Top Ten Tips for Natural Childbirth

The first natural childbirth I saw wasn’t pretty.  It involved a good deal of flailing, cursing and pooping.  Additionally, the patient kept repeatedly screaming, “This isn’t how it looked on the baby story!”  As a young med student, accustomed to seeing epidural deliveries, I remember walking out of the room thinking, “Why on earth would anyone want to do that?”

Over the years, I’ve seen many beautiful natural deliveries. I’ve begun to understand the longing women have to birth naturally. Witnessing women who choose to do it au naturale is inspiring. Their strength is amazing.

I have cared for a lot of women attempting natural childbirth. Some by choice, others by accident. I’ve seen what works and what doesn’t. After reading Jessica’s review of Unbound Birth, I thought I would assemble my list of helpful hints.

The Pregnancy Companion’s Top Ten Tips for Natural Childbirth

10. Be  Healthy Before You Get Pregnant

The journey of natural birth begins well before the first contractions. Actually it starts before the pregnancy test fades to pink. For a healthy baby and natural birth, the best first step is a healthy mom. Obesity is one of the biggest risk factors for gestational diabetes and pre-eclampsia.  Both of these conditions often require induction (see #1) which can decrease your chances of successful natural childbirth and increase your risk of cesarean section.   Chronic medical conditions such as asthma, hypertension, hypothyroidism and diabetes can also causes pregnancy complications. Having them under optimal control before conception is key. 

9. Know Why You Are Choosing Natural Childbirth

Do not choose natural childbirth because your mom did it, your husband thinks you should or all the girls in your MOPS group are doing it. You choose it because in your heart of hearts you know that natural childbirth is important to you.  You must truly believe that its the best thing for you and your baby.

This is your birth, your delivery, your decision.  It’s your vagina that’s getting a cantaloupe squeezed through it.  It has to be your conviction.

8. Have a Strategy

Natural childbirth will likely be one of the most challenging things you ever do in your life. You need to be prepared. Whether it’s Lamaze, Bradley or hypnobirthing, know what your plan is for when things get bad. After you formulate a plan check to see what items your hospital has available (i.e. showers / birthing tub) and what you need to bring (i.e. Yoga ball). Practice the different birthing positions. Keep a list of your pain management strategies.

7. Have a Good Coach

When you are in transition and you are experiencing pain on a level that you have never felt before, you may not remember all those birthing strategies you practiced. That’s why you need a coach.  Some husbands are great at this, others not so much. If your husband may not be the best birth coach, hiring a Doula (a professional birthing coach) may be a good option.

6. Have a Really Quick Labor and  Come to the Hospital  When You are 7 cm

Or at least labor at home as long as possible. Discuss with your provider how soon you need to come to the hospital. This will be dependent on how dilated you are, how many babies you have had and how far you live from the hospital.

Having a quick labor is also helpful, but sadly I don’t have the magic recipe for that or else we’d be selling a lot more books.

5.  Be Determined

I have a lot of patients who tell me, “Well I want to try to go natural, but leave the option open for epidural if it gets really bad.”  These women, with the rare exception, end up with epidural. Labor is stinking hard and it does get bad. Of the women who say epidural is not an option, about 50% of them make it natural.

Realize this is going to be hard and stick to your guns.

4. Don’t Listen to the Haters

If natural childbirth is important to you then it doesn’t really matter if anyone else thinks you can do it, it only matters if YOU think you can do it.  I have patients ask me all the time if I think they will make it natural.  I always say, that anything is possible.

I have been proved wrong many times by patients who succeeded in natural childbirth despite the odds. Patients I thought would cave – like the unprepared teenager who had to be induced, but was just stubborn enough to stick to her guns and make it natural. There have also been patients who I swore would make it, like the 30 something with a 10 page birthplan and the Bradly book memorized, who got her epidural at 1 cm.

3. Don’t Get Fat

When you gain weight in pregnancy you gain it EVERYWHERE, including your pelvis. The fat takes up space in the birth canal that the baby desperately needs to squeeze through.  All those extra calories can lead to a big baby, making it even harder for the baby to come out. Additionally, packing on the pounds increases your risk of pre-eclamplsia and gestational diabetes, both of which increase the need for induction and cesarean section.

A normal BMI patient should gain between 25 – 30 pounds during pregnancy with the majority of that being after 20 weeks.

It’s all about moderation:  Give into to your crazy pregnancy cravings twice a week not twice a day.

2. Keep Walking

Gravity is your friend. Stay mobile in labor as long as possible, let gravity help urge the baby further down into the birth canal. When walking hurts too much, rock on a yoga ball or stand and sway your hips back and forth.  Stay out of the bed as long as possible.

1. Avoid Induction

Natural childbirth is hard. With the rare exception, its one of the hardest things you’ll every do. Natural childbirth with pitocin is even harder. It can be done, but it makes the already crushing contractions even more abrupt and intense. Some medical conditions do necessitate induction, but if you can avoid it, that  is your best option.

I must now give a disclaimer: I have never personally experienced natural childbirth.  If you want me to be totally honest, I have never actually had a vaginal delivery. But I’ve delivered over a thousand babies, so I have observed many natural labors.  These are the strategies that I’ve observed leading to the most successful natural births.

For those who have delivered naturally, do you agree with my tips? What do you think was the most helpful in your natural birth?

{Photo Credit}

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  1. 1


    Great post … I was skeptical reading this at first because you’re an OB, but I actually agree with most of it :)

    The only thing that was different for me is that there was no “longing” to have a natural birth. I had a natural birth because it just made sense – that’s what our bodies are built to do.

    I don’t believe birth is supposed to be hard and horrible. I’m not saying it’s not for many women, these days, but I just don’t agree with the notion that “nature is usually perfect EXCEPT when it comes to women birthing.”

    I realised that we are not supposed to have horrific experiences to have our babies. Birth can be beautiful, but its just that we are so caught up in our overly processed world that it interferes with what’s natural – women in a sense have forgotten how to birth naturally.

    It’s not our fault, but it’s important to teach each other that while it’s great to have medical support when unexpected things arise, birth is normal.

  2. 2

    Ruth says

    Yes, it’s a good list! I had a natural first birth (with a posterior baby) that took a couple of days but only 6hrs in hospital. Positive birth, but very painful and hard to cope with. Then I had an emergency classical caesarean at 25 weeks with our surviving fraternal twin. Not so fun. I was blessed with a beautiful, perfect VBAC (in hosiptal, but the staff missed the birth so I was able to catch our baby myself!) where I had no internal exams, no constant monitoring, no anything other than an IV placed for precaution (I had consented to monitoring, the midwife was off getting the doppler when I birthed kneeling in the shower!!)

    The only suggestion I would make is – don’t ‘stay out of the bed as long as possible’ ….Just stay out of the bed altogether!! Due to some complications with my first birth, I was on the bed. Same with labouring second time around (next to no amniotic fluid, haemorrhaging severely etc) Last birth was amazing, and there was no lying in a bed ;-)

  3. 3

    Janna Cornish says

    I completely agree with everything you said. It is so true how we want to give natural a go, but have an epidural on stand by. That was actually what I said. I did a hypnnobirthing class – however I ended up with so many complications in my pregnancy, I knew that wouldn’t be possible. Only weeks before I have birth I was told I wouldn’t be able to have an epidural due to a platelet count of 75,000, and in a way I was glad for this as it have me no option. I ended up with severe pre eclampsia with a bp reading of 180/120. I was induced at 37+4 and lucky for me delivered vaginally in 6 1/2 only using the gas. I agree – induction is so intense and painful, but I was so proud of myself!

  4. 5


    This is a great post. I agree with most of it.

    That said, it seems a little fat phobic. Don’t get me wrong, obiesity is a risk factor, but in my experience, only in that it is also a symptom of many other health problems (or cause, in the case of Type 2 diabetes).

    I am obese. I’m not like, 400lbs obese (which would look really akward as I’m only 5′ tall to begin with…I’d literally be wider than I am tall!) but I AM overweight. With my first, I weighed 218lbs at conception. I was also induced and gave birth naturally despite the pit. Like you suggest here, I have fast labors, though. My first “active” labor was only 6.5 hrs long.

    Then again, I prodomal labor for WEEKS before having a baby. The shortest bout of start n stop labor I’ve had before delivery was two weeks. I wish I was exaggerating. With the exception of my first child, I started active labor at at least 4cm dilated.

    Anyway, my point is that being fat doesn’t necessarily mean you are going to have tons of problems delivering naturally. for many women, getting pregnant happens whether they are fat or not. There are a LOT of things a woman can do during her pregnancy to help make natural delivery *likely*, even if she is obese. I have attended births (I’m a doula) for obese women that went perfectly. In fact, the last one I attended was for an obese friend of mine who had a textbook, perfect delivery despite being fat AND have gestational diabetes.

    These tips are excellent and if you happen to be reading this and are fat, just remember that the author is an OB. She is obligated to tell you that being fat can cause problems-and she’s right. But it’s not a “forget it” sentence. I’ve given birth to three children (two of them at home) without any problems at all, a fat vagina notwithstanding. Remember, fat if squishy. It moves. If you’re pregnant and fat, start with eating a healthy diet and and stick to it. I don’t mean go on a diet. NEVER restrict calories while pregnant. I mean eat whole, wholesome foods, many small meals throughout the day instead of three huge ones and stay away from things like donuts and candy bars. Get out and move, walk, jog, whatever. follow these tips, most especially Number One and number Nine.

    Also, educate yourself. Know what normal birth is supposed to look like (hard, sweaty work!) and understand that “normal” is a huuuuuge range of variety. Know what hospital interventions are likely, what they are for, if they are evidence based or traditional, etc etc. Learn about what your body does during labor and delivery and what complications actually are and how they are treated.

    At the end of the day, wonderful people like the author here cannot give birth for you. Only you can give birth. birth is something we DO, not something that happens to us.

    • 6


      I didn’t mean to be ‘Fat Phobic’ but as I was writing this I was looking for risk factors that could be on some level controlled. Gaining an excess of 50-60 pounds (which I see happen quite often) during a pregnancy does increase your risk of c-section. I am hoping to encourage women to really prepare their entire pregnancy for a healthy delivery. And you are right it is possible to be overweight an delivery naturally, even with induction. I have had some similar deliveries lately that were great. But current statistic put the c-section rate with a BMI >40 at 50%, which is way too high.

  5. 7


    Oh I wanted to answer one of your questions: What was the most helpful thing for my natural births?

    For me, aside from the absolute belief that I could and would do it (I, too, believe that female mammals are designed to give birth…there’s a whole human race to back me up on that one) it was my support team. I had one hospital birth and two home births. Home is definitely an excellent place to be if you want a natural birth because it’s the place most women feel the safest and least restricted when it comes to coping. It’s the one place where they can truly, completely relax and just go with it. However, it’s not an option for many women, for a variety of reasons. Because of that I can’t say “being at home” was the most helpful thing; for me it was just where I needed to be. However, the one thing that was true for all three of my births was that the people supporting me, be that my midwife, my husband, or my friends, were truly supportive.

    There was never a moment where anyone was trying to get me to choose an epidural. I was never subjected to scare tactics because somebody needed to make a tee-time. There was never a moment during any of my births where the people around me didn’t believe that I was going to birth my baby. There attitude was always one of support: they were there if they needed me but as long as I had a handle on it they left me to do my work in peace. I think this is PARAMOUNT. Women need to feel confident going into the birthing room and when their confidence wavers (and it WILL, birth is HARD) they need their support people to remind them that they ARE competent and completely capable. It made all the difference in the world for me.

  6. 8


    The only thing I would add is make sure you have a supportive medical team and OB (or just choose an out of hospital birth to begin with). I am a Bradley instructor and I see a HUGE difference between my students who have to “fight” to get what they want and those that have a team that encourages natural birth. I know if I had been in a hospital with my daughter I would have ended up with a cesarean due to failure to progress, but my midwives stuck by me through all 42 weeks of pregnancy and 41 hours of labor!

  7. 9

    Lucy says

    I found your tips wise however I’d like to add a few more tips of serenity! I am 26 weeks pregnant with my first baby (she’s a girl) and so far I am loving my pregnancy and hope that I will love my natural labor too. I have participated in various seminars, read many books (and blogs) and most importantly, I experienced my sister’s birth to her son (with a midwife) some 15 years ago. This experience has helped me immensely when it comes to visualizing my own labor, simply because I have a slight feeling of what to expect! However, from both my experience and the advise I’ve been given, one must find the beauty in the moment (or hours if so) of labor. Adding some small details such as lighting some candles (even in the hospital), dimming the lights (even at the hospital), walking and humming a favorite song (or lullaby) while labor begins, squeezing a yoga ball when in pain are a few more tips I would add to mothers-to-be. Take it easy and your body know exactly what to do (no other mammal has a doula or a coach). One must allow that knowledge to flow…

  8. 12


    Yay for natural birthing!! I birthed my last two at home and what a night and day difference for us! My first two were induced, really unnecessarily, and hospital births, with everything under the sun done to me and baby. Hubby and I looked at each other and said *there as to be a better way*… And there was. We found an awesome midwife and supportive group of other natural birthing couples. We still saw my ob throughout each pgnancy, but planned homebirths with last two and we were very honest with doc all along. He literally asked us after the first home birth – how did you do it? – like he couldn’t fathom such a thing and never believed we’d really go through with it.

    We miscarried our fifth baby last year at around this time. We had no idea that anything was wrong until our first ultrasound at 13 wks. Horrible. Gut-wrenching. But God still provides.

    So glad to find you ladies! Saw you on mommyhood memos!!

    • 13


      Great list, all very good!

      As for within point six about goign to hospital after dilated and “Having a quick labor is also helpful, but sadly I don’t have the magic recipe for that or else we’d be selling a lot more book”.

      I think we do have the ‘magic answer’ and you have made mention of it yourself.

      It is relaxation.

      It is relaxation of mind and body. Some women have that pure faith in their bodies that brings this state to them naturally. Other women go out and learn relaxation and faith in their bodies!

      (sadly MOST women don’t have the faith or belief and therefore they do not relax. They also don’t know it is part of the ‘magic ingredient’.)

      Women choosing yoga, meditation, pilates for pregnancy, HypnoBirthing, calm birthing.. these women are taking the action to learn relaxation.

      With relaxation of mind and body comes:

      lubrication, opening, oxytocin – therefore effective contractions, a relaxed uterus and therefore room for baby to shift into correct position, relaxed muscles allowing baby to move through birth path and pelvis… the list goes on, you are an OB, you could probably list another 10 more physiological processes to do with birth that are enhanced by relaxation skills…

      Having said all that…

      I birthed my baby naturally without those relaxation skills.. and it is possible to have a successful natural vaginal delivery, vagina intact. the difference is it is like the birth at the start of the article, painful, long, full of screaming and poo!

      Best wishes,

      Natalie Joy Meade

  9. 14

    Ashley says

    I agree with doctor Rupe. She is a great doctor. I am over weight and she is right. I have seen her for about 7 years. My first pregnacny I didn’t really take care of myself the way I should have. I also ate what ever I wanted to. That pregnacny was ruff. I had high blood pressure. So, before I got pregnant again. I joined a gym and changed how my famliy ate. I got my blood pressure way down. This pregnacny has been alot easier. My blood pressure has been good and I have only gained about 34 lbs. I am 37 weeks prego. Everyones body is different and every pregnacny is different. I personaly just roll with it and move on. I was only in labor for about 5 hrs with my first. Hoping this time goes the same.

  10. 15

    Allison Pickle says

    I agree with everything you say Dr. Rupe! Good list! All very true.You are the best doctor this woman could ask for! :) I really like the point about making epidural not an option. As humans we will usually take the easier road. It is better to say in your mind that epidurals do not exist. That sounds silly but it was what I had to tell myself to have my VBAC naturally.

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