Quick Hit: Calm Birth
My friend Cristina wrote an incredible post about her recent birthing experience that I wanted to share with everyone. An excerpt:
No tears. No screams. And all I had was half a glass of Prosecco eight hours before my daughter, Francesca, showed off her pipes and I had her little naked body in my arms. My doctor told our doula (childbirth coach), "This is rare, isn't it? You don't see births like this." Cindy, who calls her practice Gentle Birth Doula Services, attempted to convince the doctor that she had seen births like this.
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It's great to hear that your friend had such an amazing birth experience. However, I really dislike the implication that all births can and should be like that, and that if you just try hard enough, you too will be smiling though your contractions. How do you think women who've had really difficult births feel after reading that?
She writes "Do you hate me for believing that our bodies were designed to have children?" No. But there's a reason why death during childbirth has historically been on of the leading causes of mortality in women.
I agree with your sentiment here --- all women's birth experiences are different, and even the most hardened natural-birth activist types will sometimes tell you their birth was incredibly painful --- but I think this is a separate issue from the one about maternal mortality. In many cases, an incredibly quick and uncomplicated birth can be the MOST painful. Births that involve lots of pain medications can sometimes be the most dangerous (not always, and I had an epidural myself so I say this with no judgment).
In my opinion, reducing maternal and fetal mortality (as most rich countries of the world have done a far better job of than the US) and trusting in women's natural ability to give birth go hand in hand. Trusting women and the process of birth, and minimizing interventions to only the ones that women want and evidence has shown reduce risks is the way to make birth as safe as possible. You can especially see in US culture how starting from the idea that birth is horrible and dangerous -- and therefore piling on lots of sometimes unnecessary and unwanted interventions -- makes birth LESS safe, not more. Hence our hugely high c-section and mortality/morbidity rates.
Birth IS dangerous, though. Our maternal mortality rates are nowhere even close to those in countries where women don't usually don't have access to medical care.
According to the WHO, "Five direct complications account for more than 70% of maternal deaths: haemorrhage (25%), infection (15%), unsafe abortion (13%), eclampsia (very high blood pressure leading to seizures – 12%), and obstructed labour (8%). While these are the main causes of maternal death, unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible."
There was no pre-Western-medicine Eden where birth was easy and safe. I'm all for trusting women's instincts when it comes to birth, but it is an inherently dangerous process and good medical care is a necessity.
You are correct - trained attendants to detect and act on a problem in a labor (and pregnancy) early is key to safe birth. You can see this by looking at mortality rates for homebirth with a midwife (just as safe for low-risk women as hospital) and unattended childbirth at home (more dangerous). Having hospital back-up for non-hospital births is a key factor in the safety of homebirth.
None of that contradicts the fact that in most cases, low-risk pregnant woman should be (if they wish) able to labor undisturbed without routine interventions. That situation (no interventions unless needed) is in fact what makes birth the safest. What I am saying is that routine interventions interrupt the natural process of birth and make it more dangerous. For most women, labor will be safe and we should prceed on that assumption, of COURSE preparing for an emergency situation if one should arise, just as we do in every other aspect of our lives. I certainly know where the hospital is and how to get a piece of food out of my baby's throat if he's choking...that doesn't mean I approach every meal he has as a potential medical emergency.
Also, its important to note that the reasons women in the past in rich countries, and currently in undeveloped countries, generally died in or after childbirth were lack of antibiotics for infection, hemmorage, and other problems caused by poor sanitation and nutrition. Those aren't the only reasons, but they are the main reasons. These are problems that in most cases can be prevented and treated even in a non-hospital setting by, for example, a midwife.
Sorry, one more thing. I just want to say that those of us who advocate reform of US maternity care, with the exception of a very few people, are in no way advocating some sort of "back to the land" approach. We are not saying birth was safer in the "old days" or in undeveloped countries. We can also look at WHO statistics and know that this is not the case.
What we are saying is that changes could be made to how technology and pharaceuticals are used today which would make things MORE safe. In many cases, this would involve reducing the use of interventions unless truly needed. This does not denigrate the importance of these interventions when they are needed. But evidence and the experience of other rich countries (where healthcare financing provides a disincentive, instead of an incentive, to overuse technology) shows that this approach of using technology APPROPRIATELY saves lives of women and babies. Take a look at maternity practices in Finland or Sweden, for example, and their infant and maternal mortality rates. Both intervention rates and death is lower. Also, take a look at US infant and mortality rates since the early 80s...interventions have gone WAY up, maternal and fetal mortality has been stagnant.
That is all we want for here....we don't want a situation like in 19th centruey France or modern day Congo.
My mom always complains about the way that birth is depicted in movies and on tv, with women hysterically screaming and acting like monsters. My mom gave birth three times and although she didn't have a doula, she said the experience each time, while unpleasant, was still relatively calm and peaceful. No screaming or swearing at the nurses.
And I think that the exaggerated, caricature of labor that is depicted in our pop culture is ultimately really harmful to women who give birth, because I'm sure it creates a lot of heightened fear and anxiety.
That said, I think it's also important to remember that we shouldn't discount the experiences of women who do experience a lot of pain or trauma during labor. I've noticed a new trend of trying to convince mothers that they should take steps to make birth as natural as possible (i.e. that they should use no pain killers, should give birth at home etc.). However, while calm births are certainly possible and can be a beautiful thing, I don't think it should ever be considered a failing on the mother's part if the birth process isn't as calm and peaceful as ones like this.
"I've noticed a new trend of trying to convince mothers that they should take steps to make birth as natural as possible (i.e. that they should use no pain killers, should give birth at home etc.)."
this "trend" is almost 40 years old, still very hard to come by for the 99odd% of women labouring in US hospitals, and statistically leads to better outcomes for mother and child.
I would say that having a midwife-assisted birth is actually as old as time itself! Doctors only got in on the game relatively recently, (victorian era-ish) when they saw how much money they could be making in the baby-catching business. They then started a long campaign to portray midwives as barbaric to further seal their position... though you are correct that midwives have returned to popularity in the last 40 years!
And to those who say people are "pushing" this choice on others- so not true! We just want women to KNOW about the option, and make sure that OUR choice isn't frowned upon! Unfortunately, there is a LOT of misinformation about midwives and doulas that we need to correct!
Agree with this comment. A few odd apples aside, I think most of us out here advocating for reform of maternity care in America are looking for MORE choice, not less. Its not necessarily about convincing people that birth needs to be as natural as possible, but instead about removing the scare tactics around birth which have been improperly used by the medical powers-that-be to create a culture around birth which maximizes their own profits, while minimizing women's choices.
US women have so few choices for their births - 99% of US babies are born in hospitals, despite the fact that out-of-hospital birth is just as safe (or potentially even safer depending on whether you count "freedom from unwanted interventions" along with risk of infact/maternal mortality) for low-risk women. I don't think this fact is that well-known, as doctors for obvious reasons do not publicize it, and oftentimes insurance companies won't pay for alternative birth arrangements.
My mother is an obstetrician and I have to say this vilification of her profession drives me nuts. It is absolutely true that her presence is not necessary at most births and she is the first to admit that. But to write physicians off as some giant scam is absurd. When things go wrong in the delivery room they can go wrong very quickly - even if the pregnancy wasn't 'high risk'. Sometimes she has mere seconds to save the life of the mother or the baby. Maybe you'll write that off as just another scare tactic of the medical establishment but the women who are alive today with healthy babies probably feel differently.
I absolutely believe that every woman has a right to decide how she wants to give birth. But doctors not villains, nor are they irrelevant.
And here's an interesting aside to put things into perspective: I was talking to my mom about doulas the other day. She really has no issue with their presence in the deliver room at all. But she did mention an interesting fact - some of the doulas who attend her patients during birth actually make more money to be there than she does.
Certainly most OBs are wonderful people who work very hard sincerely helping their patients. But you need to admit that AMA and the ACOG's positions on many birth issues diverges quite markedly from peer organizations in other countries, in a way that lessens US women's choices. E.g., the ACOG's position on homebirth for low-risk women, and their recent announcement "allowing" women to drink moderate amounts of clear liquid during labor. Since neither position is supported by evidence-based studies or the desires of many women, its hard for some of us not to doubt the motivations/methods of the profession as a whole. I mean, one example, episiotomy continues to be used routinely despite much evidence that it most cases it does not improve outcomes and actually worsens them. Same with lithotomy position birthing. I don't want to villify individuals, just to point out that US maternity practices and ACOG positions are not up to international standards or supported by evidence. Have you had a look at Jennifer Block's book Pushed? It not only point out these facts, but also has a very OB-sympathetic analysis of why things got to be this way in the US due to financing of health care and liability factors.
My mother is an obstetrician and I have to say this vilification of her profession drives me nuts. It is absolutely true that her presence is not necessary at most births and she is the first to admit that. But to write physicians off as some giant scam is absurd. When things go wrong in the delivery room they can go wrong very quickly - even if the pregnancy wasn't 'high risk'. Sometimes she has mere seconds to save the life of the mother or the baby. Maybe you'll write that off as just another scare tactic of the medical establishment but the women who are alive today with healthy babies probably feel differently.
I absolutely believe that every woman has a right to decide how she wants to give birth. Doctors not villains, nor are they irrelevant.
And here's an interesting aside to put things into perspective: I was talking to my mom about doulas the other day. She really has no issue with their presence in the deliver room at all. But she did mention an interesting fact - some of the doulas who attend her patients during birth actually make more money to be there than she does.
I have seen many calm births. the midwife Iworked with has a naturally calm style. I know a woman who learned with Ina Mae Gaskins (wrote Spiritual Midwifery) who said the same about her and people who learn from her.
I have seen many calm births. the midwife Iworked with has a naturally calm style. I know a woman who learned with Ina Mae Gaskins (wrote Spiritual Midwifery) who said the same about her and people who learn from her.
oh, and remember, when it comes to women's experiences, West African religions and the diaspora and so much more-
DON'T believe what you see in the movies!
This bothers me as well. The cultural framework around birth is something that we as women absorb. If you're hammered with messaging that labor is this excruciating, traumatic event that results in you acting like a beast to your partner, the doctor, etc etc--then this is going to cause you a lot of stress going into the event because you're going to have this expectation that you're going to go through the worst pain of your life, and it may become a sort of self-fulfilling prophecy.
Is this some sort of collective unconscious recognition of the bad old days when women would regularly die in childbirth, or is this just a means of scaring women about sex by making sure that the "consequences" of sex are shown as gory and painful and potentially life-threatening?
I think television is different, but in movies, I would bet that the rate of maternal mortality in movies is pretty high, close to 50%, because so many "heroes" necessarily had to never know their parents.
sorry, this was intended to be a reply to marie123's first comment.
"then this is going to cause you a lot of stress going into the event because you're going to have this expectation that you're going to go through the worst pain of your life, and it may become a sort of self-fulfilling prophecy"
What you say here is physiologically totally true. One of the factors that makes birth more painful/longer/more dangerous is the mother's stress level. Just like every other mammal, we labor the most effectively when we are calm, warm, dark and private environment where we feel safe. Makes sense, because the last thing you want is to have a defenseless baby and physically vulnerable mom at a time when predators and other dangers are present. So when there are bright lights, lots of commotion and stress, this releases adrenaline which counteracts oxytocin, the hormone that makes contractions productive. This causes pain because your body is effectively working against itself... its trying to contract to dialate your cervix, while on the other hand it is trying to shut that process down until the danger has gone away.
The more a woman is stressed about her birth, and the more she is made to labor in anu nfamiliar environment with strangers who poke and prod her, all things being equal, the slower and more painful her labor will be. This is why some of us are highly critical of traditional hospital births, which basically place women in conditions antithetical to physiological labor in the name of "safety"...instead, this environment makes birth less safe by creating a stress response that undermines the natural process of birth.
In Naomi Wolf's (take from her what you like) Misconceptions, she argues (on behalf of the women she spoke with) that if women were more aware of the actual pain they were going to go through, they would have felt more prepared to deal with it.
If women weren't as surprised by the pain, they might not go to the epidural so quickly.
So, although birth in the media is shown as a lot of screaming and hoopla, those representations actually do not give women much of a sense of what the pain will actually be like.
She argues that women think it will be a little painful, but the women were so taken aback by the pain, it was surprising as well as excruciating.
I've had a pain for a penis stretching my vagina, a head going through my pelvis, stretching out my vagina, vulva, and possibly rectum will be painful. Transcendent, exciting, miraculous? Yes! But also painful.
Does anyone else feel like saying that women can smile through contractions actually reinforces gender roles regarding women needing to be pleasant all the time?
I like that this is out there. All stories of birth should be, and all women should be empowered to have whichever kind of birth they would like. But it's also okay for women to feel anger, pain, and frustration, especially during such a life-altering experience.
I wasn't at all trying to imply that homebirth or other choices aren't beneficial for lots of women. What I was trying to say is that it's important not to imply that a woman is failing in some way if she doesn't end up with a calm birthing experience like the one described. Unfortunately, stories like this one can sometimes suggest that if a woman doesn't have a calm, transcendent labor that it's her fault for not making the right birth decisions.
Telling women about options that might make their labor experience better is a very good thing, but implying that labor will be perfect and wonderful if women do x,y,z is what I have a problem with.
When I wrote my comment I was thinking specifically about a story recounted in the book "Better" by Atul Gawande about a female physician who wanted to go through a very natural birthing process. This woman said that she felt like a failure when medical complications led her to ask for interventions and pain killers.
This was supposed to be a reply to uberhausfrau
I think the tendency to feel like a "failure" for wanting pain meds and interventions is actually caused by our overly medicalized birth environment, not natural birth people. If we had a system more like most European countries (where midwives, birth centers and homebirth were accepted, integral parts of maternity care instead of considered fringe activities by a few rebels), each birth experience would not need to be "all or nothing" like it is here. For example, in Holland where 1/3 of all babies are born at home, something like 40% of all women who plan to give birth at home end up heading to the hospital for whatever reason, most times because they want pain relief. Its not a failure, its normal and a choice they are able to make without adverse consequences. Here in the USA, if you try to birth at home and then end up tranferring, you are met with a huge amount of animosity because you've been a "bad woman" who didn't follow directions and show up at the hospital as you were told as soon as your water broke.
A long way of saying that medical domination of birth, which refuses to accept any other kind of birth as legitimate despite all evidence that it is just as safe in many cases, is what I believe causes a lot of women to feel like they have "failed" when they need to unexpectedly call on doctors in their birth experience. For me, that is the proper role of doctors in the birth process -- people standing by to help in the event a usually safe and natural process goes wrong or gets too intense. Unfortunately, US docs have made it clear they are not willing to play a supporting role, and will respond with hostility and an "I told you so" attitude when asked to do so.
I don't think the implication is that all births can/should be like this one.
The point is that some births can be less medicalized. Secondly, it presents us with a birth narrative that's different from the most perpetuated ones.
It reminds me of one time when I was in the ER for food poisoning and a woman in labor came in. She was just sitting there looking slightly annoyed. I was incredibly disappointed.
"Do you hate me for believing that our bodies were designed to have children?"
Yes, yes I do. Our bodies were not "designed" for anything. They evolved to be good enough, not finely honed. A woman's pelvis is a compromise between having a pelvic opening large enough to pass a baby with a large head and having a pelvic opening small enough to allow the woman to stand upright. Birth suffers more than posture in this compromise.
I am happy for this woman and her lovely birth experience, and it's cool to hear from someone whose experience differed so much from what the media portrays/ what we generally hear about. However, this piece is written in the most obnoxious way imaginable. I think WickedAnnabella made some good points: "...I really dislike the implication that all births can and should be like that, and that if you just try hard enough, you too will be smiling though your contractions."
This piece, thought it I'm sure it didn't mean to, does imply that this is the case. Lines like "do you hate me for believing that our bodies were designed to have children?" remind me of Maggie Gyllenhaal's character in "Away We Go": feeling constantly better than everyone else because she has found serenity in experiences that others find painful or unpleasant. It also reminds me of the ways in which that ABC special presented "orgasmic birth," as though it were some beautiful holy thing that everyone should strive for. The truth is that birth is different for everyone, because bodies and people are different. So if you get lucky and happen to have a lovely birthing experience, good for you, but don't make it sound as though women who experience pain during birth are not as holy as you are. (The author does acknowledge that luck was involved, but in a way that feels hasty and flippant to me. "I was lucky, sure, but back to how much I win at birthing.")
What's more, this piece smacks of privilege. "I was using Evening Primrose oil and raspberry leaf tea to encourage [the baby]." (This is possibly my least favorite sentence ever written.) She makes leisurely trips to Bed Bath and Beyond and Macy's. She makes references to being familiar with yoga poses. She clearly has time and money to burn. I'm not faulting her for this, but for failing to acknowledge the connection between privilege and the ability to have a nice, calm birth in a manner of one's own choice.
I think it's important to hear from a wide variety of people about their birth experiences, but I think it should be done in a way that isn't holier-than-thou. "You're doing it wrong" implications are the opposite of constructive.
Evening primrose oil and raspberry leaf tea are not marks of privilege. They are incredibly cheap herbal supplements that I also took while pregnant on a modest salary living in a 2-flat in a blue collar neighborhood in Chicago when I was pregnant. I'm not sure why the thought of using herbal medicine so offends you, but it isn't something only the wealthy do.
As far as having choice in birth, that isn't only for the privileged either. My 2 midwife-assisted births cost us far, far less than hospital births. We were uninsured at the time and being able to birth at home was not only what I wanted from a feminist perspective, it kept us out of crippling debt.
Here is an article from RH Reality Check, written by Feministing's own Miriam, about why low-income women are not commonly able to give birth outside of hospitals.
http://www.rhrealitycheck.org/blog/2009/03/19/the-cost-being-born-at-home
Here is a list of different evening primrose oil prices on Amazon.
http://www.amazon.com/s/ref=nb_ss_0_12?url=search-alias%3Daps&field-keywords=evening+primrose+oil&sprefix=evening+prim
I'm not saying it's wrong to utilize either of these things or that using them means you're rich. And it sounds like home birth absolutely made the most sense from both a financial and a feminist standpoint in your case. I just think it is important to acknowledge things like that you and I know about home birthing as an option (whereas many women in very low-income communities do not, as Miriam points out in the article) or that we can afford to spend at least some amount of money on herbal supplements, whereas many low-income women could not.
Having birthed vaginally, I found the article quite interesting. My experience of calm seemed quite similar to hers (up until about 8cm) except for the doula and herbs. I credit a great pregnancy/Lamaze course for the education that kept me knowledgeable and unafraid.
I had to go into the hospital sooner because my water had broken and that's what I was "told" to do. I wish I had stayed home much longer. I was bored in the hospital for 8 hours until I consented to Pitocin. I didn't need pain management until 8cm - when it was almost too late to administer! While my labor was technically 15 hours, I only count the time I had to push - less than 30 minutes. The rest of the time I was watching Food Network (food envy) and chatting up my visitors.
As for the screaming of other mothers, women should be taught that often it only tenses their core muscles and makes pushing more difficult and interferes with breathing; meaning more painful birth. And it freaks the hell out of us new moms in the next room! haha
I think not having received a thorough education regarding the birth experience, what can reasonably expected and how to take control of the situation back from the doctors makes a lot of women scared, contributing to the stress. I believe this is a result of the medicalization of birth.
(Full disclosure: I would go to a hospital again just in case I'd suddenly need medical assistance.)
I wonder why no-one gets all high-and-mighty if they don't happen to need novocaine at the dentist? (Well, perhaps there are some people who take pride in that, but nobody takes them seriously.) Needing or not needing medication should not be subject to judgment.
Oh, excuse me, this is something related to motherhood/sexuality? OK, judge away, since everything related to that is under scrutiny!
Incidentally, I did have 2 drug-free childbirths with midwives, and I do think it's wise to be aware and consider natural approaches. However, anything beyond the reasonable pride of being a new mother is pure smugness. Ugh. (I'm also a total wimp at the dentist and need extra novocaine, FTW.)