Thoughts on Birth

“Birth is not only about making babies. Birth is about making mothers ~ strong, competent, capable mothers who trust themselves and know their inner strength.”

-Barbara Katz Rothman


My friend Melissa recently wrote a great post on Unassisted Childbirth (UC) (click here to see her followup post as well). She discussed her opinion of UC, her thoughts on the open letter Navelgazing Midwife wrote to the Australian birth activist whose baby was stillborn during her UC, and ends realizing that we in the developed world are bickering over type of attendant when there are women and babies dying for lack of a skilled attendant at all. I have been pondering the post and formulating a comment. While I was doing that, I came across something that I thought was very relevant to the discussion. I subsequently decided to write my own post in lieu of a comment on Mel's blog (sorry Mona, I know how fun it is to get comments!)

Birthing Your Baby blog pointed to an excellent Mothering.com article called Breaking Free of Mother-Guilt*. Here are some excerpts:

How, for example, do we discuss the overuse of cesarean delivery without making the one-fifth to one-quarter of us who've had one feel bad, or promote extended breastfeeding without seeming to blame women who haven't been able to do it?

I suggest that the answer lies in achieving a certain perspective. This perspective starts from the premise that each of us does the best she can—given the particulars of our knowledge base, resources, support system, and the circumstances in which we find ourselves (and which we often cannot fully control). No one should ever allow herself to feel judged inadequate for doing the best she could, or the best she knew at the time of choosing. But we must also note that because our knowledge base is one of the keys in our decision-making process, it is absolutely appropriate that every effort be made to disseminate good information as widely as possible—never to blame people for past choices or idiosyncratic situations, but to get good facts out to whoever needs and can use them.

A UC is where a woman gives birth intentionally either alone, or with family/friends, but without a trained birth attendant such as a midwife or OB. I'm not going to say that I agree or disagree with the practice of UC. Each situation is unique, and each woman does the best she can, makes the best decisions she can, given her "knowledge base, resources, support system, and circumstances". I am sure that the Australian woman felt strongly she was doing what was best (and maybe she was- no details have yet been released). Babies and mothers die sometimes during childbirth. It happens in the best hospitals. It happens in assisted home births. And it happens in unassisted births. There are also beautiful outcomes regardless of location or who is in attendance. Not that it is a crap shoot whether you and your baby will live and die. I absolutely think that some birthing environments lead to better outcomes than others (and research supports that). But sometimes even in under the best circumstances things do go wrong. Presumably each woman does her best to minimize the risks she perceives, and others may disagree based on their own perceptions, but we must be careful not to judge. I have made different decisions with regard to each of my births based on my research and experience. I can't beat myself up for decisions I made with my first and second births which I won't repeat for this third birth. I'm in a different place in my journey, knowledge, resources and circumstances.

What about the women who just haven't got the same range of choices many of us do? The women who live in communities where there is no qualified birth attendant? Or women who have access to a birth attendant but tragically no access (for a variety of reasons, including lack of funds or pure apathy on the part of the medical staff) to emergency medical care when it is required? Read a this news story about a young African woman who died recently of postpartum hemorrhage, leaving behind her newborn and four older children. She was unable to get to a medical facility for treatment. Melissa said:

There is a poverty of skilled birth attendants in the world, and here we are in our developed nations quibbling over to choose or not to choose a birth attendant. It makes me think of Marie Antoinette's "They are hungry? Let them eat cake!" We have so much we don't realize how privileged we are. Instead of buzzing around gossiping about the birth of one UCer's baby in Australia, we should be standing up and shouting for the rights of women in countries around the world whose babies and who themselves are dying by the thousands because they don't have the option to choose a skilled birth attendant.

True that we in the developed world often don't recognize and appreciate how privileged we are. True that we should be standing up and shouting for the rights of women who are denied basic medical care. But it doesn't mean that we shouldn't also continue to work locally to educate women and caregivers, and to advocate for change where evidence based protocols are not being followed. To work to improve the outcomes and experiences of mother and baby.

The more I learn about childbirth, the stronger my feelings that God has designed us women beautifully for birthing our babies. Given education, support and safe environment, I believe that the majority of women have the capacity to safely give birth vaginally, joyfully, and to come away feeling strong and empowered. It grieves me that so many women are left believing that their bodies are broken. That some have outright traumatic experiences. Unnecessarily.

Consider the "cascade of interventions" which begins with a procedure not medically indicated and which leads to a real medical emergency in the end.

Example: A woman comes to the hospital in very early labour. She is offered the drug pitocin to speed her labour- with the promise that the baby will be born very soon as a result. She is not informed of the risks of pitocin (which include ruptured uterus, postpartum hemorrhage, and fetal asphyxia. See the link to read more about pitocin. Interestingly, the article states, "...the drug never was approved by the FDA for use in augmenting labor."). The pitocin makes her contractions much stronger, and they become very painful. She is offered an epidural to relieve her pain, but again not informed of the risks of epidural anesthesia (they include fetal malpositioning, instrumental/surgical delivery, difficulty breastfeeding). The epidural slows the contractions. The pitocin is therefore increased. The contractions are much more intense and unrelenting than non-augmented contractions, and the baby doesn't tolerate them well. Fetal heart rate indicates distress. Emergency c-section ensues. Woman is grateful that the medical team 'saved' her baby. But the baby wouldn't have needed saving if labour had not been artificially augmented with the drug pitocin!! Was this woman's body broken? Did she come out feeling strong and capable?

Some may say, well at least the baby is ok, and that's all that matters. Yes, absolutely it matters, but doesn't it also matter that major abdominal surgery could have been avoided? That a normal physiological event was transformed into a medical emergency- with all the risks and harmful side effects that come along with that... unnecessarily? That mother and baby unnecessarily missed out on all of the benefits of a normal vaginal birth? Humans are incredibly adaptable and absolutely can overcome suboptimal conditions. Thank God we can; medical interventions do save the lives of babies and moms who wouldn't otherwise survive. But if we have an opportunity to provide optimal conditions for birth- the birth of the baby AND of the woman as a mother- the burning question for me is why wouldn't we do our best to seek it and to provide it??

The beliefs I stated above are based on my research, circumstances, experiences, understanding and general gut feel. Each woman has her own unique set of circumstances and worldview and I certainly can't and shouldn't force anyone to hold the same beliefs as me. But what I can do is to offer solid information that allows women to make informed decisions about their birthing experience- from the care provider to the location to the interventions accepted. Consumer demand as a result of good information will hopefully bring change where evidence-based care is not being provided. That is why I want to be a Childbirth Educator- knowledge can make such a difference to a life. My challenge is to provide that information in such a way that doesn't minimize anybody's experience or cause guilt or offend.

I realize this post is a bit on the rambly side, but since it is a blog post and not a dissertation I trust you'll forgive me. There are plenty of related topics that beg discussion, and topics included which lack depth. But I think I'll leave it at this for now.

* a related article, Regrets, is also well worth reading

Read this doula's blog entry about a pitocin induced labour she attended. The birth stories in the comments are also very interesting.