are low, but you catch bits of conversation. “It’s been over 2 minutes…” says one staff member. “The OR is ready…” says another. Your OBGYN finally enters the room, takes one look at the screen and says “Yep that’s a c-section. Let’s get you moving.” Your birth nightmare has now materialized. Not only is your crunchy birth plan out the window, but you’re also fearful for your baby’s safety. Scared and uncertain, you don’t offer a word of resistance as they wheel you into the operating room. 

Within minutes you’re strapped to a board and told to stay calm. Hardly an issue, as you’re still limp from the epidural. The room becomes blurry as your eyes fill with tears. Moments later you hear a pitiful little wail. “Is that my baby? Can I hold her?” 

“Not just yet”, you’re told. “We need to get her fixed up.” You catch a glimpse over the curtain and wait for several agonizing minutes while staff members stitch you back together. You hear them joke about the poor golfing conditions and wonder at how the world spins on while everything inside you is broken to pieces. Finally the doctor comes around and delivers more painful news. “Your baby is in the NICU. She wasn’t breathing as well as we’d hoped and we had to get her on oxygen.”

“Is this my fault? Did I do something wrong?” You ask tearfully. 

“Oh no, honey”, the OB reassures you. “We see this all the time after c-sections.” 

“When can I see her?” 

“Just as soon as you’re good to go.” 

The next thing you know, you’re in a wheelchair, an icepack on your belly, rolling your way into a softly lit room. “Are you Mom?” a NICU nurse asks. “Would you like to hold her?” You sneak a glance at the infant in the isolette and are almost scared to reply. Wires and tubes cover the body and face of the traumatized little creature staring blankly at the ceiling. The nurse tucks Baby into your arms. You are perfectly still, too nervous to move or speak. “Talk to her,” she recommends. “Hey little one,” you say chokingly. Baby looks in the direction of your voice and focuses intently on your face. “She knows you. How sweet,” the nurse remarks as she leaves the room. “She knows me?” You think to yourself. “But how?” Alone, in pain, and now responsible for a tiny little stranger, the tears flow unceasingly. Where is the powerful mother-baby bond you were promised? How do you know this child is yours? They just told you she’s yours, but how do you know? 

Months pass, you and Baby are doing fine. Her first birthday comes and goes and before you know it, you’re pregnant with number two. 

As your due date nears you make it clear that you will not under any circumstances entertain another c-section. 

“Honey I know it’s important to you, but VBACs really don’t happen all too often. We’ll schedule your cesarean for the 18th…”

The above story is a conglomerate of the many traumatic births experienced by women pressured into unnecessary interventions. And while some are perfectly happy with these interferences, most bemoan the trauma and disempowerment of the ordeal. 

So in answer to my cousin, I choose to avoid the cascade of interventions as best I can. And sure I’ll admit that…

Not all epidurals lead to a c-section, but they do make you 3.4x more likely. 

And not all epidurals lead to a lowered fetal heart rate, but 30% do. 

And not all c-sections lead to a NICU stay, but 9.3% do. 

And not all c-section moms repeat the surgery, but 87% do. 

And while it’s possible to get induced and avoid an epidural, it is extremely unlikely. 

And most tragically, most c-section and NICU moms miss the golden hour, putting their babies at a disadvantage in terms of brain development and emotional attachment. Studies indicate that missing this first hour can hinder the mother-baby bond indefinitely. 

So while these numbers reflect risks and not absolutes, I’ll take my chances with the homebirth c-section rate of 5.2%.