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Physiology, what is this? The Real Deal

Birth is not what it looks like on television and in films.

It usually doesn’t start with a gush of your waters releasing, it doesn’t involve highpitched screams and your first instinct is definitely NOT to lie down.

Most of us have to re-learn what labour and birth look like and to learn a lot about our bodies in the process. In this chapter, we will go through some of the things you need to know about how your body works during labour and birth, with the goal of helping you make YOUR best choices informed by basic information on biology and physiology.

What is physiology?
A word that we use a lot in pregnancy, labour, birth and postpartum is physiology. The term basically means what the body does under normal circumstances to get a certain job done. For example, to get oxygen into your blood cells, the normal physiological process is for you to breathe in and out and for your body systems to distribute the oxygen where it needs to be. Most of the time this gets done perfectly without any interference, but sometimes and under special circumstances, you need help.
The same is true of pregnancy, birth and postpartum - your body knows what to do, and if left alone in most cases it will get the job done well. After all, giving birth is a normal bodily function just like breathing is. But just like physiological breathing, physiological birth requires a few basic conditions to help it along - more on that in coming paragraphs. Physiology is also a much more accurate term than “natural” or “vaginal” birth which can be varied and have different meanings for different people.
Physiology isn’t just about you and your body’s processes, it also involves your baby’s adaptation to life outside the womb. A normal physiologic labour and birth is one that is powered by the innate human capacity of the woman and foetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts the normal processes. Some women and/or foetuses will develop complications that warrant medical attention to assure safe and healthy outcomes.
However, supporting the normal physiologic processes of labour and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.

Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by American Midwifery Organisations ACNM, MANA and NACPM (2013)
Usually, physiological labour and birth involve:
• Labour beginning on its own and progressing on its own
• A vaginal birth of the infant and the placenta
• A normal amount of blood loss after birth
• Mother and newborn being together after birth in direct skin to skin contact
• Waiting for the umbilical cord to be white and limp before clamping
• Initiating breastfeeding soon after birth

Physiological birth is not an all-or-nothing experience - including any of these in your birth and postpartum can make these easier for you and your baby.
For example, you can have a caesarean section with skin to skin contact and breastfeeding soon after birth, which can help you and your baby with postpartum adaptations.

Some things interrupt the physiological process of birth, like:
• Induction of labour or being given drugs that speed up and strengthen labour waves (also known as augmentation)
• Pain medication
• Not being able to eat or drink in labour
• Harsh environment (bright lights, a cold room, no privacy, no supportive companions, many healthcare providers)
• Time constraints (having to give birth within a certain period of time, shift changes)
• Any situation where the mother feels threatened, unsafe or unsupported•• Birth with episiotomy, vacuum, forceps, fundal pressure, caesarean
• Immediate cord clamping
• Separation of the mother and baby after birth

It isn’t your job to ensure a “perfect” physiological experience for labour, birth and postpartum. However, it is your healthcare provider’s job to provide an environment and way of working that respects the physiological birth processes and gives your body the best chance to do its job well. When choosing your providers and place for birth, you can ask them what THEY do to ensure that you have the best chances for a physiological process.
Their answer will tell you a lot about the way they work and help you decide if that’s the right kind of care for you.
Physiology isn’t a perfect ideal that you have to obsess about achieving. Instead, think of it like a way of making things as smooth as possible for you and your baby as you go through an important body
and life process together. Even if there are some unplanned changes or detours along the way, ensuring that you have at least some components of physiological birth make it easier for both of you.