Is there anything you can do in pregnancy to make a “natural birth” more likely? We’ve got ten tips that may increase your chances.
1. Plan to give birth at a birth centre or at home
Giving birth at a midwife-led birth centre or at home increases your chance of a straightforward birth significantly when compared with a standard obstetric-led labour ward. Research has shown that even if you’re at low risk of complications, your chance of having an episiotomy, an assisted birth or a caesarean is higher if you give birth at a labour ward.
If you have to give birth in an obstetric-led unit, it’s worth knowing that some units have much higher rates of intervention than others. Contact your nearest units to find out which one has the lowest rates of induction, caesarean and other interventions.
2. Practise perineal massage
If you’re a first-time mum, there’s some evidence that you can reduce your chances of having an episiotomy by massaging your perineum in the last weeks of your pregnancy. Perineal massage prepares your perineum for the stretching it has to do when your baby is born.
Perineal massage once or twice a week in the last weeks of pregnancy is more effective than every day. But it doesn’t appear to make any difference to your chance of episiotomy if you’ve already given birth vaginally before.
3. Breech baby? Try some turning techniques
If your baby is breech (bottom down) in late pregnancy you will be offered a caesarean. Before you get to that point though, you should be offered external cephalic version (ECV).
ECV involves your obstetrician trying to turn your baby head down by pushing with her hands from the outside. It’s offered from 36 weeks of pregnancy. You could also try some self-help methods to turn your baby. If your baby doesn’t turn, you can still try for a vaginal breech birth, although most breech babies in the UK are born by caesarean.
4. Try to avoid induction, if possible
Induction of labour tends to mean more interventions, such as continuous monitoring, epidural for pain relief and a lower chance of having a straightforward birth.
If you and your baby are healthy, but your pregnancy has gone overdue, check with your midwife or doctor that any recommendation of induction is based on your individual circumstances, not just your hospital’s policy.
5. Stay at home until you’re in active labour
Being admitted to the labour ward while you’re still in early labour is likely to increase your risk of interventions. Such interventions include the need to speed up your labour later on and the need for medical pain relief, such as an epidural. Because of this, it’s likely that you’ll be advised to stay at home until you’re in active labour. There are lots of coping strategies for early labour at home while you wait for signs of progress.
6. Keep mobile in the early stages of labour
Evidence suggests that walking and staying upright may shorten the length of the first stage of labour. It also suggests that you’re less likely to need an epidural or have a caesarean.
Stay mobile as much as you can, in between resting, and eating when you feel hungry. Once with your midwife, she should encourage you to adopt whatever position you feel comfortable in. Birth centres and labour ward rooms often have mats, birth balls, bean bags or grab rails to help you with this.
7. Work with your natural labour hormones
The main hormone that makes labour happen is oxytocin. Oxytocin won’t work as well if you’re scared or stressed out by what’s happening. As adrenaline levels rise, oxytocin levels fall. So understanding what’s going on and trying to stay as relaxed as you can is likely to help your body to release this hormone that will help your labour to progress.
When you’re in labour, endorphins will also help you cope as labour gets stronger. Known as your body’s natural opiates, endorphins can help you zone out into a trance-like state so that your primitive birth instincts can kick in and take over.
8. Practise relaxation and breathing techniques in advance
Practising relaxation techniques such as deep breathing, massage and meditation during pregnancy will help you get more out of their use in labour.
You’ll have time to get to know your body, and to work out where you hold tension. Some relaxations help you to let go of muscle tension and physically, as well as mentally, unwind. Deep relaxation and hypnosis techniques may help you to address anxieties so that you feel more positive about labour and birth. Once you’re in labour, you can use these techniques to help you cope with your contractions.
9. Choose your labour support carefully
There is good evidence that having continuous support in labour increases your chance of having a straightforward birth. Many maternity units try to offer one-to-one midwifery care during labour and some employ doulas as part of the maternity staff. Ask your midwife whether your local birth centre or maternity ward offers this. If you opt for a home birth, a midwife will come to your home and stay with you during active labour and another midwife will join you when you get to the pushing stage.
Most women have one or two birth partners with them too. You may have every confidence in your partner’s ability to support you during labour or you may be thinking of asking a friend or relative. Attending antenatal classes together can help you both to prepare. You may decide to employ a doula alongside your partner as well.
10. Avoid having an epidural
Having an epidural for pain relief in labour may lead to a longer pushing stage, and increase your risk of needing an assisted birth.
If you have an epidural, there are still some helpful strategies you can use when you get to the pushing stage. Waiting a while before you start pushing can increase your chance of a straightforward birth. If you feel a strong urge to bear down then it’s fine to push. If not, then waiting to push for between one hour and three hours is better.
The position you’re in during the second stage may also make a difference when you have an epidural. You may reduce your risk of needing forceps or ventouse by lying on your side. This is better than lying on your back with your legs in stirrups or sitting with your back supported.