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 I see it as an outdated phrase that might have once been empowering, but is now power stripping, guilt tripping, and creating division in the birth world and in those who choose to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.

A Day In The Life: How A Doula Supports You During Labor

At least once a day new friends and strangers ask me,


“So what does a doula do anyway?”


I do my best to answer with the most concise elevator speech I can manage.


“A doula provides continuous physical and emotional support to a laboring person and their partner. They facilitate communication between the care provider and client, promote evidence-based resources and choices, and create a safe and loving pregnancy and birth environment for their clients. I like to think of it as your best friend who also happens to know a whole lot about childbirth and will always respect and support your choices.”


While the above statement is completely true, I think of my work as so much more than that. Sometimes when I give my elevator speech to people I actually want to shout,




This is also a big reason why I offer free consultations. Everyone is different and a doula molds and shifts to your needs and wishes to help you have the most positive birth outcome. I am here to help you figure out what that might mean for you and your partner.


I thought that a great way to describe what a doula does is to go through a typical ‘Labor Day’ as a doula. This, of course, is a fictional description of someone’s labor day. It is comprised of my extensive birth support experience of what is common of a typical full-term, unmedicated, vaginal delivery at a hospital. This is not the support case for everyone and definitely not how every birth I attend goes but it is a great insight into what doula support might look like in this case.


Doula Diaries: Nadia and Jim


So we will call this Birthing Person Nadia and her Partner’s name is Jim. They have expressed wishes for an unmedicated vaginal birth in the hospital. This is their second baby. Their first was born vaginally 3 years ago and is named Poppy. During our prenatal appointments we have discussed their birth wishes and preferences, practiced comfort measures, and done evidence based research to support choices or answer any questions they might have as pregnancy goes on.




Nadia has reached her 41st week and is beginning to feel some contractions every 15 minutes or so. She calls me and tells me of the sensation. I talk to her on the phone and listen through a contraction, using guided imagery to slow her breath and help her to relax. I encourage her to go about her day-to-day activities as much as she can. She loves walking around the mall with her mom so she makes that a plan and promises to keep me updated, drink water, and eat fulfilling meals. I begin to prepare my doula bag, eat something healthy, and update my childcare and back-up doulas so that they are prepared for the upcoming birth.




Nadia calls me with an update that her contractions are getting closer together – every 7-8 minutes – and they are feeling more intense but definitely manageable and that she does not need me there yet. Labor feels REAL. Now that Jim is home, I encourage him to work on the comfort measures we talked about. I remind them both that this is a great time to bond with one another, to be intimate (in whatever form that takes) and foster that love connection while it is just the two of them. Nadia’s mother takes Poppy to her house for a play date so that Nadia and Jim can be alone.



Jim calls and says that Nadia’s contractions are 5-6 minutes apart and she is starting to work hard through each of them. Nadia and Jim are ready for me to come over. I encourage Nadia to try to go potty while Jim refills her water and then get into the bathtub and get comfortable while I head over.




Once I arrive, I find Nadia in the tub relaxing in the warmth. I find her playlist she created on Spotify and turn it on so she can relax to the music. I set up some LED Candles and turn off the lights. I put a big towel over her exposed skin and begin pouring water over her to keep her warm and relaxed. I know that she wants Poppy to come see her during labor so I suggest to Jim that he call the Midwife to update her on the contraction patterns while I call Nadia’s mom to ask them if they can come over now that she relaxed into labor. Nadia’s Midwife suggests, since they are close to the hospital, that she labor until 2-3 minutes apart before heading in. After every contraction I offer her some water.



Contractions are now 3-4 minutes apart and I have been squeezing Nadia’s hips in the tub while Jim strokes her hair and repeats the words of encouragement they have written together. Nadia is focused and calm through each contraction. Poppy has come in to give her kisses and has left to go get ready for bed with Nadia’s mom. I encourage her to relax her jaw and make whatever sounds are comfortable for her, I even chime in to help her feel more comfortable. I gently help her to sway her hips to the music from her playlist. She expresses that she is ready to go to the hospital and I help her to get out of the tub and change into her laboring nightgown, slippers and a sweater while Jim gets the car ready to go. Nadia’s mom comes to kiss her and says she will come to the hospital as soon as she can with Poppy. On the way to the hospital, I call ahead to labor and delivery and inform them that we are on our way in active labor and to alert Nadia’s midwife. They know to expect us and have a room ready so that Nadia can skip over being stuck in triage for another hour without a room.



While Nadia is answering questions in Labor and Delivery, I am putting away her things, spraying her room with a Lavender Spray she likes, covering the clocks, putting the LED Candles up, dimming the lights and screens, turning down the monitor volume, upping her music, giving the nurse her birth plan and introducing myself, and getting her water and comfy pillows close to her. Her contractions during this time are met with hip squeezes from me and loving caresses from Jim. Her Midwife arrives and she gets a cervical check – 7cm, 0 station.



During the excitement of the hospital trip, Nadia’s contractions have spaced out to 5 minutes apart and is having a hard time getting back into the labor zone. I suggest moving to the shower, but she does not want to move because she is in pain (her words). We get her onto her birthing ball so she can be upright and I wrap a Rebozo around her head, covering her eyes and ears. Jim places his hands on her hips and assists her in rocking side to side. I guide her through imagery of facing the ocean with the waves rushing over her feet and rocking her side to side. We stay like this through a couple of contractions. Everything gets very quiet in the room.



Nadia begins grunting and quietly says, “I have to poop. The baby is coming.” I call the nurse and let her know that she is feeling the urge to push. The nurse comes in and we both get Nadia up so that she can do a cervical exam. Nadia is fully dilated and ready to push the baby out. I remind the nurse that Nadia’s preference is to push unassisted in a quiet space so that we can all be respectful of that. The nurse is excited for Nadia and goes to get the Midwife and delivery team ready for the birth.




There is excitement all around as the L&D Team fills the room. Lights come on, there is a lot of movement, and the energy has shifted away from the peaceful anticipation. My focus is on Nadia and I help her get into her most comfortable position for pushing. I cannot control the room, but I can be there for her. I remind Jim to focus on her and be her support, and I lean in to Nadia and whisper in her ear, “Just stay focused on your baby and Jim’s voice. Nothing else here matters. You are incredible, let’s breathe slowly together.” We start breathing through the pushes all together. Within a few minutes, the baby is born and is immediately placed on Nadia’s chest.




As per my client’s request, I take as many photos on my phone as I can to capture the moment. I also ask Jim and Nadia if Delayed Cord Clamping was something that they still wanted to do and, if so, to remind their midwife. I congratulate my client and help to facilitate their post-birth wishes.



Once everything has calmed down in the room, I dim the lights again and make sure they are comfortable. I encourage them to rest and bond in this first hour. I plan to leave for a bit to give them space and ask if there is anything they would like to eat. I take their food orders and begin moving all of their things to their new postpartum room, setting it up so it is ready for them when they transfer. I pick up food and upon my arrival back in the room, I help Nadia to facilitate a good breastfeeding latch.



Once everyone is comfortable and in their new postpartum room, I congratulate my clients, pack my bag, and thank the nurses on my way out. We will have a phone call in the next day, a gift drop off of herbal baths and lactation cookies when they arrive home, and a postnatal visit to walk through their birth and provide any resources they might need.


But it never has to end there. My clients and I usually remain friends. We connect through social media and text with check-ins and questions. I stay a support for this postpartum period, making sure they don’t feel that they are alone.