Risks of natural childbirth?

Proponents of the medicalised approach to birthing say that natural
childbirth is just as risky if not riskier.

Lists of statistics on risks associated with epidural use are all over
the internet but I'm having a hard time finding figures on risks of
natural childbirth.

Anybody have a link for me?

"Lady Penelope Creighton-Ward" wrote in message
ups.com...
Proponents of the medicalised approach to birthing say that natural
childbirth is just as risky if not riskier.

Lists of statistics on risks associated with epidural use are all over
the internet but I'm having a hard time finding figures on risks of
natural childbirth.

Anybody have a link for me?


well any research risks of using epidural, induction etc. is compareing
against something, check to see if this is natural childbirth and that it is
sound and it will usually give figures for each risk for each group, like
10% in the natural group received oxygen after delivery 15 % in the epidural
group etc.

Also, it depends how you define natural childbirth, so people thinking about
medicalised might be comparing that to animal style birth, unassisted and
alone whereas natural childbirth is usually under the supervision of a
midwife, or obstetric nurse with no interventions, but plenty of observation
and monitoring of the feotal heartrate done at regular intervals rather than
continuously. I'm fairly sure I can pull something up about non continuous
versus continuous monitoring if that would help you.

it also depends what you mean by risks, if you include natural 3rd stage as
a part of natural child birth, then you do get more PPH in that than medical
3rd stage, but is that a risk? some people say yes, others say no, we always
have the drugs on hand, by starting of naturally we reduce the risks of
retained placenta and then we can give the drugs if it becomes necessary and
perform other treatments such as uterine massage.

I think to get info, you have to think of more specific questions you want
answers too and also find out what the medical proponents are considering to
be natural childbirth, because you can have a labour that is entirely
natural but still have a c-section or other intervention because it becomes
necessary, but what to they then count it as, I expect they would find it
very hard to argue that if they had had a medical approach they wouldn't
have had a c-section, so natural childbirth was not a risk.

Anne

Anne Rogers wrote:
"Lady Penelope Creighton-Ward" wrote in message
ups.com...
Proponents of the medicalised approach to birthing say that natural
childbirth is just as risky if not riskier.

Lists of statistics on risks associated with epidural use are all over
the internet but I'm having a hard time finding figures on risks of
natural childbirth.

Anybody have a link for me?


well any research risks of using epidural, induction etc. is compareing
against something, check to see if this is natural childbirth and that it is
sound and it will usually give figures for each risk for each group, like
10% in the natural group received oxygen after delivery 15 % in the epidural
group etc.

Also, it depends how you define natural childbirth, so people thinking about
medicalised might be comparing that to animal style birth, unassisted and
alone whereas natural childbirth is usually under the supervision of a
midwife, or obstetric nurse with no interventions, but plenty of observation
and monitoring of the feotal heartrate done at regular intervals rather than
continuously. I'm fairly sure I can pull something up about non continuous
versus continuous monitoring if that would help you.

it also depends what you mean by risks, if you include natural 3rd stage as
a part of natural child birth, then you do get more PPH in that than medical
3rd stage, but is that a risk? some people say yes, others say no, we always
have the drugs on hand, by starting of naturally we reduce the risks of
retained placenta and then we can give the drugs if it becomes necessary and
perform other treatments such as uterine massage.

I think to get info, you have to think of more specific questions you want
answers too and also find out what the medical proponents are considering to
be natural childbirth, because you can have a labour that is entirely
natural but still have a c-section or other intervention because it becomes
necessary, but what to they then count it as, I expect they would find it
very hard to argue that if they had had a medical approach they wouldn't
have had a c-section, so natural childbirth was not a risk.

Anne

Fair points, Anne. The person I'm discussing this with says
incontinence is a classic problem of natural childbirth. I seem to
recall there were studies proving this was a myth after all, do you
know about that?

Lady Penelope Creighton-Ward wrote:

Fair points, Anne. The person I'm discussing this with says
incontinence is a classic problem of natural childbirth. I seem to
recall there were studies proving this was a myth after all, do you
know about that?

Yes, there was a study about that. I'll see if I
can find it. Keep in mind that the folks who are talking
about that are discussing vaginal birth vs. c-section,
not medicated vs. unmedicated or some other aspect of
"natural" birth.
In addition, one has to keep in mind that it is
easily possible that some of the pelvic floor damage
associated with vaginal birth is *caused* by interventions
or mismanagement. For example, IIRC, pelvic floor damage
and incontinence problems are more likely to happen with
an epidural (probably because when you can't feel what
you're doing, you're more likely to injure yourself).
Maternal positioning is likely a factor. Instrumental
delivery may well be a factor. I'm sure there are other
things I'm not thinking of off the top of my head. So,
even if studies show that there is a greater rate of
incontinence with vaginal birth, it may be due to medical
mismanagement and unnecessary intervention more than
simply the fact of vaginal birth. And, of course, I'm
sure you've already suggested to your friend that
incontinence is not the only risk of vaginal birth *or*
elective c-section.
So...let's see what I can dig up...

If you're discussing with a friend the relative merits of
vaginal birth vs. elective c-section, probably the best
resource (and on which specifically discusses the incontinence
issue) is the booklet you can download at:
http://www.maternitywise.org/cesareanbooklet/
In addition, you can download the tables with the supporting
data that informed the booklet, which contain a wealth of
information. In the supporting tables data, they note
wrt the incontinence issue that they didn't find a *single*
study that was appropriately designed to determine whether
the risk of incontinence was due to vaginal birth or
to interventions. What they did find was:

- women who experienced birth practices known to increase
the risk of pelvic floor damage were more likely to have
issues with incontinence compared to c-section
- pregnancy increases the risk for future urinary incontinence
for all women (regardless of the mode of birth), and
women who've had a vaginal birth have a slightly increased
risk of incontinence in the immediate postpartum period
- the proportion of women experiencing incontinence following
birth drops sharply in first few months postpartum, and the
gap narrows or closes compared to women who've had c-sections
- persisting differences between women with vaginal birth and
those with c-sections basically disappear before age 50, and
postmenopausal incontinence is more due to age/smoking/obesity
or other non-birth related factors
- studies have inconsistent definitions of incontinence that
make it difficult to interpret them
- many studies suggest that reducing birth practices associated
with pelvic floor damage (most women who have a hospital vaginal
birth experience at least some of these practices) would
substantially reduce incontinence in women with vaginal birth
(and thereby reducing or eliminating the difference between
women with vaginal birth and women with c-section birth)

Hope this helps,
Ericka

Ericka Kammerer wrote:
Lady Penelope Creighton-Ward wrote:

Fair points, Anne. The person I'm discussing this with says
incontinence is a classic problem of natural childbirth. I seem to
recall there were studies proving this was a myth after all, do you
know about that?

Yes, there was a study about that. I'll see if I
can find it. Keep in mind that the folks who are talking
about that are discussing vaginal birth vs. c-section,
not medicated vs. unmedicated or some other aspect of
"natural" birth.
In addition, one has to keep in mind that it is
easily possible that some of the pelvic floor damage
associated with vaginal birth is *caused* by interventions
or mismanagement. For example, IIRC, pelvic floor damage
and incontinence problems are more likely to happen with
an epidural (probably because when you can't feel what
you're doing, you're more likely to injure yourself).
Maternal positioning is likely a factor. Instrumental
delivery may well be a factor. I'm sure there are other
things I'm not thinking of off the top of my head. So,
even if studies show that there is a greater rate of
incontinence with vaginal birth, it may be due to medical
mismanagement and unnecessary intervention more than
simply the fact of vaginal birth. And, of course, I'm
sure you've already suggested to your friend that
incontinence is not the only risk of vaginal birth *or*
elective c-section.
So...let's see what I can dig up...

If you're discussing with a friend the relative merits of
vaginal birth vs. elective c-section, probably the best
resource (and on which specifically discusses the incontinence
issue) is the booklet you can download at:
http://www.maternitywise.org/cesareanbooklet/
In addition, you can download the tables with the supporting
data that informed the booklet, which contain a wealth of
information. In the supporting tables data, they note
wrt the incontinence issue that they didn't find a *single*
study that was appropriately designed to determine whether
the risk of incontinence was due to vaginal birth or
to interventions. What they did find was:

- women who experienced birth practices known to increase
the risk of pelvic floor damage were more likely to have
issues with incontinence compared to c-section
- pregnancy increases the risk for future urinary incontinence
for all women (regardless of the mode of birth), and
women who've had a vaginal birth have a slightly increased
risk of incontinence in the immediate postpartum period
- the proportion of women experiencing incontinence following
birth drops sharply in first few months postpartum, and the
gap narrows or closes compared to women who've had c-sections
- persisting differences between women with vaginal birth and
those with c-sections basically disappear before age 50, and
postmenopausal incontinence is more due to age/smoking/obesity
or other non-birth related factors
- studies have inconsistent definitions of incontinence that
make it difficult to interpret them
- many studies suggest that reducing birth practices associated
with pelvic floor damage (most women who have a hospital vaginal
birth experience at least some of these practices) would
substantially reduce incontinence in women with vaginal birth
(and thereby reducing or eliminating the difference between
women with vaginal birth and women with c-section birth)

Hope this helps,
Ericka

Thanks for all that, Ericka. The discussion is really about the pros
and cons of epidurals but it kind of spilled into the cons of natural
birth, and I just couldn't find a comprehensive list of any sort
online...

Lady Penelope Creighton-Ward wrote:

Thanks for all that, Ericka. The discussion is really about the pros
and cons of epidurals but it kind of spilled into the cons of natural
birth, and I just couldn't find a comprehensive list of any sort
online...

One of the best resources for the pros and cons
of epidurals is:

http://www.kimjames.net/epidural%20main%20page.htm

Best wishes,
Ericka

Lady Penelope Creighton-Ward wrote:
Anne Rogers wrote:
"Lady Penelope Creighton-Ward" wrote in
message ups.com...
Proponents of the medicalised approach to birthing say that natural
childbirth is just as risky if not riskier.

Lists of statistics on risks associated with epidural use are all
over the internet but I'm having a hard time finding figures on
risks of natural childbirth.

Anybody have a link for me?


well any research risks of using epidural, induction etc. is
compareing against something, check to see if this is natural
childbirth and that it is sound and it will usually give figures for
each risk for each group, like 10% in the natural group received
oxygen after delivery 15 % in the epidural group etc.

Also, it depends how you define natural childbirth, so people
thinking about medicalised might be comparing that to animal style
birth, unassisted and alone whereas natural childbirth is usually
under the supervision of a midwife, or obstetric nurse with no
interventions, but plenty of observation and monitoring of the
feotal heartrate done at regular intervals rather than continuously.
I'm fairly sure I can pull something up about non continuous versus
continuous monitoring if that would help you.

it also depends what you mean by risks, if you include natural 3rd
stage as a part of natural child birth, then you do get more PPH in
that than medical 3rd stage, but is that a risk? some people say
yes, others say no, we always have the drugs on hand, by starting of
naturally we reduce the risks of retained placenta and then we can
give the drugs if it becomes necessary and perform other treatments
such as uterine massage.

I think to get info, you have to think of more specific questions
you want answers too and also find out what the medical proponents
are considering to be natural childbirth, because you can have a
labour that is entirely natural but still have a c-section or other
intervention because it becomes necessary, but what to they then
count it as, I expect they would find it very hard to argue that if
they had had a medical approach they wouldn't have had a c-section,
so natural childbirth was not a risk.

Anne

Fair points, Anne. The person I'm discussing this with says
incontinence is a classic problem of natural childbirth. I seem to
recall there were studies proving this was a myth after all, do you
know about that?

It seems to me, on a list of various risk factors, maternal or fetal death
being on that list, that maternal incontenance would be pretty low on my
list of things to worry about, and certainly not the main reason that I'd
forgo a natural birth for a medicalised one.
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03
Addison Grace, 9/30/04

Check out the family! -- www.MyFamily.com, User ID: Clarkguest1,
Password: Guest Become a member for free - go to Add Member to set up
your own User ID and Password

Lady Penelope Creighton-Ward wrote:
[...] The person I'm discussing this with says
incontinence is a classic problem of natural childbirth.

Meaning *urinary* (not fecal) incontinence? I researched this 2 years
ago, when I was dealing with some urinary incontinence issues post
delivery of my 1st (some of the details I posted here at the time). By
researched, I mean I read medical (not consumer) reference books, dug
deeply into the National Library of Medicine website, and searched the
medical research literature using PubMed. I found, obtained, and read
several medical research reports addressing the specific outcome of
urinary incontinence after different modes of childbirth. The bottom
line: the primary contributor to urinary incontinence is simply being
pregnant through the 3rd trimester! Nothing else made a significant
contribution.

BTW, my issues resolved completely within 3 months post delivery.
(What a relief!) The National Library of Medicine's details of
physiology and management of bladder function were most helpful to me,
providing specific techniques that helped me manage well during my
return to normal function.

Thanks for all that, Ericka. The discussion is really about the pros
and cons of epidurals but it kind of spilled into the cons of natural
birth, and I just couldn't find a comprehensive list of any sort
online...

Hi. I see that there is a link to our cesarean booklet at
MaternityWise.org. I'm dropping into this discussion to provide you
with the updated link (we've changed our name from Maternity Center
Association to Childbirth Connection, and our new website is
www.childbirthconnection.org). Our organization provides evidence-based
maternity care information to women and health professionals. To take
an evidence-based approach means that we evaluate studies to determine
how they were conducted, and what they mean to maternity care. If there
are no or not enough studies to evaluate an area in maternity care, we
do not offer guidance on it.

Here's the new link to the cesarean booklet:
http://childbirthconnection.org/arti...=10164&area=27

As for risks associated with epidurals, and other forms of labor pain
medication, we have information on pros and cons here, as well as other
forms of labor pain medication:
http://childbirthconnection.org/arti...=10185&area=27

As for risks associated with "natural childbirth" (with no medical
intervention) or physiologic (going with the woman's body), that
depends on the situation of the mother and the resources available to
her. The best information that we have does not compare epidural to
childbirth with no pain medication. We provide comparisons of types of
narcotics. The act of having an epidural has changed the physiology of
childbirth, in that it involves more medical interventions, like
electronic fetal monitoring, it could lengthen labor which could
increase the use of Pictocin, or artificial induction of labor, etc.

With reference to incontinence and pelvic floor dysfuction as it
relates to childbirth (and yes, it is a nucance, so it's understandable
why one would want to protect their pelvic floor), we have a whole
section devoted to it:
http://childbirthconnection.org/arti...=10206&area=27

Medical interventions such as use of forcepts and vacuum extraction do
increase the risk of damage to the pelvic floor, which can cause
incontinence. Routine episiotomy can also harm a woman's pelvic floor
rather than help avoid injury. A JAMA study was conducted on the harms
of routine epsiotomy. We provide a response and explination of it, with
advice to women he
http://childbirthconnection.org/arti...=10004&area=27

We're not saying that vaginal birth by itself will not damage the
woman's pelvic floor, as data and studies conducted are not specific
enough to deduce where the problems actually occur.

We have a chart in our national survey of mothers, called Listening to
Mothers, that tells what types of labor pain relief mothers preferred.
This included labor immersed in water, use of the shower, and use of
the birth ball. The link to that report is he
http://childbirthconnection.org/arti...=10068&area=27

And finally, evidence has shown that use of a trained doula (a woman
supporting a woman during childbirth) can make for a more satisfying
childbirth. Information on doulas is he
http://childbirthconnection.org/arti...nk=257&area=27

This is a long post, but I wanted to clarify where you can find some of
these answers within our site.

Best,
Childbirth Connection (formerly Maternity Center Association)

wrote:
Thanks for all that, Ericka. The discussion is really about the pros
and cons of epidurals but it kind of spilled into the cons of natural
birth, and I just couldn't find a comprehensive list of any sort
online...

Hi. I see that there is a link to our cesarean booklet at
MaternityWise.org. I'm dropping into this discussion to provide you
with the updated link (we've changed our name from Maternity Center
Association to Childbirth Connection, and our new website is
www.childbirthconnection.org). Our organization provides evidence-based
maternity care information to women and health professionals. To take
an evidence-based approach means that we evaluate studies to determine
how they were conducted, and what they mean to maternity care. If there
are no or not enough studies to evaluate an area in maternity care, we
do not offer guidance on it.

Here's the new link to the cesarean booklet:
http://childbirthconnection.org/arti...=10164&area=27

As for risks associated with epidurals, and other forms of labor pain
medication, we have information on pros and cons here, as well as other
forms of labor pain medication:
http://childbirthconnection.org/arti...=10185&area=27

As for risks associated with "natural childbirth" (with no medical
intervention) or physiologic (going with the woman's body), that
depends on the situation of the mother and the resources available to
her. The best information that we have does not compare epidural to
childbirth with no pain medication. We provide comparisons of types of
narcotics. The act of having an epidural has changed the physiology of
childbirth, in that it involves more medical interventions, like
electronic fetal monitoring, it could lengthen labor which could
increase the use of Pictocin, or artificial induction of labor, etc.

With reference to incontinence and pelvic floor dysfuction as it
relates to childbirth (and yes, it is a nucance, so it's understandable
why one would want to protect their pelvic floor), we have a whole
section devoted to it:
http://childbirthconnection.org/arti...=10206&area=27

Medical interventions such as use of forcepts and vacuum extraction do
increase the risk of damage to the pelvic floor, which can cause
incontinence. Routine episiotomy can also harm a woman's pelvic floor
rather than help avoid injury. A JAMA study was conducted on the harms
of routine epsiotomy. We provide a response and explination of it, with
advice to women he
http://childbirthconnection.org/arti...=10004&area=27

We're not saying that vaginal birth by itself will not damage the
woman's pelvic floor, as data and studies conducted are not specific
enough to deduce where the problems actually occur.

We have a chart in our national survey of mothers, called Listening to
Mothers, that tells what types of labor pain relief mothers preferred.
This included labor immersed in water, use of the shower, and use of
the birth ball. The link to that report is he
http://childbirthconnection.org/arti...=10068&area=27

And finally, evidence has shown that use of a trained doula (a woman
supporting a woman during childbirth) can make for a more satisfying
childbirth. Information on doulas is he
http://childbirthconnection.org/arti...nk=257&area=27

This is a long post, but I wanted to clarify where you can find some of
these answers within our site.

Best,
Childbirth Connection (formerly Maternity Center Association)

Wow you have all the bases covered, haven't you? Thanks so much for
this!