The physiological management of normal birth has always identified by a consensus of the scientific literature as the safest and most economical form of maternity care for healthy women. It is the one used by those countries with the best maternal-infant outcomes.
Stedman’s Medical Dictionary defines physiological as:
“..in accord with or characteristic of the normal functioning of a living organism”.
When providing services to a healthy childbearing population, physiological care should be the universal standard used by all birth attendants and in all birth settings. It is always articulated with the medical system and includes the appropriate use of obstetrical interventions for complications or at the mother’s request.
The classic principles that define physiological care include a basic confidence in normal biology and support for the spontaneous process of labor and birth. This tradition sees the use of medical and surgical intervention as restricted to abnormal situations.
It should be emphasized that physiologic care is neither passive or neglectful or nor is it just a matter of abstaining from the unnecessary use of medical interventions. It’s a pro-active process for preserving maternal-fetal wellbeing that relies on a formal body of knowledge and a specific skill set for addressing the physical, biological and emotional needs that women and their fetuses face during labor. This includes continuity of care throughout active labor by individuals known to the mother.
Other important principles are patience with nature, an absence of arbitrary time limits and the right use of gravity. Physiologic care also acknowledges the laboring woman’s need for physical and psychological privacy. This includes the right of a healthy mother with a normal pregnancy to control her environment and to direct her own activities, positions & postures during labor and birth. The non-interventive approach to normal childbirth is careful not to disturb the healthy spontaneous process.
Normal Spontaneous Birth
This requires changing institutional policies whenever they interfere with the requirements of normal physiology. To achieve these goals, evidence-based maternity care employs a system of one-on-one social and emotional support and non-drug methods of pain relief (such as movement, touch, and use of warm showers and deep-water tubs), in conjunction with the judicious use of pain medications or anesthesia when requested or medically necessary.
It encourages the mother to be upright and mobile during both labor and birth by walking around at will, changing positions and activities frequently, getting in and out of the shower or using a deep-water tub. Being upright and able to move about during contractions also diminishes the mother’s perception of pain, perhaps by stimulating endorphins and takes into account the positive influence of gravity on the stimulation of labor.
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Right use of gravity helps dilate the cervix and assists the baby to descend down through the bony pelvis, greatly reducing the need for obstetrical interventions.
Physiological management of normal labor and birth is associated with the lowest rate of maternal and perinatal mortality. It is protective of the mother’s pelvic floor and has the fewest number of medical interventions, the lowest rate of anesthetic use, obstetrical complications, episiotomy, and operative deliveries.
For women who choose physiologically managed care (i.e. normal, non-medical vs. medicalized), the C-section rate ranges from 4 to 10 percent, which is three to seven times less than medicalized childbirth [citation]. Millions of health care dollars can be saved every year on the direct cost of maternity care and a reduction in post-operative, delayed and downstream complications associated with Cesarean surgery. [Top 5 Hospital Procedures & Cost, Reuter, 2005].
This is a hugely important cost-saving to employers who pay for employee health insurance, for taxpayers who underwrite government-financed programs for the indigent and for the uninsured who must pay out of pocket. For a variety of reasons, the obstetrical profession in the US turned its back on physiological childbirth nearly a hundred years ago.
The absence of physiologic care, combined with the routine use of interventionist obstetrics, means that every year millions of pregnant women spend the many hours of their labor lying in bed while an extensive array of counterproductive and medically-unnecessary procedures are done to them. This results in an artificially high rate of complications and operative deliveries.
Unfortunately, the obstetrical response to the increased morbidity that accompanies excessive intervention in vaginal birth is to propose the ultimate iatrogenic intervention – medically unnecessary Cesarean surgery.
There is a move within the obstetrical profession to promote electively scheduled Cesarean for healthy women as the preferred standard of care for the 21st century.
Associated topic: The Obstetrical Standard of Care in the US – historically illogical and fundamentally flawed
