Natural childbirth: everything you need to know

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Natural childbirth

Here we are: the pregnancy is almost at the end and the time for delivery is approaching. If a caesarean hasn't already been scheduled for some medical reason, mom is probably full of doubts and worries. So here's everything you need to know about natural childbirth.


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There is strength, tenderness, humanity. And life. It is not easy to describe the moment when a woman gives birth to her child. Especially when we talk about natural childbirth, ...

In this article

  • What is really meant by natural childbirth?
  • How does a natural birth work?
  • How long does the birth last?
  • Give birth with pain? It's not for sure!
  • Anyway, childbirth is not just pain!
  • Ok, it's time: how do I notice?
  • What Do I Do When Labor Begins?
  • How do I choose where my baby will be born?
  • I chose natural birth ... how can I avoid it ending in a caesarean section?
  • All the benefits of natural childbirth
  • Natural childbirth after caesarean
  • Natural birth in water
  • Natural childbirth how to prepare

What is really meant by natural childbirth?

The word "natural" must not be misleading: we do not necessarily speak of extreme situations, such as those of those who decide to give birth in the midst of nature. In reality, by natural, or spontaneous, birth we mean that it occurs by vaginal route without the need for medical aids, such as using the suction cup to facilitate the baby's exit or administering oxytocin to stimulate contractions. In the latter case, the birth is still vaginal but it is said operating.

Often, however, the term Natural childbirth it is used simply to indicate the birth that takes place without recourse to the caesarean sectionwhether it is operational or not.

"It is not easy to know how many operative and completely spontaneous births are in the country" says Anna Locatelli, director of obstetrics and gynecology at the Carate Brianza Hospital, associate professor at the University of our city Bicocca and referent for the region Lombardia of the Del Paesena Society of Perinatal Medicine.

Instead, we know how many natural births there are compared to those with caesarean section: according to an Istat survey on pregnancy, childbirth and breastfeeding, in 2022 caesarean sections were 36,3% of the total (with a peak of 45,2% in the southern regions). Far too many, considering that for the World Health Organization, caesarean sections should not exceed 15%.

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How does a natural birth work?

All in all, the principle of childbirth - which occurs in three or four stages depending on the type of classification used - is quite simple.

  1. We start with one prodromal phase, of preparation, in which the mother's tissues prepare for the passage and exit of the baby. Sometimes, this phase goes completely unnoticed, while in many cases it is accompanied by preparatory contractions, which are quite irregular and more or less intense, but still bearable. Many women compare them to menstrual pain.
  2. The second phase is that of active labor and it is distinguished in turn by two parts: the dilating phase and the expulsive one. As the name implies, the phase dilatant is the one in which the complete dilation of the cervix and is characterized by contractions more and more close and intense. "Historically the beginning of this phase was made to coincide with the start of the dilation" explains Anna Locatelli. "In the nineties, however, a document of the World Health Organization indicated as the starting point the one in which the dilation reaches at least the 3 cm. And now there is a certain current of thought coming from the United States that would like to move this moment even further, to 4/6 centimeters ".
  3. La expulsive phase it's time for pushed, leading to the birth of the baby.
  4. Finally, there is the afterbirth, that is, the expulsion of the placenta.

How long does the birth last?

This is the million dollar question: everyone is asking it, worried by the stories of friends or family members who speak of labor that lasted an infinite number of hours. "In reality there are no fixed times" comments gynecologist Anna Locatelli "The duration of each phase of childbirth varies greatly from woman to woman and can depend on many factors, both physical, such as the characteristics of the mother's tissues and the size of the child or pelvis, both environmental ".

In other words, it appears that too the way in which the woman experiences childbirth - if and how she feels supported by those around her, if she can walk or not, if and how her pain is soothed - can affect its duration.

However, if you want to give some reference time indications, you can take the English guidelines for physiological birth, according to which at the first birth, the duration of labor up to the expulsive phase should not exceed 18 hours (which drop to 12 in the case of subsequent children). "In short, the old saying remains valid according to which the sun must not be allowed to set twice on a woman who is about to give birth"comments Locatelli.

Give birth with pain? It's not for sure!

Like all pains, childbirth is also very subjective. There are women who find the first contractions unbearable, others - the really lucky ones! - who arrive at the expulsive phase almost without realizing it. The fact remains that, according to the scientific literature on the subject, childbirth is the most violent pain a woman can experience in life.

Fortunately, today it is possible to avoid or significantly reduce this pain, first of all thanks to epidural anesthesia, the method considered to be the most effective, even if it is not entirely devoid of side effects. In order to access it, it is necessary to make an anesthetic visit in the last trimester of pregnancy and perform some blood tests. The problem, however, is always the same: not all birth points offer the service 24 hours a day, because an anesthetist must always be present and this is not necessarily the case.

More recently, some Del Paeseni hospitals (few, actually) have begun to offer the possibility of give birth with nitrous oxide or laughing gas, a harmless gas with a mild euphoric and analgesic effect, which relieves the pains of labor and delivery. Even this method, however, is not without limits: in addition to being very expensive (and therefore not very widespread), it can cause nausea and malaise.

In addition to pharmacological methods, there are many "natural" and soft strategies that can be attempted to try to suffer less: from aromatherapy, from hypnosis to massages.

However, it must be said that, according to a large study conducted by the Cochrane Collaboration, an important international initiative that deals with the critical review of information on health interventions, for many of these strategies there is not yet enough data to show that they are really effective.


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Anyway, childbirth is not just pain!

It is inevitable: when one thinks of childbirth, one immediately thinks of the contractions and pain that will be felt. "And yet the birth is not just this and it is a pity that all the discussion stops there!" says Roberta Spandrio, midwife at the San Gerardo hospital in Monza and one of the authors of the book Physiology of birth (Carocci, 2022).

According to Spandrio, there are so many other feelings at stake, which will always come to mind in the years to come when one remembers the moment in which one's child was born. "There is often a mix of conflicting emotions: fear, but also joy for the imminent arrival of the baby, or fear of not making it interspersed with the feeling of being invincible"comments the midwife." Not to mention the moments of sharing with dad, her tender or worried looks, certain really beautiful couple dynamics ".

It is no coincidence that many women already a few days after the birth of their first child declare that they would gladly relive the experience of childbirth. "It wouldn't happen if only evil was at stake" concludes the midwife.

Ok, it's time: how do I notice?

One of the main fears of pregnant women, especially if they are having their first child, is not to notice that the birth is coming and, consequently, not to arrive on time at the hospital. In reality, this hardly ever happens, and it is much more common to rush to the hospital when it is still too early.

"If the woman is already in her second child, the problem does not arise, because she immediately recognizes the first serious contraction," explains midwife Roberta Spandrio. Even at the first birth, however, it is difficult to be wrong: "There are always signs, for example the loss of the mucous plug, which, however, can even precede the onset of labor by a few days. "In general, most women say they experienced, even before the contractions started, the feeling of something different: "There are those who feel particularly tired, or restless" says Spandrio.

Contractions, however, are hard to ignore: they become more and more frequent, regular and intense, heralding that the time is indeed near. Not to mention that, in some cases, there may also be the rupture of the water (or, better, of the membranes), with more or less abundant loss of liquid.

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What Do I Do When Labor Begins?

"When you understand that the birth is approaching, you often panic, but you have to rest assured, and avoid rushing to the hospital, because if you are hospitalized, the management of the prodromal phase of childbirth becomes more difficult and less customizable "advises midwife Roberta Spandrio. According to which the best time to go to hospital is when the contractions become regular and occur roughly every five minutes for at least two hours.

What if a little blood mixed with mucus appears on the panties together with the contractions? "Do not worry: everything is absolutely normal. Indeed, it is a positive sign, which indicates that the process is now underway. In any case, let us always remember that at this stage, the movements of the child and that their presence is always reassuring ".

Sure, passing the time, with the contractions - and anxiety - increasing isn't always easy, but a few tricks can help. "For example, do a nice hot bath, possibly in the tub, with water around 37 ° C "suggests Spandrio." It helps to relax, calming the nerves and alleviating the sensation of pain "." And again, try to distract yourself as much as possible, compatibly with the pain. Maybe rest, if it's night, or read or listen to music ".

Eating and drinking is allowed, indeed recommended: "The uterus is a muscle, to do its job well it needs energy, which it gets from food and drink".

How do I choose where my baby will be born?

"Often the only criterion for choosing the hospital in which to give birth is proximity" says midwife Roberta Spandrio. "If on the one hand it is understandable that this is the case, on the other it is also a little surprising, because one has the feeling that the woman is not really the protagonist of this choice and suffers it a little, based on external conditions".

According to the midwife, however, it is really important to start think aheadwhere and how you want to give birth. "Not in the last weeks of pregnancy, but earlier, because there are many parameters to take into consideration". For example: do you want a birth in a hospital, or in a private clinic, or maybe you are tempted by maternity homes or a home birth?

And again: do you want to avoid a caesarean at all costs, unless there is an emergency? Then better inquire about percentages of caesareans done in the chosen hospital, taking into consideration whether it is a first or second level center (where the percentages are a little higher, because even the most complicated cases refer to it). The same goes for practices such as episiotomy or induction of labor, which in some centers are practiced routinely, without clear medical indications. However, it must be said that in these cases it is more difficult to obtain data.

The birth plan

It might be useful to draft a birth plan, in which to indicate your preferences with respect to how you would like the event to go, for example the desire to be able to assume any desired position or to avoid invasive practices such as the administration of oxytocin to favor contractions or episiotomy.

But be careful: in Del Paese the birth plan has no legal value and doctors are not required to respect it. Some do not even accept it and certainly it is not included in the patient's medical record. "In some hospitals, however, it is discussed in advance with the woman, in order to understand well what her requests are and to explain to her what the medical reasons for certain procedures may be" comments Anna Locatelli.

So, all in all, it is worth doing it: to clarify your ideas and to know what to discuss with your doctor or with the head of the room in the hospital where you intend to deliver your baby.

Read also: How to give birth

I chose natural birth ... how can I avoid it ending in a caesarean section?

We said it: in Del Paese the percentage of caesarean sections is very high, more than what would be necessary to guarantee the health of mother and child. Let's say it right away: the caesarean should not be demonized, it is sometimes very important to safeguard the health and well-being of mother and child. At times, however, it clicks simply because the birth seems to take too long, or because the woman appears too tired and discouraged, or for reasons of comfort of the structure.

Yet, there are strategies that, according to what is reported by the international scientific literature, they help reduce the risk of a natural birth turning into a cesarean at some point. Here they are.

  • The ability to freely choose the position in which to stay;
  • The ability to do water labor;
  • The one-to-one relationship with an operator, that is constant and direct assistance from a person, usually the midwife, possibly trusted. In reality, in Del Paese this is not so frequent, at least in the hospital, because the personalization of assistance in many cases is not provided. However, there are hospitals that are moving in this direction, for example by ensuring longer shifts or more flexibility of their staff. In addition, the figure of the doula is also making its way in this regard, which could play an interesting role of emotional support for the pregnant woman.

Natural childbirth after caesarean

Cesarean delivery is associated with an increased risk of placenta previa in subsequent pregnancies. And after a first caesarean, often the children who come later are also given birth.

But be careful: VBAC, vaginal birth after caesarean is a concrete possibility: "There are now a lot of data in favor: trying a trial labor is certainly a reasonable choice" concludes Locatelli.

Natural birth in water

More and more women are choosing to give birth in water. An article published by the Cochrane Collaboration brought together the results of various scientific investigations on the subject, to conclude that immersion in water during labor reduces the use of anesthesia epidural or spinal and also the duration of labor itself.

Natural childbirth how to prepare

The best way to get prepared for natural childbirth is to know what awaits us, by attending a pre-birth course, for example, we can ask many questions to midwives, pediatricians, nurses and learn the best relaxation, breathing and pain management techniques.

All the benefits of natural childbirth

The idea of ​​vaginal birth, we have said, can be frightening. So why not focus on the many benefits of natural birth?

"To begin with, there is great satisfaction that the mother draws from it "underlines the gynecologist Anna Locatelli." Childbirth is a truly relevant experience, which the woman will always remember because it represents a maximum self-expression, both from a physical and psychological point of view ".

And beyond that there are the "practical" advantages, starting with the fact that the recovery is very fast. A very short time after birth, the mother can move, walk, take a shower. She may feel a little "bruised", but there are no major pains, unlike what happens with a caesarean which is always a surgical procedure.

Other advantages are greater ease ofstart breastfeeding well and immediately - maybe already in the delivery room - and one greater likelihood of breastfeeding even in the long term, less risk for the newborn, especially in terms of respiratory problems and, finally, less risk for future pregnancies and births.

Read also: Childbirth, live with the experts

Questions and answers

What is meant by natural childbirth? 

By natural, or spontaneous, birth we mean what happens vaginally without the need for medical help.

How long does a natural birth last? 

According to British guidelines, a natural birth should not last more than 18 hours. In reality there are no fixed times. The duration of each stage of childbirth varies from woman to woman and can depend on many factors.

What is the best time to go to the hospital for childbirth? 

The best time to go to the hospital is when the contractions become regular and occur roughly every five minutes for at least two hours.

  • Natural childbirth
  • spontaneous birth
  • give birth
  • Caesarean section
  • Caesarean section
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