Natural Hospital Birth: The Best of Both Worlds Cynthia Gabriel The Harvard Common Press , 2011 Boston, Massachusetts 256 pp, $16.95, pb

Cynthia Gabriel, doula and medical anthropologist, provides the practical information women need to give birth as naturally as possible. She unhesitatingly defines “natural birth” as “the most instinctive, self-directed, intervention-free birth possible” and celebrates its empowering worth for women and for attendant practitioners. Natural Hospital Birth enables women to engage in a positive way with an environment which, often depending on luck, either forwards or thwarts their desires to give birth naturally. It suggests many concrete strategies a mother-to-be can use to achieve confidence in the rhythm of her labor and to negotiate among the most common obstetrical beliefs and practices that could change the unique nature of her experience. It gives a clear idea of what to prepare for, summarizes what to do, or try to avoid, condensing each scenario into a few reminders so that a woman and her team can actually remember and use them. The rich text includes helpful lists, charts, illustrations, and many personal stories.

Part One, “Preparing for Your Baby’s Birth,” encourages women desiring natural birth to be self-assured and unafraid, in tune with their instincts and emotions and informed about the hospital practices they may encounter. Above all, during labor they must feel safe, calm of spirit, relaxed, and open physically, spiritually, and emotionally. To this end, the author, while aware that expectations may go awry, encourages pregnant women to create two birth plans, and to take them seriously, even reverently. The first (more of an essay, perhaps, than a plan) would include a vision of an ideal birth, hopes, dreams, fears, lessons learned from past experiences; the best “birth team” (friends, family, practitioners) to choose for assistance during each phase of labor; and possible familiar rituals that will nurture them. The second shorter plan is designed to invite a useful dialogue and collaboration with birth attendants and medical practitioners. It will list the woman’s desires positively and specifically—to let labor begin on its own, to remain at home as long as possible during early labor. It will stipulate replacing interventions and medications with time-honored alternative techniques, such as dimming the labor room lights, enjoying as much privacy as possible, freedom to eat and drink when needed, moving around and adopting the most useful labor positions, and using water for relaxation. This document is meant to be flexible; it can be adapted to new circumstances as they arise.

Gabriel urges women to identify challenges beforehand. She presents the kinds of situations in which they may find themselves and suggests rehearsing possible incidents, from practicing positions for labor to the actual range of things they might say to prepare for the known—and unknowable—events to come. Optimally, they maintain a strong sense of what feels right and comfortable for themselves, keeping in mind their needs and those of their babies.

Part Two, “Giving Birth,” describes labor, first, as a “snapshot” of what will happen at each phase, and then in detail as to how it will feel and the challenges it presents, from early on up to the baby’s birth and afterwards. It offers information about how to handle early day and night labor (walk, watch a movie, meditate, sleep, ignore it as long as possible). It asks a woman to figure out her labor patterns, identifying categories of pain intensity and effective labor postures. It specifies certain concerns about the baby that may arise, such as changes in heart rate or position in the womb, with ways to assess them both on her own and with her birth team’s assistance.

In the hospital, women can postpone the use of suggested medical interventions, taking their time, by uttering the powerful but simple phrase “I’d like to wait an hour.” They choose among the comfort measures mentioned above and accept relief from the intensity of contractions through touch, visualization, massage, and movement. They have heard about surrendering to labor pain, and (with encouragement) letting go of the thoughts and fears that prevent them from releasing and opening up. Gabriel advises women to experience the range of their emotions according to their natures—laughing, crying, and moving around, retreating inward, or meditating—all of which create the capacity for the deep breathing which allows for oxytocin and other endorphins to move labor forward.

A useful chart depicts the possible physical, emotional, and “baby-caused” reasons for labor to cease. Labor plateaus, a natural part of the birth process, are not unusual, though their timing often does not correspond to a hospital’s time protocol or a practitioner’s schedule, and the tendency is to hurry women along with medication or other interventions. However, plateaus offer an opportunity to figure out what’s going on, to ask for advice if needed, and to let labor resume at its own pace. Women can learn to distinguish emergency situations from nonemergencies. If indeed truly medical problems exist, or emergencies happen, the hospital staff is trained to deal with them. It is up to the woman to remain as calm as possible.

The book’s appendix contains common medical interventions arranged in the order in which one would encounter them—medical induction, amniotomy, vaginal exams, electronic fetal monitoring, epidural analgesia, episiotomy, and routine Pitocin to deliver the placenta. Each is described, with points to consider and alternatives to take their place.

Increasingly, natural birth in hospitals may seem an unrealistic goal, given the climate of doubt fueled by the prevalence of medical routines, the mindset of physicians and nurses who have never attended births with minimal or no interventions, and the increased fear of labor that exists among women in our present culture. Indeed, women may have to strategize before and during labor, treading carefully, winding through a maze of institutional procedures, hoping that their convictions expressed positively and tactfully will inspire hospital personnel to understand their vision of giving birth. Such planning would be unnecessary if they could confidently deliver their babies just as they wanted with medical help nearby when required. But if that is not possible, books as strongly written as Natural Hospital Birth are greatly needed. They can make a difference.

Here is a wealth of wisdom garnered by a doula whose profession enables her to understand both women’s intense drive to give birth using their own powers, and the character of the institutions in which most babies are born. Its realistic stories and pragmatic advice shine a light on what has already been accomplished. It will inspire many women to achieve the satisfying, even transcendent birthing experiences that also benefit their babies and families. I recommend this book for all pregnant women, families, and practitioners who want to understand the deep connections between body and mind, and the immense value of a natural labor experience intelligently and fully lived.