In the natural labor world, there are tales of a mystical, magical creature: the Unicorn Birther.  The Unicorn Birther is a woman who somehow reaches near complete dilation with little to no discomfort and only mild, infrequent contractions. Many people confuse the Unicorn Birther with women who manage their labors extremely well, utilizing breathing and other techniques. I commonly see patients who have studied Hypnobirthing who resemble Unicorn Birthers in their calm demeanor, but a true Unicorn Birther is something very different. Women who cope well with labor will still communicate discomfort and have contractions in short intervals that build both in intensity and frequency as the labor progresses, while Unicorn Birthers will look at you, smiling and bewildered when asked about discomfort, reporting only a little tightening or pressure. The other type of woman who is often confused with a Unicorn Birther is the woman who has a very fast labor, what is referred to in the medical community as a precipitous birth. However, anyone who has taken care of a woman delivering precipitously or anyone who has had such a labor can tell you that it is far from a serene experience. This labors are usually fast and furious, with strong, frequent, and painful contractions that seemingly come out of nowhere and result in a bright red, mad and screaming infant in under four hours. This is very different than a unicorn labor.

It has been estimated that as many as 1% of women fall into this category, reporting little to no pain in labor, but it is still a fascinating experience to work with the real life, walking and talking version of these tales, even when you have seen it before. Just recently, I helped a Unicorn Birther deliver her baby, staring at her in disbelief, as she bounced around the labor room, contracting only every six or seven minutes, smiling, laughing, with perfect makeup and beautiful eyelashes at a good eight centimeters of cervical dilation. I would watch each contraction peak on the monitor, but her smile was unmoved. Sometimes she would touch her belly, feeling the firmness, and state that she “thought” that one may have been stronger. I found myself surprised and relieved that she was aware enough of her body to come to the hospital rather than having her baby on the kitchen floor.

However, very interestingly, of all the Unicorn Birthers I have delivered, I have never had a single “easy” unicorn delivery. Each one of my unicorns have, in fact, had a malpositioned, usually sunny-side up or OP, baby that did not descend into the pelvis without a whole lot of encouragement. This may be why the sensations of labor are so different for these patients, the lack of decent with a cervix that somehow dilates nicely despite the baby remaining high in the pelvis. In each of my experiences with unicorns, once their babies finally did descend, typical sensations of labor ensued and suddenly they looked like normal laboring women, though they often delivered so quickly that the story remained that the labor was essentially pain free.

So, what can these Unicorn Birthers teach us mere mortals about pain in childbirth? Probably something we already intuitively know: that much of the pain of childbirth comes from the forces of labor moving the baby against resistance: the resistance of the not yet fully dilated cervix, the resistance of the muscles, soft tissue, and bones of the pelvis, and finally the resistance of the vaginal wall. When we lessen the resistance, the pain of labor is reduced. This is why epidurals contain medicine to relax the mother’s muscles, not just numb pain sensations. This is why labor tubs relieve pain, the buoyancy lessens the effective weight of the baby moving through the pelvis, thereby reducing the friction acting against it. This is also why mothers who have labored previously often do not feel painful contractions until much later in labor process, as their tissues and pelvis are already stretched and do not resist the descent of the baby to the same degree. This is why meditative methods of childbirth are the most effective. Women learn to control their responses to discomfort and relax their bodies, allowing their labors to progress in an easier fashion. It is also why alternative positioning that promotes an open and relaxed pelvis is usually more comfortable and effective than more constricted positions.

Ultimately, birth is something you must flow with, not fight against

​

There is no shortage of natural birth books. I should know. My bookshelves are full of them and, as an obstetrician who cares for a large number of women wanting natural births, is my business to know what is in them. I definitely have my favorites and regularly refer my patients to one book or another, depending on their needs. However, as I worked to build support for naturally laboring moms within my delivering hospitals and tried to offer my patients better options and techniques for working through their unmedicated births, I found the supply of books and information about natural birth lacking. Here are some of the main challenges I discovered:

1. Religious-Type Devotion to Natural Birth: Many of the natural birth books available to women offer incredibly inspiring natural birth stories and useful tools and strategies for working through an unmedicated birth. Unfortunately, this is often presented in an overzealous fashion, that exaggerates the benefits of natural birth and describes birth and the woman's body with terminology usually reserved for the divine. Birth is presented as something to be "believed in" or "trusted." Naturally laboring women are referred to as goddesses. While I fully support efforts to normalize a physiologic birth process and give women confidence that it is something they can achieve, such biased views of natural birth create unrealistic expectations for women and their partners as they embark on their birthing journey and set women up for disappointment, guilt, and even depression if their own birth does not happen in such a heavenly fashion. This bias also rings very untrue for those who work within the medical community, who each day have experiences with birth that make it extremely difficult to trust. When natural birth is presented with such fervor, doctors, nurses, and even some midwives are less inclined to hear the valuable information contained within natural birth texts or take the women desiring a natural birth seriously.
2. Fear-Mongering: While the medical community is frequently accused by natural birth proponents of fear-mongering or "playing the dead baby card" in order to get women to consent to medical interventions, there is quite a bit of fear-mongering on the other side as well. In most natural birth texts, articles, and blogs, medical intervention is painted with a broad stroke of negativity. For example, women are often told that epidurals definitively increase their chances of a cesarean, drug their babies, and lead to more difficulty breastfeeding, when there is surprisingly little evidence for these supposed facts. Doctors are described as scalpel-wielding villains, without the philosophy or even knowledge to care for women laboring in a natural fashion. Women are told to avoid the hospital for as long as possible in order to help reduce their chance of unnecessary intervention.  It is no wonder that women planning a natural birth feel frightened of their care providers and write multi-page birth plans.
3. Lack of in-depth information about common natural birth requests and strategies: Many natural birth books present overly simplistic explanations of common natural birth techniques. For example, women are encouraged to walk or ambulate, because it "promotes gravity" or is what our hunter-gathering ancestors did and any efforts to restrict movement in labor are reduced to paternalistic holdovers of old-fashioned delivery techniques that kept the physician in control of the process. While these explanations may be partially true, they do not go nearly far enough in helping women and their care providers understand why ambulation is important and the barriers that are currently in place in many maternity units that prevent women from moving as freely as they would wish. This understanding is necessary in order for women and their care providers to work together to achieve this portion of a woman's labor plan. Another thing that is necessary is broader knowledge of the science that actually exists regarding natural birth requests and strategies. For example, most nurses and doctors are unaware of the studies suggesting that a labor tub may speed up labor and aid in correcting a malpositioned baby or the studies showing the impact of a doula or the hospital environment on the labor process. Due to the abundance of misinformation readily provided everywhere from the internet to the supermarket checkout line, pregnant woman may also be more concerned about the impact of certain medical interventions on their birth process than is warranted by the actual science. Women and healthcare providers alike need better information about natural birth in order to make informed choices.

So, I spent two years reading hundreds of studies about natural birth and writing the book I wish I had, both when I was pregnant with my second child and when I was a young attending working with naturally laboring mothers. It is a natural birth book that is not trying to convince anyone to have a natural birth or pick any one magical method of preparing for a natural birth. The only case this book tries to make is that natural birth plan requests are reasonable and can be met without abandoning good and safe care and women have the right to make those requests and the medical community has the obligation to respect them. By adding a little science to natural labor, women and their providers can embrace what has been shown to work, let go of the fear and distrust that too often taints provider-patient relationships, and find that elusive middle ground where women can be both safe and heard.