By Ailish Delaney
When I had my three children, I had them naturally. That is to say that I delivered them vaginally, without the need for surgical intervention. And they were all three born perfectly, with no problems.
However, this is not always the case – there are many risks connected to natural childbirth, most of which are never pointed out to the mother-to-be.
It is a phrase heard a million times over – ‘women have been having babies for centuries’ – which, while it is true, does not reflect the dangers involved. In years gone by, when medical intervention was not available, the rate of both infant death and maternal death were much higher.
According to Dr David Richmond, of the Royal College of Obstetricians and Gynaecologists, around 90% of women will suffer some degree of perineal tearing during a vaginal birth.
There are four degrees of tears:
A first degree tear is the least damaging, and means that it is just the lining of the vagina that is damaged. This may or may not require suturing.
Second degree tears are the most common, and involve the vaginal lining and the submucosal, or deeper tissues of the vagina and will require more sutures.
Third degree tears are a lot more complex, and involve the deeper tissues of the vagina as well as the anal sphincter muscles. Each layer must be stitched separately, with particular care given to closing the muscle layer which supports the sphincter.
Fourth degree tears involve all of the above and extend right through to the rectal lining. This requires multiple layers of stitching and close attention. Happily, this is the least common degree of tearing, and is usually limited to assisted births (vacuum or forceps delivery) or when the baby’s shoulder gets stuck.
The pressures forced upon the pelvic floor muscles during the active, or pushing, stage of labour are immense, so it is no wonder that, as a result, a lot of mothers who have given birth naturally suffer from incontinence.
Pushing in childbirth can cause dysfunction of the pelvic floor, which can have a devastating effect on the mother.
Stress incontinence is when a woman leaks urine when her bladder is under pressure, for example from laughing, or sneezing, or coughing.
Urge incontinence on the other hand, is when the woman has a sudden urge to urinate and cannot control it.
Bowel incontinence is the loss of control over the bowel, leading to the involuntary expulsion of gas, or faecal matter.
Uterine Prolapse – when the ligaments which support the uterus (womb) become weakened, damaged or stretched through in natural childbirth, the uterus can literally drop down into the vagina.
Rectal prolapse is similar to the uterine prolapse, but involves the rectal wall collapsing downwards, and can cause a protrusion from the anus.
One of the major risk factors in a natural delivery is that of heavy blood loss.
When heavy bleeding (more than 500mls) happens within 24 hours post-birth it is known as primary postpartum haemorrhage (PPH), and can be caused by problems with the placenta, such as retained placenta or placenta accrete (the placenta growing deeply into the uterine wall).
When heavy bleeding occurs between 24 hours and 6 weeks post birth, it is known as secondary PPH. It is usually caused either by retention of placental tissue and/or infection.
This heavy and abnormal bleeding is alarming and can become life threatening, resulting in an emergency hysterectomy, thus effectively ending the mother’s chance of having further children, and plunging her into an immediate menopause if the ovaries are removed in the operation.
Risks to the baby
Of course, it is not only the mother who can suffer as result of complications during natural childbirth.
There are several risk factors involving the baby which can occur without medical supervision and/or help.
Umbilical cord prolapse is a thankfully rare complication of natural birth, but it can happen. This occurs when the umbilical cord comes out before the baby, compressing the cord and obstructing blood flow to the baby, causing distress. This is a medical emergency, and without treatment the baby is at risk of brain injury, cerebral palsy or death through asphyxiation.
Shoulder dystocia happens when the baby’s shoulders get stuck and prevent the baby being born. This can be the case with a big baby, and is an emergency situation, because failure to release the shoulders in time can cause foetal distress and even death.
Meconium inhalation is often the result of the baby becoming distressed during labour. Meconium is the waste product from the baby which, if expelled into the amniotic fluid can be inhaled by the baby. If meconium is seen, the baby will need manual aspiration, where his nose and mouth is cleared by the doctor or midwife. If, however, it has gone into his lungs, the baby will need to go to intensive care for breathing support.
The umbilical cord can become wrapped around the baby’s neck during natural childbirth, and while this is not always dangerous, it can become an emergency if it is wrapped too tightly and restricts the baby’s breathing.
So, while the argument that women have been giving birth naturally for centuries does stand, it doesn’t mean that it is, or ever was, necessarily safe. Lifestyle changes (such as being overweight or obese) can result in bigger babies, which creates many dangers for both mother and infant, while the results of giving birth without help can be far reaching and devastating to all affected.
In short, natural childbirth can be safe, as long as medical help is available and accepted if the unthinkable happens and either the baby or the mother’s well-being becomes compromised. When all’s said and done, the only thing that really matters is that both mother and baby are safe and well.