Sheridan at the Enjoy Birth blog wrote a wonderful post, starting with:

Imagine the year is 2035.  People rarely cook at home anymore for a few different reasons.  They have gotten too busy and because of subsidies from the food industry eating at a restaurant is less expensive.  They actually pay more out of pocket to eat at home.  Many people look back and remember, “People actually prepared meals AT HOME!  It is amazing that they were willing to go through all that time and energy and that so many survived.”

It is an excellent analogy to the current “birth wars” that Jennifer Block wrote about here, discussing home birth versus hospital birth.

Both articles are must-reads!

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

Stay tuned for our upcoming International Birth Wisdom week!  

FLEX (Spain) currently airs this ad campaign for their mattresses.  A lovely homebirth on a FLEX mattress because where you sleep, your home, is the most important place in the world.  The place that welcomes a new life into this world is a special place and the memory lingers there!

Our thanks to Birth Activist for one of many birth community members to find this ad!

One thing that has been on my mind lately, is the fear of childbirth (technical name, tocophobia).

Sometimes women are afraid of childbirth prior to having any children, and this is not really surprising — after all, the average woman will have seen few actual births, but only those portrayed in movies and on soap operas. Of course, those are all not just dramatized (fake) but are typically dramatic — water breaks and the woman has to get in the hospital this instant or the world will come to an end!! Or she’s stuck in the backside of nowhere in labor with just her husband (yes, I still remember when Jennifer had Abby on Days of Our Lives, and Jack was the only other person in the cabin, with serious snow outside), and everybody is panicking. Or labor is portrayed as the worst and most awful thing that it is possible to endure, until the magic epidural comes and makes everything all right. The other thing that is now available on TV, that I didn’t have as a child, are shows like “A Baby Story” which do portray actual births, but I notice that an inordinantly high number of those end in a C-section, or are otherwise highly interventive; and I’m not surprised that this leads to a fear of birth prior to the woman’s actually giving birth the first time. And this doesn’t even begin to touch on all the labor and birth horror stories that mothers for some reason feel so imperative to scare first-time pregnant women with.

Other women, however, have given birth before, and this experience has made them scared to have any more. Some women may choose never to have any more children at all (this happened to a friend of mine; her daughter is now about 8-9 years old). Or they may choose a C-section because they can accept pain from surgery and the attendant post-op pain (which may be manageable by narcotics), but they fear the lengthy but intermittent pain from labor. But there are other options.

After her first very painful birth, this woman was terrified to give birth again, but she chose to overcome her fears by using hypnosis to relax during labor. If you watch the video on that link, you’ll notice that they show a few clips from an online video of a woman using hypnosis during labor. That woman in the video was Independent Childbirth Educator Sheridan from EnjoyBirth blog whose painless childbirth using hypnosis (Hypnobabies) was what this Georgia mom saw that gave her the courage to try to give birth again. [I’ll clarify that although the news story referred to hypnosis during birth as “HypnoBirth,” that is a name for a particular type of childbirth hypnosis, and Hypnobabies is another, and it was this type that Sheridan used during birth, and what she teaches.]

The fear of childbirth is very real. And it’s understandable, considering all the negative images surrounding birth that we are bombarded by almost from our own births — and considering that most of us were born in less-than-ideal circumstances ourselves (my mom was under general anesthesia and given an episiotomy, and I assume I was dragged out of her womb by my head), perhaps it might be not too big of a stretch to say that we are surrounded with negative birth images from the time of our birth. But all too often, doctors are just willing to tell women who are afraid of childbirth, “Oh, don’t worry about a thing — if you don’t want to give birth, we can give you a C-section.” While I can accept that women should have the right to choose to give birth as they wish, I wish that doctors (and others) would give a little extra time to ask a woman why she’s afraid, and see if they can work through her fears, rather than just cutting her open unnecessarily. If her fear is irrational yet she holds onto it, fine, give her a C-section; but if she has a rational but misguided fear (for example, I heard recently of women who want a C-section because of a fear of their “vaginas exploding”), then get to the root of the fear! Instead of treating her like a little child who is afraid of getting her dress mussed by going outside, treat her like the rational woman she is, and give her true information to combat the

F-alse

E-ducation

A-ppearing

R-eal.

Preconceived notions are… interesting. I’m in the middle of watching the wonderful A&E version of Jane Austen’s Pride and Prejudice and the theme is, of course, Darcy’s and Elizabeth’s mistaken first impressions about each other, and working through the negative prejudice each had about the other, to get to the truth about themselves and each other. Sometimes first impressions can be very accurate; but sometimes they can be completely wrong.

When it comes to choosing a care provider, it is important not to blindly accept anyone’s recommendation, nor to follow merely a “first impression,” but to closely examine the person who is to be caring for you during pregnancy, labor, and birth. Just as Elizabeth learned that Wickham was not the kind, honest, and honorable person he appeared to be at first, so you may find that your midwife or obstetrician may not be exactly what she appears to be.

A friend recently mentioned that she was going to be trying a “natural” induction method (castor oil), and I didn’t say anything about the negative observations I had just recently heard about it; and I’m afraid it may have negatively affected the baby. At one point, it was “touch and go” for the baby. I said, “never again” — regardless of how much I think the mother may resist my input.

A fellow childbirth educator had an experience some years ago when a friend of hers mentioned that she hadn’t felt her baby move much lately. Not wanting to make her unnecessarily worried, she did not suggest that she go get checked out, although she herself had had a necessary preterm C-section for just the same thing. The friend’s baby was stillborn a few days later. “Never again.”

You read here about a birth educator who attended a vaginal twin birth as a doula, and both she and the pregnant woman were so glad to find a doctor willing to allow a vaginal birth, instead of insisting on a C-section, that neither one questioned whether the doctor had the experience necessary to attend a twin birth. As happens with some frequency, the second-born baby was breech, and the birth of the baby was quite traumatic, with the doctor showing his or her inexperience, and ultimately, fear. But the doctor told the mother afterwards — and perhaps the doctor believed it as well — that the trauma the baby endured was better than being brain damaged or dead; so the mother believed that the doctor ultimately saved the baby, and is content with what happened, although it was very unnecessary. “Never again.”

We do hear from time to time that we, as natural childbirth advocates, are extreme.  We’ve heard many a commentary that compares natural childbirth to a throwback to living like a pioneer.  We’ve all had the experience of having women who know we are natural childbirth and birth rights advocates walk away from us quickly or politely (sometimes not) shut us down.

We wonder sometimes if it’s worth risking having people try to paint us in that radical light to keep doing what we do: quelling preventable mother and/or newborn injury ~ physically, mentally and emotionally ~ including death.

Never again.

In a recent discussion we have had on our independent childbirth educators email list, the topic turned to one of the basic differences between supporting a woman through labor, and medicating a woman through labor; between listening to a woman’s complaints, and “fixing” a woman’s complaints; between most home births and far too many hospital births.

One woman told of an experience in supporting a woman through her labor.  The mother turned to her doula and husband once and said, “This sucks!” The doula answered, “Yes, I know it hurts, but you can do it.”  The mother responded, “Yes, I know I can do it. I just wanted to let you know it sucks!”

How many nurses, husbands, or other birth-support people would have heard the woman say that, and offered her medication to “fix her problem”? She wasn’t needing anything fixed — she just wanted to communicate. Isn’t there a whole industry in attempting to help men and women communicate, especially in marriage and other personal relationships? Why should we think that doctors (who are typically trained in the all-male tradition of med school for generations) and the medical establishment will know how to communicate in the all-female world of birthing mothers?  Men tend to want to know the answer. Doctors are also trained in how to fix problems, medically. Mothers want to talk about it first.

So many women just want to be listened to. These basic differences will not just disappear because women are in labor. Some people — both men and women, although men tend to fall into this much more easily than do women — just want to know the answer and use it to fix problems, even if the “fix” is something unwanted by the person who is dealing with the situation.

When a woman’s birth-support team moves too quickly from listening and encouraging – and the other basic tenets of female relationships and female support – they may undermine a woman’s innate courage and strength.  This can happen regardless of the sex of those who surround her in birth.

What if, instead of telling her “you can do this,” the doula had responded, “would you like an epidural?”  The mother may have heard, “You’re not strong enough to handle labor without drugs, so just go ahead and get an epidural before it gets any worse.”  For my part, I’m very vulnerable to suggestion during labor.  A question like that — as innocent as it sounds — may have been enough to make me say “okay.”  Because, after all, if the people who are watching me labor think I need an epidural, then maybe I do!

Fortunately, nothing like that happened during either of my labors.  Instead, the midwives asked open-ended questions, like, “What do you want to do?”  Every time they asked a question or made a suggestion (like getting into or out of the labor tub) I obeyed it as much as if it were a command; questioning it no more than if they had asked me if I wanted some cake, or if I should breathe.

Sometimes, women just want acknowledgement of what they’re going through, rather than changing what they’re going through.  At times labor hurts, it’s intense, you just can’t get comfortable and there is no way in hell you would call what you’re doing relaxation.  It can suck.  It’s time to honor that too.  Don’t fix us.  We’re not broken.

This movie, Orgasmic Birth, focuses on the women giving birth, and that’s something the public has been waiting for a long time!! Every woman you’ve ever shared birth with is in this film. There is the mother who believes you trust doctors for everything and she ends up with an induction, epidural and baby finally born after two vacuum attempts … and she believes the doc saved her. You see the mom who also believes the same, is induced, and has a cesarean. However, the movie starts and ends with the mothers who have believed in the birth process, their bodies and that how they birth matters to their babies. You hear from fathers who love that their babies were born surrounded by their home and loved ones…their natural environment to begin life in.

Instead of the black/white contrast of The Business of Being Born, you have a sophisticated segue in the sense that the commentator’s information is presented around the story told so the dots are connected fully because these women tell their own story and the commentator fills in the ‘real’ story. It’s not told fear based, it’s told from a know natural birth perspective. No rant. It just is.

We believe that it is also the intent to interview everyone in a home or home-like atmosphere, with the exception of hospital footage for those two moms with routine medicalized birth … and that’s a smooth, thinking contrast. Every person is speaking softly even when venting on medical birth. Love the moment that Dr. Northrup tells us with medical intervention we “screw it up” — “it” being normal birth.

It is also one of the first films presented to the public to show a wonderful birth class outside of the hospital. We don’t know if it is the producer’s intent but perhaps the film is trying to turn Lamaze around and portray Lamaze in the Institute for Normal Birth light. We say this because the producers limited themselves to Lamaze. They did also keep footage of someone mentioning a Lamaze in-hospital class that they didn’t like.

We wish more had been done to represent other independent birth ed options as independent childbirth educators are among the most deeply anchored normal birth supporters in America and have always known that hospital preferred birth classes are a disservice to women, hindering their access to unbiased information and, many argue, used only for props to keep women birthing in hospitals. Around the world, normal birth education may not be done in the traditional setting that we in America are accustomed to but it is still independent of medical fear and bias, with knowledge transfer occurring rather as a woman to woman knowledge share with midwives as the informational conduit.

We do wish the film included reflection on mothers who are second or even third generation homebirthers as well. These women kept normal birth in America from completely fading away. There really needs to be a film as a tribute to these women pioneers. In other words, it is important that nations, especially America, fully recognize that home birth, normal birth is not something new; that women have believed in and enjoyed their normal births before 2008.

The births shown are wonderful. One of the best births is the mom who talks about childbirth as a mother’s sacrifice. You might cringe because you start thinking here we go… “Birth is painful. Birth is a sacrifice. Birth is about a medal.” However, to our delight, this mother delivers within a pretty normal window for active labor, 26 hours, she’s birthing at home and the midwife says outright in a hospital she would have been given pitocin and c-sectioned by now. The great thing is the mom talking afterwards about enjoying that birth for its own challenge for her if not for any great spiritual or relaxing birth story.

This is a great contrast to the mom who I mentioned above with the vacuum baby who says not until closer to her due date and hiring a doula did she hear anyone talk about embracing contractions. Until then everyone talked about labor as a difficult thing. You really do get the full connection of the contrast between the two women’s births… some of the responsibility lies with women doing the work to face and/or overcome fears… some of the responsibility lies with careproviders’ attitudes about birth and their inability to provide humanized birth. It’s not only about medical vs. normal birth. It’s also about what women are told, have been told and how it’s still quite accidental for women to hear about birth as an enjoyable event in their lives.

The abuse survivor’s birth and another homebirth will make you cry. The very personalized births will leave you smiling and swaying with the moms. Very cool.

We can’t wait to share it with you and we hope to see you at our screenings!! Just check our “Birth Events Near You” page on this blog.