I Hate ‘Natural’ Birth: A Doula’s Appeal for Physiologic Birth

Many of my clients and perspective clients will inquire of my services in the hopes of having a ‘Natural’ Birth. Usually from their words I can glean what that term means to them: unmedicated, low-intervention, peaceful, vaginal. And while I understand what they are asking for in terms of support, I always ask for clarification: “In terms of your birth, what does ‘Natural’ mean to you?”

My concerns with the term ‘natural birth’ go deep. I see it as an outdated phrase that might have once been empowering, but is now power stripping, guilt tripping, and creating division in the birth world and in those who choose to have their babies, their way.

A fetus growing and being born is a natural event, whether the method of conception, pain management, provider, or birth location varies. When we use the term ‘natural’ for a certain kind of birthing, it can muddy those waters and easily make birthing families feel overly attached to an ideal, or guilty when that ideal does not become their reality.

There have been times when I meet with my birthing clients whose research, friends, and family have guided them to decide on having ‘as natural a birth as possible’. But in the private space of our meetings, they express that they would like an epidural but feel that they would be shamed, or less of a mother for choosing that route. On the other hand, I have clients who don’t want any pain medications and get bullied by family, friends, partners, and providers into thinking that their ability to have effective pain management that is non-pharmacological is IMPOSSIBLE; that people choosing to have ‘natural’ births are hippy dippy crunchy granola or just masochistic.

This creates such a large division and just on one topic of birth!

There are other complications with the premise of natural birth that can be shaming, especially when a birth veers far off track.

My Birth

I remember my own birth when we phased out of being able to have a safe home birth and arrived at the hospital to be induced. There was so much judgment around us having come from a home birth. There was an underlying tone from the staff of, “Well what did you expect? With the dangers of HOME BIRTH?” When I made the choice to receive an epidural for pain management, I remember my nurse coming in and saying,

“I am so proud of you.”

As a doula I knew exactly where she was coming from. Often, I am in awe of my clients making difficult decisions during their births, especially when they might have gone off of their initial birth wishes. But the way she said it left such an awful taste in my mouth. It felt like she was saying that she had been watching and waiting for me to ask for an epidural. I didn’t hear ‘pride’; I heard “I told you so”.

The next day, when I made the call to give birth to my baby via cesarean, I felt the most empowered I had been the whole birthing process. There were no family members or partners telling me I had to go ‘Natural’ and there were no medical providers who were pressuring me to take all of the interventions. I remember when I stated my preferences for ‘In the Event of a Cesarean’ to the obstetrician and this calm washed over me. I remember having my hands free, wearing my own nightgown into the OR. I remember my husband and my mother by my side, keeping me present. I remember smelling lavender essential oils and hear John Denver singing ‘Annie’s Song’ in the background under the bright lights. And I remember the deep breath I was reminded to take right as I pushed my little babe Julian out into the world and heard his cry for the first time. How magical it was when he was tucked in deep to my nightgown as I heard:

You fill up my senses, like a night in the forest
Like a mountain in springtime
Like a walk in the rain
Like a storm in the desert
Like a sleepy blue ocean
You fill up my senses, come fill me again

I heard those words. I hear that cry. He was snapped against my skin under the elastic of my nightgown and I held him close. The whole world melted.

That was the most natural feeling moment of my whole birth.

After my birth I was told on repeat, “At Least” or “You did the best with the circumstances”. I was told to mourn my birth. All of the messages I received about natural birth growing up didn’t make it seem any better. I didn’t feel like my cesarean was a birth to be celebrated. That magical moment I had wasn’t nourished. It wasn’t ‘Natural’ enough to be incredible. But it was! I was empowered, I was bonded with my baby, and all of the choices surrounding my birth were mine. Would it have been better if I hadn’t felt empowered or in charge of my birth but delivered vaginally, unmedicated, and at home? Is that really what is natural?


I once commented on a post in an online doula support group sharing my view of the outdated ‘Natural Birth’.

I was immediately shut down.

Oh, well natural birth means unmedicated and vaginal. So that is what most people take it to mean.” Thank you, Miriam Webster of the Doula Dictionary for completely closing the book on the emotionally damaging implications that this phrase has caused.

Thank you for making me even more emboldened to say:

I am here to call BS on Natural Birth.

I now introduce a different term that can be all encompassing and also supportive to every birthing person:

Physiologic Birth.

This is a term I use with clients and birth workers to reference birth that is as birthing person and baby centered as possible, allowing for instinctual movement, limited interventions, and ample room for hormones to flow of their own accord. This is term is evidence-based, empowering, and allows the birthing person to create a birth that meets their needs while using physiologic birth as a baseline.

There is this widespread belief that hiring a midwife and birthing at home is as natural as it gets when it comes to birth. But in reality, when we see animals in the wild birthing their babies, they are alone, in the dark, and unsupported by a medical professional. They act on instinct and continue to birth babies with few complications.

In a way, you could consider even having a home birth or hiring a midwife as an intervention. So why is it that we only term interventions as being in hospitals with obstetricians and pain meds? Because in order to make someone feel safe, we have to invite them into an environment where they can feel safest in the best way for them. Whether that is alone, with a midwife, or with an obstetrician, in the hospital, the home, birth center, or the woods.

Using the term physiologic birth allows for people to find a baseline for birth. It’s not some magical reach that only folks with a high pain tolerance and lots of money can achieve. It is, for all intents and purposes, a birth with the least amount of UNECESSARY interventions so that the body can work in its own physiologic way. It leaves room for any needed medical interventions based on the physiologic and biologic messages that the body is sharing. It allows for the complete communication of provider and birthing person. It allows for adaptation, change, and positivity.

Even more than anything else, it allows for empowerment. It is so hard to see a birthing person achieve their goals of having an unmedicated and vaginal birth, to have done it ‘naturally’ and to be disappointed in their experience. I shudder to think that this is what people mean by Natural Birth. Feeling powerless and disappointed is, in my opinion, the opposite of what birth should naturally feel like. So why do we spread the message that it is the ultimate when it comes to birth? Birth should be empowering and positive, no matter the preferences, location, or changes to the plan.

So how can someone have an epidural or other medical interventions and still experience a physiologic birth?

When I have a client who says that they are planning to have an epidural (usually the main socialized indication that you are no longer having a natural birth) I think about a great term called ‘hormonal gaps’.

Anything that interrupts the physiologic flow of birth is called a hormonal gap:

Turning lights on

Getting into the car to go the hospital

Asking too many questions of the birthing person

The list goes on!

All of these have the potential to interrupt the flow of hormones that keep labor progressing. An epidural can be a great labor tool for pharmacological pain relief, but it does create a hormonal gap. The lack of sensation inhibits the flow of oxytocin, which can snowball into a host of other interventions. Because of that, we have to find ways to FILL that gap.

Let’s bring that birth back to a baseline while still empowering the birthing person for their choices. I like to do some meditations with music, essential oils, dim lights, upper body massage, and positional support to keep my client focused and aware that they are still birthing. They still need to trust their instincts and allow the pain relief of the epidural to help them hone in on their needs. In that way, we are bringing that birth back to baseline, back to as physiologic a birth as possible. Not unattainable, not lesser than and always natural.

Let’s form a society that lifts all births up. That doesn’t push down birth OR put it on a pedestal. That sees it for the natural experience that it is, in the hospital, at home, in the OR, at a birth center, or otherwise. We all deserve that, and we are all deserving of experiencing a birth that is true to our core. A birth that is supported by our community, providers, and by the billions of ancestors who birthed empowered before us.