Different types of giving birth: Water birth, epidural & natural

Have you decided on the type of birth experience you would like? While nothing is set in stone and pregnant mothers should be prepared for the unexpected, deciding on how you would like to bring your child into the world can help put your mind at ease. 

The types of giving birth are specific to each mother and baby’s needs. Our resident doula walks you through how many ways to give birth there are, as well as the advantages and disadvantages of each. 

Different ways of giving birth

Medical assistance and care can vary during the birth of a baby. Depending on your baby’s health and positioning, as well your own needs, physical capability and wants, there are various ways of delivering a baby.

• Unmedicated or medicated vaginal birth in a hospital or at a midwifery unit
• Unmedicated or medicated vaginal water birth at a midwifery unit
• Unmedicated, vaginal home birth
• Unmedicated water birth
• Medicated or unmedicated vaginal birth after C-section (VBAC) in a hospital or at a midwifery unit
• Scheduled Caesarean
• Unplanned Caesarean

Medicated birth options

“I wasn’t sure what to expect about the level of pain I was going to experience and how it would feel when the baby comes out, so the epidural helped me tremendously to feel at ease about Raydon’s birth.” Charlene (35) mother of Raydon (3 weeks)

Even if you’re planning an unmedicated birth, or if you’re having your baby in a hospital you should know about the available medications. When you utilise pain medication to lessen or eliminate the pain of childbirth, it is known as medicated birth. Pain-related medications used in childbirth include:

• Analgesics (medication that reduces pain)
• Tranquillisers (medication that calms)
• Anaesthetic (medication that produces a loss of sensation)

The most popular form of pain medication during childbirth in a hospital is an epidural, a form of anaesthetic nerve block. Sensory nerves below your waist are blocked when you have an epidural. You will still be able to move your muscles but you may not necessarily be able to feel them. It usually takes about 30 minutes to start working, covers a wide area and is administered with a long, fine needle in a space near the spinal cord.

As some mothers prefer to avoid the after-effects of the epidural (drowsiness, lethargy, possible nausea), they may opt for pain medication such as analgesics or gas and oxygen. This may not take the pain away completely, but it will “take the edge off”, which is sometimes all one needs! The benefit of painkillers is that you are still capable of moving and feeling, but the pain is more bearable.

“EVEN IF YOU’RE PLANNING ON AN UNMEDICATED BIRTH, IF YOU’RE HAVING YOUR BABY IN A HOSPITAL YOU SHOULD KNOW ABOUT THE AVAILABLE MEDICATIONS.”

Unmedicated birth ways

“I felt so empowered being able to tell when my body was going from early labour to transition to full dilation. I was completely unaware of anything else going on around me…it was just me, and my baby. I was in control of my body and of my birth, and I loved it.” Safeeyah (25), mother of Abdul (2 months)

Unmedicated birth is also sometimes called natural birth and it means you give birth without any medication whatsoever. So, no analgesics, tranquillisers or anaesthesia are involved. It is a very personal choice and the reasons for unmedicated birth varies. Many mothers do not want to expose their babies to any harmful or unnatural substances whether that is through the placenta or breastfeeding, so they choose to go medication-free.

Usually, women who choose unmedicated births use non-pharmacological forms of pain management like:

• patterned breathing
• counter-pressure
• touch and massage
• hypnobirthing or mental focus
• birthing balls
• aromatherapy
• and, of course, a doula to help with the above!

Natural childbirth

Natural birth is vaginal labour, where the baby is delivered with limited to no medical intervention. While it seems quite daunting, women have been doing this since the beginning of time, with far fewer resources available. A vaginal birth without medication benefits both mother and baby.

Advantages of delivering a baby naturally

• The microbiome, or bacterial environment, is established by the birth method. Some research suggests the development of the infant microbiome is associated with the likelihood of developing allergic diseases during childhood.
• Babies born vaginally tend to have fewer breathing problems.
• Other benefits of vaginal delivery include a quicker recovery for the mother and circumvention of abdominal surgery and the associated risks that come with a C-section.
• Vaginal childbirth has a lower rate of infection and a shorter hospital stay.

Disadvantages of giving birth naturally

• Tearing of the perineum (the tissue between the vagina and anus).
• Medical reasons for not having a vaginal delivery as determined by the healthcare provider.

At home childbirth

Long before the advance of medicine, delivering your baby at home was the only real option women had. Back in the day, unsanitary conditions often led to complications. But today, home birth is considered low risk to women and babies, given our deep knowledge of natural birthing processes.

The biggest advantage of home birth is that it’s at home! There are other things you can further consider with an at-home birth. 

Other advantages are

• No worries about being transported to and from the hospital.
• You have all the snacks, clothes and people you need!
• Because your environment is familiar and comfortable, recovery and transition to breastfeeding are much easier.
• Anyone that the parents want there can be there and see the baby afterwards.
• There are no “silence” rules at home!

The disadvantages of home birth include

• Everything that is needed for the birth needs to be purchased.
• If the home is far from the hospital or the weather is bad, a midwife may not be able to be there on time.
• If there are problems, the mother and/or baby will need to be transported to the hospital.
• It has to be a low-risk pregnancy.

Hospital delivery method

A hospital delivery doesn’t stop a woman from attempting vaginal delivery, with or without an epidural. Many women opt for hospital births due to quick access to surgical interventions in the case of an emergency. 

The benefits of a hospital birth include

• Immediate access to necessary interventions in emergencies e.g. C-sections.
• More pain management options as well as advanced monitoring for higher-risk patients.
• A perceived ‘safer’ environment.

Disadvantages of hospital delivery

• There is a higher chance of being treated or perceived as a ‘patient’ i.e. “being ill” at a hospital. 
• Sometimes labour is rushed in the hospital, resulting in a greater chance of the “cascade of interventions” taking place. 
• Other risks of hospital childbirth (and any stay in the hospital) include a higher chance of infection.

Water birth in South Africa

A labouring woman goes through all or some of the stages of childbirth in a tub – be that a portable one or a normal hot tub or birthing pool. The mother can birth outside of the water, or she can choose to have her baby born underwater. Water births are very relaxing and it has been proven that contractions are less painful in water.

Benefits of water birth

As it allows a labouring woman to utilise a lot of varied positions, water birth helps to control the pain of contractions. The partner can be part of the water birth by getting into the water with the labouring woman to support her.

Disadvantages of water birth

Setting up a birthing pool can be a bit of a schlep unless it is a fixture at a midwifery unit or hospital. There are also critics alleging that water birth may increase infection risks, but there are many ways to prevent infection and as long as the water is clean and fresh, it is not riskier than different births out of water.

Baby delivery with Caesarean birth (C-section)

“Planned C-section takes all the stress out of planning for childcare, being physically and emotionally ready, feeling more in control leading up to delivery where I’d never felt that way before. I was extremely nervous when I thought I had to give birth vaginally. My planned C-section changed everything and I felt cool, calm and in control.” – Anna (39) mother of Mia (4 months)

Reasons for a scheduled C-section opposed to natural birth

There are many reasons for scheduled C-sections. The main reasons are:

• Medical conditions, for example, diabetes, kidney disease and high blood pressure. These can cause a vaginal birth to be dangerous as they cause stress to the mother’s body and a C-section birth may be safer. Also, if you are HIV positive or suffer from genital herpes, the viruses may be transmitted to your baby.
• Your baby’s health condition. Congenital diseases or other serious illnesses make travelling through the birth canal dangerous for your baby.
• Sometimes doctors use macrosomia as a reason why a mother has to have a C-section. That means a baby is too big to be born vaginally. Unfortunately, this reason is often abused by healthcare providers.
• If you are obese, it increases the risk of C-section because of risk factors like gestational diabetes, and because obese women often struggle to birth vaginally.
• One’s chances of a C-section increases with maternal age as well.
• The baby’s position: If your baby is feet-first or butt-first in a breech position and cannot be turned, you will quite probably be advised to have a C-section.
• A lot of times doctors will advise you to have a C-section when you have twins or multiple babies.
• With placental problems like placenta previa (placenta is blocking the cervical opening) or placental abruption (the placenta has separated from the uterine wall), a C-section will be considered safer for you and your baby.
• Other pregnancy complications like preeclampsia (high blood pressure due to being pregnant) or eclampsia (a very rare condition causing seizures) may cause your doctor to advise a C-section.
• Unfortunately, having had a previous C-section increases your risk of subsequent procedures. However, VBAC birth (vaginal birth after C-section) is frequently successful and recommended if there are no other health issues.

Reasons for an unscheduled C-section vs normal delivery

A lot of times, the need for a C-section is not evident until a woman is in full-blown labour and can be an unplanned way to give birth. A few of those reasons may be: 

• Labour doesn’t start, i.e. your cervix isn’t dilating even with the presence of contractions for more than 12 to 24 hours.
• Labour comes to a halt. You may go through the early stages of labour up to three to four centimetres and then everything comes to a standstill. Oxytocin may jumpstart contractions but when that doesn’t work or your baby’s head is too big, a C-section may be necessary.
• Foetal distress is another reason for a C-section. As soon as any signs are picked up that your baby is in distress, the doctor will opt for a C-section.
• Another reason is a prolapsed umbilical cord. This means that the umbilical cord slips into the birth canal before the baby does. As your baby comes through it will be compressed and will quite likely cut off the oxygen supply. In this case, your doctor will do a C-section.
• If the uterus tears, a C-section is required and vaginal birth is no longer feasible.

Elective C-sections

Many women (especially those who have already had caesarean sections) prefer C-sections to vaginal births and ask for this in advance. It is not always possible and care providers may encourage a trial of labour first, but in South Africa, elective C-sections are very common.

In rare cases, mothers receive general anaesthesia (where you aren’t awake) for their labours, but this is usually done for certain medical reasons and as a last resort.

If you end up having a C-section, you’ll likely receive an epidural along with a local anaesthetic.

AS WITH EVERYTHING ELSEWHERE LABOUR AND BIRTH ARE CONCERNED, HAVING A MEDICATED OR UNMEDICATED BIRTH IS NOT ALWAYS UP TO YOU

Induced labour and delivery

Induced labour is another one of the ways of giving birth based on medical requirements.

Induction may be necessary if your baby isn’t coming on its own. As an induction is not your choice a lot of time, you can still have an unmedicated birth. When labour is induced, it means that the birth of your baby is going to be artificially started – there are several reasons for that. Most of the time, it is done when there are medical problems or other complications.

Steps with a medicated induction

• Place an internal monitor to evaluate the uterine contraction pattern.
• Place an internal monitor on the baby’s scalp to measure the infant’s welfare.
• Check for meconium (a greenish-black substance, which is the baby’s first stool and that indicates distress).

For a natural induction, a hook that looks like a crochet tool called an amnihook is used to rupture the sac of waters. With a medical induction, labour is usually induced with Pitocin, a synthetic form of the drug oxytocin that’s given intravenously. A baby should be born within 24 hours after induction was done to prevent infection.

Medical reasons for inducing labour might include:

• Small baby
• Diabetes
• High blood pressure
• Past-due pregnancy

As with everything else where labour and birth are concerned, having a medicated or unmedicated birth is not always up to you. What you can do is equip yourself with knowledge, choose an option that you’re most comfortable with, and trust your care provider to make the best possible choices for you and your baby.

How to deliver a baby with these different methods

Fewer things compare to the magic of childbirth and nothing beats holding your baby for the first time. You should have the freedom to choose between the different types of giving birth. 

Although the freedom to choose is wonderful, at the same time, women are so very lucky that we have different ways to give birth that ensure the safety of our newborn baby.