First off, let me start by saying, no, I’m not pregnant. Now that that’s out of the way, how did I get interested in natural childbirth? I think it all started when my best friend Anna had her baby two years ago. I asked her how it was to give birth and she gave me an unexpected answer, especially considering she did not have an epidural, she said “It was one of the most wonderful experiences of my life.” This surprised me. It was such a contrast to what had I seen my entire life, movies and TV shows where women are sweating and screaming bloody murder, breaking their husband’s hand yelling at him, “You did this to me!”. Then of course you talk to women and they love to tell you their labor horror stories.
Labor has always been presented to me as something to fear, dread and try to get over with as soon and painlessly as possible. So when my friend described labor as a “wonderful experience”, it made me stop and think. Then the thinking turned to researching which was done though reading many web articles, watching a documentary called “The Business of Being Born” and then reading a book called “Pushed: The painful truth about childbirth and modern maternity care.” That’s when everything changed. I am writing this so that other women (and men too) will give a second thought to going into the hospital and assuming that the doctor will not do anything to put yourself or your child in danger. In this essay I plan to cover issues with doctors, induction, epidurals, VBAC, fetal monitoring, and caesarian section.
Now don’t get me wrong. This is not to say that hospitals are pointless and doctors are unnecessary and that childbirth is always perfect and risk free. There are times when there are complications and doctors and hospitals save the mother and baby’s life. I am very grateful for the work that they do but pregnancy is not a disease, it’s not an illness and labor is not a procedure. And let’s face it, what do doctors study and specialize in? Pathology! Their job is to intervene and control, not to step back and let nature take its course.
Here’s a quote from Pushed that explains it well,
"Americans trust doctors and they trust hospitals, and they equate the two with health. And people want what’s best for their babies. They assume that you decrease your risk by going to a hospital and having a top-flight doctor. What they don’t understand is that obstetricians are surgeons, and they know pathology, but they really suck at wellness."
You always need to remember, like any other job, doctors get paid and it’s not always quality instead of quantity that gets them that money. If you can’t trust car salesmen, contractors, plumbers and what not, why would doctors be different? The biggest controller of a doctor’s action these days is the insurance companies. In Florida, for example, the annual insurance rate for an OB doctor is $200,000! So as one doctor said, “If you get paid $2400 to deliver a baby and you pay out $90,000 in malpractice, you have to do a lot of deliveries to pay that fee.” Insurances don’t pay doctors by the hour, so they can either let a woman deliver naturally and it takes 12 hours or more or they can do a 45 minute C-section and take on more patents which equals more money.
It’s not only the money that controls doctors’ actions, it’s legal as well. The reason why their insurance is so high is because of all the malpractice suits. So doctors often have to base their actions, not on medical necessity, but on what’s going to keep them from being sued. As stated in Pushed;
"If a bad outcome occurs, it has to look like the doctor has done everything she or he possible could. In other words, physiological birth doesn’t look good in court; getting the baby out earlier, faster, and with as many medical interventions as possible does."
Doctors often do what they need to keep practicing. Self preservation is a strong instinct.
It might be helpful to show some statistics that show that maternity care in the U.S. is failing. First, maternal mortality rates: “women are 70% more likely to die in childbirth in the U.S. than in Europe.” As for infant mortality, according to the World Health Organization, we [the U.S.] rank second to last among 33 industrialized countries. Also, in 2002, infant mortality rose for the first time since 1958. There are obviously some problems.
To keep this from become a disorganized rant, I am going to attempt to put this into a chronological order of what happens when a woman comes into the ER in labor. The first issue starts right here. It used to be that hospitals would turn away women who were in just the beginning stages of labor. They understood then that there was no reason for the mother to spend so much time at the hospital. Now, they run a risk at sending a woman home because the “what if” of if something goes wrong while she is gone. So a woman comes into the ER in the very early stages of labor and she’s admitted and the clock starts ticking. What I mean by this is that many hospitals have a protocol about the amount of time it should take a woman to give birth otherwise it becomes “dangerous” or in other words, they don’t have enough time or beds to keep you that long. Many hospitals have a 24 hour rule that the woman needs to go into labor within 24 hours of their water breaking, and they don’t always wait that long. Studies have shown that 60% of women will go into spontaneous labor within 24 hours of their water braking and 95% will begin labor within 72 hours. So what’s the rush?
What happens next? They will lay the woman on the bed give her an IV and strap a fetal monitor to her belly. First problem, laying on a bed. Sorry to be a bit graphic here, but giving birth is like having a bowel movement. There are contractions of abdominal muscles to push something out. Now what is the best position in which to do this most important act? Well squatting of course! Now imagine instead that you are lying on a bed with your feet propped up in stirrups. Now try pooping! Oh wait, except you have been constipated and this is going to be an especially difficult one. This is how illogical it is to have the woman laying down. There are higher rates of vaginal tears and longer, more painful labor in this position. Not only is the position the problem but the lack of movement as well. It is much more comfortable for a woman to be able to move around and change positions. So why do doctors insist on the woman lying down? The electronic fetal monitor.
The electronic fetal monitor (EFM) is a device that monitors the fetal heart rate and was originally intended for use in managing abnormal, high-risk pregnancies. The early studies of the EFM showed great results and so it became a maternity ward staple and used on every woman as a precaution. The problem with the initial study? Same old story, those who originally tested the EFM held more than half of the company’s stock. Can we say “biased”? So what do the later studies say?
"In two studies of high risk women assigned to either EFM or frequent listening by a nurse with a fetoscope, use of EFM was found to impart no benefit, but it more than doubled or tripled the cesarean rate."
Also,
"The National Center for Health Services Research reviewed more than 600 studies on the EFM and concluded that continuous EFM had yet to show improved fetal outcome, except in the case of very small babies."
So despite research, this device is still in use. As you read this, you will start to see the snow ball effect of these supposedly “harmless” “precautionary” interventions. Like the first quote stated this intervention triples the cesarean rate. Why is that? Well first of all, the main problem with the EFM is that it shows false drops in the fetal heart rate. When the doctor sees this he/she states “The baby is in distress!” and into the operating room they go. Also, the paper strip from an EFM is admissible as courtroom evidence and acts as a paper trail which forces doctors into doing C-sections.
Alright so now our poor mom has tubes and wires all over her and she is forced to stay in bed. What comes next? The doctor comes in, he/she’s in a hurry or because, like mentioned earlier, they admitted the mom too early, the doctor states “She is failing to progress. Time to induce.” And they give mom, in the conveniently ready IV, a dose of Pitocin. (In a study of low-risk first time mothers 70% received Pitocin.)
In natural childbirth the body releases a hormone called Oxytocin. Perhaps you have heard of it. It’s the same hormone released at orgasm for both men and women. It is also released during the rush of being in love or when you have the feeling of emotional connection with a friend and also it’s what causes the release of milk to a nursing baby. It is a powerful, emotional hormone that not only has a physical function but helps with emotional bonding between mother and child. In labor, it contracts the uterus in a perfectly rhythmic motion that allows for resting periods in between for mother and baby and ends with an “ejection reflex” that pushes the baby out. This rhythm is important both to give the mom a rest as well as give the baby a rest because the contractions cut off oxygen supply to the baby.
Pitocin, on the other hand, is an artificial oxytocin. This drug works very well in causing the uterus to contract. But that’s about it. This drug does not cross the blood brain barrier to also include the emotional affects of oxytocin. Also, Pitocin stops the production of natural oxytocin. The other problem with Pitocin is that it does not have the same natural rhythm. As one doctor described it, “These [Pitocin induced contractions] are bad-ass contractions. I personally think it’s cruel and unusual punishment to give somebody Pitocin without an epidural.” Pitocin induced contractions are stronger and more frequent than natural contractions. So what happens to the baby? It becomes oxygen deprived for too long and the handy dandy EFM detects a drop in the fetal heart rate and again off to the operating room we go. Inducing ups the woman’s chance of a C-section by two or three times. (Are you seeing a pattern yet?) “A recent American Congress of Obstetrics and Genecology survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame.”
The physiologic process of birth is beyond what science and medicine can reproduce or understand. Doctors are beginning to put themselves in a place where they think they have it figured out better than nature has. Here’s what Pushed says about it;
"Although modern medicine can chemically mimic dilation and contractions with manmade prostaglandin and oxytocin, it has not been able to fully explain or successfully replicate the onset of labor. The moment when spontaneous labor begins is a moment that remains mysterious, a private hormonal conversation between mother and fetus that scientists have yet to fully decode."
"What we understand now is that the baby participates in the initiation of labor. In particular, the baby gives a signal when its lungs are mature. For a baby to be born it implies that the lungs are ready, because to be born is to breathe. In other words, induced labor is premature labor."
So now the woman has been induced and is in severe pain, now what is she screaming for? GIVE ME AN EPIDURAL!
Even in cases where the mom is not induced, epidurals are highly popular. Use of epidurals increased from 22% in 1981 to 66% in 1997 and is estimated to be 80% today. Like I said, very popular! Why is that? Well of course there is the obvious, less pain but also a misunderstanding of pain. In modern society there has been this equation; pain=bad. This is not true, it may seem like it, but it’s not. Take for example the rare disorder where people are born with the inability to feel pain. They usually don’t live very long. Pain is an important signal. As one midwife stated “Pain is important. It is not a side effect, rather it is a central component of normal birth, not something from which mothers should be distracted.” Here is how she puts it;
"What do we do when we experience pain in general? We respond to it. Consider a toe blister- you protect the wound with movement. You shift your gait, lift your heel, or even kick off your shoe. You move. And that is precisely what a woman needs to do in labor. She’s got to move to get this baby though the pelvis more easily. The baby’s position is key, and if a woman’s water is broken and she’s immobilized, the baby will have a harder time angling itself into the pelvis and working its way down and out. If the woman can feel labor, she’s moving, she’s tightening, she’s releasing, she’s moving her hips."
Also, if you have an epidural, we go back to the problem in the beginning, you have to stay in bed. As I have been trying to show all along, childbirth is a complex natural process that medicine cannot replicate. Because I am no doctor and do not have much medical knowledge and can’t explain it well, I am just going to use the book.
"Oxytocin is but one hormone in the bath of birth. Endorphins, natural opiates that are also secreted during sex, reach peak levels during birth and are responsible for the altered stated of consciousness that women often describe toward the end of labor-a reproductive version of the “runner’s high.” The endorphins stimulate release of prolactin, which is central to breastfeeding. Adrenaline and nonadrenaline, the fight-or-flight hormones, are released in both mother and baby. In the baby, these prime the lungs and protect the brain against the stress of birth. Epidural anesthesia blocks adrenaline as well as the endorphins."
So as you can see, pain is important. There is a reason for it. It’s a part of the process. Not to mention there are many natural ways to handle the pain plus if the woman was able to move and is not being induced, the pain is much more bearable. The feminist movement has pushed for easing the woman’s load and pushing for her right to do it the easy way. What they are doing though is calling women weak. A woman’s body is made to carry a baby and give birth. Women are strong enough to do it, without an epidural. Most of our own mothers did.
Alright, now for the big one, cesarean section, commonly known as C-section. If you couldn’t tell already, the previous interventions all tend to lead to this final and most invasive and unnatural of interventions. Let’s start with some statistics. In 2005, 30.2% of US women gave birth by cesarean section. Now let’s put some context on that number, the World Health Organization maintains that in developed country, the proportion of cesareans should not exceed 15%. We have doubled that.
C-Sections are becoming more and more popular. Many women are even choosing C-sections without medical need. Why go though all that work and pain when you can just cut the baby out, right? Doctors seem to be deciding the same. One CDC study found that “1 in 9 first-time mothers in 2003 had a cesarean for no apparent reason.” It has also been found that “the strongest predictor of surgical delivery is not health status or age, but where and with whom a woman gets care.” Another study found that “the number of C-sections performed is driven by mostly nonmedical factors, such as provider density and local medical malpractice pressures, and is mostly unrelated to the mother’s medical condition.” Some doctors push C-sections more than others. Like I stated earlier, if the doctor is busy or overloaded with patents the most convenient thing for him/her is to do a C-section.
The next question then becomes, what’s so bad about C-sections? It’s more dangerous for the baby and the mom. Center for Disease Control research of 5.7 million US births found that “infants born by cesarean with no medical risk factors were nearly three times more likely to die within the first month of life than those born vaginally.” Three times more likely! That’s not worth the convenience if you ask me. And for the mom? It’s even worse. A woman giving birth by cesarean is four times more likely to die than a woman giving birth vaginally. According to a World Heath Organization study, the main cause of maternal deaths in industrialized countries is complications from anesthesia and cesarean section. The medical world may be less willing to inform you of these risks; in the consumer-friendly pamphlet on C-sections it suggests that “primary cesarean section is equivalent in risk to vaginal birth.”
Another problem with C-sections is what happens the next time you are pregnant. Vaginal birth after C-section (VBAC) is banned in over 300 U.S. hospitals. They claim that the risk of complications in having a VBAC are too great. There are right about one thing, there are many dangerous complications after a C-section, “an abruption, detachment of the placenta before birth, is twice as likely after just one cesarean section and is a major cause of infant death. Placenta previa, which occurs when the placenta grows over the cervix, is 50% more common after surgery and can cause complication for both mother and baby.” The specific complication they are worried about is a uterine rupture. A uterine rupture is when the uterine rips open along the C-section incision scar. How common is this complication that forces women into another C-section? Less than 1% of VBAC experience this. And what happens to that 1%? 90% of uterine rupture cases end with a healthy mom and baby. So as Pushed puts it,
"If you are a woman attempting a VBAC, you have around a 75% chance of delivering vaginally and avoiding another major surgery and at least a 99.5% chance of not suffering a uterine rupture. If you choose a repeat cesarean, you have a 99.8% chance of not suffering a uterine rupture and a %100 chance of having another major surgery, with all the risks and drawbacks that entails. These include longer hospital stay; longer and more painful recovery; higher risk of infection; organ damage, adhesions, hemorrhage, embolism, and hysterectomy; more blood loss; higher chance of re-hospitalization; higher chance of a complication with the next pregnancy; less initial contact with the baby; less success breastfeeding; higher risk of respiratory problems for the baby; and twice the risk of the most catastrophic complication of all: Maternal death."
So let’s just ask ourselves, why then are hospital banning VBAC and doctors refusing to do them? Something to think about.
Last part, are hospitals natural birth friendly? (If you don’t know the answer to this question then you really haven’t been listening) In the United States there is only one hospital (for those curious people, it’s in Oregon) that meets the standard for a “Mother Friendly” hospital. Here are the qualifications to be called “Mother Friendly”:
1. Labor begins spontaneously.
2. Women have freedom of movement during labor.
3. Interventions are medically justified rather than routine.
4. Women have continuous emotional and physical support.
5. Pushing occurs in any position but flat-on-back.
6. Mother and baby are not separated.
So now that I have shown you all the things that can and do go wrong with modern maternity care, what are your options? The most natural and non-invasive birthing method is having a midwife and doing a homebirth. This is what I am hoping to do. I understand that not everyone is comfortable with having a home birth. There are many “what ifs” to having a home birth and ideally you want that medical intervention, when needed. Birthing centers are another great option that is a good balance between a fully natural birth and medical help if necessary. Unfortunately, there are only 175 independent birthing centers, 25 in Texas and none in 12 states. So this is not an option for everyone. Another great option is to have a doula. This is a birthing coach that can help advocate for you while you are in the hospital. But keep in mind, the doula can’t interfere with what the doctor decides to do and with hospital policy. Most importantly, research this stuff for yourself. Know when medical intervention is “needed” and not just protocol. And remember, childbirth as a normal, physiological event to be directed by the woman’s body NOT a pathogenic, meaning unhealthy, procedure to be directed by the woman’s physician.
Babies are born, not delivered!
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