tips for a low-intervention, physiologic birth in a hospital

I’m not going to lie: having a low-intervention or intervention-free, physiologic birth in a hospital takes some serious commitment and a lot of proactive preparation.

Why? Well, maybe it’s like trying to live in a totally foreign country that doesn’t understand your language, culture, values, or needs. The country isn’t designed to accommodate anything about your lifestyle because it has it’s OWN language, culture which are the default. In order to preserve the lifestyle you’re accustomed to there, you’ll have a lot of hard work to do so. Or, you can give up and acclimate and adopt the culture/values/language of that other country.

It’s an imperfect metaphor, I know. But I think it begins to convey the challenges to natural birth posed by the hospital environment alone.

However, it can be done. I’ve witnessed it done in varying degrees. And in this post, I’d like to just make some unofficial observations about what seemed to contribute to the success of those mamas who pull it off with flying colors!

1) Clear intentions.

These mamas were ultimately already birth-trusting women who were confident they could give birth without intervention and that was just what they were going to do.

2) Bringing their own self-selected birth team.

These mamas brought someone with them, who would be with them throughout, who really “got it” and was comfortable advocating for them as needed, and telling unsupportive hospital staff to get lost if needed. They were going to be ready to respectfully ask for whatever tools or support was needed. A doula or a midwife-wearing-doula-hat are two great examples of the sort of team member they they bring along. A confident, supportive spouse is great, too, but often these births happen when there’s a second support person.

3) Arriving at the hospital late in the game.

Laboring at home as long as possible, until labor is very well established and therefore less likely to stall out upon arrival in maternity admitting is helpful. Furthermore, at home you can labor more freely and accomplish much of your work in the comfort of home, arriving at the hospital ready to push your baby our. Having less time stuck in a single room is really great, lest you begin to feel like a caged animal.

4) Refusal of even the most basic hospital protocols/procedures.

Such as refusal of the wheelchair they offer you at the door, the hospital gown, an IV port, or a fetal monitor. These things may seem small and insignificant, but consenting to them can subtly change your mindset from Powerful Laboring Woman to Hospital Patient. It begins to change the locus of control from that which is within yourself to that which is external, namely the medical professionals. And once that shift happens, you’re more susceptible to the other more invasive interventions.

5) A die-hard avoidance of the hospital bed.

Some of the most home-like hospital births I’ve seen happened when the mama basically labored everywhere but the bed, and even gave birth off the bed. Yes, you’re allowed to do that! Staying off the bed allows you to labor in more instinctual positions, and also makes it hard to pin you down. So pace, sit on the ball, crouch on the floor or the couch, walk the halls, sit on the toilet, have a shower or a bath… just don’t lay down on the bed. And if your urge to push comes on while you’re in one of those places, you are actually allowed to say “no thanks” when a nurse or doctor asks you to move to the bed; let your OB or CNM get into a weird position to catch your baby!. Alternatively, you can get on the bed but be on all fours or squatting; it doesn’t have to mean laying on your back. (Unless you genuinely WANT to lay down to give birth, then that’s obviously fine, too).

6) Saying no to cervical checks and continuous fetal monitoring.

Research shows that both of these things do NOT improve maternal or infant outcomes at all. If anything, they are associated with higher cesarean rates. The hypervigilance over your cervix and your baby’s heart rate lead to heightened anxiety and compulsion to intervene, as well as putting you “on the clock.” Instead, ask for intermittent fetal monitoring (every half hour during active labor and every 10-15 minutes during pushing). You might want a single cervical check when you feel pushy so that you can release fear that you’re pushing too soon, but not even that is necessary and I’ve seen some hospital mamas have their babies without any at all!

7) Choosing a nurse midwife or an OB with a reputation for supporting vaginal birth.

Generally speaking, nurse midwives are supportive of natural birth and very willing to let your labor and birth unfold without interruption. If possible, working with one is a great idea! If your area doesn’t have CNMs or your insurance won’t cover them, do your research on your OB. Ask around to see what the word on the street is, and also ask at your first appointment about his/her c-section rate, and their experience supporting non-medicated vaginal birth.

That’s not an exhaustive list. If you have more tips, I’d love for you to add them in the comments.

I’m rooting for you!