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!

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THIS ENTRY HAS BEEN EDITED TO CORRECT SOME FACTS RELATED BY “TRACY.” Yes, the stories you will be reading are true stories and experiences that occurred and are occurring.

The year is 1997. The place is Hackensack, New Jersey. A mother awakens in the early hours of the morning to go to the bathroom. She has spent the past two months with an uncomfortable ‘burn’ sensation whenever she rises from a sitting position. She is approximately 32 weeks into her pregnancy and out of habit she checks when she wipes. The paper is dark. She turns on the bathroom light and the amount of blood in the toilet alarms her. She calls her doctor’s office then 911 and then quietly awakens her husband not wanting to awaken her sleeping children. She calls a young woman who has babysat for her in the past. Her husband is trying not to panic but he runs outside waiting for the ambulance to arrive so he can direct them to the correct home.

Upon arrival at the hospital it is determined the birth is going to occur. This is her second spontaneous VBAC. The first occurred in 1995. She is advised by her obstetrician that a vaginal birth is the healthiest birth for her baby to receive every hormone he/she needs to signal to her baby that birth is imminent. Her obstetrician tells her matter of factly that she cannot be given pain medications as those drugs will depress babies’ respiratory systems.

Within hours a beautiful little boy is born. He weighs 4 pounds, 4.5 oz. He is the largest preemie in the NICU. She is pumping and bringing her breastmilk to the hospital for her son. She is there from 4am in the morning when her husband is home from work and she remains until late afternoon with him caring for their daughter until he brings her to the sitter and then comes to see his son and wife for a couple of hours before heading back to work again.

In those days while she is holding her son, singing to him, feeding him her milk and trying to coax him to breastfeed himself the nurses talk to her. It is during those days that she learns it is confirmed her son’s premature birth is due to a placenta abruptia and she learns it is common for pregnancies following cesareans. Two births earlier she had had an unnecessary c-section … they wouldn’t stop with the vaginal exams and fetal scalp blood draws …. she was in distress and her son made it clear he felt her distress.

* * * * *

The year is 2002. The place is Connecticut. A mother dreams a foretelling of an appointment with her doctor where she asks her doctor to talk to her now about cesareans and epidurals. She wants to know ahead of time so she can make choices if there is an emergency. Her next appointment is a deja vu. She asks to speak to her doctor now about cesareans and emergency situations. Her doctor brushes her off and tells her she’s fine. Nothing’s going to happen. Just a few days later her water breaks prematurely at 26 weeks. She is at the hospital and she is told if labor begins attempts will be made to stop it. If the medications do not work the birth will proceed. Nurses come in and tell her to sign this form and that form … one form being for a c-section. She says she is not consenting to a cesarean right now. The nurse states it is only in case of an emergency and she won’t have time to sign a consent form. She asks to talk about the procedure and her options first. The nurse tells her someone will come in after the doctor is finished with his observations of the labor and will talk to her then. No one ever comes.

The labor is proceeding. Within a few hours she feels her child emerging. The doctor sees the baby is a frank breech and pushes the baby back in and up the canal. Her husband sees a lot of blood. Mom is scared and no one is answering her questions. An anesthesiologist shows up and gives her directions to position for an epidural. What epidural she asks? The epidural for her c-section anesthesia. What C-Section she asks? Also, if there is going to be one she wanted general. That’s not a healthy option the doctor says. An epidural it is and it is not until after that she sees she was given a classical T incision but the doctor tells her she is triple stitched.

In the postpartum check ups that follow she has questions about what was done and why. Her doctor responds that she is being difficult and she should be happy her baby is healthy and alive. She responds that she has had miscarriages, her baby was ripped from her body and is still in the hospital away from her so please excuse her for not being easier right now. Two years later she receives her hospital records as she requested and sees no one has written why she had a cesarean or any information regarding the surgery other than she has a classical incision.

The year is 2007. She is pregnant and she is joyful in her pregnancy. She wants to refuse a vaginal ultrasound on the grounds of the previous ones coincidentally preceding miscarriages. She is again accused of being difficult and her doctor is defensive of technology and it’s use is solely to know ahead of time if something is wrong with her baby. She dismisses any connection between ultrasounds and miscarriages. NOTE: “Tracy” miscarried twice, within five months of each other, since her cesarean. Her third miscarriage occurred two days after a more invasive type of ultrasound, a transvaginal ultrasound.

She is unhappy with how she, her thoughts, her research into her options and what is healthiest are dismissed. She wants to birth a different way. With someone who will hear her and who will read the research with her and who knows what normal, spontaneous birth looks like, feels like, smells like.

So she begins her search for answers and she comes across research that lists the order for the risk of uterine rupture based on type of incision as:

low transverse 0.5% [Haq 1988] – 2.0% [Clark 1988]

low vertical 1.3% [Enkin 1989]

classical and inverted T 2.2% – 4.0% depending on the study

upright T and J-incision may be higher; data needs to be found

Frye, Anne “Holistic Midwifery Volume I

She comes across articles that foretell the difficult journey she has ahead, a fight for the right to choose her own health care for her body, for her baby.

There is a strange contrast that exists in the American College of Obstetricians and Gynecologists in which they support the right of women to choose an unnecessary Cesarean section–in the name of patients’ choice, patient autonomy, and informed consent; but are not allowed to have a vaginal birth after Cesarean (VBAC), or to give birth to their breech babies vaginally–despite what the patient wants, regardless of the same rules of patient autonomy, and in defiance of the practice and doctrine of informed consent. Here is a very interesting article from the Annals of Family Medicine, May 2006, entitled Patient Choice Vaginal Delivery?, which explores this dichotomy.

The introductory paragraph of the article is as follows:

Patient-choice cesarean delivery, a primary elective cesarean delivery performed without a medical indication, is increasing among pregnant women. The American College of Obstetricians and Gynecologists (ACOG) has released a formal opinion supporting obstetricians who perform elective primary cesarean delivery, citing the ethical premise of patient autonomy and informed consent. As physicians who advocate for women’s right to choose among a variety of medical options, we are pleased at the emphasis on preserving women’s medical choices. We are, however, perplexed at the narrowness of the choice. In recent years we have seen a decline in women’s choices for vaginal birth as vaginal birth after cesarean (VBAC) becomes less available and vaginal breech birth is rarely performed. The question of patient-choice cesarean delivery asks only whether a woman should have the right to choose a cesarean delivery in the absence of a medical indication. A woman’s right to choose a vaginal delivery is not addressed.

It is tempting to just quote the entire article, because there are so many good points it brings out, but I will refrain and just encourage you to read this article for yourself, and perhaps discuss it with your doctor. The authors cite many sources in the above paragraph and throughout the article, supporting their statements with published studies. They discuss the risks of C-section to the mother (both in the immediate post-partum, as well as its implications for future pregnancies), vaginal breech births and VBACs, their risks and benefits, what studies have said about them, what ACOG’s official recommendations are, and how these same births are handled in other countries.