We recently watched “The Business of Being Born” and since we are in this business, (I am now 37 weeks pregnant so I’m considered full-term! Bring it on baby!) We enjoyed all the questions and issues it brought up. Mostly, I think it is interesting how we are taught by our culture to fear birth and to mistrust our bodies, when the majority of births are normal. Yes, birth is unpredictable and can be extremely frightening, but our culture is obsessed with this fear when childbirth is a very normal part of most woman’s lives. (My heart does ache for friends who have struggled with infertility or lack a proper sperm donor.)

I have some strong opinions about childbirth since it is a field I have been active in, even years before my own child bearing. I trained as a doula (labor assistant, see http://www.dona.org/ for more info) in 2000. I have always been amazed with birth. I feel it is a miraculous and spiritual process where the power of God moves through a woman’s body to bring new life. Before I was trained as a doula and assisted other women through childbirth, I just kind of assumed I would deliver my future children the way most American women do: in a hospital, with an OB and medical interventions. The film discusses the current crisis in American maternity care. Just watch the film to find out what I’m talking about as there is too much to mention. (The documentary is available thought Netflix and your local library). Suffice it to say that Cuba and Poland have better infant mortality rates than the USA. I read another article recently that stated “the maternal death rate in the USA is four times higher than it should be and why is no one talking about this?”* . There are many very alarming trends that hurt our women and children, many of which come from cultural/medical perceptions which treat birth as a pathology and not a normal, healthy, state of being. I am very grateful for the medical advances that are available and that save women and children everyday. However, in the majority of women, birth is a normal process. With proper preparation, a belief in the birth process, and confronting the fear of childbirth instead of giving into it, I believe women could have more options in the process of birth. Many more problems can arise when unnecessary medical interventions are introduced. (I am not judging people who choose a medical birth, but I do think if women really looked at what is going on in maternal/child health and knew what questions to ask that some different choices would be made.) Here is a local example from Utah. Utah has an 80% induction rate, which directly corresponds to a nearly 40% cesarean rate since induction greatly increases the probability of a surgical outcome. Many OB/GYNs insist that pitocin creates the exact same physical effect as oxytocin, the body’s natural hormone. Not so. This assumption ignores the many other dynamics taking place in the body of a woman who is coming into labor naturally. Pitocin contractions tend to be much more intense and less manageable without pain medications and can put the baby through unnecessary stress. In normal circumstances, about 15% of pregnancies will have a medical reason to end in a cesarean, which again, is wonderful and saves lives. But C- sections are major surgery and carry all the attending risks of major surgery. When they are happening over twice as often as they should, it is time to ask some questions.

Many women feel technology is giving them more options but it is actually taking choices away. What happens with an epidural is a good example. Epidurals are great in relieving pain, but everything that comes with an epidural (urinary catheter, continuous fetal monitoring, IVs, the epidural needle itself, etc) make it necessary for a woman to labor in bed. There are few positions less helpful to the labor process (and birth) then being flat on one’s back. It negates the help of gravity and impedes the woman’s ability to move freely, all of which can help the baby descend and get into a good position for birth. For pain relief and management, laboring in a bath or shower or using different pressure points and positions are also very helpful but are no longer an option. I been present for multiple epidurals and I have seen good and bad examples of the effects they have on a laboring woman. (Good example, a mom with a very, very long labor and was exhausted, chose an epidural, was able to rest and finish dilating, got to 10 cm and successfully brought her beautiful baby into the world. Bad example, the baby’s heart rate slowed down dramatically after the epidural, which necessitated more interventions, not to mention frightening the new parents. Prior to the epidural the baby was tolerating labor without any complications.) As a personal irony, my mom, who gave birth to my six older siblings naturally, had an epidural for my birth and loved it!

As I was taught as a doula, when considering medical procedures we should consider the risks, benefits, and alternatives available. (Even here, there is question as to whether hospitals provide full disclosure as to the risks entailed with certain procedures. If this were not an issue, I don’t believe that purely elective C-sections for healthy pregnancies would ever take place).Women are typically not taught to think like this about childbirth and the medical establishment is certainly not forthcoming with any options other then those which fit their model (a model which is typically geared toward artificial timelines in labor progress and aggressive management). Many first time moms I have spoken to did not even know they had other options in childbirth outside of the typical interventions. And even if a woman is aware of other options, the power disparity that typically exists between a laboring woman and her OB/GYN makes choice illusory.

* from “Masking Maternal Mortality” by Ina May Gaskin in the March/April 2008 issue of the magazine “Mothering”.
More reading about the cultural fear of birth:
http://www.davis-floyd.com/userfiles/Culture%20and%20Birth.pdf
Robbie Davis-Floyd is a Cultural Anthropologist and has many interesting articles about childbirth here: http://www.davis-floyd.com/ShowPage.asp?id=158

On a personal note:
Colin was born in a hospital, and the birth itself was a wonderful and empowering experience. I had Brian laboring with me and could not have done it without him. He has become a great advocate for natural childbirth as he is among a minority of people who have witnessed how labor can proceed naturally (only about 14% of American women give birth naturally). We also had a great nurse, midwife, and two very supportive friends who came to welcome Colin into the world. The hospital never pressured me to receive pain medication or unnecessary interventions, and I was very, very happy to not have an IV, continuous fetal monitoring (Doppler yes but I was not strapped to the bed). However, I had a very quick labor (8 hours total, about 5 hours in the hospital) and things may have been different if I had been hanging out there for 24+ hours. I trusted my body. I trusted the birth process, and visualized every contraction bringing me closer to holding my baby. I was able to totally relax, not fight against the process but completely give into it. The only time I felt uncomfortable in the whole process was when the nurse made me stay still or in a position I did not want to be in to take my blood pressure. I was free to move around and naturally and innately found ways to be comfortable. We had a situation with Colin after he was born where we felt that hospital policy took precedence over what would have been best for our situation, and this is why we are choosing to give birth in a birth center instead of a hospital this time. The birth center is amazingly peaceful and lovely, and has a 3% cesarean rate (which is partially due to the fact that higher risk pregnancies are referred out to OBs and hospitals, as they should be.) All other outcome statistics are also better than average at the birth center. I do understand that if there is anything threatening my life or the life of my baby, we will head to a hospital, and I completely trust my midwife to make that judgment call. I am almost more nervous for this birth experience than I was the first time around since Colin was so easy and since if I develop complications I will need to go to a hospital. But knowing all that I know, and that birth is unpredictable, I know it will be ok however things happen. I simply hope for a healthy baby and a healthy me.