"Normal birth", does it exist or is it just a value judgment?If you search for scientific papers about "normal birth", you will find very few prior to 2007 when the expression was popularized by midwifery organizations. The Royal College of Midwives started their "Campaign for Normal Birth", and papers began to appear with titles like "Preserving Normal Birth" and "Normal Birth: Women's Stories". What does it really mean to call a birth "normal"? Does it reflect actual statistics on what birth is like or is it merely a value judgment? Is birth "normal" when it follows a particular course, or is it "normal" by virtue of fulfilling the function of producing a healthy baby for a healthy mother?
I would argue that the biggest difference between the medical model and the "normal birth" paradigm is that the medical model derives from statistical analysis and focuses on the functional outcome of birth, whereas the "normal birth" paradigm makes explicit value judgments ("normal" is superior) and is obsessed by process, rather than outcome.
Doctors describe "normal" with reference to large populations. How do we know what a normal blood sugar is? We look at the distribution of blood sugar levels through the population and the functional results. Normal is the statistical range of blood sugars compatible with healthy bodily function. This has two important corollaries. 1 There is no particular value assigned to normal blood sugar, beyond the value of avoiding illness. 2 A blood sugar level is normal regardless of how the level was attained. A blood sugar of 100 is normal regardless of whether it occurs spontaneously in a non-diabetic individual or whether it occurs after a dose of insulin in a diabetic.
When it comes to childbirth, also, doctors describe "normal" with reference to large populations. How do we know what the normal length of labor is? Doctors look at the distibution of labor lengths throughout the population. "Normal" is the statistical range of labor length compatible with minimal complications. The same two corollaries that applied to blood sugar also apply to length of labor. There is no particular value assigned to a labor of normal length, and, more importantly, a normal length of labor does not depend on whether it occurs spontaneously or whether it occurs because of pitocin augmentation.
The "normal birth" paradigm is very different. Because of the value judgment that "normal" is superior, every effort is made to pretend that all spontaneous variations are "normal". In fact, for all intents and purposes, spontaneous IS "normal". Hence, getting stuck at 8 cm for 5 hours is "normal" and should simply be observed. The "normal birth" paradigm is obsessed with process. A pitocin induced labor that follows the curve is not "normal" (even though it falls well within the statistical guidelines for length of labor) because it did not happen spontaneously.
Obstetricians are focused on functional outcome. A "normal birth" is one that gives a healthy baby to a healthy mother. In contrast, believers in the "normal birth" paradigm actually spend time debating whether a women who has a C-section has had ANY "birth" let alone a "normal birth". The "normal birth" paradigm uses the word "normal" in the same way as homophobes refer to heterosexual relationships as "normal"; it claims or implies that C-section birth is "abnormal" in the same way that some people refer to disabled people as "abnormal". The "normal birth" paradigm uses the word "normal" in the worst possible sense; as a value judgment where "normal" is superior and everything else is "abnormal".