May 2009


Many women choose a hospital for their first birth and talk about a home or birth center birth for the NEXT birth.  The slimmest thread firmly wound through a decades-long tapestry promoting hospital birth equates with a safe birth has effectively sewn up a veil of secrecy: home birth is not only safe, it is an inherited treasure.  A hospital birth for the normal, healthy woman (of which most of us are) denies a woman her birthright, to welcome her new family among family.  

I usually talk in my classes about how “this” is the *only* chance you’re going to get to birth *this* baby.  Sure you may go on to have other babies, but you only get *THIS* chance to birth *THIS* baby.  I also share with moms that because of this fact, the significance of this birth is infinitely greater than the significance of this birth is to your nurse, OB, midwife, etc. – Louise Delaney

So, what if our first birth is based on a myth: that hospital birth is ‘safer’?

I think there are some who choose to not deal with the reality that we tell them about, or choose not to believe that things can go so terribly awry iatrogenically because, after all, the doctors are only out to help us. When a traumatic birth does happen I think it is something of a shock for these folks. Many get angry. The survivors learn and grow from it – and these are the ones who become much more proactive the next time around, take control and do things differently “the next time.” ~ Melissa R. Bradley MethodTM Educator

OR what if our first birth is based on a friend’s outcome and not based on doing our own exploration and work for what we want?

My friend was due with her first child three months after I was due with my second. I emailed her a lot of documents from my birth classes, talked to her on the phone, bought her a few choice birth books etc. But whenever I tried to help her question some of what she told me about the midwives (medwives) that she was working with, she totally ignored me. We’ve talked about it since, and she basically told me – I knew your birth stories (two unmedicated, un-interfered with, empowering hospital births), and I figured, if you had a good hospital birth I could too. But she didn’t – I *gave* her a lot of information, which was a lot different that my own experience of taking Bradley classes and *seeking* the information I wanted/needed. For whatever reason, she had to have her own “before” birth & then learn/grow from it and have “the next time” happy, respectful, empowering birth (in a freestanding birth center, btw). ~ Christina @ Birthing Your Baby

It is a long, often solo journey a woman will take to find within herself evidence that the decision to birth at home is a good choice and that the burden to prove it is a good choice is not hers to bear.  It is the physician who holds the burden to prove his/her advice and protocol is the safe choice.  That is the crux of medical liability and is wholly relevant in the decision to choose a hospital birth.

In our society, women need to learn the hard way that fairy tales don’t happen, that no one can save you but yourself…and the people around birth should present their offerings (options) without judgement, for women to choose.  Women should be empowered and not controlled by birth professionals/facilities. ~ Randi King in Norman OK

The first birth is the pivotal birth. Every birth experience that follows builds on that one.  Our choices now are choices for the NEXT birth.  The first birth doesn’t have to be either perfect or awful and earth shattering to make us think. We don’t have to choose differently than the first birth; but it’s the first one that gives us a place to begin experiencing not just birth but ourselves as mothers, women, people. We may not all have ground shaking, earth thundering thoughts but we have them.  The experience belongs to us.  We choose what to do with it.  Choosing to do nothing different is still an influenced choice ~ made on that experience.  

Let’s say a woman has a fast hospital birth and rather than choose to just stay home next time she chooses to go early to the hospital, possibly scheduling an elective induction.  This scenario isn’t just welcomed by the state medical examining boards who have lobbied to ensure this is legal and protected under the audacity to call it an ‘option’ when in truth she has not been told home birth is a good option too!  How likely is she to find a physician today who would assure her that her fast labor is not something to fear and that perhaps she should consider a home birth?  That indeed he/she (the medical provider) may even have a home birth practitioner to refer her to?  

We do not foresee the medical world embracing the challenge to be more knowledgeable about normal birth.  The woman with the fast labors and whom the medical community embraces as having the ‘option’ of electing for a scheduled induction is more likely to end up with a cesarean even if she didn’t ‘plan on’ having one.  Then she will find herself in a battle to VBAC for her NEXT birth.  She  may not have the luxury of choosing differently for her NEXT birth.  

What will YOU do to have a first birth that leaves you with few regrets or changes for your NEXT birth?   Why not have the birth of your choosing, rooted in truth and your ability to know yourself and your baby now?

I know my cesarean was really indicated. short short cord, knotted, every time he would begin to descend his heart rate dropped a bit lower. Breech was the only way he wasn’t pulling on it (the surgeon explained this to me in minute detail since he knew my background) which explains why he stayed breech on and off for the last few weeks. I really wanted him to turn head down, and he complied (which fits his personality so far too! so cool… anyway… back to the story). But by complying with my need/desire for a head-down birth, he put himself in a position that pulled on the cord/knot. I saw the knot – I’d call it a double knot… one on top of another… He never did crash, and I never did establish a labor pattern. I just KNEW something was up. So I called in and had the surgery. That was a leap, for sure… to lay myself up on that table without a KNOWN reason. I just knew. Knew it all along really…So yeah. I trust the process more… I had a cesarean with my first baby – 15 years ago – and now again with my 5th – 3 VBACS in between. Seems I’ve come full circle in alot of ways. I trust moms more too – when someone says to me, “something doesn’t feel right” I will NEVER brush that off even for a second. Not even in my head. I don’t think I did it before, but for sure I won’t do it now.   But yeah… it wasn’t a failure, just… I still ***wish*** for my homebirth. Maybe someday.  ~ Kelly

The first birth is ‘herstory’.  It is a myth that women who seek a home birth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves.  It is not rational to say home birth is never safe; saying so is the product of hysteria.  Protecting choice, not limiting choice, is good, no, GREAT health care.  Tell a friend, tell your state government, tell the White House, the NEXT birth is now.

 

A survey on a popular parenting website recently asked the question, “Do you think older siblings should be present at birth?” As one might imagine, the ensuing comments reflected a wide spectrum of attitudes toward childbirth. Some mothers wrote that they would like to, or even had already, shared the beautiful experience of their baby’s birth with his or her older siblings. Others wrote vehemently that the labor room was no place for a child. Here are just a few of the comments that struck me:

On the pro-sibling side —

1. My six year old daughter is very excited to attend the birth of our third baby. (We also have a 3 year old son.) She was the one who expressed interest in attending the birth. I am having the baby at a Birth Center. In this home-like setting she will be able to participate as much or as little as she likes. We have discussed the birth process at length and have even watched some videos so that she will know what to expect. I think it will be a great way for her to bond with the baby and a way to remind her that she is an important part of our family. Plus, she is a female and may have children of her own one day. How many of us have had the opportunity to attend a birth before we have our own children? I think this will help her see that having a baby is a natural thing and give her confidence when it is her turn.

2. My 2.5 year old daughter watched my 2nd daughter’s birth (it was a c-section) from start to finish from a viewing room, on the side of the operating room. 
It was SO GREAT having her there (with Grandma) because it took my focus and stress away and I just loved seeing the excitement in my little girl’s eyes, as she watched her little sister come into the world.
 
And on the anti-sibling side: —

 1. Would you let your kids watch the “making” of the baby, too??? They have NO business being in the room while the mother is giving birth! Outside waiting with a grandparent is fine, but certainly not in the same room!

2. There is no question in my family that being there wouldn’t work for my kids. My girls, 3 & 5 are very protective of Mommy. They would be completely traumatized by the birth. If they were older, I would consider it, but at their ages and with their personalities, we will leave that process to a movie in health class.

3. To expectant parents, birth is a natural and beautiful thing. To a child, it is confusing and icky and scary. I know there are a lot of people here that think their child was ok with it, but trust me, they don’t see it the same as an adult does. There are just some things you don’t show off to a child-no matter what age. My opinion: leave the children out of the delivery room and in the hands of a caregiver until the baby and mommy are more “presentable”.

And my personal favorite:

4. I think small children need to have mostly positive associations with the birth of the new sibling. They have the rest of their life to learn about real life and how their sibling really got there.

A common thread that one might expect runs through all these comments, namely, the parents who view childbirth as normal, healthy, and empowering invite their older children to witness the event, while the parents who see it as scary, traumatic, and shameful (or “icky”) do not. It’s no surprise, therefore, that the pro-sibling numbers seem to be much higher among home-birthers, since regarding childbirth as natural and healthy is a prerequisite of sorts for choosing to birth at home.

As I read through page upon page of the survey respondents explanations for their positions, an even more important distinction became apparent.  The pro-sibling (dare I even call them “pro-birth”?) parents seem to recognize that they have the power to influence their children’s attitudes toward childbirth and family. Not only do they know birth is healthy, they are also raising their children to see it that way. As Kathy blogged about recently,our culture faces an epidemic of fear about birth. What better way to combat that fear in the next generation than to help them understand the inherent well-ness of birth while they are still young?

Of course, the anti-sibling parents exercise that same influence over their children’s worldview, whether or not they recognize it. As many readers commented, children are sensitive creatures. Children whose parents regard birth as scary will likely grow up scared of birth themselves, regardless of whether they witness one first-hand.  The last comment, while short, says it all: To the writer, the process of birthing the baby leads to “negative associations” (which the writer, interestingly, equates to “real life” in the next sentence).

Until relatively recently in history, birth took place not in the hospital with doctors and nurses, but in the home with a midwife and female family members. By the time a woman gave birth to her first child, she had likely had the opportunity to witness several babies enter the world. Ask a pregnant woman today whether she has ever witnessed a birth in real life, and her answer will likely be “no.” Our culture has televised births (a disproportionate number of which end in cesarean), movie births (in which the deliveries are either comical or end in tragedy), and books about pregnancy and birth. Yet our direct exposure to normal birth is almost nil.

I can’t help but think that the children, especially the daughters, of the pro-sibling / pro-birth parents will have better birth experiences in adulthood than the children of the anti-sibling group. Imagine a generation of young women who were raised to recognize birth as sacred, healthy, and empowering – women whose earliest family memories include experiencing the beauty and nature of childbirth.  If more girls grew up with this perspective, I believe maternity care could change dramatically in a generation.

Sadly, in this particular survey, only 27% of respondents voted to allow siblings to witness the new baby’s birth. (To be clear, there was no “maybe” option — a full 73% of those taking the survey voted “NO” to children’s presence at birth.) For those of us hoping to see dramatic changes to maternity care in the next generation or two, these numbers are discouraging.

I am convinced that those of us with positive birth experiences, those of us who recognize birth as healthy and empowering, have not just an opportunity but in fact a responsibility to share that wisdom with the next generation of mothers.  I am not advocating inviting your neighbor’s children into the labor room. Yet I do advocate healthy dialogue about your healthy, positive birth stories. You don’t need to bare all the finest, most personal details. But consider sharing your views on birth, particularly your attitude toward your own birth experiences, with the young women (or even the young men) in your life. It may be just the “normal” perspective they need.

The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

There are many variations on the only thesis available to opponents of home birth: What do the statistics say? Despite the enticement of a warm, peaceful and private birth that a home birth offers, the perceived importance of missing technology lingers like impending doom. In America, less than 1% of births takes place in homes. It is difficult for the other 99% of Americans to make the transition from technology as the benchmark for establishing worldwide leadership to the reality that the human body is designed to give birth and it has evolved to make many variations in labor and birth look so easy.

The Stockholm Birth Center Study followed one birth center’s outcomes over a ten-year period culminating in 2000 and comparing the outcomes to the associated hospital’s birth outcomes. The one strong observation in this study is the truism that many women will choose a birth center because of the perceived safety in having a hospital nearby. However, it is a mistake to conclude the birth center is free of institutional intervention. The study’s results are negated because of the influence of the obstetrical backup. Every woman who chose the birth center for her birth location was still subjected to the institutional care package. This is the most influential determinant in whether or not a woman is “risked out” of laboring and ultimately delivering in the birth center.

A birth center so closely associated with a hospital is not autonomous and must operate under strict supervision by institutional birth practitioners. The authors themselves state they did not study the effect of individual labor and delivery protocols, but rather the care documented in each case as a “package.” In addition, they have correctly remarked standards of maternity care do not exist, but they have again missed the mark on the importance of this statement. This is critical to interpreting the outcomes, because one solitary intervention can turn out to be the predictor of a birth outcome. For example, every care provider practices according to their comfort level; although every care provider will monitor a baby’s heart tones in labor, how the monitoring is done varies by care provider. Continuous electronic fetal monitoring (EFM) can range in definition from ten minutes hooked up to a monitor every hour on the hour to a handheld doppler check through a contraction every few hours to a telemetry unit (a girdlelike band outfitted to wirelessly transmit fetal monitoring data) that allows the mother walk more freely.

The ability to walk freely even under continuous monitoring allows the mother greater mobility for finding a position that increases her ability to cope with her contractions. Setting aside the U.S. Preventative Service’s Task Force’s findings and stance that continuous fetal monitoring provides no benefit at all – and the data showing that continuous EFM results in more cesareans – it can be argued that fetal monitoring that limits a mother’s mobility is therefore more likely to result in more intervention as the mother shows signs of distress and therefore the baby does as well.

The authors of the Stockholm Birth Center study argue that many other studies have reached conclusions similar to theirs. In the same publication we are offered a Cochrane Systematic Review of Home-Like versus Conventional Institutional Settings for Birth. Here the reviewers concluded births in home-like settings compared to purely hospital settings “provided only modest benefits including reduced medical interventions and increased maternal satisfaction.”

A hasty read of this data by institutional birth practitioners correctly supports their ingrained training that routine intervention is acceptable and “safe.” However, the paper actually clearly demonstrates that all births taking place in a hospital are going to meet up with interventions at some point during labor, and it is the overuse of technology that needs to be analyzed. Indeed that message is there somewhat cryptically as the authors instead hinder the possibility of improving on the scope of research by advising “caregivers and clients should be vigilant for signs of complications.” It is difficult for any woman who has given birth or who respects her body to hear such little value placed on the differences the studies do reveal, such as the “modest benefits” of “reduced medical interventions” and “increased maternal satisfaction.” Surely even one avoided episiotomy would be appreciated by the woman whose perineum would have been cut and would find several women healing from receiving an unnecessary episiotomy envious.

In 1998, a study of infant mortality in planned home births was conducted in Australia. Author Hilda Bastion reviewed these outcomes as neither hospital nor home births have defined what constitutes standard care. She reviewed both midwives and medical practitioners, registered and unregistered, minimal experience and heavy case load. Also included in the study were births that would be deemed risky by virtue of poor health in the mothers or other underlying health conditions. This is crucial to understanding the bias of many hospital birth proponents: It is not the intent of home birth advocates to claim home birth is best for everyone, but rather a viable option for low-risk and otherwise healthy women. The author goes so far as to note it is a disturbing trend that midwives may be encouraging and willing to take high-risk births because of the high number of low birth-weight infants counted in the statistics. In fact, it is quite possible that a woman who cannot afford good nutrition may also not be able to afford hospital birth care, and perhaps a midwife is her better choice than no care at all.

In general, birth care is divided into either purely institutional care or modified institutional care. No research exists on pure, spontaneous vaginal birth over an intact perineum without induction agents, drugs, surgery and instruments. What is available is mounds of research on what a mother or baby can “tolerate” in labor and what interventions have achieved an acceptable degree of risk. The acceptable degree of risk is not defined by an independent counsel but often influenced by the strongest or loudest lobbying effort, as witnessed by the American College of Obstetricians and Gynecologists’ (ACOG) August 2007 statement on the advance of midwifery options for consumers. ACOG’s bottom line is midwifery options must be controlled and home birth as an option must be eliminated. The average consumer misses the bias and conflict of interest: A rise in home births means a decrease in income for a field already plagued by the reality that there is no money to be made in natural childbirth.

In addition to a lack of studies of organic birth as defined above, there are no long-term, randomized longitudinal studies to confirm or deny the correlation of many interventions. For example, the impact of a mother’s drug use in labor on emotional bonding, breast-feeding, postpartum depression, later drug abuse (baby as a young adult), etc. In the 1970s, Doris Haire, the President of the American Foundation for Maternal and Child Health, said, “No drug has been proven safe and effective for use during pregnancy or childbirth.” Considering that 25% of drugs introduced in the market today are recalled or pulled off the market in 1 to 5 years, this statement has never been more true. Until such time that midwifery care can be studied with a critical but appreciative eye, we will find only the weakest of studies boxed in by outdated beliefs that American women cannot afford to birth outside of a medical institution. In fact, it is our country that cannot afford to NOT offer free standing birth centers as a birth care option for American women.

Works Cited
Bastian, Hilda, “Perinatal Death Associated with Planned Home Birth in Australia Population Based Study”: BMJ 1998; 317: 384-8

Hodnett, E.D and S. Downe and N. Edwards and D. Walsh, “Selected Cochrane Systematic Reviews: Home-like versus Conventional Institutional Settings for Birth”; BIRTH Issue 32:2; June 2005

Waldenstrom, Ulla and Charlotta Grunewald, “The Safety of Birth Centers Responses to a
Critique of the Stockholm Birth Center Study”; BIRTH Issue 32:2; June 2005