“In my daily routine I see absurd situations, where having a “natural” birth is more important than the well-being of the baby. Very often I see a great frustration on the part of mothers when a “natural” birth is not possible, since they have spent the entire pregnancy creating an idyllic scenario, where such a birth is the fundamental condition for the beginning of the “perfect life”. ” with his son”. Who explains this is Dr. Flavia Correa, a neonatologist pediatrician, PhD from the Autonomous University of Barcelona, ??and who has practiced in Spain and Portugal.
In the last five years, Correa says, there has been a greater demand for having a “natural” birth. A definition, he stresses, that does not exist from a scientific point of view, where one speaks of eutocic labor (which begins and ends spontaneously) and dystocic (when some type of medical intervention is necessary). “What is now called a “natural” birth would be a birth without medical intervention, such as forceps, a vacuum, a cesarean section, an episiotomy or anesthesia,” Correa describes. An idea, “the natural”, that is gaining strength in Spain and that generates expectations that are not always met.
It is the case of Rosanna. When she got pregnant eight years ago after an assisted reproduction process, it was clear to her that she “wanted to give birth in the most natural way possible,” she recalls. Giving birth like this she understood: “A vaginal delivery, without an epidural, in which they respected my timing and I could follow my instincts and the movements that my body asked of me.” To prepare, she had done “a lot of Pilates and prenatal yoga,” as well as drawing up a “birth plan.”
The preparation also involved a course at a CAP in Barcelona’s Eixample. Though she didn’t realize it at the time, in retrospect, Rosanna sees that what they taught there was a bit unique. “We had a midwife who based the sessions on explaining to us that we could give birth like animals: like female giraffes, elephants or chimpanzees… She told us to watch that YouTube video of how the giraffe gave birth and then we would comment on it in the course. There was also a session in which we did motivational exercises, with songs of ‘I can give birth’”. A very tribal environment whose objective was one: to give birth in a “natural” way.
Pseudoscience also made its presence felt when, late in the pregnancy, Rosanna’s baby had not yet turned around. The midwife recommended exercises, playing music for the baby (with a speaker from the vulva), and a private moxibustion session: a Chinese treatment that involves burning bundles of herbs on top of the belly. The session cost him about fifty euros.
Rosanna will never know if it was due to the moxibustion, but the baby turned over, heralding the natural birth she wanted. However, things got complicated. Her water broke, but there were no contractions, so after twenty hours and still no contractions, the medical team decided to give her hormones to induce them. “Since my water had already broken, I was dying of pain. I couldn’t hold the contractions!” says Rosanna. “I was crying. I saw myself unable to give birth naturally and I was feeling worse and worse: ‘You’re not like the giraffe, but you’re crying’, I thought. I remember the feeling of failure because I wanted the epidural…”.
Failure and pain gave way to relief when, after the analgesia was applied, Rosanna relaxed, began to dilate rapidly, was given an epidural, and her baby was born soon after. “Everything was fine, but I remember the moment the child came out and saying to me, disappointed: ‘Oysters, with an epidural…’ But my partner saw me and said: ‘But what are you saying?! We have a wonderful boy! You’re both fine.’ And all of a sudden I thought: “Of course I am! What a motorcycle they have sold me!”
Eight years later, Rosana is still somewhat angry. Not with the doctors who treated her, but with an ideology that made her believe that giving birth like giraffes was normal. “It cannot be that these motorcycles are sold in this way. And I tell you that if it had been a cesarean section, I would have felt just as guilty or worse. In the entire course they did not do a single session of preparation for the caesarean section! If the discourse was that “there are many” then, precisely for this reason, mothers must also be prepared”.
But in the imaginary of natural upbringing, a caesarean section is not a resource that saves lives, but rather a perfidious interference. The message is that childbirth is something that women are capable of doing instinctively and the so-called “medical intervention” is seen as an obstruction to the designs of nature. This message has consequences: “In recent years I have detected an increase in pregnant women who come to the clinic with fear. Fear and pressure”, says doctor Carlota García Valdecasas. This specialist in Obstetrics and Gynecology regrets that the information received through the media, social networks and prenatal courses: “Instead of clearing up doubts and empowering women, many times they lead them to think that childbirth is treated in hospitals in a way that is not only inhumane, but negligent”. From certain sectors, this doctor denounces: “An idealized model of a birth without anaesthesia, without pain, vaginal at all costs is sold, which must be lived intensely and in which doctors and midwives are drawn as obstacles in the way that nature Has thought”.
It could be said that perinatal medicine is being a victim of its success. “In the second half of the 20th century, in Western countries, there was a great development of obstetrics and neonatology, with a brutal decrease in the mortality rate and the postnatal quality of life, both for the mother and the baby”, explains Dr. Correa. The current exaltation of the “natural” seems to forget: “That during a birth there are potential situations of great risk for the mother and, above all, for the baby. For this reason, medical interventions (forceps, suction cup, caesarean section, episiotomy or anesthesia) have been developed, which have significantly improved maternal and child health indices. It is true that in a few cases these interventions are performed without indication, especially cesarean section, but that is not what happens in the vast majority of the time, ”she emphasizes.
The question of caesarean sections, which in Spain, in 2020, accounted for 25% of births (the WHO considers the ideal rate to be between 10% and 15%), is one of the arguments of the concept of “obstetric violence”. This term applies to unnecessary medical interventions during childbirth, carried out without giving sufficient information or seeking the consent of the women. It is increasingly used in social networks and formal media (where there is even talk of “torture” towards mothers), although it is forcefully refuted by doctors.
“Every time I hear ‘obstetric violence’ I feel a pang of pain,” says Dr. García Valdecasas. For her, it is evident that there are cases of negligence: “But the term does not intend to settle what is a negligent act, but rather seeks to create the state of opinion that in a hospital not only will care be respectful, but that violent crimes will be committed. The term obstetric violence should not be accepted, because it degrades our work; as professionals and as people.
The Spanish Society of Gynecology and Obstetrics (SEGO) also strongly rejects this term, which considers it “inappropriate, tendentious and unfair”. In 2021, in a statement regarding the legal recognition of obstetric violence, SEGO declared itself in favor of “revealing the unpleasant experiences of many women and positioning them in the public debate”, but emphasized that: “It should not be confused in no way the inadequate praxis with the unfulfilled expectations of childbirth”.
“It is very difficult to live with your back to the constant bombardment in the media and social networks, where every medical action is questioned, from putting a line to performing an episiotomy… Everything seems to be dangerous in a delivery room,” says Dr. García Valdecasas. “Whereas,” she adds, “if one only read some media, one would come to think that all births flow spontaneously and no complications appear in a” natural “way, but are generated by the intervention of doctors and midwives.” These movements, concludes this specialist: “They manage to create distrust towards the health system, polarize attitudes and make any line that deviates from the mantras of natural childbirth create guilt and pain.”
Dr. Correa is also a witness to this distrust: “I see more and more situations like this in couples at the time of delivery, influenced by the bombardment of misinformation they receive on the internet.” To be highlighted: “The theories that defend that a “natural” birth is always the best for the baby or that attachment depends on having a birth of this type or not.” This, the doctor emphasizes: “It is simply not true. Mother/child attachment is not conditioned by the existence of a non-instrumental birth. It is something natural and inherent, as scientific evidence shows.”
This specialist warns of another absurd situation: “The rejection of the presence of professionals at the time of delivery, including the pediatrician. Since the end of the last century we have achieved that the pediatrician’s presence is constant, because sometimes the baby is born without breathing and has to be resuscitated, before a minute of life. This has saved thousands of babies and has substantially reduced the sequelae of neonatal hypoxia. Denying this presence would be like going back years in the quality of perinatal care.”
But the idealization of the natural continues, unstoppable. There is talk of wonderful “mammalian”, “spiritual” and even “orgasmic” births. From the “power” to give birth “without interventions” (but, yes, with a doula: birth attendants without official qualifications who charge around €1,200 for “full service”). Other countries, such as the United Kingdom, are given as an example, ignoring the debate that exists there regarding the excess of zeal for “natural” childbirth in its public health. Associations for “respected childbirth” set the networks on fire when someone denounces the hospital for performing a caesarean section. However, they were silent before the recent news of a sentence to the Canary Islands Health because, according to the ruling: “Natural childbirth was imposed on the mother.”
The debate is heated and polarizing. And in the background there is another key aspect: the mental health of mothers. If so many expectations are created, if the mother considers that she has not had the “perfect birth” she dreamed of, because she needed a cesarean section or she requested an epidural. If she feels that she has “failed” and she believes (wrongly) that she will not be able to bond with her baby… How will this anguish affect such a vulnerable moment?
“The main cause of the lack of mental health related to the peripartum is the excess of expectations created from false information,” says Dr. Correa. “It makes me very sad to see a mother crying during a cesarean section because her expectations of the delivery have not materialized, without enjoying the birth of the child who is healthy and vigorous, despite fetal suffering that motivated the cesarean section… The most important thing, this doctor recalls, is to have a child that is born healthy: “It is something that seems obvious, but it is not what we health professionals are attending to.”
