Your Body, Your Baby, Your Birth: A Mother’s Most Important Decision

Author’s Statement

Keep in mind while reading this essay that it is formatted in a certain
way to show the author’s view of the problem at hand, options for a
solution to that problem, and my final recommendation to the reader.
This is an informational piece along with my personal view. Every mother
has the right to make her own decision of what she feels is best for
her and her family. I only hope this can spark questions in your mind
that you may not have considered before and lead you to a personal
exploration of information to make your own decisions. Happy reading and
best wishes to all the expecting women out there. I hope this helps you
on your journey.

Sincerely,
Brooke Kunkel

***************************

Your Body, Your Baby, Your Birth:
A Mother’s Most Important Decision

Brooke Kunkel
April 2010

“Oh mighty one, the ancient inscrutable,
without name or form,
Disguised as Brahman, Abraham, the Primordial One,
You come to us as the gift of a child.
Salutations, salutations to you a million times,
For manifesting Yourself in every grain of creation.”
-Deepak Chopra

Problem

This is my first pregnancy, and when I asked my obstetrician about
natural childbirth her response was “Why would you want to endure the
pain when we have the technology to relieve it?” She also stated that
natural un-medicated births are uncommon, and there’s no reason to be a
“hero”, “We are here to deliver your baby safely,” she stated. It’s no
wonder that when women become pregnant and seek the advice of medical
doctors (as they are taught to believe this is what you are supposed to
do) they are faced with this idea that labor is a horrifyingly painful
experience and that the doctor will save the day and take care of
everything, in the meantime stripping the woman of her confidence in
herself and her body.

Because of this interaction with my doctor, I began looking into
alternative birth options. I really didn’t feel that being pregnant was a
medical illness that needed such dramatic procedures and drugs.
Childbirth is not a new thing, women have been doing it for thousands of
years, and obviously it works more often than not, otherwise the world
wouldn’t be so populated. I knew my grandmother had home births, and
she said the pain wasn’t too bad, that’s just the way it was. I was
confident there were better ways out there to go about childbirth. Being
this is my first pregnancy I had no idea what my options were but I
knew in my gut this doctor scared the bejeesus out of me and I had an
urge to run for the hills. Through research I found out about birthing
centers, homebirth, midwives, and doulas as possible alternatives.

To understand where we are today in the world of modern medicine and
childbirth, we need to look at our past. The History of Midwifery and
Childbirth in America: A Time Line by Adrian E. Feldhusen explains that
the first immigrants in Colonial America used midwives during childbirth
and it was estimated that births were successful 95 percent of the
time. But as the years progressed, and as physicians became more popular
and available to middle and upper-class, midwives were seen as ignorant
immigrant women that had no place in the childbirth setting. Only women
who could not afford a doctor used midwives. In Victorian times, women
were seen as “frail” and doctors believed that “normal” deliveries were
rare and interventions were designed to save women from the “evils” of
labor. During this time maternal mortality reached a high of 600-700
deaths per 100,000 births. By 1938 doctors used “twilight sleep” in all
deliveries; these women were drugged and literally removed from the
experience of birth leaving her with no memory of the delivery of her
child. Ninety-seven percent of births occurred in hospitals by 1960.
Women’s groups encouraged the revival of midwifery and Stephen and Ina
May Gaskin founded The Farm in 1971 — a place women could go for midwife
attended natural childbirths. A conflict ensued between the homebirth
movement and the medical profession leading to the threat of losing
their medical licenses if any doctor provided backup emergency care for
homebirths. By 1980 costs were more of a concern to hospitals than
quality of care. The first study on the effects of epidural in 1993 were
stopped by the investigators because they thought it was not ethical to
continue as the high rate of cesareans women were having, yet many
doctors still use the drug today. The US has the world’s most expensive
maternity care but hast the worst pregnancy outcomes than almost every
other country. Currently, midwifery is still illegal in many states
(Feldhusen). For more information on the history of midwifery see- http://www.midwiferytoday.com/articles/timeline.asp?a=1

Today, childbirth in the hospital is no stranger to interventions.
BabyCenter states, “The number of women whose labor is induced has more
than doubled since 1990. The number of cesarean deliveries in 2006 rose
to 31.1 percent of all births, a 3 percent rise from 2005 and another
record high. The c-section rate has climbed 50 percent in the United
States over the last decade.”

Once such intervention is the induction of labor. Induction poses the
risks of abnormal fetal heart rate, shoulder dystocia (where the
shoulder of the infant cannot pass over the pubic bone) and a risk of
your baby being admitted to the neonatal intensive care unit. Babies
that are induced just aren’t ready to be born yet, and the process of
induction can cause more intense contractions and fetal distress.
Increased risk of forceps or vacuum extraction used for birth, increased
risk of cesarean section, and jaundice are also common among induced
pregnancies.

Drugs including Epidural and Pitocin are commonly used by obstetricians
during the labor process as well. These have severe side effects on the
mother and baby. Epidurals are used by women because they feel they
can’t endure the pain of labor. The side effects of Epidurals for the
mother include “hypotension (Drop in blood pressure), urinary retention
and Postpartum Bladder Dysfunction, uncontrollable shivering, itching of
the face, neck and throat, nausea and vomiting, postpartum backache,
maternal fever, spinal headache, feelings of emotional detachment,
postpartum feelings of regret or loss of autonomy, inability to move
about freely on your own, loss of perineal sensation and sexual
function” (James). Some of the more severe and rare risks include
“convulsions, respitory paralysis, cardiac arrest, allergic shock, nerve
injury, epidural abscess, and maternal death” (James). During labor,
the side effects of epidurals are “prolonged first stage of labor,
increase of malpresentation of baby's head, increased need for Pitocin
augmentation, prolonged second stage of labor, decrease in the ability
to push effectively, increased likelihood of forceps or vacuum
extraction delivery, increased likelihood of needing an episiotomy, and
increase in possibility of cesarean section” (James). For the baby, the
epidural poses the risk of “fetal distress, abnormal fetal heart rate,
drowsiness at birth, poor sucking reflex, poor muscle strength and tone
in the first hours” (James).

Pitocin is used during labor for the purposes of “speeding up” the labor
process when the obstetrician feels it’s not progressing as it should.
“Pitocin might cause a tumultuous, difficult labor and tetanic
contractions, rupture of the uterus and dehiscence of a uterine scar,
lacerations of the cervix, retained placenta or postpartum hemorrhage.
Postpartum perineal and pelvic floor pain is increased as a result of
augmented uterine contractions. Fetal complications might include fetal
asphyxia and neonatal hypoxia, physical injury and neonatal jaundice.
The use of pitocin also might be a factor in cerebral palsy from
deprived oxygen and autism” (Stillerman).

“There is a moment when every woman thinks, ‘I can‘t do this.’ If she is
lucky, she has a midwife, a doula or her mom to whisper in her ear,
“You are doing it.” As she does it, she becomes someone new: a mother.
If the birthing process is skipped or occurs in a hostile situation, or
if the interventions become overwhelming, she becomes a different mother
than she would have been if she had only had a supportive, midwifery
model of care.... How are women supposed to protect themselves while in
labor? How do they recover from this? What does it mean when they refuse
to file reports or grievances? What does it say about our society when
our hospitals, which are supposed to be places of comfort and healing,
are instead places of coercion, abuse—even assault and battery?”
Emotional Impact of Cesareans by Pam Udy

With c-sections being at an all time high, what exactly are the risks
women undertake? According to the Canadian Medical Association, in a
recent study women who undergo c-sections are at risk for cardiac
arrest, wound hemotoma, hysterectomy, major perpetual infection,
anesthetic complications, venous thromboembolism (a serious condition in
which the arteries leading from the heart to the lungs becomes blocked
possibly causing death), hemorrhage requiring hysterectomy, longer stay
in hospital after delivery, and most importantly, death. They state “The
risks of severe maternal morbidity associated with planned cesarean
delivery are higher than those associated with planned vaginal delivery.
These risks should be considered by women contemplating an elective
cesarean delivery and by their physicians” (Maternal Health Study Group
of the Canadian Perinatal Surveillance System).

A newborn baby is fully capable of responding to the emotional and
physical environment in which he or she is born, and the exposure to
drugs can have lifelong consequences. During a natural vaginal birth,
the mother is not given any drugs to dull the pain, nor is the baby
affected by drugs. The mother is fully aware of the experience and in
control of her body. The hormones oxytocin, adrenaline, and endorphins
are naturally released by the brain during labor creating deep feelings
of love, passionate attachment, and the “motherly instinct” of
protecting her newborn child.

During a vaginal birth the hormones released help stimulate the thyroid,
adrenal, kidney, lung, digestive, circulatory and immune systems.
During the delivery, as a baby passes through the birth canal, they are
exposed to flora that strengthens these systems helping the baby
immediately. It is still being studied but it is possible that it can
lead to long-lasting and permanent benefits to the child (Buckley).

Some women fear natural childbirth, some of that fear is caused by
horror stories women speak of about a birth they “heard” about or
something they saw on TV. These are just that, rumors, or tales of
malpractice. Pain during labor can be prevented; an educated midwife or
doula can help you with techniques to make your labor easier. Not only
breathing techniques, but also counter pressure, water therapy (and
water births), even different positions for contractions and birthing.
Aromatherapy, visualization, hypnotherapy, and various birthing aids
like a birthing ball can help progress labor at the same time reducing
pain. More importantly, having a doula or midwife there to personally
coach you through the entire experience and offer words of encouragement
and support will be most beneficial in keeping your confidence and
spirits up and the pain and fears at bay.

The founder of The Farm, Ina May, is an advocate for homebirths and
proper maternal care in the United States. From 1971 and up to the year
2000 the cesarean rate for the women who gave birth at The Farm was 1.4%
and their forceps and vacuum extraction rate was 0.05% whereas the US
national cesarean rate was at 24.4% and instrumental delivery rate was
about 10% (Gaskin, xiii).

“Simply put, when there is no home birth in a society, or when home
birth is driven completely underground, essential knowledge of women’s
capacities in birth is lost to the people of that society—to
professional caregivers, as well as to the women of childbearing age
themselves. The disappearance of knowledge once commonly held paves the
way for over-medicalization of birth and the risks which this poses.”
Home Birth-Why It’s Necessary by Ina May Gaskin

The numbers are there, the myth of homebirths being unsafe has been
busted. “A six-year study done by the Texas Department of Health for the
years 1983-1989 revealed that the infant mortality rate for non-nurse
midwives attending homebirths was 1.9 per 1,000 compared with the
doctors' rate of 5.7 per 1,000. Certified nurse midwives' mortality rate
was 1 per 1,000 and "other" attendants accounted for 10.2 deaths per
1,000 live births” (Tipton).

Certified Nurse Midwives can provide prenatal care that is more personal
than you get as a patient with an obstetrician or in the hospital
setting. Midwives will most likely come to your home for checkups, they
bring all of their supplies with them, and can prescribe medications if
need be just as a doctor does. More importantly, they get to know you on
a personal level, they understand who you are as a person, what your
wishes are for birth, and get to know your family. This bonding is
important as during the labor process it reduces stress and will make
the labor a more positive experience.

Options

Homebirth with a certified Nurse Midwife and Doula for women who are
low-risk. Certified Nurse Midwives can be hired to do all prenatal care
and testing. Water births are popular among midwives due to the ease of
pain and gentler birthing process. Doulas are a good aid in helping the
midwife and also bring alternative methods of pain relief to the
atmosphere.

Birthing Center or Hospital Birth with a Certified Nurse Midwife for
higher risk women. Birthing centers and some hospitals have noticed the
demand for women wishing natural birth attended by midwives. The places
will act and seem more like hospitals in the patient care area and the
availability of emergency services. They will also provide prenatal care
along with delivery. In emergency situations, Obstetricians are
available on hand.

Doulas in the hospital setting. For the women that are uncomfortable
with letting their OB go, Doulas are recommended. They can provide
valuable information and support you just don’t find with obstetricians
or the hospital nursing staff. They are there for you, and will help you
and your doctor stick to your birth plan and help further explain what
the doctor may want to do and provide you with accurate information so
you can make the best choice for you and your baby.

Recommendation

To honor the body and the experience, also to ensure that women are
respected and the knowledge and spiritual experience of childbirth is
not lost, it is important to move away from the care of obstetricians to
that of a midwife. Women should strive for a natural un-medicated birth
plan both for her own health, and that of the baby. The best chance of
this is through a Certified Nurse Midwife in the home setting. Depending
on your risk factors, you may want to go to a birthing center that is
friendly to this type of birth plan, or for a high-risk patient a
hospital where births are attended with a midwife, unless of an
emergency where only then should an obstetrician be called upon.


Helpful Links

Ina May Gaskin (Midwife, Homebirth Advocate)- http://www.inamay.com/

Birth Options (Documentary)- event)''>http://www.thebusinessofbeingborn.com/

Birth Options (Websites for support and Information)- http://www.mybestbirth.com/

http://www.yourbirthright.com/#/next-free-teleclass/4538368664

http://www.americanpregnancy.org/labornbirth/homebirth.html

Homebirth Birth stories- http://www.childbirth.org/articles/stories/categories/homebirthstories.html

Natural Birth Pain Management- http://www.givingbirthnaturally.com/labor-pain-management.html

Water Births- http://www.waterbirth.org/mc/page.do;jsessionid=479A5BBDA06D87FDEF730899EFD35CC6.mc0?sitePageId=38425

National Vital Statistics Reports- http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf

USA: Deadly delivery: The maternal health care crisis in the USA
(Amnesty International)- http://www.amnesty.org/en/library/info/AMR51/007/2010/en

Maternal Death Rates- http://www.cnn.com/2010/HEALTH/03/12/maternal.mortality/index.html

Video: ABC News Report on maternal deaths linked to cesareans- http://abcnews.go.com/WNT/video/moms-risk-10014105

Avoiding a Cesarean- http://pregnancy.about.com/od/laborbirth/a/avoidcesarean.htm

http://pregnancy.about.com/gi/o.htm?zi=1/XJ/Ya&zTi=1&sdn=pregnancy&cdn=parenting&tm=7&f=00&tt=14&bt=0&bts=0&st=23&zu=http%3A//www.gentlebirth.org/archives/avoidsec.html

Cesarean Birth Story- event)''>http://birthcut.com/

Suggested Reading about Natural Childbirth-
Ina May’s Guide to Childbirth by Ina May Gaskin
Mind Over Labor by Carl Jones
Birthing From Within by Pam England
Gentle Birth, Gentle Mothering by Sarah J. Buckley, MD

Works Cited

"TWILIGHT SLEEP; Is Subject of a New Investigation". The New York Times.
1915-01-31. http://query.nytimes.com/gst/abstract.html?res=9E05EED8113EE733A05752C3A9679C946496D6CF. Retrieved 2008-08-05.

Feldhusen, Adrian E. “The History of Midwifery and Childbirth in
America: A Time Line.” Midwifery Today. 2000. 28 April 2010. http://www.midwiferytoday.com/articles/timeline.asp?a=1

Babycenter. “22 Suprising Facts About Births in the United States” 28
April 2010. http://www.babycenter.com/0_22-surprising-facts-about-birth-in-the-united-states_1372273.bc?page=4#articlesection6

Maternal Health Study Group of the Canadian Perinatal Surveillance
System. “Maternal mortality and severe morbidity associated with
low-risk planned cesarean delivery versus planned vaginal delivery at
term” Canadian Medical Association. 2007. 28 April 2010. event)''>http://www.cmaj.ca/cgi/content/full/176/4/455

James, Kim. “Epidural Risks and Side Effects”. 28 April 2010. http://www.kimjames.net/epidural_risks_and_side_effects.htm

Stillerman, Elaine. “The Truth About Pitocin”. March 2006. 28 April
2010. http://www.massagetoday.com/archives/2006/03/11.html

Gaskin, Ina May. Ina May’s Guide to Childbirth. New York: Random House,
2003.

Tipton, Janet. “Is Homebirth For You?”. Friends of Homebirth. 1990. 28
April 2010. http://www.gentlebirth.org/format/myths.html#Studies

Buckley, Sarah J. MD. Gentle Birth, Gentle Mothering. Berkley: Celestial
Arts, 2009

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