Physiological Birth in the Hospital: Is it truly possible?

The first time I saw an animal give birth, I was in kindergarten. My kindergarten teacher--a gangly, kind young man named "Mr. Bob"--had misdiagnosed our class pet mice as both being female. Unbeknownst to our five-year-old innocence, this fact was discovered one fine morning when one of my classmates screamed "Mr. Bob! Pinky is killing Gracie!" We all ran horrified to the site of Gracie's apparent murder, where Pinky was furiously jumping on poor Gracie. Mr. Bob promptly pulled Pinky out by "her" tail and separated "her" into another cage. But alas, it was too late. Gracie was pregnant.

Three weeks later, another pleasant kindergarten morning was once again punctuated by a classmate screeching. "Mr. Bob! GRACIE IS DYING!!" Once again, we all rushed over to Gracie's cage, where she was barely visible under a pile of pine shavings...with a tiny pink squirmy thing slowly emerging from her hind end. Gracie gave birth to ten eraser-sized babies that morning as fourteen mesmerized five-year-olds stood around her cage. Poor Mr. Bob. 

I will never forget how after each of her babies were born, Gracie would lick each one, examining it in between her little paws, nudging it with her little nose. Gracie the Mouse imprinted on me that morning.

Now, as a doula, I can't help but think about physiological mammalian birth whenever I attend a birth. Think about it yourself: how do ALL other land mammals give birth when left alone to do so? They:

• Find a safe place that is generally dark, quiet, and undisturbed.
• Create an environment in this safe place--a "nest" so to speak.
• Are alone.
• Don't ask for help.
• Follow their instincts.
• Most of the time give birth PERFECTLY with no interference.
• Are the first and usually only other being to touch their young.
• Feed their baby/babies immediately.
• Are never separated from their young.

Now, how many humans do this? Not many. In fact, modern birth pretty much directly contradicts almost every single one of these instinctual things. If a momma is giving birth in the hospital she may:

• Give birth in a foreign place with bright lights, a loud intercom, and hospital staff barging in her room every fifteen minutes.
• Wear a shapeless, flapping gown worn by who knows how many before her; lay in a creaking bed with puzzle-piece mattress and bedding that could give you paper cuts (and pillows covered in plastic!) under florescent lights that make even the freshest of us look like crypt keepers.
• Be surrounded by people she may or may not have invited to her birth.
• Be given "help" whether or not she asks for it--one or more people who have no intimate connection with her may stick their fingers inside her on multiple occasions.
• Be pressured at some point to go against her instincts. And what happens when instincts are contradicted? Physiology and hormones create the "fight or flight" mechanism, depriving the core organs (one of which is the uterus!) of oxygen and blood flow which can cause increased pain and labor dystocia (stalling or lack of progression) and even cervical regression (decreased dilation--most people aren't even aware this might be possible)! If the mammalian brain thinks something is hostile or unsupportive of the birth process, the mammalian body responds by stopping labor to protect the baby from the hostile environment. I have witnessed labor completely stopping when something caused a mother fear, anxiety, frustration, or anger. 
• Have her baby be "delivered" by one or more caregivers. 
• Not be the first, or even the second or third, person to touch and speak to her baby.
• Be separated from her baby for minutes or hours after birth.
• Be separated from her baby for tests, exams, or other routines for hours at a time in the days that follow.

Okay. So that's a stark contrast. And it bears the question--is physiological birth truly possible in the hospital setting? Keep in mind, while out-of-hospital birth sounds like the perfect answer to this, a home or birth center, or mossy woodland birth is not something many (most) women can have. So for those mommas, who can only give birth in the hospital--what options do they have to have a truly natural birth in a truly unnatural setting? In my experience, yes, this is possible. But it relies on several key components.

First, your caregiver has to be on board. And this means that this caregiver is willing to follow YOUR cues. Which also means YOU have to be willing to call the shots. It sounds easy enough to take responsibility for your birth, but actually doing it is another. There must be an open dialogue and respect between you. In my case, this meant I was eating chicken Cesar salad and chocolate chip cookies a few hours before birth, during which my midwife never turned on the overhead light, and at one point was laying awkwardly on the bed, so I could stay in the hands-and-knees position I had assumed naturally while pushing. One of many examples of how SHE followed MY lead that day, instead of her telling me how to give birth for her convenience.

Second, you have to sharpen and FOLLOW your instincts. If something doesn't feel right DON'T DO IT (or let it be done to you). And if you feel like something is necessary, DO IT (or ask that it be done).

Third, choose your hospital wisely. Choose a hospital that gives you autonomy when it comes to what you will wear, where and how you will labor, what interventions you will choose, and will provide you with a comfortable space to make your own. 

Fourth, HIRE A DOULA! Part of my job is to help create your birth nest, and then to shelter that nest while you work away at birthing in it. And then I will continue to protect your nest as you welcome your little one into it and spend the first hours of your life together snuggling in it instead of being separated by the artificial light and warmth of the newborn warmer. 

So, the answer to the question...is physiological birth possible in the hospital setting? Well, there will not be a daisy-studded field, or a pile of soft leaves, or a crystal clear pool from the water of an Alaskan glacier...but, you CAN have a self-directed birth which will translate into the closest thing possible inside a hospital.

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