By Emma Suttie, D.Ac, AP
I would like to preface this by saying that I believe that everyone has the right to choose how they live their lives and how they choose to give birth. If there is anything that travel has taught me, is that I am very lucky to live in a place where we are able to have choices over a great many things. What I wish to present here is how I have chosen to travel this path, and to give information. I have seen through many years of clinical practice that many people are unaware of how medicalized the process of pregnancy and especially birth has become in this country. I only wish to educate so that people may make the most informed choices possible and fully understand all possible outcomes for the choices they are making.
This beautiful image from http://www.hartshornportraiture.com/
It was years ago when a pregnant patient told me about a documentary that she had watched called The Business of Being Born. The doc discusses the history of prenatal and natal care and the increase in the use of doctors and hospitals as well as medical procedures during the birth process in the last century. It is also a film about midwives and the important role they play in pregnancy and birth. Here are some statistics taken from the film (which was released in 2008):
- Midwives attend more than 70% of births in Europe and Japan
- Midwives attend less than 8% of births in the US
- The US has the second worst newborn death rate in the developed world
- The US has one of the highest maternal mortality rates among industrialized countries
- In 1900 95% of births took place at home
- In 1938 half of all births took place at home
- Since 1996 the cesarean rate in the US has risen 46%
- In 2005 cesarean sections were performed for one out of every three births
- A cesarean section is now an elective procedure
- The US spends two times as much per birth than any other country in the world
This lovely image from blog.vonbon.ca
Natural Pregnancy and Childbirth
I am presently pregnant with my first child. Ironic as I have treated many pregnant women in the past with the book knowledge but without the direct experience. I watched the film again and it was with a fresh, and perhaps more invested perspective.
I should say that for me, I always knew that when I had babies that I would have them with a midwife, preferably at home and in water. This has always been normal to me. Perhaps it is because my mother also had me with a midwife, in England, where apparently, that sort of thing is considered more “normal”. Once I was born I remained in the same room as my mother, and my father was allowed to also stay in the room, and bring my mother any foods or drinks she liked. Anything to make her more comfortable. I have been pretty surprised by some of the reactions that I have gotten from people when I tell them I will not be having my baby in a hospital, but in a tub, at home, with a midwife. The eyes get very large and there is a pause, as if they are waiting for me to say that I am just kidding. This reaction surprises me, but after watching that film, I realize that it shouldn’t. Among me and my close friends, this way of having a baby reflects the way in which we choose to live our lives. Naturally. Gently. Kindly. And with the reverence and respect for our bodies and that they know exactly what to do without intervention. Anyone outside that small circle seems to be a bit horrified and sometimes angry at the idea, saying that it is irresponsible and dangerous if anything were to go wrong. So let me tell you a few things about how having a baby with a midwife works, because many people simply don’t know, and knowledge is the best antidote to fear.
One thing that really surprised me was that people in the US on the whole seemed to not know very much about midwifery in general. One person, when asked, likened it to having a baby in a barn which made me laugh out loud. And then I realized that they were serious. The other thing was that a bunch of women with small children were asked if they had ever considered having their baby with a midwife and none of them had and they seemed a little freaked out by the idea, like it had never ever crossed their mind.
In the film it states that in the 1900’s began a bit of a smear campaign demonizing midwives as primitive, dangerous and unclean. Up until that time throughout the world, they had been the ones delivering all the babies. But modern medicine was being developed and techniques that were thought to make the birth process safer, cleaner (and certainly more profitable), began to be employed, and births moved from the home to the hospital.
I think because of this there is a lingering idea that if you decide to have a baby with a midwife she will somehow not be as qualified as a doctor or OBGYN if there are problems or complications with the birth. I believe that this is completely untrue.
First of all, midwives (at least in the US) only deal with low risk mothers. I am sure this is determined in different ways depending on where in the world you are, but here it is a point system. At your initial appointment, the midwife takes a detailed medical history about you and your partner. This is similar in scope and detail to an acupuncture initial appointment (without the spouse part ;) And there are certain criteria that are given points, like certain medical conditions, genetic history, age of parents, etc… In this system you are allowed 3 points. More than that and you will not be offered care because you are no longer considered low risk. At that point, you must have your baby with a doctor in a hospital as you are considered slightly higher risk.
The appointment continues with the midwife listening to your heart and taking a lot of blood for labs. They check for the same things a doctor would, making sure that you are free of disease, infection, STD’s and to make sure that all your levels are within a normal range. You are also asked to do a series of urine tests to test for levels in your body and determine your general health. You are asked where you would like to have the baby, at the birthing centre, or at your home, and if you would like to have the baby in water (which is available in both places). You and your midwife have to know where you are planning to give birth and if it is at your home, then the midwife makes a trip to your house and makes sure everything is ok before the event. They also bring with them everything they need for you to give birth, everything they would have at the centre. You must also be within 15 minutes of a hospital in case of an emergency so that you can get there safely and quickly.
Although birth centres vary in design, the ones that I have seen have many of the following features. They are often in old houses and non commercial structures. The appointment rooms are designed like large, comfortable bedrooms, with normal beds, lots of pillows, a rocking chair and bathtub and shower. Like a lovely bedroom in a quaint bed and breakfast, a place you would want to be. They are not clinical environments, and the energy is relaxed. Although all the medical equipment needed for each appointment is in the room, it is put away in drawers and cupboards, to keep the environment comfortable and to keep the mothers and their spouses relaxed.
The rest of the centre also has a relaxed atmosphere, and people smile and say hello. You get to know your midwife (often several midwives, as they are all on call all the time) and the staff. When you arrive there are often mothers having their babies in the adjacent rooms, and children playing. There is often a lending library with books on a wide variety of subjects that can be borrowed. There are various classes offered for you and your partner from birthing, to breastfeeding to help prepare you for what is happening, and what is coming.
Meeting with your midwife for appointments, there is always a discussion and they are happy to answer any questions that you have. Midwives are there to answer questions and give you information, not to make decisions for you about your pregnancy or birth. The decisions are always up to you. They also have a great respect for the process of pregnancy and birth and are there to support it and help when they are needed.
What Have We Lost?
Ina May Gaskin is a pioneer in the field of midwifery and has been delivering babies at The Farm Midwifery Centre in Tennessee where she is founder and director since it opened in 1971. I have posted a TED talk she did below where she discusses the culture of fear surrounding birth in the US. It is a powerful talk.
Ms. Gaskin’s talk really resonated with me for many reasons. The main one is that she states that women have become afraid of the act of childbirth and that the confidence in their own bodies and their innate knowledge has been lost. To take that thought even farther, I think that we have largely lost our connection to our own bodies. And, more importantly, I think that we have forgotten to trust that our bodies have evolved over hundreds of thousands of years to do things like give birth. One of the reasons that I chose to study Chinese medicine, and the reason that I connected with it so strongly is that the entire system has not lost this connection. In fact, the medicine has been built with this at its foundation. We are not doing something to the body, we are supporting the body and giving what it needs to heal itself. And this is the way, the graceful dance of the midwife and childbirth, that the process can happen. Without fear, and with joy. They are not standing over you, calling the shots, telling you what to do because they know best. They are supporting you through the process and giving you what you need to do what you already know how to do.
I believe that the medical industry has exacerbated this problem and fed the fear that women now overwhelmingly feel about childbirth. Countless images of childbirth in the media have women screaming in pain and begging for painkillers. Medical interventions for women giving birth in hospitals are commonplace and seem to be based on the doctors convenience rather than concern for the wellbeing of the mother and baby. The rate of Cesarian section in the US is much higher than anywhere else and increasing every year.
For me, a hospital is where you go when you are sick. Having a baby is not a sickness. And doctors are not trained in health, they study and treat disease. They are experts in illness. Things aren’t exciting for a doctor unless there is a pathology, something is going wrong. That is what they are trained for. Most doctors or OBGYN’s haven’t even experienced a natural live birth. They are familiar with administering pitocin (a drug that induces or speeds up labour), episiotomies (a cut in the perineum which is the space between the vagina and the anus) and epidurals (an injection into the lower spine through which pain medications are administered). All of these procedures have their downsides, and those are the ones that they will likely not discuss with you. Sometimes, of course, these procedures are necessary, but unfortunately, many times they are not. I urge you if you are having a baby, or care about someone who is to arm yourself with all the information so that you can make the most informed decision possible.
Pregnancy and childbirth are a wonderful, exciting time in a woman’s life. It can certainly be an overwhelming time for a lot of reasons as well. There is a lot of information out there and we tend to be bombarded with advice, books and websites telling us the best way to do things. My advice would be to listen to your gut. Your instinct. You have it for a reason, and it has evolved over many thousands of years to serve you and keep you safe. It does not have to be a scary experience, in fact it can and should be a wonderful and edifying experience, one of the most powerful ones you are bound to have in this lifetime. To create life is one of the most profound and beautiful experiences that we can ever hope to have, and I wish for any of you who go down that path that it is incredibly joyous and empowering, and one you will never forget.
Reducing Fear of Birth in US Culture –
Ina May Gaskin at TEDx Sacramento
The Business of Being Born
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The Business of Being Born
Ina May Gaskin
The Farm Midwifery Center – The Farm Midwives
Books By Ina May Gaskin
Birth Matters: A Midwifes Manifesta
Ina May’s Guide To Childbirth
Ina May’s Guide to Breastfeeding
Birth Without Fear : Chinese Medicine Living