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Book Review: Natural Labor and Birth: An Evidence-Based Guide to the Natural Birth Plan by Michelle Aristizabal, MD

I was very pleased with Dr. Aristizabal’s book, “Natural Labor and Birth”, although I must admit I went into it thinking I would just be reading about things I already knew as I’ve attended over 700 births as a doula. That was true in most cases, but I really liked her approach. It was an encouraging book to read because it didn’t come across as judging interventions. While it championed natural birth as a viable and healthy option for women, it also acknowledged the prudent use of interventions. It has been my experience whether in personal interactions or in
books or the media, that one side is so staunchly defended to the detriment of the other. For instance, natural birth is touted as so much of an ideal that anything unnatural is judged inferior. Likewise, when women speak of their plan for a natural birth they are often met with resistance from friends and family, or even their providers or nurses. And that simply isn’t fair, especially since it is the woman’s journey. It has always been important to me that birth be
approached with an open mind from all involved. And I feel Dr. Aristizabal does this.

There is a clear defense of natural birth, as the title describes. But I found it enlightening and interesting when I encountered places in the book where she would use evidence to discourage the presumed correlation between interventions. The most popular one that comes to mind is the often-warned connection between an epidural and the increased likelihood of a c-section. She compares a decent number of studies and couldn’t even draw a correlation between an early epidural versus a late epidural and their impact of having a c-section. It’s just not a cut and dry issue. No labor is. She also goes on to say that the most predictive factor in whether one might be increasing their chance for a c-section is their providers’ philosophy of care. And since the studies to date don’t appear to have evaluated the impact the patient may have on the process, it’s still somewhat murky. But the intervention is not the culprit as much as the people deciding or defending its use. Honestly, that was the point in the book that caught my attention the most. I found her perspective refreshing. And for it to be evidence- based was just icing on the cake.

I also appreciated that she didn’t stop at birth but continued her analysis of studies relating to the postpartum time frame. She addressed the huge deficit in postpartum support that protects the fourth trimester. She also acknowledges how to bolster breastfeeding success. So much can be done to improve what is offered to mothers in the hospital especially, but also at home. She also discussed the importance of postpartum care at home, including pelvic floor and core strengthening exercises, in addition to mental health well-being assessments. I appreciated her holistic, whole-istic and balanced approach by covering every important issue in regard to pregnancy, birth, and postpartum.

In a country where homebirth is just now starting to take hold and grow, it’s important that we present options for a natural birth in the hospital without vilifying the medical system. There needs to be a level of trust to labor well, and finding the balance within the hospital setting for making a natural birth most likely, while still being flexible in case there are changes in the plan, is the best of both worlds. Trusting providers, trusting options, trusting a woman’s intuition, and trusting the process can all be incorporated within the hospital and result in a very high likelihood of a natural birth. And with books like this one, it will only make a natural labor and birth within the hospital a more recognized and realistic option.

*Michelle Aristizabal, MD, FACOG, is a board-certified General Obstetrician and Gynecologist in
Montclair, New Jersey. She runs a busy, private practice with a special focus on supporting women who desire low-intervention, unmedicated births.