Please Stop Saying “Natural” When Discussing Childbirth

Yesterday during my 36-week pregnancy appointment, my doctor started to perform the standard late-pregnancy cervical exam, but she couldn’t finish it because I began to scream from the unbearable pain of the speculum, and then her fingers, inside me. “I guess you’re not a good candidate for vaginal birth after all,” she smirked as she quickly abandoned her efforts to see if I’ve dilated, referencing my seeming lack of pain tolerance (and clear lack of stoicism).

Since we had already been discussing an upcoming C-section due to the size of my baby, I wasn’t particularly offended at what I’m sure was an offhand comment. But, the fact that my rejection of intense pain, rather than a silent endurance of it, was what she thought was noteworthy brought up a lot of issues for me around the way people who give birth are often made to feel as though suffering through pain not only demonstrates physical strength, but also moral superiority. It embodied what, as a first-time mum, I am just starting to experience: There are countless ways people are shamed surrounding having a baby, including about the birth itself. Some of the shaming around routine procedures like epidurals and C-sections is explicit and some of it is implied, notably with the use of terms like “natural birth.”

As any pregnant person who ventures online knows, pregnancy-oriented message boards and social media platforms like Instagram and Pinterest are full of statements like: “Our bodies were created for this!” There are a huge number of people who encourage (to the point of insisting on) “natural” births, which, to them, means vaginal and unmedicated childbirth, and discourage others from choosing interventions of any kind. It’s enough to make anyone who has had a C-section or an epidural feel like they’ve failed in some intangible, but profound way.

“Our societies have a high degree of importance that we place on maternal sacrifice, and a kind of martyrdom that goes with being a mother,” Anna Smajdor, associate professor of practical philosophy at the University of Oslo, told VICE. “It's a badge of honour to show that you’re suffering, that you’re sacrificing yourself as a mother.” Aside from placing expectations on birthing parents that stem from deeply embedded harmful beliefs, the natural birthing movement is also often exclusive of marginalised communities, as Alicia Bonaparte, associate professor of sociology at Pitzer College in California, told VICE. “Natural births tend to occur within racialised and class lines, which means that many poor women and women of colour do not have the ability to advocate for a natural birth,” she says.

Both home births and unmedicated births are on the rise in the U.S., and there is, of course, nothing wrong with giving birth exactly the way you want, provided it’s safe. There are advantages and disadvantages to both vaginal births and C-sections, to whether one chooses to get an epidural or not, and to the myriad other highly personal decisions that are made between a birthing parent and their doctor. Many people have wonderful experiences with unmedicated home births, and many others have easy-breezy experiences with elective C-sections. How someone gives birth, then, is a morally neutral proposition, which is exactly why the rhetoric and terminology used around birth — the hurtful comments and outdated terms hurled thoughtlessly, including by some doctors — needs to be abolished. 

Somi Javaid, MD, an OB/GYN, sexual health specialist, and founder of HerMD, tells Refinery29 that she frequently meets women who are hard on themselves because they didn’t have the delivery they were expecting — which is often a vaginal birth, rather than a C-section — and feel their families and friends are disappointed in them. “I remember having to deliver a patient via caesarean section due to an emergency circumstance,” Dr. Javaid says. “Afterwards both mother and baby were doing fine, which was such a relief and a momentous moment. As I talked to her afterwards, I noticed her family was laughing with joy, but she was crying. She shared with me later that she felt like a failure because she wouldn’t be able to join her stroller club and walk as quickly as the moms who had undergone a vaginal birth; she felt like she had cheated with a caesarean section.” As a surgeon and a mother of three who has had two C-sections, Dr. Javaid says she found the patient’s grief heartbreaking: She wanted her to celebrate this moment of new life, not feel ashamed for how her baby had been born.

Thankfully, companies and doctors are beginning to recognise that much of the discourse around pregnancy, childbirth, and parenting is not only outdated but potentially psychologically wounding — and that includes the terminology. Peanut, an app that connects women in all stages of motherhood, recently developed a glossary called Renaming Revolution which includes 63 phrases that are due for an update, along with suggested alternatives to them, with the help of experts including linguists, therapists, and OB/GYNs like Dr. Javaid. 

As part of the glossary, instead of the stigmatising term “natural birth,” Dr. Javaid advocates for being more specific and saying either “vaginal birth” to mean vaginal delivery or “surgical birth” to mean caesarean section. 

“I don’t believe that we should label women that have intervention as unnatural,” says Dr. Javaid. “When we use the word natural for a vaginal birth, I think that’s what we imply — that women who choose to have medications to alleviate pain or who have to undergo a caesarean section are somehow choosing an unnatural path for themselves or for their unborn baby. This sensitive time in a woman’s life is the last time we need to make her feel guilt or shame about her decision or her circumstance. I believe it is time to use empowering, realistic, and descriptive medical terminology.”

The glossary was originally inspired by a video in which a woman expresses how “shitty” she feels after her doctor called her a “geriatric mom” because she’s having a child over the age of 35. A better term, the Peanut experts suggest, is “35-plus pregnancy.” (There, was that so hard?)

“I love moving away from terms like ‘geriatric pregnancy’ and ‘advanced maternal age’ to ‘35-plus,’” says Dr. Javaid. “So many women, due to career choices or life choices, are having babies later in life.” And they shouldn’t be made to feel shamed for how they’ve prioritised their lives.

The glossary, which Peanut is circulating to clinics and physicians, also includes the suggested elimination of terms like: infertile (instead: reproductive struggles); failed pregnancy (instead: pregnancy that will not carry to term); birth defect (instead: birth difference); and stay-at-home mum (instead: full-time childcarer). Dr. Javaid and other experts believe that a glossary like this can help raise awareness and eliminate some of the stigma and shame around pregnancy and childbirth. 

“Words matter,” says Dr. Javaid. “A lot of us do not receive any sensitivity training in medical school and residency.” I hope someone forwards it to my doctor’s office.