It is about a journey, called labor, that delivers mother and child into each others' arms.

The definition of "normalcy" in birth has given rise to a surprising level of controversy, resulting from a confusion as to the reference point for normal. Is normal birth that which is socially "usual," and if so, are not Cesarean births (or other complications) usual and therefore "normal" in our society? From a social definition and use of the word "normal" as the "norm" (the "typical," "usual" or "average") naturally this would appear to be true. However it is not in a social context, but a biological context that the definition of "normal" birth is presented within these pages. Normal in a biological or physiological sense does not presume a social judgment, but is rather a purely functional term in biomedical usage. In medical charts and at medical conferences, the terms "unremarkable, N.S.V.D." (normal, spontaneous, vaginal delivery), and "normal" are used interchangeably.

My intent in using the biological "normal" is to keep biological normalcy in birth alive in the medical field as well as in our general society. The definition of normal birth in medical terms simply means the natural resolution of labor which does not require medical intervention and in which neither the life of the mother or child is threatened or compromised without such intervention. The fact of increased complication in birth in present society should not obscure our understanding of the normal process. We must not lose sight of normalcy in the face of our recent need for increased technological support in birth. But what contributes to this rise in complications?

Women are struggling, as are the men of our culture, in times of changing values which affect family cohesion and durability. The age of the nuclear family reached its peak and decline in the 1950's. A mother's rebellion from the powerless isolation of suburbia continues to reverberate throughout the 20th century. The fact that children and motherhood are naturally and biologically a part of womanhood inevitably renders childbearing susceptible to an increasing degree of unsettlement as women struggle for identity in economic as well as emotional terms. There is no question as to the absolute necessity for these changes, yet pregnancy and childbirth will be more conflicted for the average woman until the whole of' society has adopted and adjusted to support the changing identity of women in the second half of our century. In a more general sense, the women's movement has indeed catalyzed needed changes for men and children as well. But as a culture we are only beginning to assimilate these changes.

Pregnancy has always been a time of stress, the natural and healthy stress of transformation to motherhood. Pregnancy, labor, and birth have always served as nature's bridge to mothering. It is a natural state of self-reflection and a time when a slight increase in anxiety may be generated and useful to fuel the psychological integration needed in becoming a mother.

The psychological task of pregnancy has been identified as the work of integrating the psyche to include the emotional construct of mothering (Holistic Prenatal Care, Chapter 2, Mindbody Press). Is it any surprise that complications in labor and birth increase with the difficulty of this task?

Society has been reduced to the smallest biological unit possible in childbearing-the single parent and child family. Never before has this smallest of family units been so prevalent. The fact that more women are choosing single motherhood than ever before, in a time when procreation is a choice, reflects the obvious increase in the stress of the role and identity of mother in our culture within a larger family context.

Though by no means attaining a majority, there has been an increase in women choosing single motherhood over traditional shared parenthood. Some women report the stress of both relationship and mothering as overwhelming and markedly prefer to adapt to the adjustments of motherhood on their own (The Finer Report on One-Parent Families and The Journal of Family Practice, 14(3): 581-586, 1982). In the course of history, single motherhood has never before emerged as a viable alternative. The fact that it is being chosen as such echoes the stress that has enveloped women as we quest for change on a societal and cultural level. The changing times of our society are a needed and creative stress born of the energy and potential for personal and cultural evolution. But our times are not without reflection upon the perinatal period, a period which already stimulates a natural increase of anxiety for integration of motherhood.

Our society is in flux, and is not yet supporting the woman of our times sufficiently in the mothering role. Yet women will continue to birth -- to bring forth the needed children of humanity. The human race cannot wait for society to change in order to procreate with greater ease. As women, we are members of our society and will naturally strive to integrate the role of mother on an individual level. Our belief in motherhood is the beauty of our striving, and represents the lifespring of human existence today. However, the rise in obstetrical technology and intervention has confused the definition of "normal" birth. Confusion has occurred as a result of two very divergent but interdependent phenomena: the very real rise in need for technological support in birth in a transitional society, and the very real rise in complications resulting directly from unnecessary and/or dehumanized obstetrical intervention.

In response to distress the medical model has responded with more technological intervention. In a model in which bodies are viewed as machines, naturally intervention is aimed solely at the mechanical manipulation for resolving points of cumulative stress that may peak in the full force of a woman's labor. The medical model offers women the only support it knows- mechanical resolution. Medical intervention has served not only necessarily for physical manipulation of outcome, but in some cases unnecessarily for socialization to the cultural norm of "good patient." Physicians, in some cases, perform Cesareans as a means of quick relief from the normal pain of labor when the woman in labor does not "deal well" with the pain (i.e. in our culture, quietly and without complaining). An increase in technology beyond that already necessary in stressful times has resulted in a backlash of angry women who feel cheated of the opportunity for a normal birth (Cohen, N.W. and Estner, L. J Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean, 1983). Women have reclaimed their rights to nature, to their bodies in a manner necessary for society to remain alive and healthy. Yet, times remain transitional in the 20th century, and having alternatives in childbirth available may not ensure a woman an easy transition into motherhood or an uncomplicated birth. Support of both a technological, in some circumstances, and an emotional nature, are needed. The need for increasing awareness of counseling as a natural part to prenatal care cries out to us. Availability of counseling services to support a woman's integration of mothering in a transitional society must be given if we are to use other than medical technology to reduce risk and to mitigate the stresses of the average modern woman entering motherhood.

How do we support women through the emotional integrative work to pregnancy without "blaming" ourselves or the pregnant woman for birthing outcome? What part of ourselves creates the potential to "blame" in order to recognize the impact of psychoemotional variables in the birthing process? Perhaps a social value judgment on "normal" delivery outcome is not necessary, but merely a byproduct to a competitive society. The competitive society places judgment on "performance" in all areas to our lives, invading even the privacy of our most intimate experience-birth and sexuality.

Perhaps it is the belief in competition, the erroneous interpretation of Darwin's theory of "survival of the fittest" which gives birth to the intention to blame a woman or a society for birthing outcome. And it is blame itself that tightens and restricts our capacities to help ourselves and others.

Birthing Normally addresses the need to keep sight of our biological definition of "normal." It does not serve women to be dissuaded from the biological "norm" in the name of unnecessary obstetrical technology. A 50% Cesarean rate should not replace a social normative for a biological definition of the normal (Cohen and Estner, Silent Knife ). For, if we are to stray too far, how will we return to that which is natural? How will our daughters return to a belief in their bodies to give birth? Nature may reflect a temporary stress of our times, however we must be clear in our knowledge of what is defined as "normal" biologically, so that the average woman now and eventually can return to biologically normal birth.

There is no success, no failure in birthing outcome within a holistic model. Blame becomes an anachronism... Birthing Normally is about the individual and creative way women adapt to the labor process, and about the natural and healthy stress a woman deals with in pregnancy as she adjusts to her baby to come. It is also about a woman's inevitable transformation as she hibernates that aspect of herself that will become mother. And it is about a journey, called labor, that delivers mother and child into each others' arms.

Copyright 1995 by Gayle Peterson. All rights reserved under international copyright conventions. This excerpt has been reprinted with permission from Shadow and Light Publishers. This article may be printed out for personal use but may not be reproduced in any manner, including electronic, without prior written permission from the publisher.