There’s a common perception that childbirth is inherently dangerous and that modern medicine has made it safe. But how true is this really, especially for healthy women with healthy pregnancies? The history of childbirth and the science behind maternal and infant outcomes paint a picture that challenges this narrative and makes a case for physiological birth without constant medical oversight.
A Look at Our History
If we look back just 100 years ago, the world of childbirth was filled with genuine dangers. Poor hygiene, lack of understanding about infections, and inadequate nutrition contributed to high maternal and infant mortality rates. Doctors didn’t know to wash their hands between patients, leading to deadly infections like puerperal fever. Add to this the absence of antibiotics, and it's no wonder many births turned tragic.
However, the real question is: were the dangers of childbirth rooted in the birthing process itself, or were they a reflection of the times? Evidence suggests it was the latter. The challenges faced back then—unsanitary conditions, poor nutrition, and limited medical knowledge—are not the same obstacles we face today. And while it’s true that some women and babies did not survive childbirth, most did. If birth were as universally dangerous as we sometimes imagine, the human species wouldn’t have been able to thrive and grow.
For context, in the 19th century, maternal mortality rates ranged from 500 to 1,000 deaths per 100,000 births (or 0.5% to 1% of all births) (Source: Our World in Data). Infant mortality rates were even higher, with estimates suggesting that nearly 27% of newborns didn’t make it to their first birthday (Source: Our World in Data). Yet, the majority of women and infants did survive, and humanity kept growing. In fact, the global population doubled from 1 billion in 1800 to over 2 billion by 1930.
What Changed? The Evolution of Childbirth Practices
As medical science evolved, we started to understand the importance of basic hygiene. The introduction of antiseptic practices drastically reduced deaths from infection, and medical advancements like antibiotics and caesarean births have saved countless lives. These improvements were game-changers, especially for pregnancies with more complex needs and birth emergencies. But does that mean every healthy, pregnant woman needs to be looked after by a doctor during childbirth?
The short answer is: no. In fact, when it comes to healthy, normal pregnancies, the constant medicalisation of birth often introduces more risks than benefits. The Birthplace Study in the UK, one of the largest and most well-respected studies on the safety of childbirth, found that for healthy women with uncomplicated pregnancies, giving birth at home or in midwifery-led units was just as safe as giving birth in a hospital. What’s more, the rates of medical interventions, such as instrumental deliveries, episiotomies, and caesarean births, were much lower for women who planned to give birth outside of a hospital setting (Source: Birthplace Study).
The Cascade of Interventions
One of the significant issues with having doctors oversee every healthy birth is what’s known as the “cascade of interventions”. This refers to a chain reaction where one medical intervention leads to another, often resulting in a more medicalised birth than initially needed. For example, in a hospital setting, labouring women are often attached to continuous foetal monitoring. While this may seem harmless, being tethered to a machine can limit a woman’s ability to move, which is crucial for helping labour progress. If labour stalls because the mother can’t move freely, doctors will recommend some form of augmentation, like synthetic oxytocin to stimulate contractions. The intensity of these contractions then leads to more pain relief, like an epidural, which in turn will increase the chances of a caesarean birth.
None of these interventions are inherently bad, and in certain situations, they are life-saving. But for a healthy, normal pregnancy, the body knows how to birth a baby. The process of labour is physiological, meaning it’s a natural function of the body, much like digestion or breathing. When we interfere unnecessarily, we disrupt the body’s own rhythm and chemistry. This can make the entire process riskier, yet women and their families often feel that the doctors and specialists have saved them.
Birth as a Physiological Process
Let’s break down what happens when labour is left to unfold naturally. The mother’s body produces oxytocin, often called the “love hormone,” which drives contractions. As labour intensifies, endorphins, the body’s natural pain medication, are released. These endorphins not only help the mother manage pain but also create a sense of euphoria that plays a vital role in bonding with the baby once born. If a mother feels safe, supported, and free from unnecessary intervention, this hormonal dance flows smoothly. But stress or fear can trigger the release of adrenaline, which can counteract oxytocin and slow or even stop labour.
This is where the concept of continuous, non-medical support becomes so important. In traditional societies 1,000 years ago, women were often supported by other women in the community who had knowledge of birth. These birth attendants understood the natural progression of labour and the importance of a calm, nurturing environment. They also knew simple techniques to ease discomfort and encourage labour, like changing positions, using warm water, or providing reassuring words. These women didn’t have medical training, but they had wisdom and experience.
How a Doctor’s Presence Can Impact Birth
Doctors are trained to look for problems and to fix them. This is invaluable when complications arise. But for a woman whose pregnancy has been healthy and uncomplicated, the presence of a doctor can sometimes introduce an expectation of problems. It can create an environment where birth is treated as a medical event rather than a natural process. This can contribute to a mother feeling anxious or unsure of her own body’s ability to birth. And, as we’ve learned, stress hormones like adrenaline can hinder labour.
Moreover, the aftermath of a highly medicalised birth can affect a new mother’s mental and emotional well-being. Many women reflect on their birth experiences with feelings of disappointment or trauma, especially if they felt pressured into interventions or if their labour didn’t unfold as they’d hoped. This can impact their early days of bonding with their baby and their sense of empowerment as a new parent.
Respecting the Process with Support in Place
So, where does this leave us? It’s not about rejecting modern medicine or villainising doctors. It’s about understanding that healthy, normal pregnancies do not need a doctor’s constant oversight. Midwives and doulas are highly skilled at supporting physiological birth, recognising when things are progressing normally and when additional help might be needed. They provide a balance between respecting the natural process and having the knowledge to act if something veers off course.
In today’s world, we have the incredible privilege of expecting that both a mother and her baby will survive birth—something we often take for granted given the advances in medical care. But beyond survival, it’s essential to consider the emotional and psychological well-being of the mother as she embarks on this life-changing journey.
The way a woman feels about her birth experience has a lasting impact, not only in those first tender days with her newborn but also in the months and years that follow. Unnecessary interventions, despite well-intended, can lead to feelings of disempowerment or even birth trauma. That’s why it’s so important to focus on creating a birth environment that prioritises not just physical safety but also the mother’s mental and emotional health, setting the stage for a positive start to life together for her and her baby.
In the end, childbirth isn’t about controlling every aspect; it’s about creating a space where the natural power of birth can be respected and celebrated. For healthy women, the evidence is clear: less intervention often means better outcomes. It’s about trusting the process, having skilled support, and always keeping the well-being of the mother and baby at the forefront.
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