We have come to a pivotal point in US maternity care. A revolution has been brewing for some time now and the actual beginnings started as a buzz at the various midwifery, birth and breastfeeding conferences and to some degree online, for example on blogs. Now, just as this newborn bird incrementally tears open the restrictive interventionist shell of the maternity care egg, we see that there is a light of truth being shown on this US maternity care….a care system that exudes mediocrity.
With staggering statistics of 34% cesarean rate and humiliating maternal/infant morbidity and mortality rates as the costars of this tumultuous reality show, today’s birth celebrities (Ina May Gaskin, Michel Odent, Sheila Kitzinger, Elizabeth Davis, to name a few) venture into view to call the plays like they see them ~ "if we get birth right, we get the world right". (www.oneworldbirth.net)
The marriage of evidence-based maternity care with modern medicine is dismal at this moment. With uncomplicated pregnancies turning into complicated births, one only has to look at the factors surrounding the birth to see a path of interventionism and iatrogenic dystocia. These women then take their experiences back into the community and in trying to validate their non-informed decision making, instill fear into future laboring women. Compounding this is the impact of the media, who sensationalizes childbirth to the extreme so that the lines are truly blurred between fact and fiction.
In the 1970s, those of us who were in the birth professional spoke louder than now, literally and figuratively, regarding the policies and routines that interfered with the birth process, including the cooptation of childbirth education classes into the hospital setting. Parents must once again realize that all childbirth education classes are NOT created equally and they will not receive cookie-cutter classes regardless of where they attend classes. While it would be very unfair of me to say that all hospital childbirth education classes were guilty of the sin of omission in many details of information (mainly because I have worked for at least one hospital who didn’t have such stringent ties on their childbirth educators), I can say that for the vast majority of childbirth educators who teach in a hospital setting, an evidence-based curriculum is challenged by obstetricians and anesthesiologist who have little if any training in physiologic birth. And basically because the childbirth education department in such a hospital is NOT the huge money maker department, sins of omission occur. The whole truth is not told. Parents essentially do not get the full story.
When identified as a “patient”, a human begins to feel a certain vulnerability, a need to be cared for and a need to trust. And so an expectant mother and her partner begins to put their trust into care providers that may or may not fully understand the emotional, hormonal or spiritual piece that the expectant parents assume they know. Let’s be clear, how many women have either thought this scenario or verbalized it:
When I am ready to give birth to my child, I want the baby to come early so it can be admitted into the NICU and out of my touch for hours or days. To obtain this end, I want to have my membranes stripped in that painful procedure, be given a synthetic hormone to speed my labor and shuts down my body to make its own natural hormone. I definitely want to lay as still as I can on my back, so labor slows, the baby does not complete the cardinal movements easily and the weight of the baby and the uterine contents puts tremendous strain on the vena cava. In the presence of the resulting fetal distress, I will push and hold my breath and deprive my uterus and baby of more oxygen, thus making the fetal distress worse. At this point, my care provider will perform abdominal surgery on me to deliver my child so I can have a recovery period so much longer than with a vaginal birth and thus, my baby will go to the NICU.
Absurd? Yes. But this same scenario happens every hour of every day of every week of every month of every year. And our species is not thriving. One only has to look at the CDC statistics to see that the US is behind such countries as Qatar. It is not supposed to be that way. We are the leaders of the world. We are more innovative and smarter than that. We must do better. We must consider the expectant mother as whole being not a uterus and vagina. We need to make the scenario of the “patient” in a hospital less frightening as the power of fear and the impact of fear and the hormones surrounding fear are revealed. If that interaction was honored for what it is, and respected, and if women were supported by educated care providers who knew how to care for women regardless of their choices, AND if expectant parents were fully educated about all of the options and possible scenarios, birth would be a better beginning.
If you have not viewed the video clips available from www.oneworldbirth.net, I urge you to do so. See what is being said and take part in the conversation/ revolution.
It is right time; the right place.
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