midwives

We watched a documentary film the other night, and our minds were changed forever. The Business of Being Born had actually been recommended to me by multiple friends and acquaintances, so I was curious to see what all the fuss was about. Dan and I are so glad that we had the opportunity to watch this movie before we set foot in the hospital for labor and delivery in a few weeks. It was a true eye-opener and I feel strongly that every woman who is expecting, as well as every woman who plans on giving birth someday, should watch it.

Produced by Ricki Lake, the documentary explores the contemporary experience of childbirth in the United States and turns a critical eye to the American health care system which emphasizes drugs and costly interventions, often at the expense of the best possible outcome for mothers and their babies. The film has an obvious bias in that it documents several home birth experiences assisted by midwives and shows them in a much more positive light than hospital births in which mothers are riddled with drugs and various forms of intervention. It’s a very clearly anti-hospital perspective, but the documentary does put forth a strong argument with very solid facts and supporting evidence:

The U.S. stands alone in the developed world in its physician-driven birth system — midwives attend over 70% of the births in Europe and Japan, versus 8% in the U.S. While the U.S. spends twice as much money per birth as any other country, it has the second worst newborn death rate and one of the highest maternal mortality rates among developed nations.

The film points out that the medical industry has convinced the majority of American women that they “don’t know how to birth,” creating a culture of fear — hence why women these days are so afraid of birth and the pain associated with it that they will cling to anything that helps diminish that fear, including pain medication and all sorts of intervention. In the past few decades, there has been alarming increase in the number of women who have Caesarean sections, with the most recent statistic showing that C-sections make up a third of of all births in this country. While in some cases, C-sections are necessary due to any of a number of possible complications, the reality is that most of them are unnecessary and could have been prevented. OBs are basically surgeons, and since they are often more knowledgeable about surgery than natural birth, C-sections are an easy way for them to speed up the delivery process and get the mother and baby in and out of the hospital as fast as possible. Litigation concerns also drive doctors to perform C-sections as soon as the slightest complication surfaces. These days in the U.S., childbirth is treated as a medical emergency rather than a natural occurrence.

 

The above clip from the documentary in particular stuck in my mind: it shows how the use of one drug can lead to another, and yet another… creating an inevitable domino effect. Pitocin is very commonly used to increase the intensity and frequency of contractions. This also means increased pain for the laboring mother, which often leads to her getting an epidural anesthetic to help alleviate the pain. But the epidural often slows labor, leading to a perceived need for more pitocin; this cycle of pitocin and epidural (along with any of a number of other drugs) may well continue until the baby’s blood and oxygen flow is compromised, leading to an emergency C-section. The doctor is then credited with saving the mother and baby, when the domino effect of all these intervention drugs may have been what actually contributed to or caused the emergency.

Overall, I thought it was a very powerful documentary, and it was really well put together, interviewing several women and documenting a number of births. It also gives a brief background of the history of birth in America, and how the medical industry has changed the childbirth experience within the past century. You can see the full trailer below.

 

On a personal level, Dan and I were really forced to rethink our birth plan after watching this film. After reading all my pregnancy books and listening to the labor and delivery experience from other mothers, I had kind of accepted without question that I would get an epidural and whatever other pain relief medication when it came time to deliver my baby — it just seemed like it was what all women did. I never really thought about all of the adverse consequences that may come about from going along with all of those intervention measures that the hospital throws at you. Isn’t it funny that we as Americans spend so much time researching certain things, such as what latest camera to purchase, but don’t give nearly as much thought and consideration to how we give birth to our children?

For us, it was a real wakeup call and we have decided that we are going to try as much as possible to have a natural birth. But before I go further into the reasoning of why, I want to preface this by saying that I absolutely do not think that not having a natural birth makes a person any less of a woman or a mother than one who does. In the same vein, I know I need to be realistic and be aware that you can go into labor with your heart set on a natural birth, but end up needing medical intervention or even an emergency C-section if a truly severe complication arises. My mother went to Lamaze classes throughout her first pregnancy when I was in her belly, preparing to have a natural birth, but ended up with preeclampsia (high blood pressure during pregnancy) and had to schedule an emergency C-section before my due date even came around. Due to the nature of C-sections performed back then, VBACs (vaginal birth after C-section) were not an option for her and she had to have all three of her subsequent children by scheduled C-sections as well — and she is the best mother I could have ever wished for, and I admire and respect her.

But I can’t help but feel that there is something inherently wrong with the picture when I see expectant mothers talking about how they will absolutely be getting that epidural when it comes time for them to go to the hospital. How can you be so sure that it will be necessary when you aren’t even in labor yet? Are you just planning on getting it because the hospital advises that you should? I feel like when you go into labor requesting all these drugs and medical intervention at the outset, you’re already setting yourself up to fight an uphill battle in terms of having a regular vaginal birth. You’re not even supposed to get an epidural until you are at least 5cm dilated, but not all hospitals abide by this rule and I’ve heard stories of women who had the epidural administered prematurely and they ultimately ended up in the operation room for an emergency C-section. (According to a statistic I read, getting an epidural any time before you are 5cm dilated triples your odds of needing a C-section.) A lot of people forget that C-sections are major surgery, and while hospitals have a lot of experience with them (apparently moreso than with natural births these days), it still poses a danger to both mother and baby and should be avoided in favor of a regular vaginal birth, unless absolutely necessary. Having a C-section also interrupts the release of oxytocin, a hormone that is released in natural childbirth which helps trigger an immediate bond with your baby and also stimulates breastfeeding. As I mentioned above, my mother had a C-section for all four of her children, so in the back of my head, I’ve always been aware that it could be a possibility for when I have a baby — but I’d like to avoid it if at all possible.

Another point that the documentary only briefly mentioned — that Dan and I ended up discussing further in detail afterwards — is that the rise in the use of these intervention drugs coincides with the rise in cases of ADHD and autism in children in the past few decades. There’s no real evidence that shows a direct link between the two yet, so it could be purely coincidental and more due to the fact that more and more women are giving birth when they are older… but we were discussing how we honestly wouldn’t be surprised if in the future, they find that there’s a direct correlation between such disorders and medicated births.

I know that this is starting to sound very anti-medical establishment and I’m making hospitals look like the “bad guys” for pushing interventions on women, but this is not the case. I have a lot of respect for the doctors and nurses that work in the labor & delivery units in hospitals (I know a few myself), and I think it’s amazing how every day they assist in bringing new lives into the world. I’m grateful that we live in a time when we’re equipped with more knowledge and medical advancements than ever to safely deliver babies, and thank goodness for the doctors who know how to administer an intervention when there are emergency situations that necessitate one. While The Business of Being Born seems to push home births, I personally don’t think I could ever do a home birth — I’m too paranoid that something will go wrong, and a home birth is just in general a little too New Age for me. I will likely always rely on a hospital for labor and delivery (although I may consider a birthing center in the future), and it would be silly of me to bash them when I am going to be completely in their care.

I do think it’s important, however, to find a hospital that is respectful and supportive of your birthing plan. Thankfully, the hospital we plan to deliver at is Kaiser Walnut Creek, which has a very progressive midwifery program; Kaiser hospitals in the Bay Area are known in general to set the standard for other Kaiser branches around the country, so we are pretty confident that we are in good hands. The hospital will assign us a midwife when we arrive to deliver, and an OB will only be brought in if there’s a complication or we request it. Kaiser Walnut Creek has a low C-section rate, and are known to be pro-natural birth and I’ve heard that they let you labor and push at your own pace, without trying to rush you with drugs and intervention. It’s such a relief to know that they will respect our hopes to have as natural a birth as possible, so that we won’t have to expend our energy putting up a fight in the eleventh hour.

We were able to conceive this baby without intervention, and she has been growing healthy and strong the past eight months in the womb without intervention, so it only makes sense that the best way for her to come into this world would be without unnatural intervention. Again, I know that there are so many unpredictable and unknown factors that may come into play in the delivery of our child, and although I may dream of a natural birth, I’m not necessarily going to get what I want when the time comes. I know I need to prepare myself for such circumstances, and if it truly comes down to a life-threatening situation for the baby, I will of course gratefully accept medical intervention. But with nearly 33% of women delivering their babies by C-section today (compared to the less than 5% back in 1965), I can’t help but question how many of those were truly unavoidable and how much of the intervention that is pushed onto mothers is really necessary.  I know that labor and delivery will be the most difficult, painful, and challenging experience I’ve encountered yet, but I just want to make sure that we’ve done as much as possible to have our ducks in a row to make it as smooth, healthy, and safe a delivery for both myself and for our daughter.